移植时间对嗅鞘细胞移植治疗脊髓损伤效果的影响★

Abstract

BACKGROUND:
Many factors affect the outcome of olfactory ensheathing cell transplantation for obsolete spinal cord injury, such as the time of injury, segment and sex. The best time to do olfactory ensheathing cell transplantation is unknown up to now.
OBJECTIVE: To investigate the influence of time windows of olfactory ensheathing cell transplantation on the recovery of motion and sensation function in spinal cord injury patients.
DESIGN: Self-control observation.
SETTING: Department of Neurosurgery, Taian Disabled Soldier's Hospital.
PARTICIPANTS: 135 patients with spinal cord injury were enrolled at the Department of Spinal Cord Surgery, Taian Disabled Soldier's Hospital of Shandong Province from June 2004 to June 2007, including 121 males and 14 females, aged 7-59 years, averagely 36 years. Duration of spinal cord injury included 0-6 months in 21 cases, 7 months-2 years in 71 cases and over 2 years in 43 cases. These patients or their guardians signed an informed consent of the cell transplantation. The experimental procedures were accorded with the rules of Ministry of Health of China (No. 91-006) and approved by the Taian Disabled Soldier's Hospital of Shandong Province.
METHODS: ①Olfactory bulbs of aborted fetus were digested into single olfactory ensheathing cells, and then cultured for 7-15 days. Parturients signed the informed consent. This study was approved by the Hospital Ethical Committee. ②After general anesthesia, olfactory ensheathing cell suspension was implanted into the corresponding region by the multi-targeted injection with a microscope. According to the injury condition, targets generally located in upper or lower injured region and left or right normal spinal cord. The amount of targets depends on the size of the injured region. About 1 000 000 units of cells were injected into each target, about 50 μL of suspension, at 2×1010 L-1, 2-5 targets. ③American Spinal Injury Association impairment scale was used to assess the motion and sensation function in spinal cord injury patients before transplantation and 2-8 weeks after transplantation.
MAIN OUTCOME MEASURES: Scores on American Spinal Injury Association impairment scale.
RESULTS: 135 spinal cord injury patients were involved in the result analysis. Motion and sensation function was improved in spinal cord injury patients at different time windows compared with that before transplantation (P < 0.01). There was no significant difference in scores on motion and sensation function and the increased degree of the score at different time windows after transplantation (P > 0.05).
CONCLUSION: Olfactory ensheathing cell transplantation can promote the recovery of nerve function in spinal cord injury patients, without the difference in time windows.

Department of Neurosurgery, Taian Disabled Soldier's Hospital, Taian 271000, Shandong Province, China

Zheng Zun-cheng★, Master, Associate chief physician, Department of Neurosurgery, Taian Disabled Soldier's Hospital, Taian 271000, Shandong Province, China
zhengzuncheng65@
tom.com

Correspondence to: Liu Chao, Master, Attending physician, Department of Neurosurgery, Taian Disabled Soldier's Hospital, Taian 271000, Shandong Province, China

Received:2007-10-13
Accepted:2007-12-10
(07-50-10-5532/H)

Zheng ZC, Liu C, Gao R, Zhang L, Wei SG, Zhang K, Zhang L, Kuang NF, Zhang LQ, Song YJ. Influence of transplanting time on olfactory ensheathing cell transplantation for spinal cord injury.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(3):583-586 (China)
[www.zglckf.com/zglckf/ejournal/upfiles/ 08-3/3k-583
(ps).pdf]

摘要
背景： 嗅鞘细胞移植治疗陈旧性脊髓损伤的疗效可受多种影响因素如受伤的时间、节段、性别等的影响，而患者受伤后应在哪个时间段进行嗅鞘细胞移植目前尚无定论。
目的：关注嗅鞘细胞移植时间窗的选择对脊髓损伤患者运动和感觉功能恢复的影响。
设计：自身前后对照观察。
单位：泰安荣军医院神经外科。
对象：选择2004-06/2007-06山东省泰安荣军医院脊柱脊髓外科收治的脊髓损伤患者135例，其中男121例，女14例；年龄7~59岁，平均36岁。脊髓损伤时间：0~6个月21例，7个月~2年71例，2年以上43例。纳入患者或其（未成年）父母了解这一临床试验的特殊性和可能结果；患者或其监护人同意接受细胞移植治疗并签自愿接受协议书；实验和治疗方案符合中国卫生部（91-006）文件规定，经山东省泰安荣军医院伦理委员会批准。
方法：①将流产胚胎的嗅球消化成单个嗅鞘细胞后培养7~15 d待用。产妇同意提供流产胚胎用于实验，此方案经过医院伦理委员会批准。②患者全身麻醉后，借助显微镜将已培养好的嗅鞘细胞悬液采用多靶点注射的方法分别移植到相应的区域内。靶点的选择据损伤情况而定，一般位于损伤区域的上下两端及左右侧正常脊髓处。据损伤区域的大小决定靶点的多少，每个靶点注射细胞量约100万单位，悬液约50 μL，含量大约2×1010 L-1,一般为2~5个靶点。③于移植前及移植后2~8周按照美国脊髓损伤学会制定的美国脊髓损伤学会标准评估患者运动和感觉功能。
主要观察指标：美国脊髓损伤学会标准评分。
结果：脊髓损伤患者135例均进入结果分析。不同移植时间窗脊髓损伤患者运动和感觉功能均较移植前有明显提高，差异有非常显著性意义（P < 0.01）；不同移植时间窗患者移植后运动和感觉功能分数及分数提高程度比较，差异无显著性意义（P > 0.05）。
结论：嗅鞘细胞移植可促进脊髓损伤患者的神经功能恢复，且不存在移植时间窗差异。
关键词：嗅鞘细胞移植;时间窗;脊髓损伤;多靶点移植

郑遵成，刘 超，高 瑞，张 林，魏树刚，张 坤，张 磊，匡乃峰，张立清，宋延军
山东省泰安荣军医院神经外科，山东省泰安市 271000
郑遵成★，男，1965年生，山东省济宁市人，汉族，1989年泰山医学院毕业，硕士，副主任医师，主要从事神经外科、脊柱脊髓损伤方面的研究。
通讯作者：刘 超，硕士，主治医师,山东省泰安荣军医院神经外科，山东省泰安市 271000

中图分类号：R394.2 文献标识码:A 文章编号：1673-8225(2008)03-00583-04
郑遵成，刘超，高瑞，张林，魏树刚，张坤，张磊，匡乃峰，张立清，宋延军.移植时间对嗅鞘细胞移植治疗脊髓损伤效果的影响[J].中国组织工程研究与临床康复，2008，12(3):583-586
[www.zglckf.com/zglckf/ejournal/upfiles/08-3/3k-583(ps).pdf]
(Edited by Wang JW/Qiu Y/Wang L)