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目的观察骨髓间充质干细胞(MSCs)移植治疗脊髓损伤(SCI)、脑外伤(TBI)、Parkinson’s病(PD)和多发性硬化(MS)的临床疗效和不良反应。方法脊髓伤病6例,TBI 3例,MS 1例,PD 1例,经骨髓穿刺采集自体骨髓222~350 ml,分离提取MSCs后经静脉途径和/或蛛网膜下腔内一次性或分次注射。干细胞治疗前、后对患者神经功能变化及不良反应分别进行评价。结果自体MSCs治疗脊髓伤病6例,5例有不同程度的感觉、运动和自主神经功能改善。治疗TBI 3例,2例运动功能明显改善,1例持续植物状态患者PVS评分由5分提高到8分。治疗PD和MS各1例,PD患者震颤减轻,肌张力明显降低;MS患者运动功能明显改善。症状和体征改善最早出现在治疗后2 d,多数患者在治疗后2周有明显改善。MSCs移植常见的不良反应包括发热(7/11例)、头痛(2/11例)、腹胀(1/11例);1例于蛛网膜下腔内注射时出现双下肢麻木、脑膜刺激征。结论MSCs移植治疗脊髓损伤、TBI、PD和MS等近期疗效明显,不良反应较少,但其远期疗效还需要进一步随访和观察。
Objective To observe the clinical effects and adverse reactions of bone marrow mesenchymal stem cells (MSCs) transplantation in the treatment of spinal cord injury (SCI), traumatic brain injury (TBI), Parkinson’s disease (PD) and multiple sclerosis (MS) Methods Six cases of spinal cord injury, three cases of TBI, one case of MS and one case of PD were collected from bone marrow of 222-350 ml by bone marrow aspiration. MSCs were separated and extracted via intravenous route and / or subarachnoid space injection. Before and after the treatment of stem cells, neurological function and adverse reactions were evaluated respectively. Results Six cases of spinal cord injury were treated with autologous MSCs. Five cases had different degrees of sensation and motor and autonomic function improved. 3 cases of TBI treatment, 2 cases of motor function improved significantly, 1 case of patients with persistent plant PVS score increased from 5 to 8 points. Treatment of PD and MS in 1 case, PD patients with tremor reduced muscle tension was significantly reduced; MS patients significantly improved motor function. Symptoms and signs of improvement first appeared in the 2 d after treatment, most patients 2 weeks after treatment significantly improved. Common adverse reactions of MSCs transplantation included fever (7/11 cases), headache (2/11 cases) and abdominal distension (1/11 cases). One case suffered from numbness of both lower extremities and meningeal irritation during subarachnoid injection. Conclusion MSCs transplantation in the treatment of spinal cord injury, TBI, PD and MS obvious short-term effect, adverse reactions less, but its long-term efficacy needs further follow-up and observation.