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背景:前期动物脑干损伤模型实验中观察到骨髓基质细胞源神经干细胞移植后对脑干损伤具有趋化作用。目的:观察骨髓基质细胞源性神经干细胞移植治疗持续性植物状态的可行性及临床效果。设计、时间及地点:自身对照观察实验,于2002-10/2006-12在解放军北京军区总医院神经外科进行。对象:选择持续性植物生存患者45例,年龄3.5~56.0岁,男28例,女17例。方法:患者入院后进行意识指数评分、各项术前常规检查、脑电图、听觉诱发电位检测。取患者自体骨髓20~30mL,分离出骨髓基质细胞,再经过扩增及预分化处理后,将骨髓源神经干细胞制成109L-1浓度。经开颅或立体定向及导管介入将骨髓基质源神经干细胞植入脑内特定区域,靶区为损伤脑区皮质、室管膜下区、纹状体区、丘脑底核或患侧大脑中动脉、椎动脉。主要观察指标:3~4月后检查记录昏迷指数、脑电图、听觉诱发电位,并与治疗前进行对比。结果:全部患者干细胞移植后,生命指征均平稳。5例有短时发热,经对症处理体温恢复正常。3~4个月后随访复查,患者意识(昏迷)指数、脑电图、听觉诱发电位均明显改善。结论:骨髓基质细胞源性神经干细胞移植治疗战创伤性脑损伤及其后遗症,具有促进中枢神经系统组织及功能恢复的作用。
BACKGROUND: Preimplantation brain stem injury model experiments showed that bone marrow stromal cell derived neural stem cells have chemotactic effect on brain stem injury after transplantation. Objective: To observe the feasibility and clinical effect of bone marrow stromal cell derived neural stem cell transplantation in the treatment of persistent vegetative state. DESIGN, TIME AND SETTING: Self-control observation experiment was performed at Department of Neurosurgery, General Hospital of Beijing Military Region, People’s Liberation Army from October 2002 to December 2006. PARTICIPANTS: Forty-five patients with persistent plant survival were selected, aged 3.5-56.0 years, 28 males and 17 females. Methods: The patients were admitted to the hospital after the index score of consciousness, the preoperative routine examination, EEG, auditory evoked potential test. Patients with autologous bone marrow 20 ~ 30mL, bone marrow stromal cells were isolated, and after amplification and pre-differentiation treatment, the bone marrow-derived neural stem cells made 109L-1 concentration. After craniotomy or stereotactic and catheterization, bone marrow stromal cells derived neural stem cells were implanted into specific regions of the brain. The target area was damaged brain cortex, subependymal zone, striatum, subthalamic nucleus or ipsilateral middle cerebral artery , Vertebral artery. MAIN OUTCOME MEASURES: Scores of coma, EEG, auditory evoked potentials were recorded after 3 to 4 months and compared with those before treatment. Results: All patients showed stable signs of life after stem cell transplantation. 5 cases of short-term fever, symptomatic treatment of body temperature returned to normal. Follow-up 3 to 4 months after the review, patient awareness (coma) index, EEG, auditory evoked potentials were significantly improved. CONCLUSION: Bone marrow stromal cells derived neural stem cells transplantation can be used to treat traumatic brain injury and its sequelae, which can promote the recovery of central nervous system tissue and function.