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干细胞疗法有望逆转脊髓损伤

更新时间:2013-12-05 13:59:00点击次数:2417次字号:T|T

对患有慢性脊髓损伤(chronic spinal cord injury)的病人而言,行走显然是他们的目标,但是这并不是唯一的目标。重新恢复感觉和生活自理能力也是重要的目标。如今,在一项新的研究中,来自美国新泽西医学与牙科大学罗伯特-伍德-约翰逊医学院的研究人员发现干细胞疗法和物理疗法结合在一起有望逆转脊髓损伤的症状。相关研究结果近日发表在美国著名学术期刊《Cell Transplantation 细胞移植》上,论文标题为“Autologousbone marrow-derived cell therapy combined with physical therapy inducesfunctional improvement in chronic spinal cord injury patients”。
        在这项研究中,论文通信作者Hatem E.Sabaawy博士和同事们开展一项涉及70名患有胸椎脊髓损伤(thoracic spinal cord injury)或颈脊髓损伤(cervical spinal cord injury)的病人的临床试验。这些病人之前已接受过至少六个月的治疗,但是都没有效果。他们被随机性地分为两组:一组作为对照只接受物理治疗,另一组除了接受物理治疗外,还在他们的损伤位点附近接受来自他们自己骨髓的干细胞的注射。依据美国脊髓损伤协会脊髓损伤分级(American Spinal Injury Association ImpairmentScale),研究人员在18个月内每月对病人进行神经功能评定和体能评价来确定他们的感觉和运动功能是否改善。
        在相同的时间段内,只接受物理治疗的对照组病人没有一个人表现出感觉和运动功能改善。尽管损伤严重度存在差别,但是所有同时接受骨髓干细胞疗法和物理疗法的病人最早在这项研究的第4周就对触觉刺激和感觉刺激产生反应。在12周之后,他们在感觉和肌肉力量上发生改善,这种改善与体能增加和大小便处理能力提升相关联,从而最终允许病人无需借助导尿管而生存下去。基于美国脊髓损伤协会脊髓损伤分级,表现出改善的病人也能够坐直和在他们的床上翻转。
        在为期18个月的研究结束时,基于美国脊髓损伤协会脊髓损伤分级,50名同时接受物理疗法和干细胞疗法的病人中有23人表现出显著性的改善。有几个人在辅助下能够行走。
        干细胞疗法使患有胸椎脊髓损伤的病人能够更好地控制他们的运动技能,这预示着将有望逆转这些患者的脊髓损伤的症状并使他们最终获得痊愈。

推荐原文阅读:
Cell Transplant. 2013 Feb 26.
Autologous bone marrow-derived cell therapy combined with physical therapy induces functional improvement inchronic spinal cord injury patients.
El-Kheir WA, Gabr H, Awad MR, Ghannam O, Barakat Y, Farghali HA, Maadawi ZM, Ewes I, Sabaawy HE.
Abstract
Spinal cord injuries (SCI) cause sensory loss and motor paralysis and are treated with physical therapy, but most patients fail to recover due to limited neural regeneration. Here we describe a strategy in which treatment with autologous adherent bone marrow cells is combined with physicaltherapy to improve motor and sensory functions in early-stage chronic SCI patients. In a phase I/II controlled single-blind clinical trial (clinicaltrials.gov identifier: NCT00816803), 70 chronic cervical and thoracic SCI patients with injury durations of at least 6 months were treated with either intrathecal injection(s) of autologous adherent bone marrow cells combined with physical therapy, or with physical therapy alone. Patients were evaluated with clinical examinations, electrophysiological somatosensory evoked potential, MRI imaging, and functional independence measurements. Chroniccervical and thoracic SCI patients treated with autologous adherent bone marrow cells combined with physical therapy showed functionalimprovements over patients in the control group treated with physical therapy alone, and there were no cell therapy-related side effects. At 18 months posttreatment, 23 of the 50 cell therapy-treated cases (46 percent) showed sustained improvement using the American Spinal Injury Association (ASIA) Impairment Scale (AIS). Compared to those patients with cervical injuries, a higher rate of functional improvement was achieved in thoracic SCIpatients with shorter durations of injury and smaller cord lesions. Therefore, when combined with physical therapy, autologous adherent bone marrowcell therapy appears to be a safe and promising therapy for patients with chronic spinal cord injuries. Randomized controlled multicenter trials are warranted.

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