Chang Zhitian, Mao Gengsheng, Sun Lizhong, Ao Qiang, Gu Yongquan, Liu Ying
Department of Neurosurgery, Siping Hospital of China Medical University, Siping, Jilin 136000, P.R. China; Tuhua Bioengineering Company Ltd., Siping, Jilin 136000, P.R. China.
Department of Neurovascular Surgery, General Hospital of Armed Police Forces, Beijing 100000, P.R. China.
Exp Ther Med. 2016 Dec;12(6):3535-3540. doi: 10.3892/etm.2016.3811. Epub 2016 Oct 18.
The aim of the study was to examine treatment of cerebral hemorrhages with bone-marrow or human umbilical cord-derived mesenchymal stem cells (BMSCs or Hu-MSCs) and conventional surgical approaches, and determine and compare the effectiveness, feasibility, safety and reproducibility of each method. A retrospective analysis was performed on a cohort of cell-treated cerebral hemorrhage patients from October 1, 2007 to October 1, 2009. A total of 24 patients, all of whom received conventional surgical treatment, were classified as follows: i) The control group consisted of 8 patients who received only hematoma removal surgery, ii) the autologous group consisted of 7 patients who received additional autologous bone marrow mononuclear cell transplantation, and iii) the allograft group consisted of 9 patients who received additional umbilical cord mononuclear cell transplantation. After conventional hematoma removal surgery and X-ray supervision within 24 h and at 7 days, neurological disability and function tests were completed 3, 6, 12, 36 and 60 months later. The T-cell marker plasma levels were analyzed after 60 months. The results showed that, at approximately 3.5 months after graft the hematomas in all the groups were completely reabsorbed as observed on computed tomography scans. However, the functional outcomes in the cell-transplanted groups were better than in the control group after 5 years. While the National Institutes of Health Stroke Scale, modified Rankin score and modified Barthel index scores were simliar in the cell-transplanted groups, patients in the allograft group had better outcomes than those in the autologous graft group starting at 3 months and until the end of the follow-up period. The serum levels of T-cell markers CD4, CD56 and human leukocyte antigen-DR in the allograft group showed no signs of immunogenic graft complications and there were no significant differences in T-cell subtypes among the patient groups. The results of the present study suggest that, treatment of cerebral hemorrhage patients can be safely and effectively accomplished using Hu-MSC grafting and larger clinical trials should be considered in the future.
本研究的目的是探讨采用骨髓或人脐带间充质干细胞(BMSCs或Hu-MSCs)及传统手术方法治疗脑出血,并确定和比较每种方法的有效性、可行性、安全性和可重复性。对2007年10月1日至2009年10月1日接受细胞治疗的脑出血患者队列进行回顾性分析。共有24例均接受传统手术治疗的患者,分类如下:i)对照组由8例仅接受血肿清除手术的患者组成;ii)自体组由7例接受额外自体骨髓单个核细胞移植的患者组成;iii)同种异体移植组由9例接受额外脐带单个核细胞移植的患者组成。在进行传统血肿清除手术后24小时内及7天时进行X线监测,3、6、12、36和60个月后完成神经功能障碍和功能测试。60个月后分析T细胞标志物血浆水平。结果显示,在移植后约3.5个月时,计算机断层扫描显示所有组的血肿均完全吸收。然而,5年后细胞移植组的功能结局优于对照组。虽然细胞移植组的美国国立卫生研究院卒中量表、改良Rankin评分和改良Barthel指数评分相似,但同种异体移植组患者从3个月开始直至随访期结束的结局均优于自体移植组。同种异体移植组的T细胞标志物CD4、CD56和人类白细胞抗原-DR的血清水平未显示免疫原性移植并发症迹象,且患者组间T细胞亚型无显著差异。本研究结果表明,使用Hu-MSC移植可安全有效地治疗脑出血患者,未来应考虑开展更大规模的临床试验。