| Objective The research of regeneration and repair after central nervous system injury has been the hot spots in the field of neuroscience. The use of stem cell transplantation for spinal cord injury is one of the hotspots in spinal cord injury repair research in recent years. Umbilical cord mesenchymal stem cells (UC-MSCs) and umbilical cord blood mononuclear cells (UCB-MNCs) are currently used for spinal cord injury in basic and clinical research, which have the advantage of easily obtained, no immune rejection, do not exist ethical problem, etc. UC-MSCs or UCB-MNCs transplantation in the treatment of spinal cord injury patients, to observe their ASIA sensory and motor score, the spinal cord injury degree, changes in nerve electrophysiology, as well as activities of daily living; and to further explore the UC-MSCs or UCB-MNCs transplantation in the treatment of functional recovery of spinal cord injury clinical research to lay the foundation; and through the research of the neural electrophysiology changes which before and after UC-MSCs or UCB-MNCs transplantation, for neural electrophysiology check in with a spinal cord injury to provide an objective evaluation of the clinical application of basis; By comparing the recent effect of UC-MSCs or UCB-MNCs transplantation therapy and comprehensive rehabilitation therapy, to provide the basis for the treatment of spinal cord injury and the improvement methods.Methods Eligible for stem cell transplantation in August2010to September2011, can at least accept the comprehensive rehabilitation treatment in one month, voluntarily and signed informed consent to spinal cord injury patients with30cases, the experimental group of15cases,15cases in the control group. The experimental group that stem cell transplantation group, on the basis of comprehensive rehabilitation, giving the UC-MSCs or UCB-MNCs transplantation. The control group was only given comprehensive rehabilitation. To evaluate and test the ASIA sensory and motor score, the spinal cord injury degree, the activities of daily living and related nerve electrophysiological indicators before treatment and2month,4month after first treatment.Results1, Change of ASIA scores:compared with before treatment, both experimental group and control group had improvement in light touch, pinprick and motor scores in2and4month after first transplantation, and there were statistically significant difference (P<0.05); between the two groups the difference were not statistically significant (P>0.05).2,Activities of daily living (ADL) evaluation: compared with before treatment, both experimental group and control group had improvement in modified Barthel index scores in2and4month after first transplantation, and there were statistically significant difference (P<0.01); between the two groups the difference were not statistically significant (P>0.05).3,The change of ASIA damaged levels in different course of disease before and after treatment:the patients with within half a year in all7cases,1case in the4month after first transplantation, ASIA by grade B returned to grade C;1case in the2month after first transplantation, damage section dropped a neural plane, and in the4month after first transplantation, ASIA by A level classification back to class B.4,Nerve electrophysiology check:①compared with before treatment, the P40latency and amplitude of two groups had no significant difference(P>0.05); the P40latency compared between the two groups was no significant difference(P>0.05).②Different periods in the experimental group before and after treatment, the velocity and amplitude of motor nerve conduction, the incubation periods and speeds of sensory nerve conduction were improved. While there were some indicators had been improved in the control group after treatment. Compared with the two groups, the experimental group was better than the control group.③Within two groups of patients before and after different periods of treatment, the iliopsoas IP average volatility had been increased, the difference statistically significant (P<0.05); first treatment after2month and4month, iliopsoas average IP volatility between the two groups were statistically significant difference (P<0.05); Before an experimental group after treatment, the rectus femoris muscle in patients with IP, the average volatility and treatment compared to no significant difference (P>0.05), first treatment after4months, the IP average volatility of rectus femoris of the experimental group were statistically significant difference (P<0.05); Compared with before treatment, Control group in different treatment periods, the IP average volatility of the rectus femoris were no significant difference (P>0.05);2month and4month after first treatment, the IP average volatility of the rectus femoris were no statistical difference between the two groups (P>0.05).Tow groups of patients before and after different periods of comparison, the tibialis anterior muscle, extensor hallucis longus muscle and soleus muscle of the IP average volatility had no significant improvement.5,Safety observation index and adverse reactions:all safety observation index did not appear abnormal changes after transplantation. No emergence of any adverse reactions after intravenous transplantation.4cases of headache after subarachnoid transplant,2cases of low heat,3cases of low back pain, and2to3days the symptoms disappeared.Conclusion1,UC-MSCs or UCB-MNCs by intravenous and subarachnoid transplantation in the treatment of spinal cord injury is safe.2,UC-MSCs or UCB-MNCs transplantation can improve the ASIA scores and activities of daily living score, but the results are not better than the control group.3,The UC-MSCs or UCB-MNCs transplantation therapy in early decline maybe can let SCI patients' damage plane down and improve their ASIA damaged levels.4,After UC-MSCs or UCB-MNCs transplantation in the treatment of SCI patients, their neural electrophysiology test results have different improvements, the results are better than the control group; Nerve electrophysiological examination in the clinical application as a standard of objective assessment of nerve and muscle function recovery of patients with SCI. |
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