Bone marrow mesenchymal stem cells versus bone marrow mononuclear cells for treating cerebral palsy

doi:10.3969/j.issn.2095-4344.0413

Abstract

Abstract:

BACKGROUND: Bone marrow mesenchymal stem cells (BMSCs) and bone marrow mononuclear cells(BMMNCs) have been both used to treat spastic cerebral palsy. However, the differences in their therapeutic effects remain unknown.
OBJECTIVE: To compare the therapeutic effects of BMMSCs and BMMNCs in cerebral palsy children as well as on fine motor function.
METHODS: 105 children with spastic cerebral palsy were enrolled and randomly assigned to three groups: BMMSCs group, BMMNCs group and control group. Patients in the two transplantation groups received four intrathecal cell injections, and those in the control group received Bobath therapy, twice a day, for consecutive 3 weeks. The Gross Motor Function Measure (GMFM) and Fine Motor Function Measure (FMFM) were used to evaluate the therapeutic efficacy at 3, 6 and 12 months after transplantation.
RESULTS AND CONCLUSION: At 3 months after cell transplantation, scores in A dimension of GMFM and in A, C dimensions of FMFM in BMMSC group were all superior to those of BMMNC group and control group (P < 0.05). At 6 months after cell transplantation, scores in A, B dimensions of GMFM and in A, B, C, D and E dimensions of FMFM in BMMSC group were better than those of BMMNC group and control group (P < 0.05), and total scores of GMFM and FMFM were also better in the BMMSC group (P < 0.05). At 12 months after cell transplantation, scores in A, B and C dimensions of GMFM and A, B, C, D and E dimensions of FMFM scores in BMMSC group were all superior to those of BMMNC group and control group (P < 0.05) as well as the total GMFM and FMFM scores. There were six cases of low intracranial pressure headache in BMMNC group and six cases of low-grade fever in BMMSC group. In summary, both BMMSCs transplantation and BMMNCs transplantation are safe, effective and feasible for the treatment of spastic cerebral palsy in children, and moreover, BMMSCs transplantation is a better method than BMMNCs transplantation to improve gross and fine motor functions of spastic cerebral palsy children.

中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

Key words: Cerebral Palsy, Bone Marrow, Mesenchymal Stem Cells, Cell Transplantation, Tissue Engineering

CLC Number:

R394.2

Dai Guang-hui, Liu Xue-bin, Zhang Zan, Cheng Hong-bin, Wang Xiao-dong, An Yi-hua. Bone marrow mesenchymal stem cells versus bone marrow mononuclear cells for treating cerebral palsy[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(1): 70-76.

Figures/Tables 4

对照组脑瘫患儿治疗后粗大运动功能的变化见表6。治疗后3个月GMFM评分与治疗前相比，A、B、C、D、E功能区得分、GMFM总分较康复治疗前有所提高，但差异无显著性意义(P > 0.05)。治疗后6个月GMFM评分与康复治疗前相比，A、B、C、D、E功能区得分、GMFM总分较康复治疗前有所提高，但差异无显著性意义(P > 0.05)。治疗后12个月GMFM评分与康复治疗前相比，A、B、C功能区得分有显著改善(P < 0.05)；GMFM总分也显著提高(P < 0.01)。D、E功能区得分提高差异无显著性意义(P > 0.05)。 2.7 各组、各时间段GMFM评分对比各组治疗后3个月，BMMSC组A功能区得分他两组比较差异有显著性意义 (P < 0.05)，BMMNC组和对照组之间差异无显著性意义(P > 0.05)；C功能区得分MSC组和BMMNC组、BMMNC组和对照组之间差异无显著性意义(P > 0.05)，BMMSC组和对照组之间差异有显著性意义(P < 0.05)；B、D、E功能区得分及GMFM总分各组之间差异无显著性意义(P > 0.05)。各组治疗后6个月，BMMSC组A、B功能区得分MFM总分和其他两组比较差异有显著性意义(P < 0.05)，BMMNC组和对照组之间差异无显著性意义(P > 0.05)；C功能区得分BMMSC组和BMMNC组、BMMNC组和对照组之间差异无显著性意义(P > 0.05)，BMMSC组和对照组之间差异有显著性意义(P < 0.05)；D、E功能区得分各组之间差异无显著性意义(P > 0.05)。各组治疗后12个月，BMMSC组A、B、C功能区得分及GMFM总分和其他两组比较差异有显著性意义(P < 0.05)，BMMNC组和对照组之间差异无显著性意义(P > 0.05)；D、E功能区得分各组之间差异无显著性意义(P > 0.05)。 2.8 BMMSC组脑瘫患儿细胞移植治疗前后的精细运动功能的变化见表7。细胞移植治疗后3个月FMFM评分与移植前相比，A、B、C、D功能区得分有显著改善(P < 0.05或P < 0.01)；FMFM总分也有显著改善(P < 0.01)；E功能区评分较移植前有所提高，但差异无显著性意义(P > 0.05)。治疗后6个月FMFM评分与移植前相比，A、B、C、D、E功能区得分有显著改善(P < 0.05或P < 0.01)；GMFM总分也显著提高(P < 0.01)；治疗后12个月FMFM评分与移植前相比，A、B、C、D、E功能区得分有显著改善(P < 0.05或P < 0.01)；FMFM总分也显著提高(P < 0.01)。 2.9 BMMNC组脑瘫患儿细胞移植治疗前后的精细运动功能的变化见表8。细胞移植治疗后3个月FMFM评分与移植前相比，A功能区得分有显著改善(P < 0.05)；B、C、D、E功能区得分，FMFM总分较移植前有所提高，但差异无显著性意义(P > 0.05)。治疗后6个月FMFM评分与移植前相比，A、B、C、D、E功能区得分有显著改善(P < 0.05)；FMFM总分也显著提高(P < 0.05)；治疗后12个月FMFM评分与移植前相比，A、B、C、D、E功能区得分有显著改善(P < 0.05)；FMFM总分也显著提高(P < 0.01)。 2.10 对照组脑瘫患儿治疗前后的精细运动功能的变化见表9。治疗后3个月FMFM评分与治疗前相比，A功能区得分有显著改善(P < 0.05)；B、C、D、E功能区得分，FMFM总分较治疗前有所提高，但差异无显著性意义(P > 0.05)。治疗后6个月FMFM评分与治疗前相比，A功能区得分有显著改善(P < 0.05)；B、C、D、E功能区得分，FMFM总分较治疗前有所提高，但差异无显著性意义(P > 0.05)；治疗后12个月FMFM评分与治疗前相比，A功能区得分、FMFM总分有显著改善(P < 0.05)。 2.11 各组、各时间段FMFM评分对比各组治疗后3个月，BMMSC组A、C功能区得分和其他两组比较差异有显著性意义(P < 0.05)，BMMNC组和对照组之间差异无显著性意义(P > 0.05)；B、D、E功能区得分及GMFM总分各组之间差异无显著性意义(P > 0.05)。各组治疗后6个月，BMMSC组A、B、C、D、E功能区得分及GMFM总分和其他两组比较差异有显著性意义(P < 0.05)，BMMNC组和对照组之间差异无显著性意义(P > 0.05)。各组治疗后12个月，BMMSC组A、B、C、D、E功能区得分及GMFM总分和其他两组比较差异有显著性意义(P < 0.05)，BMMNC组和对照组之间差异无显著性意义(P > 0.05)。 2.12 不良反应 ①头晕头痛：BMMNC组有6例(6/33)患儿、BMMSC组中有6例(6/34)患儿术后48 h内出现低颅压反应，表现为轻度头晕头痛，偶伴恶心、呕吐，呕吐呈非喷射性。上述症状下床活动后加重，平卧时症状缓解或消失。嘱这些患者采取去枕平卧位、静脉点滴生理盐水后症状缓解和消失；②发热：BMMNC组有6例(6/33)患儿、BMMSC组中有6例(6/34)患儿在术后出现了发热，均在38.5 ℃以下，无需处理，均在数小时内下降至正常。"

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