【摘要】：目的 采用GMFM88（Gross Motor Function Measure-88）及FMFM45(Fine MotorFunction Measure-45)量表評(píng)價(jià)自體骨髓間充質(zhì)干細(xì)胞（Bone MarrowMesenchymal Stem Cells， BM-MSCs）移植對(duì)腦癱（cerebral plasy,CP）患兒運(yùn)動(dòng)功能的影響。 方法 收入2010-12/2011-6武警總醫(yī)院收治的腦性癱瘓患兒20例，每例患兒進(jìn)行家族史、遺傳病、傳染病、先天性疾病咨詢(xún)排查。排除異常后抽取自身骨髓45ml與肝素2ml混勻后立即送無(wú)菌細(xì)胞室，嚴(yán)格無(wú)菌條件下進(jìn)行自體骨髓間充質(zhì)干細(xì)胞培養(yǎng)。細(xì)胞培養(yǎng)完畢后對(duì)20例腦性癱瘓患兒進(jìn)行自體BM-MSCs移植治療，采用GMFM88及FMFM45項(xiàng)量表對(duì)患兒治療前及治療后1、3、6個(gè)月的粗大及精細(xì)運(yùn)動(dòng)功能進(jìn)行評(píng)估，采用自身對(duì)照的方法研究自體BM-MSCs移植治療前后患兒運(yùn)動(dòng)功能的變化，對(duì)移植前、移植后1個(gè)月、3個(gè)月及6個(gè)月內(nèi)患兒的GMFM及FMFM各功能區(qū)分值及原始分、總分進(jìn)行多因素方差分析，評(píng)價(jià)BM-MSCs移植對(duì)CP患兒運(yùn)動(dòng)功能的影響。 結(jié)果 17例受試者順利完成此項(xiàng)研究，3例患兒失訪。采用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析，結(jié)果顯示: 1、術(shù)后1個(gè)月患兒的GMFM88總分及A、B、C功能區(qū)得分較移植前顯著提高(P＜0.05)；其中A區(qū)臥位與翻身功能區(qū),B區(qū)坐位功能區(qū),C區(qū)爬與跪功能區(qū)改善最明顯。術(shù)后3個(gè)月、6個(gè)月患兒A、B、C去粗大運(yùn)動(dòng)功能評(píng)分較移植前仍有提高，D、E區(qū)評(píng)分也有改善，但并不具有統(tǒng)計(jì)學(xué)意義。 2、術(shù)后FMFM45量表結(jié)果顯示：術(shù)后1個(gè)月、3個(gè)月及6個(gè)月B區(qū)上肢關(guān)節(jié)活動(dòng)能力、C區(qū)抓握能力功能區(qū)分值較前提高(P＜0.05)，原始總分及總分均較前顯著提高(P＜0.05)；術(shù)后1、3、6個(gè)月隨訪過(guò)程中未見(jiàn)明顯毒副反應(yīng)及不良事件發(fā)生。 結(jié)論 BM-MSCs移植治療小兒腦癱是安全的，，可有效改善腦癱患兒的運(yùn)動(dòng)功能，療效以術(shù)后1個(gè)月提升速度最顯著，術(shù)后3個(gè)月至6個(gè)月患兒運(yùn)動(dòng)功能仍有進(jìn)一步提高。
[Abstract]:Objective to evaluate the effect of autologous bone marrow mesenchymal stem cell (Bone MarrowMesenchymal Stem Cells, BM-MSCs) transplantation on motor function in children with cerebral palsy (cerebral plasy,CP) by GMFM88 (Gross Motor Function Measure-88 and FMFM45 (Fine MotorFunction Measure-45. Methods A total of 20 children with cerebral palsy admitted to the General Hospital of Armed Police in 2010-12 / 2011-6 were examined for family history, hereditary diseases, infectious diseases and congenital diseases. After removing the abnormality, the autogenous bone marrow 45ml and heparin 2ml were mixed and sent to the aseptic cell chamber immediately, and autologous bone marrow mesenchymal stem cells were cultured under strict aseptic conditions. After cell culture, 20 children with cerebral palsy were treated with autologous BM-MSCs transplantation. The gross and fine motor function of 20 children with cerebral palsy were evaluated by GMFM88 and FMFM45 scale before treatment and 1, 6 months after treatment. The changes of motor function before and after autologous BM-MSCs transplantation were studied by using self-control method. The scores and original scores of GMFM and FMFM were measured before, 1 month, 3 months and 6 months after transplantation. The effect of BM-MSCs transplantation on motor function of CP children was evaluated by multivariate analysis of variance (ANOVA). Results 17 subjects completed the study successfully and 3 children lost their visits. The results of statistical analysis with SPSS13.0 software showed that: 1, the total score of GMFM88 and the score of the functional area of SPSS13.0 were significantly higher than those before transplantation (P < 0. 05). The most obvious improvement was in area A and the functional area of turning over, the functional area of sitting in area B and the area of climbing and kneeling in area C. After 3 months, 6 months after the operation, the scores of the degenerative motor function of the patients were still improved, and the scores of DU E were improved, but there was no significant difference between the two groups. 2. The results of postoperative FMFM45 scale showed that the ability of upper limb joint movement in area B and the function area of grasping ability in area C were higher than those before operation at 1 month, 3 months and 6 months after operation (P < 0. 05). The original total score and total score were significantly higher than those before (P < 0.05). No side effects and adverse events occurred during the follow-up of 1 and 6 months postoperatively. Conclusion BM-MSCs transplantation is safe in the treatment of children with cerebral palsy and can effectively improve the motor function of children with cerebral palsy.
【學(xué)位授予單位】：遼寧醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R742.3

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