發(fā)布時(shí)間：2019-03-10 20:50

【摘要】：研究背景：強(qiáng)直性脊柱炎(AS)是一種脊柱關(guān)節(jié)疾病,主要以骶髂關(guān)節(jié)炎、外周炎癥關(guān)節(jié)病及中軸脊柱關(guān)節(jié)病變?yōu)樘攸c(diǎn)的慢性進(jìn)行性炎癥性疾病,可伴隨眼、肺、心血管、腎臟、神經(jīng)系統(tǒng)等臟器損害。其致病機(jī)制主要是免疫紊亂介導(dǎo)的炎性反應(yīng)�；颊叨加醒巢刻弁醇瓣P(guān)節(jié)活動(dòng)受限。診斷主要依靠1984年紐約修訂的強(qiáng)直性脊柱炎診斷標(biāo)準(zhǔn)。目前主要依靠藥物治療,包括非甾體抗炎藥、柳氮磺砒啶、糖皮質(zhì)激素、腫瘤壞死因子抑制劑。針對外周關(guān)節(jié)活動(dòng)受限及關(guān)節(jié)強(qiáng)直主要依靠手術(shù)治療。而康復(fù)訓(xùn)練也隨著對AS的認(rèn)識的深入而被逐漸重視。研究目的：研究間充質(zhì)干細(xì)胞輸注治療強(qiáng)直性脊柱炎的安全性及療效的研究。資料與方法：1.資料：本組收集5例強(qiáng)直性脊柱炎患者,符合強(qiáng)直性脊柱炎診斷診斷標(biāo)準(zhǔn)(1984年紐約修訂的強(qiáng)直性脊柱炎診斷標(biāo)準(zhǔn))；年齡在18至60歲之間；入組前若服用非甾體抗炎藥、甲氨蝶呤、柳氮磺砒啶、羥氯喹、小劑量激素,則劑量至少穩(wěn)定4周以上。5例患者均為非妊娠或哺乳期婦女,均無器官衰竭、艾滋病、肝炎、結(jié)核或者其他中毒感染或者精神病,均無對人血白蛋白和間充質(zhì)干細(xì)胞(Mesenchymal stem cell, MSC)培養(yǎng)體系主要成分如青霉素、鏈霉素過敏者。入組后對患者進(jìn)行評估,評估內(nèi)容如下：體格檢查、Bath強(qiáng)直性脊柱炎活動(dòng)性指數(shù)(BASDAI)、Bath強(qiáng)直性脊柱炎功能指數(shù)(BASFI)、Bath強(qiáng)直性脊柱炎測量指數(shù)(BASMI)評估；血沉、C反應(yīng)蛋白、血常規(guī)、尿常規(guī)、肝腎功能檢測；影像學(xué)等檢測。2.方法：間充質(zhì)干細(xì)胞培養(yǎng),誘導(dǎo)間充質(zhì)干細(xì)胞分化,流式細(xì)胞術(shù)對間充質(zhì)干細(xì)胞表面分子檢測,細(xì)菌(需氧菌培養(yǎng)、厭氧菌培養(yǎng))、支原體和內(nèi)毒素檢測合格的MSC方可應(yīng)用于受試患者�；颊呷虢M后,給予間充質(zhì)干細(xì)胞輸注治療,劑量為lIU/10Kg(1IU=1×107個(gè)間充質(zhì)干細(xì)胞),每個(gè)病人平均輸注1-2次。病人在輸注后均給予療效評估及安全性評價(jià),包括：體格檢查、BASDAI、BASFI、 BASMI評估；血沉、C反應(yīng)蛋白、血常規(guī)、尿常規(guī)、肝腎功能檢測；影像學(xué)等檢測及不良反應(yīng)記錄。并與治療前進(jìn)行對比,已達(dá)到評價(jià)療效的目的。結(jié)果：1.本組5名患者輸注后3名出現(xiàn)發(fā)熱,體溫在38.5-39℃之間,1例患者體溫達(dá)到39℃以上,給予地塞米松5mg肌肉注射或口服非甾體類藥物處理治療,2-6小時(shí)后體溫降至正常范圍內(nèi)。2.患者治療前及治療后療效對比：患者BASDAI、BASMI評分有不同程度的下降,BASFI評分有所上升,血沉及C反應(yīng)蛋白有所下降,癥狀較前均有所好轉(zhuǎn)。結(jié)論：間充質(zhì)干細(xì)胞輸注治療強(qiáng)直性脊柱炎患者是安全的,具有較好的耐受性,并有效降低了炎性指標(biāo),改善了患者脊柱和關(guān)節(jié)的活動(dòng)功能和生活質(zhì)量。
[Abstract]:Background: ankylosing spondylitis (AS) is a disease of the spine and joint, characterized mainly by sacroiliac arthritis, peripheral inflammatory arthropathy and mid-axis spondyloarthropathy, which can be associated with eye, lung and cardiovascular diseases. Kidney, nervous system and other organs damage. Its pathogenesis is mainly immune disturbance mediated inflammatory response. All patients have low back pain and limited joint movement. The diagnosis relies mainly on the diagnostic criteria for ankylosing spondylitis revised in New York in 1984. Currently, drug therapy, including non-steroidal anti-inflammatory drugs, sulfasalazine, glucocorticoids, tumor necrosis factor inhibitors. For peripheral joint mobility limitation and ankylosis, surgical treatment is mainly needed. With the deepening of the knowledge of AS, rehabilitation training has been paid more and more attention. Objective: to study the safety and efficacy of mesenchymal stem cells (MSCs) infusion in the treatment of ankylosing spondylitis (ankylosing spondylitis). Information and methods: 1. Materials: five cases of ankylosing spondylitis were collected, which met the diagnostic criteria of ankylosing spondylitis (the diagnostic criteria of ankylosing spondylitis revised in 1984 in New York), aged from 18 to 60 years old, and the age of ankylosing spondylitis ranged from 18 to 60 years old. If non-steroidal anti-inflammatory drugs, methotrexate, sulfasalazine, hydroxychloroquine, low-dose hormone were taken before entering the group, the dose was stable for at least 4 weeks. All 5 patients were non-pregnant or lactating women without organ failure, AIDS and hepatitis. Tuberculosis or other toxic infections or psychosis have no major components such as penicillin or streptomycin allergies to human albumin and mesenchymal stem cell (Mesenchymal stem cell, MSC) culture systems. The results were as follows: physical examination, Bath Ankylosing Spondylitis activity Index (BASDAI), Bath), Ankylosing Spondylitis activity Index (BASDAI), Bath), Ankylosing Spondylitis function Index (BASFI), Bath), Ankylosing Spondylitis Measurement Index (BASMI); Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood routine, urine routine, liver and kidney function, imaging and so on. Methods: mesenchymal stem cells were cultured to induce differentiation of mesenchymal stem cells, surface molecules of mesenchymal stem cells were detected by flow cytometry, bacteria (aerobic culture, anaerobic culture), Mycoplasma and endotoxin detection of qualified MSC can be used in patients tested. The patients were treated with lIU/10Kg (1IU=1 脳 10 ~ 7 mesenchymal stem cells) at an average dose of 1 ~ 2 times per patient. All patients were evaluated for efficacy and safety after infusion, including physical examination, BASDAI,BASFI, BASMI evaluation, erythrocyte sedimentation rate, C-reactive protein, blood routine, urine routine, liver and kidney function test, imaging examination and adverse reaction record. And compared with before treatment, has achieved the purpose of evaluating curative effect. Results: 1. Three of the 5 patients developed fever after infusion, the body temperature was between 38.5 鈩，

本文編號：2438005