脊髓损伤的最新治疗进展

脊髓损伤以后引起原发性损伤和继发性损伤导致损伤的神经组织难以修复。目前脊髓损伤的重点主要集中在减轻和延缓继发性损伤造成的伤害。本文总结了近年来在脊髓损伤治疗领域的进展包括传统的药物治疗,细胞移植和基因治疗。目前动物实验研究表明细胞移植和基因治疗在治疗脊髓损伤的中取得了可喜的成果,将在未来临床应用中发挥重要作用。     

脊髓损伤治疗取得新进展新的化合物也开始登场

在意外事故中发生脊髓断裂、导致身体瘫痪的脊椎损伤，医疗现场所要求的治疗法的关键在于神经的再生。通过抑制阻碍神经生长因子来解决神经再生的问题，围绕着这一新的治疗理念，展开了针对酶、抗体以及低分子化合物的开发竞争。[编者按]     

脊髓缺血再灌注损伤的防治概况

脊髓缺血-再灌注损伤(SCII)是一种严重的神经系统损伤,是缺血脊髓组织恢复血液灌注后,脊髓组织的损伤反而加重,表现为其神经损害体征和形态学改变较前更加明显,其发生机制是多因素的综合结果,治疗措施也具有多样性,脊髓缺血后脊髓微血管结构及功能的破坏和脊髓水肿等是脊髓功能损害的主要诱因,至今为止,脊髓缺血再灌注损伤的防治主要有药物及物理治疗等方法,本文作者通过查阅中外文献对脊髓缺血再灌注损伤的特征、发生机制及防治措施作一综述,希望对研究脊髓缺血再灌注损伤防治的学者能有所帮助。     

急性机械性脊髓损伤动物模型研究进展

急性脊髓损伤(acute spinal cord injury,ASCI)是一种致残率高、后果严重的中枢神经系统性损伤,给个人、家庭以及社会带来了沉重的负担.目前仍没有治疗脊髓损伤的有效方法,但包括:干细胞、药物、组织工程的不同治疗手段已经在多种动物模型中进行了应用,并取得一定的效果.动物模型的受伤机制、有效性以及完整...     

甲基强的松龙对急性脊髓损伤患者神经生长因子水平变化的影响及其临床疗效

目的:探讨甲基强的松龙对急性脊髓损伤患者神经生长因子水平变化及临床疗效的影响。方法:回顾性研究我院收治的68例急性脊髓损伤患者的临床资料,随机分为实验组和对照组,每组34例。对照组患者给予常规治疗,实验组患者在对照组基础上给予甲基强的松龙治疗。观察并比较治疗前后两组患者神经生长因子(NGF)、脑源性神经营养因子(BDNF)水平变化及神经功能评分和并发症的发生情况。结果:与治疗前相比,两组患者治疗后血清NGF及BDNF水平均升高,且感觉功能评分及运动功能评分均升高,差异具有统计学意义(P0.05);与对照组相比,实验组患者治疗后血清NGF及BDNF水平较高,感觉功能评分及运动功能评分较高,差异具有统计学意义(P0.05);与对照组相比,实验组患者并发症的发生率较低,差异具有统计学意义(P0.05)。结论:甲基强的松龙治疗急性脊髓损伤的临床疗效较好,能够提高患者血清NGF及BDNF水平,改善感觉功能评分及运动功能评分,同时降低并发症的发病率。     

药物及靶向治疗在脊髓损伤中的治疗新进展

脊髓损伤(spinalcordinjury,SCI)是一种严重的损伤,它对患者的影响是相当持久的,SCI治疗的难点主要是由于损伤后脊髓中的微环境不利于神经细胞的再生、轴突的生长和新突触的形成,从而影响了脊髓组织的修复。现在SCI治疗的策略就是要改善损伤脊髓微环境,减少不利因素,从而促进脊髓结构修复和功能重建。本研究综述近年来逐渐发展起来的药物及靶向治疗方法,为SCI的新治疗提供参考依据,真正提高患者的生活质量。     

脊髓损伤的病理变化及治疗进展

脊髓损伤是中枢神经系统严重的创伤,多为脊柱损伤的最严重并发症之一,常造成损伤平面以下的肢体运动、感觉及植物神经功能紊乱,不仅给患者本人带来常人难以想象的心理痛苦及生活障碍,给家庭及社会同样带来高额的负担。近年来,脊髓损伤呈现出高发病率、高耗费、高致残率及低龄化的\"三高一低\"的发病趋势,逐渐成为学术界急需攻克的重大医疗问题。随着脊髓损伤病理生理机制的深入研究,针对发病机制不同阶段进行阻断的新药研究成为热点,加上干细胞技术及生物工程的发展,均为脊髓损伤后的治疗提供了新的方向。     

L-NNA对大鼠急性脊髓损伤的影响

实验采用雌性 Wistar大鼠 41只 ,分为正常对照组、生理盐水对照组和 L - NNA治疗组 ,后两组制成不完全性(2 18克厘米力 )急性脊髓 (第 10胸髓 )损伤模型 ,于术后每天一次腹腔注射 L - NNA (2 0 m g/ kg)或等量生理盐水 ,连续四周 ,然后处死动物 ,行脊髓 NOS染色和超微结构观察。结果显示 ,L - NNA治疗组脊髓 NOS阳性神经元染色较生理盐水对照组浅 ,两组光密度比较 P<0 .0 5 ;超微结构观察 ,生理盐水对照组脊髓神经元胞质呈空泡样变 ,线粒体等细胞器变性 ,髓鞘严重变形 ,少数髓鞘呈线团状改变 ,常伴有高电子密度的块状沉积物。但 L - NNA治疗组脊髓神经元及大部分神经纤维的髓鞘结构清晰。因此我们认为 ,大鼠急性脊髓损伤可诱导神经元 NOS表达 ,L - NNA对其损伤修复起促进作用。     

L-NAME对大鼠急性脊髓损伤的影响

实验采用雌性Wistar大鼠15只,分为正常对照组、生理盐水对照组L－NAME治疗组,后两组制成急性脊髓损伤模型,于术后每天一次腹腔注射L－NAME（20kg/kg）或等量生理盐水,连续七天,然后处死动物,行脊髓NOS和Nissl染色。结果显示,L－NAME治疗组脊髓NOS阳性神经元染色较生理盐水对照组浅,组间光密度比较P＜0.05。此外,生理盐水对照组脊髓神经元还出现尼氏体位、减少,甚至消失等现象;这些改变在L－NAME治疗组较轻,因此我们认为,大鼠急性脊髓损伤可诱导神经元NOS表达,L－NAME可对其损伤修复起促进作用。     

Oral mucosa stem cells alleviates spinal cord injury-induced neurogenic bladder symptoms in rats

Background

Spinal cord injury (SCI) deteriorates various physical functions, in particular, bladder problems occur as a result of damage to the spinal cord. Stem cell therapy for SCI has been focused as the new strategy to treat the injuries and to restore the lost functions. The oral mucosa cells are considered as the stem cells-like progenitor cells. In the present study, we investigated the effects of oral mucosa stem cells on the SCI-induced neurogenic bladder in relation with apoptotic neuronal cell death and cell proliferation.

Results

The contraction pressure and the contraction time in the urinary bladder were increased after induction of SCI, in contrast, transplantation of the oral mucosa stem cells decreased the contraction pressure and the contraction time in the SCI-induced rats. Induction of SCI initiated apoptosis in the spinal cord tissues, whereas treatment with the oral mucosa stem cells suppressed the SCI-induced apoptosis. Disrupted spinal cord by SCI was improved by transplantation of the oral mucosa stem cells, and new tissues were increased around the damaged tissues. In addition, transplantation of the oral mucosa stem cells suppressed SCI-induced neuronal activation in the voiding centers.

Conclusions

Transplantation of oral mucosa stem cells ameliorates the SCI-induced neurogenic bladder symptoms by inhibiting apoptosis and by enhancing cell proliferation. As the results, SCI-induced neuronal activation in the neuronal voiding centers was suppressed, showing the normalization of voiding function.     

大鼠脊髓损伤后表皮生长因子受体在脊髓的表达特点

目的研究大鼠脊髓损伤(spinal cord injury,SCI)后表皮生长因子受体(epidermal growth factor re-ceptor,EGFR)在脊髓的表达特点及意义。方法健康成年雄性SD大鼠,随机分为4组(每组10只):假手术组,SCI术后3 d、7 d和14 d组。应用Basso Beattie Bresnahan(BBB)评分观察大鼠行为学改变;逆转录-聚合酶链反应(RT-PCR)检测损伤段脊髓组织中EGFR mRNA表达水平;免疫组织化学方法观察损伤段脊髓灰质中EGFR蛋白表达情况;并对EGFRmRNA及蛋白表达情况与BBB评分进行相关性分析。结果行为学观察发现大鼠脊髓损伤后下肢神经功能逐步恢复;RT-PCR结果显示EGFR mRNA在假手术组大鼠脊髓中微量表达,SCI术后3 d表达显著升高,随后趋于下降,14 d时仍高于假手术组(P<0.01);免疫组织化学染色显示损伤段脊髓灰质中EGFR阳性细胞数在损伤后3 d显著高于假手术组(P<0.01),随后趋于下降,但14 d时仍高于假手术组(P<0.01);EGFR mRNA及蛋白的表达均与BBB评分呈显著负相关(r=-0.956,P<0.05;r=-0.966,P<0.05)。结论EGFR在大鼠脊髓损伤后具有时相分布特点,且与动物行为呈负相关,提示其表达可能阻碍损伤后的神经功能恢复。     

电针对脊髓损伤星形胶质细胞增生及其NGF表达的影响

目的研究脊髓损伤后电针治疗对星形胶质细胞增生及其内源性神经生长因子(nerve growth factor,NGF)表达的影响.方法选用成年雌性Wistar大鼠,随机分为3组.A组为正常对照组,B组、C组为下胸段脊髓不完全损伤.B组损伤后不治疗,C组损伤后给予督脉电针治疗.损伤后3 d、1 、2或4周应用免疫组化染色分别观察损伤脊髓胶质原纤维酸性蛋白(glial fibroblast acid protein,GFAP)和NGF表达的变化.结果 B组术后3 d,GFAP阳性细胞明显增多, 2周后开始减少,4周时仍有较多的阳性细胞;C组GFAP阳性细胞明显少于B组,1周时达高峰.脊髓损伤后NGF表达呈逐渐增加的趋势.C组NGF的表达明显高于B组,且一直保持在较高水平.NGF阳性细胞大部分与GFAP阳性细胞形态相似.结论电针治疗能减少星形胶质细胞增生,促进内源性NGF的合成,从而创造了有利于神经再生的微环境.     

Loss of Ascorbic Acid from Injured Feline Spinal Cord

Feline spinal cord contains 0.97 mM ascorbic acid, as measured by the dinitrophenylhydrazine method. Greater than 90% is maintained in the reduced form. When functioning normally, the CNS conserves its ascorbic acid with a turnover rate of 2% per h. Following contusion injury severe enough to produce paraplegia, ascorbic acid is rapidly lost from injured spinal tissue. Thus, ascorbic acid is decreased 30% by 1 h and 50% by 3 h following injury. Oxidized ascorbic acid is increased at 1, but not 3, h following impact. As a consequence of its many functions in CNS, loss of ascorbic acid may contribute to derangements in spinal cord function following injury.     

Nerve growth factor in glia and inflammatory cells of the injured rat spinal cord

Nerve growth factor (NGF) is crucial for the development of sympathetic and small-diameter sensory neurons and for maintenance of their mature phenotype. Its role in generating neuronal pathophysiology is less well understood. After spinal cord injury, central processes of primary afferent fibers sprout into the dorsal horn, contributing to the development of autonomic dysfunctions and pain. NGF may promote these states as it stimulates sprouting of small-diameter afferent fibers and its concentration in the spinal cord increases after cord injury. The cells responsible for this increase must be identified to develop a strategy to prevent the afferent sprouting. Using immunocytochemistry, we identified cells containing NGF in spinal cord sections from intact rats and from rats 1 and 2 weeks after high thoracic cord transection. In intact rats, this neurotrophin was present in a few ramified microglia and in putative Schwann cells in the dorsal root. Within and close to the lesion of cord-injured rats, NGF was in many activated, ramified microglia, in a subset of astrocytes, and in small, round cells that were neither glia nor macrophages. NGF-immunoreactive putative Schwann cells were prevalent throughout the thoracolumbar cord in the dorsal roots and the dorsal root entry zones. Oligodendrocytes were never immunoreactive for this protein. Therapeutic strategies targeting spinal cord cells that produce NGF may prevent primary afferent sprouting and resulting clinical disorders after cord injury.     

FGF对周围神经损伤后脊髓前角运动神经元的保护作用

目的：研究周围神经损伤后,局应用碱性成纤维细胞生长因子（basic fibroblast growth factor ,bFGF）对脊髓前角运动神经元的保护作用。方法：切为SD大鼠右侧坐骨神经,近端套接单盲硅胶管后,管内立好注入20μlbFGF（浓度为4000u/ml）或等量生理盐水,术后2周,观察L3－L5脊央前角外侧群大、中小型神经元乙酰胆碱酯酶（acetyl cholinesterase,AChE）,酸性磷酸酶（acid phosphatas,Acp)和一氧化氮合酶（nitric oxide synthase,NOS)的阳性细胞数、反应强度和平均灰度。结果：坐骨神经损伤后,脊髓腰节段运动神经元因受损伤的影响发明明显改变。表现为AChE降低,Acp,NOS活性升高,局部应用bFGF后,大型运动神经元(α运动神经元）阳性细胞数,反应强度和平均灰度接近正常侧,与对照组比较具有显性意义（P＜0．01）。结论：bFGF可以有效地防止周围神经损伤引起的脊髓前角α运动神经元退变,促进其恢复。     

神经生长因子样免疫反应在鸡胚脊髓发育期的配布

探讨神经生长因子（NGF）对脊髓和背根节（DRG）发育的影响。取Hamburger 30期和40期鸡胚腰段脊髓及DRG。制作20μm厚冰冻切片。用2.5S NGF抗体进行ABC免疫组化染色,观察NGF样免疫阳性反应（NGF－IR）在两时相脊髓和DRG的配布,结果在30期,强NGF－IR呈现在白质,且腹侧较强,灰质未阳生细胞。40期时,除白质显NGF－IR和背侧白质NGF－IR增强外,脊髓灰质和DRG内亦出现了一些NGF阳性细胞,特别是在背角细胞可见强NGF－IR。结果表明NGF与脊髓和DRG的发育有关。     

蛇毒神经生长因子促进周围神经再生的诱发电位观察

目的：研究蛇毒神经生长因子（sNGF)对大鼠坐骨神经损伤后诱发电位的影响,评价蛇毒神经生长因子在促进周围神经再生中的作用。方法：建立大鼠坐骨神经钳夹模型,局部滴加药物和术后肌注sNGF,通过脊髓诱发电位（SEP）,运动诱发电位（MEP）评定,观察坐骨神经修复情况。结果：sNGF治疗后可使伤后SEP,MEP提早出现,结论：蛇毒提取的NGF对大鼠坐骨神经损伤修复具有促进作用。     

Pretreatment with calpain inhibitor CEP-4143 inhibits calpain I activation and cytoskeletal degradation, improves neurological function, and enhances axonal survival after traumatic spinal cord injury

The pathophysiology of traumatic spinal cord injury (SCI) involves abnormal activation of the neutral cysteine protease calpain I (EC 3.4.22.17). In the present study we examined the effect of the calpain inhibitor CEP-4143 on cytoskeletal protection and neurological recovery after SCI in adult rats. Microinjection of 50 mM CEP-4143 into the T7 vertebral segment 10 min before a 35-g clip compression injury resulted in inhibition of calpain activation at 2 and 4 h postinjury, as determined by western blotting for calpain I-mediated spectrin degradation, and significantly attenuated the degradation of dephosphorylated NF200 neurofilament protein at 4 and 8 h postinjury. To examine the in vivo chronic neuroprotective effects of CEP-4143, animals underwent microinjection with saline or 50 mM CEP-4143 10 min before injury, followed by weekly blinded behavioral assessments for 6 weeks. Animals receiving CEP-4143 treatment showed significant improvement over saline-treated controls on the Basso Beattie Bresnahan locomotor rating scale (p < 0.02) and inclined plane test (p < 0.05). Counts of neurons in the red nucleus retrogradely labeled by fluoro-gold after introduction distal to the injury site were significantly higher in CEP-4143-treated animals. Finally, morphometric assessment of the injury site by computer-assisted image analysis revealed significant tissue preservation in CEP-4143-treated animals. We conclude that the calpain antagonist CEP-4143 exhibits biochemical, behavioral, and anatomical neuroprotection following traumatic SCI.