蛛网膜下腔移植脐血干细胞治疗一氧化碳中毒后迟发性脑病的临床研究

目的观察蛛网膜下腔途径移植脐血干细胞治疗一氧化碳中毒后迟发性脑病（DEACMP）的安全性及治疗效果。方法26例DEACMP患者，按治疗方式分两组，其中12例经脐血干细胞移植治疗为治疗组，14例经高压氧治疗为对照组，对每例患者在治疗前和治疗后进行MMSE评分、ADL评分及颅脑CT检查。所有患者连续随访1年，观察预后及有无不良反应。采用两样本t检验、方差分析及卡方检验进行统计学分析。结果治疗组患者在干细胞移植术中均无特殊不适感，术中及术后24h内生命体征平稳，无发热，无穿刺点感染、出血等，术后门诊随访，均未出现移植相关并发症。1年后治疗组患者MMSE评分为25．08±4．10，高于对照组11．7±10．33（t=4．199，P=0．0003）；治疗组ADL评分为93．33±13．37，高于对照组41．07±38．39（t=4．478，P=0．0002），差异均有统计学意义。治疗组CT检查结果好转率为83．33％，对照组好转率为30．00％两组比较差异有统计学意义（Х^2=4．402，P=0．0359）；治疗组临床痊愈率为50．00％，对照组为7．69％，差异有统计学意义（Х^2=4．055，P=0．0442）；治疗组临床有效率为100．00％，对照组为50．00％差异有统计学意义（Х^2=5．866，P=0．0154）。结论脐血干细胞移植治疗DEACMP疗效优于高压氧治疗，是一种安全有效的生物治疗方法，应得到重视和深入的研究。

Umbilical cord blood stem cell transplantation for the treatment of delayed encephalopathy after carbon monoxide poisoning through the subarachnoid space

Objective To evaluate the safety and the therapeutic effect of umbilical cord blood stem cell transplantation for the treatment of delayed encephalopathy after carbon monoxide poisoning through the subarachnoid space. Methods Totally 26 DEACMP patient were included. Treatment group （n=12） was treated by umbilical cord blood stem cell transplantation. Control group （n=14） received hyperbaric oxygen therapy Patients were followed up for 12 consecutive months. During the follow-up patient＇s MMSE scores and ADL scores and adverse reactions were recorded. Brain CT scan was performed, t test and chi-square test were used for statistical analysis. Result No patients reported adverse reactions during cell infusion and transplant-related complications during follow-up. At 1 year MMSE scores were higher in the treatment group than in the control group [（25.08 ±4.10） vs （11.7 ± 10.33）, t= 4.199, P = 0.0003]. ADL scores were higher in the treatment group than in the control group [（93.33 ± 13.37） vs （41.07 ± 38.39）, t = 4.478,P = 0.0002]. CT scan showed statistically significant difference between the treatment groupand control group in rates of inprovement （83.33 % vs 30 %, Х^2 = 4.402, P = 0.0359）. The clinical curative rates between the treatment group and control group was significantly different [（50 % ）vs（7.69 %）, Х^2 =4.055, P =0.0442]. The clinical effective rates between the treatment group and control group was also significantly different [ 100 % vs 50 %, Х^2 = 5.866, P = 0.0154）. Conclusion Umbilical cord blood stem cell transplantation was better than hyperbaric oxygen therapy and it is a safe, effective and feasible treatment.