Comparison of the effects of neural stem cell transplantation at different therapeutic occasions in the treatment of sequelae caused by craniocerebral injury
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摘要:目的 探讨不同治疗时机神经干细胞移植治疗颅脑损伤后遗症的效果。方法 将本院进行神经干细胞移植治疗的168例颅脑损伤后遗症患者根据不同治疗时机分为A组(54例)、B组(56例)和C组(58例)。A组患者治疗时机为颅脑损伤6个月内, B组患者治疗时机为颅脑损伤6个月~1年, C组患者治疗时机为颅脑损伤1年以上, 3组患者均予以神经干细胞移植治疗。观察并对比3组患者临床疗效、治疗前后功能独立性评定量表(FIM)评分以及不良反应发生情况。结果 A组患者临床总有效率显著高于B和C组, 差异有统计学意义(P < 0.05); 与第1次移植治疗前相比, 3组第4次移植治疗后3个月患者FIM评分均显著提高，差异有统计学意义(P < 0.05); 第4次移植治疗后3个月, A组患者FIM评分为(98.12±8.92)分，显著高于B组的(82.03±5.75)分和C组的(73.14±5.21)分，差异有统计学意义(P < 0.05); A组患者不良反应发生率为7.40%, 显著低于B组的17.86%和C组的25.86%, 差异有统计学意义(P < 0.05); B组和C组的临床总有效率、FIM评分及不良反应发生率比较差异均无统计学意义(P>0.05)。结论 在不同治疗时机，神经干细胞移植治疗颅脑损伤后遗症均取得一定效果，患者颅脑损伤6个月内是进行神经干细胞移植的最佳治疗时机，临床效果更为显著，可有效提高患者功能独立性，极大降低患者不良反应发生率。Abstract:Objective To investigate the effect of neural stem cell transplantation at different therapeutic times on sequelae of craniocerebral injury.Methods A total of 168 patients with sequelae of craniocerebral injury treated with neural stem cell transplantation in our hospital were divided into group A (54 cases), group B (56 cases) and group C (58 cases) according to different treatment time. The treatment time points were within 6 months of craniocerebral injury in group A, from 6 months to 1 year of craniocerebral injury in group B, and more than 1 year of craniocerebral injury in group C. All three groups were treated with neural stem cell transplantation. The clinical efficacy, Function Independent Measure(FIM) score before and after treatment and the occurrence of adverse reactions of the three groups were observed and compared.Results The total clinical effective rate of group A was significantly higher than that of group B and group C (P < 0.05). Compared with the first transplantation before, FIM scores of three groups were significantly improved after the fourth transplantation for 3 months (P < 0.05). Three months later, the FIM score of group A was(98.12±8.92), which was significantly higher than (82.03±5.75) in the group B and (73.14±5.21) in group C(P < 0.05); the incidence of adverse reactions of group A was 7.40%, which was lower than 17.86% in group B and 25.86% in group C (P < 0.05). There were no significant differences in overall clinical efficacy, FIM scores and the incidence of adverse reactions between group B and group C(P>0.05).Conclusion Neural stem cell transplantation has achieved certain results in the treatment of sequelae of craniocerebral injury at different treatment time periods, but the best treatment time is within 6 months, which has remarkable clinical efficacy, effectively improves the functional independence of patients and greatly reduces the incidence of adverse reactions.
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表 1 3组患者临床疗效比较[n(%)]
组别 n 痊愈 显效 无效 总有效 A组 54 32(59.26) 19(35.18) 3(5.56) 51(94.44)* B组 56 20(35.71) 24(42.86) 12(21.43) 44(78.57) C组 58 11(18.97) 27(46.55) 20(34.48) 38(65.52) 与B组和C组比较, *P < 0.05。 
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表 2 3组患者治疗前后FIM评分比较(x±s)
分 组别 n 第1次移植治疗前 第4次移植治疗后3个月 A组 54 43.01±6.56 98.12±8.92*# B组 56 40.86±7.14 82.03±5.75* C组 58 42.37±6.63 73.14±5.21* 与第1次移植治疗前比较, *P < 0.05; 与B组和C组比较, #P < 0.05。
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表 3 3组患者不良反应发生情况比较[n(%)]
组别 n 发热 头疼 恶心 合计 A组 54 2(3.70) 1(1.85) 1(1.85) 4(7.40)* B组 56 4(7.14) 3(5.36) 3(5.36) 10(17.86) C组 58 7(12.06) 4(6.90) 4(6.90) 15(25.86) 与B组和C组比较, *P < 0.05。
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