再生疗法和康复治疗的联合应用对神经疾病运动功能的康复效果：Scoping综述

doi:10.3969/j.issn.1006-9771.2021.12.011

摘要/Abstract

摘要：

目的综述再生疗法和康复治疗联合应用于神经疾病运动功能的康复效果。方法检索建库至2021年4月1日PubMed、Web of Science、中国知网、万方数据库中有关再生疗法和康复治疗相结合作用于神经疾病的相关研究,提取文献内容并进行Scoping综述。结果共检索文献2567篇,最终纳入26篇,其中3篇为人类临床研究,23篇为动物基础研究。研究设计主要为随机或非随机对照试验、病例系列研究。研究主要涉及再生疗法和康复治疗的联合干预对脑卒中、脊髓损伤、脑性瘫痪等神经疾病运动功能的治疗效果。结论本文从范畴上界定了再生康复在神经疾病的相关研究和应用,发现再生疗法和康复治疗的结合对于神经疾病运动功能的恢复具有一定的协同效应。未来需要更多的科研工作来支持其临床实践。

关键词: 再生医学, 细胞疗法, 再生康复, 物理疗法, 运动功能, 神经疾病, Scoping综述

Abstract:

Objective To perform a scoping review of the combination of regenerative therapy and rehabilitation in neurological diseases.Methods Literatures about the combination of regenerative therapy and rehabilitation in neurological diseases were retrieved in PubMed, Web of Science, CNKI and Wanfang data from establishment to April 1st, 2021.Results A total of 2567 literatures were retrieved, and 26 were finally enrolled, including three human clinical studies and 23 animal basic studies. The research design was mainly randomized or non-randomized controlled trials and case series. The researches mainly involved the therapeutic effect of combined regeneration therapy and rehabilitation on neurological diseases, such as stroke, spinal cord injury and cerebral palsy, etc.Conclusion The researches and applications of regenerative rehabilitation in neurological diseases were scoped, and it was found that the combination of regenerative therapy and rehabilitation has synergistic effects on the restoration of motor function of neurological diseases, and more scientific researches are needed to support its clinical practice in the future.

Key words: regenerative medicine, cell therapy, regenerative rehabilitation, physical therapy, motor function, nervous system diseases, scoping review

中图分类号:

R741

刘于畅,徐昕. 再生疗法和康复治疗的联合应用对神经疾病运动功能的康复效果：Scoping综述[J]. 《中国康复理论与实践》, 2021, 27(12): 1450-1457.

LIU Yu-chang,XU Xin. Effect of Combination of Regenerative Medicine and Rehabilitation on Motor Function of Neurological Diseases: A Scoping Review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(12): 1450-1457.

图/表 3

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表1

纳入文献的Scoping分析结果(基础研究)"

研究	国家	研究对象	再生疗法	康复治疗	干预效果(运动功能)	可能机制
Weishaupt等^[15](2013)	加拿大	Lewis大鼠(n = 46) 颈段脊髓损伤	神经营养因子注射	任务导向性功能训练	联合干预组肢体功能改善显著	不明
Zhang等^[9](2015)	中国	Sprague-Dawley大鼠(n = 60) 脑卒中	大鼠间充质干细胞移植	跑台训练	联合干预组神经行为功能明显改善	细胞凋亡减少; 干细胞存活增加
Sasaki等^[16] (2016)	日本	Sprague-Dawley大鼠(n = 40) 脑卒中	大鼠间充质干细胞移植	跑台训练	联合干预组运动功能显著改善	病灶面积减小; 胼胝体厚度增加; 突触发生增加
Tashiro等^[17](2016)	日本	C57BL/6J小鼠(n = 80) 慢性胸段脊髓损伤	神经干细胞/祖细胞移植	跑台训练	联合干预组运动功能恢复显著改善(步态、痉挛程度)	神经元分化增加; 中枢模式发生器成熟增加
Song等^[18](2016)	中国	Sprague-Dawley大鼠(n = 30) 坐骨神经损伤	神经导管移植	电刺激	不明	BDNF、GDNF、NT-3升高,神经再生增加
Akhoundzadeh等^[19](2017)	伊朗	C57BL/6J小鼠脑卒中	骨髓间充质干细胞移植和甲状腺激素注射	跑台训练	联合干预组神经行为功能明显改善	神经元凋亡减少, 脑梗死面积减少
Kim等^[20] (2017)	韩国	Sprague-Dawley大鼠(n = 40) T₉~T₁₀节段脊髓损伤	骨髓间充质干细胞移植	跑台训练	联合干预组BBB评分显著升高	BDNF、突触素Ⅰ升高
Zhao等^[21](2018)	中国	Sprague-Dawley大鼠(n = 170) 脑卒中	大鼠脂肪干细胞移植	低温治疗(33 ℃)	不明	梗死面积、细胞凋亡减少、炎症反应、胶质瘢痕形成减少血管生成增加
Morimoto等^[22](2018)	日本	Wistar大鼠(n = 18) 脑卒中	大鼠间充质干细胞移植	电刺激(100 µA, 100 Hz)	联合干预组行为测试结果显著改善	梗死面积减少, 移植细胞迁移增多,SDF-1α增加
Du等^[23] (2018)	美国	无胸腺裸鼠(n = 60) 坐骨神经损伤	神经嵴干细胞移植	电刺激	联合干预组步态恢复显著改善	腓肠肌湿重增加,干细胞、施万细胞分化增加,神经再生增多
Tashiro等^[24](2018)	日本	C57BL/6J小鼠(n = 55) 腰段脊髓损伤	神经干细胞/祖细胞移植	跑台训练	没有显著性改善	不明
Cucarián等^[25](2019)	巴西	Wistar大鼠 (n = 41) 帕金森病	骨髓间充质干细胞移植到纹状体	跑台训练	单独运动组和联合治疗组在运动功能恢复方面均有显著改善。	不明
Lin等^[26] (2019)	新加坡	Sprague-Dawley大鼠(n = 26) 腰段脊髓损伤	生物支架植入	步态训练	联合干预组踝关节屈肌力量显著升高	轴突再生增多,抗炎细胞浓度升高
Mu等^[27] (2019)	中国	Sprague-Dawley大鼠(n = 97) 脑卒中	人脂肪组织源性间充质干细胞移植	丰富环境	联合干预组大鼠前肢功能显著改善	不清楚
研究	国家	研究对象	再生疗法	康复治疗	干预效果(运动功能)	可能机制
Peng等^[10] (2019)	中国	Sprague-Dawley大鼠(n = 60) 脑卒中	神经干细胞移植	重复经颅磁刺激(10 Hz、300脉冲/d)	显著改善脑卒中后的功能恢复	神经分化增加,BNDF升高
Zhu等^[11] (2020)	中国	家兔(n = 40) 坐骨神经损伤	富血小板血浆注射	低剂量超短波	不明	轴突再生增加,肌肉萎缩减少
贾杰等^[28] (2008)	中国	Sprague-Dawley大鼠(n = 30) 脑卒中	神经干细胞移植	跑台训练	联合干预组神经行为评分显著改善	神经干细胞迁移、分化、存活率增加
周治来等^[29](2010)	中国	Sprague-Dawley大鼠(n = 40) T₁₀脊髓损伤	骨髓源性神经干细胞移植	康复训练(跑台、滚筒)	联合干预组BBB评分显著升高	神经干细胞存活率、分化率增加
周治来等^[30] (2010)	中国	Sprague-Dawley大鼠(n = 80) T₁₀脊髓损伤	神经干细胞移植	康复训练(跑台、滚筒)	联合干预组BBB 评分显著升高	Nogo-A、NgR下降
张鑫等^[31] (2014)	中国	Sprague-Dawley大鼠(n = 100) T₁₀节段不完全脊髓损伤	人脂肪间充质干细胞移植	康复训练(跑台、滚筒)	联合干预组BBB评分结果显著升高	BNDF升高
介小素等^[32] (2015)	中国	Sprague-Dawley大鼠(n = 51) 脑瘫	神经干细胞移植	针灸	联合干预组行为学评分显著改善	神经细胞凋亡减少
武玉江^[33](2016)	中国	Sprague-Dawley大鼠(n = 60) 脊髓损伤	神经干细胞移植	早期运动训练(跑台、滚筒)	联合干预组BBB评分及斜板实验评分显著升高	caspase-3下降,髓过氧化物酶下降
赵素香等^[34](2016)	中国	Sprague-Dawley大鼠(n = 80) 脊髓损伤	内皮祖细胞移植	早期运动训练(跑台、滚筒)	联合干预组改良的Tarlov评分、BBB评分及斜板实验评分显著升高	神经突触再增加,血管再生增加

表1

表2

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