What is the dose and frequency of mesenchymal stem cells (MSCs) for knee osteoarthritis?

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膝关节骨性关节炎间充质干细胞治疗方案

目前针对膝关节骨性关节炎，推荐使用低剂量间充质干细胞（约2500万个细胞）进行关节内注射，每次治疗一剂，可根据临床反应考虑6-12个月后重复治疗。1

剂量建议

  • 低剂量（少于3000万个细胞）比高剂量更有效，研究显示在疼痛评分和功能改善方面有更好的效果1
  • 临床研究中常用剂量为2500万至4000万个细胞2, 3
  • 单次注射剂量通常不超过4×10^6/kg体重，以避免血栓形成风险4

给药频次

  • 通常采用单次关节内注射，根据临床反应可在6-12个月后考虑重复治疗3
  • 大多数临床研究采用单次注射方案，随访观察至少12个月2, 5
  • 美国骨科医师学会(AAOS)指出目前尚无标准化的给药频次方案6, 7

细胞来源选择

  • 脂肪来源的间充质干细胞(AT-MSCs)在临床研究中表现出更好的疗效1
  • 骨髓来源的间充质干细胞也被广泛应用，但可能需要更大量的取材5
  • 脐带来源的干细胞也是可选择的来源1

安全性注意事项

  • 间充质干细胞治疗总体安全性良好，不良反应发生率与对照组无显著差异8
  • 应避免使用冷冻保存的细胞，因其可能导致更多不良事件4
  • 治疗前应进行干细胞产品的血液相容性测试4
  • 在使用高剂量细胞时，可考虑使用低剂量抗凝剂如肝素，以控制免疫介导的血液反应4

临床应用限制

  • 美国风湿病学会(ACR)和关节炎基金会(AF)目前强烈反对在膝关节骨性关节炎中常规使用干细胞注射治疗4
  • 美国骨科医师学会(AAOS)强调，目前尚无MSCs治疗骨关节炎的FDA批准7
  • 干细胞制剂的异质性和缺乏标准化是临床应用的主要障碍4

治疗效果评估

  • 治疗后应使用视觉模拟评分量表(VAS)和西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评估疼痛和功能改善8, 1
  • 可通过MRI T2图像评估软骨质量变化2
  • 治疗后患者通常在6-12个月内达到65-78%的功能改善2

References

4
Guideline

间充质干细胞治疗膝关节骨性关节炎指南

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

6
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

7
Guideline

膝关节骨性关节炎的间充质干细胞治疗

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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