全身体温过低
临床前研究发现冷却可以减轻继发性脊髓损伤机制。[79]Lo TP Jr, Cho KS, Garg MS, et al. Systemic hypothermia improves histological and functional outcome after cervical spinal cord contusion in rats. J Comp Neurol. 2009;514:433-448.http://www.ncbi.nlm.nih.gov/pubmed/19350644?tool=bestpractice.com 计划进行一项多中心联合试验来评估体温过低在脊髓损伤中的潜在神经保护作用。[80]Wilson JR, Forgione N, Fehlings MG. Emerging therapies for acute traumatic spinal cord injury. CMAJ. 2013;185:485-492.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612151/http://www.ncbi.nlm.nih.gov/pubmed/23228995?tool=bestpractice.com
抗 Nogo 抗体
目前仍处于临床检查的早期阶段。 使用抗 Nogo 抗体针对 Nogo-A（一种阻止人体中枢神经系统内轴突生长一种蛋白质）[81]Spillmann AA, Bandtlow CE, Lottspeich F, et al. Identification and characterization of a bovine neurite growth inhibitor (bNI-220). J Biol Chem. 1998;273:19283-19293.http://www.jbc.org/content/273/30/19283.longhttp://www.ncbi.nlm.nih.gov/pubmed/9668118?tool=bestpractice.com 和抗 Nogo 抗体促进动物模型的神经再生。[82]Freund P, Wannier T, Schmidlin E, et al. Anti-Nogo-A antibody treatment enhances sprouting of corticospinal axons rostral to a unilateral cervical spinal cord lesion in adult macaque monkey. J Comp Neurol. 2007;502:644-659.http://www.ncbi.nlm.nih.gov/pubmed/17394135?tool=bestpractice.com
利鲁唑
通过阻断钠涌入受损细胞，对白质发挥潜在的保护作用。[83]Kwon BK, Sekhon LH, Fehlings MG. Emerging repair, regeneration, and translational research advances for spinal cord injury. Spine (Phila Pa 1976). 2010;35:S263–S270.http://www.ncbi.nlm.nih.gov/pubmed/20881470?tool=bestpractice.com 对急性脊髓损伤的 I 期临床试验正在进行。[84]Wilson JR, Fehlings MG. Riluzole for acute traumatic spinal cord injury: a promising neuroprotective treatment strategy. World Neurosurg. 2014;81:825-829.http://www.ncbi.nlm.nih.gov/pubmed/23295632?tool=bestpractice.com
软骨素酶 ABC
一种细菌衍生的酶，在啮齿动物损伤模型中降解阻止了创伤后轴突生长的神经胶质瘢痕的元素。[85]Bradbury EJ, Carter LM. Manipulating the glial scar: chondroitinase ABC as a therapy for spinal cord injury. Brain Res Bull. 2011;84:306-316.http://www.ncbi.nlm.nih.gov/pubmed/20620201?tool=bestpractice.com
改性镁
当与镁结合时，亲水聚合物聚乙二醇能够保护动物模型中神经元膜的完整性。[86]Luo J, Borgens R, Shi R. Polyethylene glycol immediately repairs neuronal membranes and inhibits free radical production after acute spinal cord injury. J Neurochem. 2002;83:471-480.http://onlinelibrary.wiley.com/doi/10.1046/j.1471-4159.2002.01160.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12423257?tool=bestpractice.com
米诺环素
一种四环素类抗生素，能够减轻神经炎症、抑制细胞凋亡及预防神经元损伤。[83]Kwon BK, Sekhon LH, Fehlings MG. Emerging repair, regeneration, and translational research advances for spinal cord injury. Spine (Phila Pa 1976). 2010;35:S263–S270.http://www.ncbi.nlm.nih.gov/pubmed/20881470?tool=bestpractice.com 在一项 II 期临床试验中，接受米诺环素治疗的患者比接受安慰剂的患者运动功能恢复得更好；[87]Casha S, Zygun D, McGowan MD, et al. Results of a phase II placebo-controlled randomized trial of minocycline in acute spinal cord injury. Brain. 2012;135:1224-1236.http://brain.oxfordjournals.org/content/135/4/1224.longhttp://www.ncbi.nlm.nih.gov/pubmed/22505632?tool=bestpractice.com 一项 III 期临床试验正在进行中。
Cethrin
Cethrin 是一种与止血粘合剂结合的细菌衍生的毒素 (BA-210)，可抑制 Rho 信号通路，因此可以促进体内轴突生长。 Cethrin 在 I/IIa 期试验中提高了胸椎或颈椎脊髓损伤的患者的运动功能。[88]Fehlings MG, Theodore N, Harrop J, et al. A phase I/IIa clinical trial of a recombinant Rho protein antagonist in acute spinal cord injury. J Neurotrauma. 2011;28:787-796.http://www.ncbi.nlm.nih.gov/pubmed/21381984?tool=bestpractice.com 已规划了进一步临床试验。
碱性成纤维细胞生长因子（碱性 FGF）
在损伤处注射碱性成纤维细胞生长因子 (FGF) 提高了动物模型中的功能参数和呼吸参数，可能是通过减少谷氨酸钠介导的兴奋性毒性实现的。[89]Teng YD, Mocchetti I, Taveira-DaSilva AM, et al. Basic fibroblast growth factor increases long-term survival of spinal motor neurons and improves respiratory function after experimental spinal cord injury. J Neurosci. 1999;19:7037-7047.http://www.jneurosci.org/content/19/16/7037.longhttp://www.ncbi.nlm.nih.gov/pubmed/10436058?tool=bestpractice.com I/II 期试验目前正在招募患者。
神经调节
有证据表明神经调节有助于康复。[90]Harkema S, Gerasimenko Y, Hodes J, et al. Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study. Lancet. 2011;377:1938-1947.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154251/http://www.ncbi.nlm.nih.gov/pubmed/21601270?tool=bestpractice.com
干细胞疗法
小规模的脊髓损伤患者研究表明骨髓衍生干细胞似乎可以改善膀胱功能、生活质量和运动功能。[91]Geffner LF, Santacruz P, Izurieta M, et al. Administration of autologous bone marrow stem cells into spinal cord injury patients via multiple routes is safe and improves their quality of life: comprehensive case studies. Cell Transplant. 2008;17:1277-1293.http://www.ncbi.nlm.nih.gov/pubmed/19364066?tool=bestpractice.com[92]Yoon SH, Shim YS, Park YH, et al. Complete spinal cord injury treatment using autologous bone marrow cell transplantation and bone marrow stimulation with granulocyte macrophage-colony stimulating factor: phase I/II clinical trial. Stem Cells. 2007;25:2066-2073.http://onlinelibrary.wiley.com/doi/10.1634/stemcells.2006-0807/fullhttp://www.ncbi.nlm.nih.gov/pubmed/17464087?tool=bestpractice.com 一些通过活化自体巨噬细胞或嗅鞘细胞治疗的患者运动功能得到轻微改善，但结果并不一致。[93]Knoller N, Auerbach G, Fulga V, et al. Clinical experience using incubated autologous macrophages as a treatment for complete spinal cord injury: phase I study results. J Neurosurg Spine. 2005;3:173-181.http://www.ncbi.nlm.nih.gov/pubmed/16235699?tool=bestpractice.com[94]Lammertse DP, Jones LA, Charlifue SB, et al. Autologous incubated macrophage therapy in acute, complete spinal cord injury: results of the phase 2 randomized controlled multicenter trial. Spinal Cord. 2012;50:661-671.http://www.ncbi.nlm.nih.gov/pubmed/22525310?tool=bestpractice.com[95]Lima C, Escada P, Pratas-Vital J, et al. Olfactory mucosal autografts and rehabilitation for chronic traumatic spinal cord injury. Neurorehabil Neural Repair. 2010;24:10-22.http://www.ncbi.nlm.nih.gov/pubmed/19794133?tool=bestpractice.com
