本文選題：降鈣素基因相關(guān)肽　切入點(diǎn)：重度顱腦損傷　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:從醫(yī)學(xué)角度講顱腦損傷是指致傷外力作用于頭部,導(dǎo)致顱內(nèi)血管,神經(jīng)組織和顱內(nèi)其他組織一系列破壞的原發(fā)性損傷,并表現(xiàn)為損傷組織自身功能缺失和受其支配的其他功能障礙。繼發(fā)性損傷包括顱內(nèi)組織損傷后炎性介質(zhì)滲出,血管通透性改變等組織水腫所帶來的顱內(nèi)占位效應(yīng)和炎癥反應(yīng)。繼發(fā)性損傷與原發(fā)性損傷之間相互作用,共同形成顱內(nèi)損傷的嚴(yán)重后果。CGRP(降鈣素基因相關(guān)肽)是1982年由Rosenfeld等應(yīng)用分子克隆技術(shù)從降鈣素基因上選取的一個主要基因片段,由37個氨基酸殘基組成。作為一種重要的神經(jīng)源性血管活性肽,CGRP可以擴(kuò)張血管,顯著增加顱內(nèi)缺血部位的血流量,一定程度上減少因缺血所造成的梗死灶的體積,改善早期血管痙攣帶來的不利影響。CGRP可以刺激血管內(nèi)皮細(xì)胞生長,改善血管內(nèi)皮細(xì)胞的損傷,從而促進(jìn)血管自身修復(fù),還可以增強(qiáng)基底膜,保護(hù)血腦屏障避免功能紊亂,發(fā)揮神經(jīng)組織保護(hù)作用。相關(guān)研究發(fā)現(xiàn),重度顱腦損傷合并肢體骨折患者血清中CGRP表達(dá)水平升高。另有研究發(fā)現(xiàn)發(fā)現(xiàn)在小鼠皮質(zhì)沖擊傷模型中,受損傷的腦干部位CGRP表達(dá)明顯增高;其他相關(guān)研究也報道說在小鼠顱腦損傷的實驗?zāi)Ｐ椭?CGRP的表達(dá)水平自損傷起始2小時開始逐漸增長,在第2天時達(dá)到高峰。隨后逐漸下降至損傷前正常腦組織時CGRP的表達(dá)水平,不同研究者對于顱腦損傷后CGRP的表達(dá)變化存在一定的爭議。方法:對入院患者入組,建立檔案,簽署知情同意書,進(jìn)入研究。分為實驗組和對照組。實驗組分為重度顱腦傷組20例,重度顱腦傷合并肢體骨折組20例。入組標(biāo)準(zhǔn):1有明確顱腦創(chuàng)傷或顱腦創(chuàng)傷合并肢體骨折2無明顯手術(shù)指征者常規(guī)檢查3患者及家屬同意保守治療4無腦膜炎5無其他疾病臟器嚴(yán)重合并疾病�；颊呷朐汉蠼�(shù)據(jù)庫,記錄生命體征,GCS評分,血氧,血糖,影像學(xué)相關(guān)資料。無手術(shù)指征者,常規(guī)ICU監(jiān)護(hù)治療,對于GCS評分小于等于8分患者于D1,D3,D5,D7留取血液樣本。所有患者入組后即刻抽靜脈血入含有抗凝劑的無菌管中,4度1500g離心20分鐘后收集血漿,-80度保存?zhèn)溆�。�?yīng)用ELISA方法檢測各組患者血液內(nèi)CGRP及其人受體活性修飾蛋白RAMP1的表達(dá)水平,并分析其對于患者預(yù)后的相關(guān)性。對照組血液樣本來自體檢正常健康人血樣(20例)。應(yīng)用SPSS13.0統(tǒng)計軟件分析,計算資料均以均數(shù)+標(biāo)準(zhǔn)差,采用單因素方差分析比較組間整體差異,組間采用多個樣本均數(shù)間多重比較的T檢驗,以P0.05作為檢驗標(biāo)準(zhǔn),為差異具有統(tǒng)計學(xué)顯著性意義。結(jié)果:CGRP表達(dá)水平:重度顱腦傷組患者從第1天CGRP表達(dá)水平開始升高,第3天時CGRP的表達(dá)水平到達(dá)高峰,隨著時間延長CGRP表達(dá)水平逐漸下降。重度顱腦損傷合并肢體骨折組亦表現(xiàn)出同樣的趨勢,重度顱腦損傷組和重度顱腦損傷合并肢體骨折組第3天的CGRP表達(dá)水平顯著高于其他時間點(diǎn),差異具有統(tǒng)計學(xué)意義(P0.05)。重度顱腦損傷組和重度顱腦損傷合并肢體骨折組之間相同時間的CGRP表達(dá)量并無明顯區(qū)別,差異不具有統(tǒng)計學(xué)意義(P0.05)。顱腦損傷患者外傷后第1天~第7天CGRP表達(dá)水平均大于對照組(P0.05)。差異具有統(tǒng)計學(xué)意義。RAMP1表達(dá)水平:重度顱腦損傷組患者從第1天RAMP1表達(dá)水平開始升高,第3天時RAMP1的表達(dá)水平到達(dá)高峰,隨著時間延長RAMP1表達(dá)水平逐漸下降。重度顱腦損傷合并肢體骨折組亦表現(xiàn)出同樣的趨勢,重度顱腦損傷組和重度顱腦損傷合并肢體骨折組第3天的RAMP1表達(dá)水平顯著高于其他時間點(diǎn),差異具有統(tǒng)計學(xué)意義(P0.05)。重度顱腦損傷組和重度顱腦損傷合并肢體骨折組之間相同時間的RAMP1表達(dá)量并無明顯區(qū)別,差異不具有統(tǒng)計學(xué)意義(P0.05)。顱腦損傷患者外傷后第1天~第7天RAMP1表達(dá)水平均大于對照組(P0.05)。差異具有統(tǒng)計學(xué)意義。結(jié)論:1重度顱腦損傷和重度顱腦損傷合并肢體骨折CGRP表達(dá)水平較正常人高。2重度顱腦損傷組和重度顱腦損傷合并肢體骨折之間CGRP表達(dá)水平并無明顯區(qū)別。3 CGRP的陽性表達(dá)水平與重度顱腦損傷患者預(yù)后有密切關(guān)系。
[Abstract]:Objective: to speak from the medical point of craniocerebral injury refers to injuries caused by external force on the head, causing intracranial vascular, nerve tissue and tissue damage and a series of other intracranial primary injury, and the performance for their loss of function and tissue damage by other dysfunction at its disposal. The secondary injury including intracranial tissue injury after inflammatory exudation the change of intracranial vascular permeability, tissue edema caused by mass effect and secondary injury and inflammation. The interaction between the primary injury, forming.CGRP serious consequences of intracranial injury (CGRP) is a major gene fragment by Rosenfeld in 1982 by using molecular cloning technology is selected from the drop calcium gene, consisting of 37 amino acid residues. As an important neurogenic vasoactive peptide CGRP can dilate blood vessels, increase blood flow of intracranial ischemic area To a certain extent, reduce the infarct volume caused by ischemia, improve the adverse effects brought by.CGRP in the early stage of vasospasm can stimulate the growth of vascular endothelial cells, improve endothelial cell damage, thereby promoting vascular repair, but also can enhance the basement membrane, protect the blood-brain barrier to avoid dysfunction, play a protective role in nerve tissue. The study found that patients with severe craniocerebral injury complicated with limb increased the level of CGRP expression in the serum of patients with fracture. Another study found in mouse cortical injury model in the injured brain stem CGRP expression increased significantly; other studies reported in the experimental mouse model of traumatic brain injury in 2 hours, the expression level of CGRP from damage initiation began to increase, reached the peak at day second. The expression level then decreased gradually to normal brain tissue injury before CGRP, different researchers In a controversial change the expression of CGRP after traumatic brain injury. Methods: to establish the files of patients admitted into the group, and signed the informed consent to enter the study. Divided into experimental group and control group. The experimental group was divided into 20 cases of severe craniocerebral injury group, severe craniocerebral injury complicated with limb fracture group group 20 cases. 1: a clear brain injury associated with traumatic brain injury or limb fracture in 2 without obvious surgical indications routine examination in 3 patients and their families agree with conservative treatment in 4 without meningitis and 5 other diseases with severe disease. Organ database records of patients admitted to hospital, vital signs, GCS score, blood oxygen, blood glucose, related data imaging. Surgical indications, routine ICU care, for the GCS score less than or equal to 8 in patients with D1, D3, D5, D7 in blood samples. All patients immediately after the extraction of venous blood into the sterile tube containing anticoagulant, 4 degrees 20 minutes after receiving 1500g from the heart In plasma, -80 degrees to save standby. Expression level detected by ELISA CGRP and its receptor activity of blood serum in patients with modified RAMP1 protein, and to analyze the relationship between the prognosis of patients with the control group. Blood samples from normal healthy human blood samples (20 cases). SPSS13.0 software was used for the analysis, the calculation data were expressed by and the standard deviation were analyzed by using one-way ANOVA between groups differences, T test, multiple samples and multiple comparisons between the groups, with P0.05 as the test standard, statistically significant differences. Results: the expression level of CGRP: severe craniocerebral injury patients from the first day the expression level of CGRP began to increase. The third day the expression level of CGRP reached the peak with time gradually decreased. The expression level of CGRP in severe craniocerebral injury combined with extremity fracture group also showed the same trend, severe craniocerebral injury group and serious The other time points were significantly higher than those with limb fracture group third days, the expression level of CGRP of brain injury, the difference was statistically significant (P0.05). The merger between limb fracture group at the same time of severe craniocerebral injury group and severe traumatic brain injury. The expression of CGRP have no obvious difference, the difference was not statistically significant (P0.05) in patients with traumatic brain injury after trauma. The first day to the seventh day the expression level of CGRP was higher than that of the control group (P0.05). The difference was statistically significant.RAMP1 expression in severe craniocerebral injury patients from the first day the expression level of RAMP1 began to increase at third days, the expression level of RAMP1 reached the peak with time gradually decreased. The expression level of RAMP1 of severe craniocerebral injury complicated with limb fracture group also show the same trend, significantly higher than the other time with limb fracture group third days the expression level of RAMP1 in severe craniocerebral injury group and severe craniocerebral injury , the difference was statistically significant (P0.05). The merger between limb fracture group at the same time of severe craniocerebral injury group and severe traumatic brain injury. The expression of RAMP1 have no obvious difference, the difference was not statistically significant (P0.05). Patients with craniocerebral injury after trauma was first ~ seventh days the expression level of RAMP1 was higher than that of control group (P0.05). Significant difference. Conclusion: 1 severe craniocerebral injury and severe craniocerebral injury complicated with limb fracture limb between the expression level of CGRP and.3 showed no significant difference between CGRP positive expression and the prognosis of patients with severe craniocerebral injury fracture is closely related to the expression level of CGRP is higher than that of normal people.2 severe craniocerebral injury group and severe craniocerebral injury.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.15;R683

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