【摘要】：目的癲癇是神經(jīng)系統(tǒng)常見的疾病之一,隨著生物醫(yī)學模式的轉(zhuǎn)變,癲癇共患認知及精神心理障礙等疾病引起人們越來越多的重視,其中認知功能障礙、焦慮和抑郁最為常見,癲癇共患病受多種因素的影響,但具體發(fā)病機制并未明確。研究表明,miR-146a、miR-132可以通過調(diào)節(jié)炎癥反應或突觸可塑性在癲癇病理生理性過程中起到關(guān)鍵性的作用,同時miR-146a、miR-132在認知或精神心理障礙的發(fā)病機制中也發(fā)揮重要的作用,但在癲癇共病認知功能障礙、焦慮和抑郁中,miR-146a、miR-132的表達變化目前尚無有關(guān)報道。本課題通過觀察癲癇患者血漿miR-146a、miR-132的表達水平,研究其與癲癇相關(guān)影響因素及共病認知功能障礙、焦慮和抑郁的關(guān)系,為探求miRNA在癲癇共患病中的診斷價值提供理論依據(jù)。方法本實驗共納入75名受試對象,其中癲癇患者40例,對照組35例。對癲癇患者和健康對照行MoCA、HAMA及HAMD量表評估,同時采集癲癇組和對照組受試對象血漿標本。研究對象血漿miR-146a、miR-132的表達水平通過實時熒光定量PCR方法進行檢測。結(jié)果1.癲癇組中共病認知功能障礙、焦慮及抑郁總的患病率為62.5%,其中認知功能障礙患病率47.5%,焦慮患病率40.0%,抑郁患病率42.5%;教育程度與癲癇共病認知功能障礙呈正相關(guān),病程、持續(xù)時間、服藥數(shù)量與癲癇共病認知功能障礙呈負相關(guān);發(fā)作頻率、持續(xù)時間、服藥數(shù)量與癲癇共病焦慮呈正相關(guān),教育程度與癲癇共病抑郁呈負相關(guān),病程、服藥數(shù)量與癲癇共病抑郁呈正相關(guān)。2.癲癇患者血漿miR-146a、miR-132的表達水平相對健康對照明顯升高,其中以miR-132更為顯著,低教育水平的癲癇患者,其血漿miR-146a、miR-132的表達明顯上調(diào),癲癇起病年齡較早,病程、發(fā)作持續(xù)時間較長的患者血漿miR-132上調(diào)明顯,其中教育水平與miR-146a、miR-132呈負相關(guān),病程、發(fā)作持續(xù)時間與miR-132呈正相關(guān)。3.癲癇共病認知功能障礙、焦慮及抑郁患者血漿中miR-146a、miR-132的表達水平相對無共患疾病的癲癇患者明顯升高,同時伴隨共患疾病種類的增加,血漿miR-146a、miR-132的含量也隨之增加,其中miR-146a、miR-132與MoCA總分呈負相關(guān),與共患疾病種類呈正相關(guān),miR-132與HAMA總分、HAMD總分呈正相關(guān),回歸分析顯示,血漿miR-132表達水平的升高是癲癇共病認知功能障礙、焦慮及抑郁的危險因素。結(jié)論1.癲癇患者中認知功能障礙、焦慮和抑郁普遍存;癲癇共病認知功能障礙、焦慮和抑郁受多方面因素影響,包括社會人口學因素(教育程度)、生物學因素(癲癇臨床特征)、藥物因素(AEDs)等。2.miR-146a、miR-132在癲癇患者中表達升高,miR-132能夠反映癲癇疾病的嚴重程度,miR-146a、miR-132有成為癲癇診斷生物學標志物的潛能。3.miR-146a、miR-132能夠反映癲癇共病認知功能障礙、焦慮及抑郁疾病的嚴重程度,miR-132能夠預測癲癇共病認知功能障礙、焦慮及抑郁的風險,為癲癇共病認知功能障礙、焦慮及抑郁的臨床診斷、風險評估及療效評價提供理論依據(jù)。
[Abstract]:Objective epilepsy is one of the common diseases of the nervous system. With the transformation of the biomedical model, more and more attention has been paid to the cognitive and mental disorders of epilepsy, among which cognitive dysfunction, anxiety and depression are the most common, and the prevalence of epilepsy is affected by various factors, but the specific pathogenesis is not clear. It shows that miR-146a, miR-132 can play a key role in the pathophysiological process of epilepsy by regulating inflammatory response or synaptic plasticity, while miR-146a, miR-132 also plays an important role in the pathogenesis of cognitive or psycho mental disorders, but in the cognitive dysfunction of epilepsy, anxiety and depression, miR-146a, miR-132 There are no reports on the changes of expression at present. By observing the level of miR-146a and miR-132 expression in plasma of epileptic patients, the relationship between the related factors of epilepsy and the cognitive impairment, anxiety and depression is studied, and the theoretical basis of the diagnostic value of miRNA in the diagnosis of epilepsy is provided. Methods 75 subjects were included in this experiment. Subjects were 40 epileptic patients and 35 cases in control group. The MoCA, HAMA and HAMD scales of epileptic and healthy controls were evaluated, and plasma samples of epileptic and control subjects were collected. Plasma miR-146a, miR-132 expression level was detected by real-time fluorescence quantitative PCR method. Results the cognitive work of 1. epileptic groups was found. The total incidence of disability, anxiety and depression was 62.5%, of which the prevalence of cognitive dysfunction was 47.5%, the rate of anxiety was 40%, and the rate of depression was 42.5%. The education level was positively correlated with the cognitive dysfunction of the common disease, the duration of the disease, the duration of the disease, the number of medication and the dysfunction of the common disease recognition dysfunction; the frequency, duration, and medication of the seizures. There was a positive correlation between the number and the common disease anxiety of epilepsy, the degree of education was negatively related to the common disease and depression, the course of disease, the number of drugs and the common disease depression were positively correlated with miR-146a in.2. epileptic patients, and the expression level of miR-132 was significantly higher than that of the healthy control. Among them, miR-132 was more significant, the low education level of epileptic patients, and their plasma miR-146a, The expression of miR-132 was obviously up-regulated, the age of the onset of epilepsy was earlier, the course of the disease and the longer duration of the seizures were obviously up-regulated in plasma miR-132, and the educational level was negatively correlated with miR-146a and miR-132. The course of disease, the duration of the attack and the miR-132 were positively related to the cognitive disability of.3., and the miR-146a, miR-132 in the plasma of the patients with anxiety and depression. The level of expression of miR-146a and miR-132 in plasma increased with the increase of the species of codeveloped disease, and miR-146a, miR-132 and MoCA were negatively correlated with the type of CO developed disease, and the total score of miR-132 and HAMA, HAMD total score was positively correlated, regression analysis showed blood. The increase in plasma miR-132 expression level is a risk factor for cognitive impairment, anxiety and depression in the patients with epilepsy. Conclusion 1. the cognitive impairment, anxiety and depression generally exist in epileptic patients; the cognitive impairment of epilepsy, anxiety and depression are influenced by many factors, including social demographic factors (Education), and biological factors (epilepsy). Clinical features), drug factors (AEDs) and other.2.miR-146a, miR-132 expression in epileptic patients, miR-132 can reflect the severity of epilepsy, miR-146a, miR-132 has the potential to become a biological marker of epilepsy,.3.miR-146a, miR-132 can reflect the cognitive impairment of epilepsy, the severity of anxiety and depression, miR- 132 can predict the risk of cognitive dysfunction, anxiety and depression in epileptic comorbidity, and provide a theoretical basis for the clinical diagnosis of the cognitive impairment of CO disease, the clinical diagnosis of anxiety and depression, the risk assessment and the evaluation of the curative effect.
【學位授予單位】：西安醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R742.1

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本文編號：2136721