強(qiáng)制性運動對腦缺血大鼠運動功能和腦內(nèi)ERK表達(dá)的影響
發(fā)布時間：2018-10-10 16:12
【摘要】：第一部分強(qiáng)制性運動對腦缺血大鼠運動功能和腦內(nèi)ERK表達(dá)的影響目的：研究強(qiáng)制性運動(constraint-induced movement therapy, CIMT)對腦缺血大鼠腦內(nèi)細(xì)胞外調(diào)解蛋白激酶(extracellular regulated protein kinase, ERK)表達(dá)的影響,同時觀察強(qiáng)制性運動后腦缺血大鼠前肢肢體功能的恢復(fù)情況。方法：將45只SD大鼠隨機(jī)分為3組,分為假手術(shù)組、對照組及實驗組(每組各15只)。對照組及實驗組行大腦中動脈梗塞手術(shù)(middle cerebral artery occlusion, MCAO)。在MCAO術(shù)后第7天,實驗組和假手術(shù)組大鼠以石膏固定健側(cè)前肢進(jìn)行強(qiáng)制性運動訓(xùn)練。在術(shù)前(d0),術(shù)后第7天(d7),術(shù)后第22天(d22)進(jìn)行前肢功能評估。在術(shù)后第22天,測定梗死體積、ERK表達(dá)量和BrdU標(biāo)記的新生神經(jīng)細(xì)胞。所得的結(jié)果進(jìn)行三組間比較。結(jié)果：在部分大鼠上觀察到石膏強(qiáng)制限制后肢體有局部腫脹、關(guān)節(jié)僵硬等不良反應(yīng)。使用石膏法強(qiáng)制限制健肢對大鼠體重增長造成一定損傷,可能是由于負(fù)重運動的原因。與對照組相比,實驗組錯步率顯著降低,平衡木行走能力提高。實驗組、對照組和假手術(shù)組在造模后第22天腦梗死體積分別為18.22%±8.29%、17.68%±6.45%和-1.32%±4.12%。實驗組、對照組與假手術(shù)組比較,差異有統(tǒng)計學(xué)意義(p0.01),但實驗組與對照組間差異無統(tǒng)計學(xué)意義。在術(shù)后第22天時,三組間總ERK表達(dá)量差異無統(tǒng)計學(xué)意義；而p-ERK在對照組的雙側(cè)海馬和皮層中顯著升高,與其他兩組比較差異有統(tǒng)計學(xué)意義,實驗組p-ERK與假手術(shù)組相近。免疫熒光顯示,BrdU標(biāo)記的新生神經(jīng)細(xì)胞在實驗組中可能較對照組多,但需進(jìn)一步統(tǒng)計論證。結(jié)論：強(qiáng)制性運動可以明顯提高患側(cè)前肢的運動功能,并能降低雙側(cè)皮層和海馬區(qū)p-ERK表達(dá)水平,可能與肢體功能恢復(fù)有關(guān)。第二部分腦出血后規(guī)范三級康復(fù)治療對上肢痙攣和上肢功能的影響目的：研究腦出血后規(guī)范三級康復(fù)治療對上肢痙攣和上肢功能的影響。方法：將364例腦出血患者隨機(jī)分為對照組(n=181)和康復(fù)組(n=183)�？祻�(fù)組進(jìn)行規(guī)范的三級康復(fù)治療,包括早期床旁康復(fù)介入、恢復(fù)期在康復(fù)�？撇》恐委煛⒑笃诙ㄆ诳祻�(fù)家訪指導(dǎo)；對照組未進(jìn)行規(guī)范的三級康復(fù)治療。在入組時(Mo)、治療1個月(M1)、3個月(M3)和6個月(M6)時對患側(cè)上肢進(jìn)行改良Ashworth評定(MAS)和Fugl-Meyer評定,對結(jié)果進(jìn)行統(tǒng)計分析。結(jié)果：兩組患者的基線資料差異無統(tǒng)計學(xué)意義。入組時,兩組痙攣的發(fā)生率均約為23%,在M6時,康復(fù)組痙攣發(fā)生率為43%,對照組為60%。在M6時,兩組MAS分布和評分差異均有統(tǒng)計學(xué)意義(p0.05)。兩組Fugl-Meyer評分隨時間均顯著提高,差異有統(tǒng)計學(xué)意義(p0.05)。在M1、M3和M6時,康復(fù)組評分均高于對照組(康復(fù)組分別為24.71±19.80,39.83±19.50和48.87+18.25；對照組分別為17.13±16.46,24.87±18.36和30.68±19.41,p0.05)。結(jié)論：腦出血后進(jìn)行規(guī)范三級康復(fù)治療有助于減輕上肢痙攣程度,顯著改善上肢功能。
[Abstract]:Part one the effect of compulsory exercise on motor function and ERK expression in the brain of rats with cerebral ischemia objective: to study the effect of mandatory exercise (constraint-induced movement therapy, CIMT) on the expression of extracellular protein kinase (ECK) (extracellular regulated protein kinase, ERK) in the brain of rats with cerebral ischemia. At the same time, the recovery of forelimb function in rats with cerebral ischemia after compulsory exercise was observed. Methods: 45 SD rats were randomly divided into 3 groups: sham operation group, control group and experimental group (15 rats in each group). (middle cerebral artery occlusion, MCAO). Of middle cerebral artery infarction in control group and experimental group On the 7th day after MCAO, the rats in the experimental group and sham operation group were trained with gypsum to immobilize the healthy forelimbs. Forelimb function was evaluated preoperatively (day 0), postoperative day 7 (day 7) and postoperative day 22 (day 22). On the 22nd day after operation, infarct volume, ERK expression and BrdU labeled neonate neurons were measured. The results were compared among the three groups. Results: local swelling and joint stiffness were observed in some rats. The use of gypsum to restrict the weight gain of healthy limbs may be due to weight-bearing exercise. Compared with the control group, the staggered rate of the experimental group was significantly reduced, and the walking ability of the balance beam was improved. The infarct volume of experimental group, control group and sham operation group were 18.22% 鹵8.29 鹵17.68% 鹵6.45% and -1.32% 鹵4.12% respectively. There was significant difference between the experimental group and the sham operation group (p0.01), but there was no significant difference between the experimental group and the control group. On the 22nd day after operation, there was no significant difference in total ERK expression among the three groups, but p-ERK was significantly increased in the bilateral hippocampus and cortex of the control group, which was significantly higher than that in the other two groups. P-ERK in the experimental group was similar to that in the sham operation group. Immunofluorescence showed that the number of BrdU labeled neonate neurons in the experimental group may be more than that in the control group, but further statistical proof is needed. Conclusion: compulsory exercise can significantly improve the motor function of the affected forelimb and decrease the expression of p-ERK in bilateral cortex and hippocampus, which may be related to the recovery of limb function. The second part: the effect of standard tertiary rehabilitation on upper limb spasm and upper limb function after intracerebral hemorrhage objective: to study the effect of standard three stage rehabilitation treatment on upper limb spasm and upper limb function after cerebral hemorrhage. Methods: 364 patients with intracerebral hemorrhage were randomly divided into control group (n = 181) and rehabilitation group (n = 183). The rehabilitation group received standard three-level rehabilitation treatment, including early bedside rehabilitation intervention, convalescent treatment in the rehabilitation specialized ward, and regular rehabilitation home visit guidance in the later stage, while the control group did not carry out the standard three-level rehabilitation therapy. (MAS) and Fugl-Meyer were evaluated by modified Ashworth at 1 month (M1), 3 months (M3) and 6 months (M6) after (Mo), treatment. The results were statistically analyzed. Results: there was no significant difference in baseline data between the two groups. The incidence of spasms in both groups was about 23. At M6, the incidence of spasms was 43 in the rehabilitation group and 60 in the control group. At M 6, there were significant differences in MAS distribution and score between the two groups (p0. 05). The Fugl-Meyer score of the two groups increased significantly with time, and the difference was statistically significant (p 0.05). At M1M3 and M6, the scores in the rehabilitation group were higher than those in the control group (24.71 鹵19.80,39.83 鹵19.50 and 48.87.18.25, respectively; in the control group, 17.13 鹵16.46, 24.87 鹵18.36 and 30.68 鹵19.41, p0.05, respectively). Conclusion: standard three-level rehabilitation therapy after intracerebral hemorrhage is helpful to reduce the degree of upper limb spasm and improve the function of upper limb.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3
[Abstract]:Part one the effect of compulsory exercise on motor function and ERK expression in the brain of rats with cerebral ischemia objective: to study the effect of mandatory exercise (constraint-induced movement therapy, CIMT) on the expression of extracellular protein kinase (ECK) (extracellular regulated protein kinase, ERK) in the brain of rats with cerebral ischemia. At the same time, the recovery of forelimb function in rats with cerebral ischemia after compulsory exercise was observed. Methods: 45 SD rats were randomly divided into 3 groups: sham operation group, control group and experimental group (15 rats in each group). (middle cerebral artery occlusion, MCAO). Of middle cerebral artery infarction in control group and experimental group On the 7th day after MCAO, the rats in the experimental group and sham operation group were trained with gypsum to immobilize the healthy forelimbs. Forelimb function was evaluated preoperatively (day 0), postoperative day 7 (day 7) and postoperative day 22 (day 22). On the 22nd day after operation, infarct volume, ERK expression and BrdU labeled neonate neurons were measured. The results were compared among the three groups. Results: local swelling and joint stiffness were observed in some rats. The use of gypsum to restrict the weight gain of healthy limbs may be due to weight-bearing exercise. Compared with the control group, the staggered rate of the experimental group was significantly reduced, and the walking ability of the balance beam was improved. The infarct volume of experimental group, control group and sham operation group were 18.22% 鹵8.29 鹵17.68% 鹵6.45% and -1.32% 鹵4.12% respectively. There was significant difference between the experimental group and the sham operation group (p0.01), but there was no significant difference between the experimental group and the control group. On the 22nd day after operation, there was no significant difference in total ERK expression among the three groups, but p-ERK was significantly increased in the bilateral hippocampus and cortex of the control group, which was significantly higher than that in the other two groups. P-ERK in the experimental group was similar to that in the sham operation group. Immunofluorescence showed that the number of BrdU labeled neonate neurons in the experimental group may be more than that in the control group, but further statistical proof is needed. Conclusion: compulsory exercise can significantly improve the motor function of the affected forelimb and decrease the expression of p-ERK in bilateral cortex and hippocampus, which may be related to the recovery of limb function. The second part: the effect of standard tertiary rehabilitation on upper limb spasm and upper limb function after intracerebral hemorrhage objective: to study the effect of standard three stage rehabilitation treatment on upper limb spasm and upper limb function after cerebral hemorrhage. Methods: 364 patients with intracerebral hemorrhage were randomly divided into control group (n = 181) and rehabilitation group (n = 183). The rehabilitation group received standard three-level rehabilitation treatment, including early bedside rehabilitation intervention, convalescent treatment in the rehabilitation specialized ward, and regular rehabilitation home visit guidance in the later stage, while the control group did not carry out the standard three-level rehabilitation therapy. (MAS) and Fugl-Meyer were evaluated by modified Ashworth at 1 month (M1), 3 months (M3) and 6 months (M6) after (Mo), treatment. The results were statistically analyzed. Results: there was no significant difference in baseline data between the two groups. The incidence of spasms in both groups was about 23. At M6, the incidence of spasms was 43 in the rehabilitation group and 60 in the control group. At M 6, there were significant differences in MAS distribution and score between the two groups (p0. 05). The Fugl-Meyer score of the two groups increased significantly with time, and the difference was statistically significant (p 0.05). At M1M3 and M6, the scores in the rehabilitation group were higher than those in the control group (24.71 鹵19.80,39.83 鹵19.50 and 48.87.18.25, respectively; in the control group, 17.13 鹵16.46, 24.87 鹵18.36 and 30.68 鹵19.41, p0.05, respectively). Conclusion: standard three-level rehabilitation therapy after intracerebral hemorrhage is helpful to reduce the degree of upper limb spasm and improve the function of upper limb.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3
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