【摘要】：目的:應(yīng)用皮膚神經(jīng)活檢技術(shù)初步探索大鼠周?chē)窠?jīng)損傷時(shí)皮膚神經(jīng)病理的改變,比較表皮神經(jīng)纖維密度與坐骨神經(jīng)功能指數(shù)、神經(jīng)傳導(dǎo)速度測(cè)定結(jié)果的相關(guān)性,為周?chē)窠?jīng)損傷的評(píng)估提供參考依據(jù)。方法:采用Wistar大鼠50只,單側(cè)進(jìn)行大鼠坐骨神經(jīng)損傷模型制作,對(duì)側(cè)作為正常對(duì)照,在術(shù)后2周、4周、6周、8周4個(gè)時(shí)間點(diǎn),通過(guò)皮膚神經(jīng)活檢、免疫組織化學(xué)技術(shù),采用C5型目鏡測(cè)微尺及Image-pro plus6.0圖像分析軟件對(duì)損傷后的皮膚神經(jīng)纖維進(jìn)行定量,同時(shí)進(jìn)行各個(gè)時(shí)段的坐骨神經(jīng)功能指數(shù)測(cè)定和神經(jīng)傳導(dǎo)速度檢測(cè),對(duì)神經(jīng)損傷后不同階段及恢復(fù)程度進(jìn)行各個(gè)指標(biāo)的相關(guān)性分析。結(jié)果:1、皮膚中的表皮神經(jīng)纖維對(duì)PGP9.5有高度免疫反應(yīng)性,鏡下可見(jiàn)大鼠表皮有豐富的神經(jīng)纖維支配。2、大鼠足背部IENFD正常參考值為20.94±0.34fibers/mm2。3、在坐骨神經(jīng)損傷后,IENFD呈明顯下降,隨著術(shù)后恢復(fù)時(shí)間的逐漸延長(zhǎng),IENFD呈逐漸升高的趨勢(shì),且與坐骨神經(jīng)功能指數(shù)及神經(jīng)傳導(dǎo)速度均呈正相關(guān)(大鼠坐骨神經(jīng)損傷側(cè)足背部IENFD與坐骨神經(jīng)功能指數(shù)評(píng)分比較:2周r=0.977,P0.001;4周r=0.956,P0.001;6周r=0.936,P0.001;8周r=0.996,P0.001;大鼠坐骨神經(jīng)損傷側(cè)足背部IENFD與神經(jīng)傳導(dǎo)速度比較:2周r=0.860,P0.001;4周r=0.912,P0.001;6周r=0.728,P0.001;8周r=0.542,P0.001)。4、IENFD在損傷恢復(fù)過(guò)程中數(shù)值變化曲線(xiàn)更陡峭,恢復(fù)速度更快。結(jié)論:皮膚神經(jīng)活檢可用于周?chē)窠?jīng)損傷的評(píng)估,IENFD在坐骨神經(jīng)損傷后恢復(fù)過(guò)程中的動(dòng)態(tài)變化與坐骨神經(jīng)指數(shù)、神經(jīng)傳導(dǎo)速度有很強(qiáng)相關(guān)性,且與病變的嚴(yán)重程度相一致,相對(duì)于其他兩項(xiàng)指標(biāo),IENFD對(duì)于周?chē)窠?jīng)損傷的評(píng)估可能更敏感。
[Abstract]:Objective: to explore the changes of skin neuropathies during peripheral nerve injury in rats by skin nerve biopsy technique, and to compare the correlation between the density of epidermal nerve fibers and sciatic nerve function index and nerve conduction velocity. To provide a reference for the evaluation of peripheral nerve injury. Methods: 50 Wistar rats were used to make sciatic nerve injury model on one side, and the contralateral sciatic nerve injury model was used as normal control. Skin nerve biopsy and immunohistochemistry were performed at 4 time points, 2 weeks, 4 weeks, 6 weeks and 8 weeks after operation. C5 eyepiece micrometer and Image-pro plus6.0 image analysis software were used to quantify the injured skin nerve fibers, and the sciatic nerve function index and nerve conduction velocity were measured. Correlation analysis of different stages and degree of recovery after nerve injury was carried out. Results: 1. The epidermal nerve fibers in the skin were highly immunoreactive to PGP9.5, and there were abundant nerve fibers innervated in the epidermis of the rat under microscope. 2. The normal reference value of IENFD in the back of the foot was 20.94 鹵0.34 fibers / mm2.3, respectively. After sciatic nerve injury, IENFD decreased significantly, and IENFD increased gradually with the prolongation of postoperative recovery time. There was a positive correlation with the sciatic nerve function index and nerve conduction velocity (compared with the sciatic nerve function index score of the sciatic nerve injury side foot back IENFD: 2 weeks rr 0.977U P 0.001; At 4 weeks rn 0.956 P0.001 / 6 weeks r0.936 P0.001 / 8 weeks rr 0.996 / P0.001.Compared with the nerve conduction velocities of the lateral dorsal pedis of rats with sciatic nerve injury: 2 weeks rr 0.860 P 0.001 / 4 weeks r0.912 P 0.001; (4) the curve of numerical change of IENFD was steeper and the speed of recovery was faster during the recovery of injury. Conclusion: skin nerve biopsy can be used to evaluate the peripheral nerve injury. The dynamic changes of IENFD in the recovery process of sciatic nerve injury have strong correlation with sciatic nerve index and nerve conduction velocity, and are consistent with the severity of the lesion. IENFD may be more sensitive to the assessment of peripheral nerve injury than the other two.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R745

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