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Nogo66蛋白眼用疫苗對大鼠高眼壓和視神經(jīng)損傷的免疫保護作用及機制研究

發(fā)布時間:2018-05-19 06:49

  本文選題:Nogo66蛋白疫苗 + 高眼壓 ; 參考:《第三軍醫(yī)大學》2009年博士論文


【摘要】: 視網(wǎng)膜神經(jīng)節(jié)細胞(retinal ganglial cells, RGCs)損傷后再生困難,這是青光眼、視神經(jīng)損傷等眼部疾病致盲的主要原因。目前認為,RGCs受損后存活或再生困難的一個主要原因是由于髓磷脂蛋白的存在,抑制因子Nogo是其中重要成員之一。Nogo在正常中樞神經(jīng)系統(tǒng)(central nervous system, CNS)有少量表達,中樞神經(jīng)受損后Nogo因子釋放增加、表達增強,不僅抑制神經(jīng)纖維再生,而且可啟動神經(jīng)元凋亡過程,導致神經(jīng)元死亡。Nogo有66個氨基酸殘基在胞膜外形成的拓撲結(jié)構(gòu),即Nogo66,是Nogo的活性區(qū)域,介導了Nogo的中樞神經(jīng)再生抑制活性。目前多項研究表明,用主動免疫或被動免疫阻遏髓磷脂或Nogo均可誘導CNS損傷動物產(chǎn)生自身免疫保護反應,減少損傷后變性,促進CNS神經(jīng)元再生。其機制尚不明確。 在前期工作中,我們原核表達純化了Nogo66蛋白,制備了Nogo66蛋白福氏佐劑疫苗,發(fā)現(xiàn)Nogo66蛋白疫苗可誘導動物機體產(chǎn)生較高滴度抗原特異性IgG抗體,刺激脾T淋巴細胞活化增殖,并可促進慢性高眼壓大鼠視網(wǎng)膜神經(jīng)節(jié)細胞(RGCs)存活、損傷后的再生修復,減少視神經(jīng)纖維進一步損害、使神經(jīng)功能得到一定保護。證實了Nogo66蛋白疫苗具有免疫原性和視神經(jīng)損傷后的保護和修復作用。 然而,青光眼和視神經(jīng)損傷是需要長期治療的疾病,Nogo66蛋白疫苗接種后產(chǎn)生的免疫效應持續(xù)時間較短,需要不斷加強免疫才能維持一定的抗體滴度和活化T細胞數(shù)量,長期高頻率地通過外周皮下注射接種疫苗的方式顯然很難保證患者的依從性,治療效果可想而知;另外,Nogo66是一個分子量為7.53461kD的小分子蛋白,小劑量皮下接種很難激活機體免疫系統(tǒng),要獲得較好的免疫效應,需要增加劑量,則有致實驗性自身免疫性腦脊髓炎(experimental autoimmune encephalomyelitis, EAE)的風險。因此,必須改變接種途徑,減少疫苗中蛋白的使用劑量,減少接種頻率,使這種神經(jīng)免疫保護的治療方法得以實現(xiàn)。 眼瞼結(jié)膜血管分布密集,血液供應非常豐富,有淺層和深層2個網(wǎng)狀淋巴系統(tǒng),在下眼瞼結(jié)膜皺褶中存在重要的局部淋巴組織,研究證實結(jié)膜的淋巴組織具有攝取粘膜表面多種抗原進行識別,并作出反應的功能,是一個理想的疫苗接種途徑。從上世紀60年代開始,經(jīng)結(jié)膜接種疫苗途徑就已經(jīng)在家養(yǎng)動物中廣泛應用。 殼聚糖(chitosan, CS)廣泛存在于自然界,具有無毒、良好的生物相容性、低免疫排斥反應等一系列特殊的化學和生物特性。且其本身具有免疫刺激活性,并可增強藥物滲透和吸收,是一種具有很大潛力的粘膜免疫緩釋材料和免疫佐劑。 本課題在探討Nogo66蛋白疫苗對視網(wǎng)膜視神經(jīng)損傷的免疫保護作用機制的基礎上,改進Nogo66蛋白疫苗的佐劑和接種途徑,制備一種滴眼液形式的Nogo66蛋白疫苗,并研究其理化性質(zhì)、免疫性質(zhì)和神經(jīng)保護作用機制。 主要研究內(nèi)容包括以下7部分: 1.不同濃度Nogo66蛋白疫苗對大鼠免疫系統(tǒng)的影響和大鼠免疫狀況評估。在正常SD大鼠接種不同濃度的Nogo66蛋白疫苗,檢測接種后不同時間點血清IgG抗體滴度和脾T細胞增殖率,主要臟器病理檢查并進行EAE狀態(tài)評價。 2. Nogo66蛋白疫苗誘導大鼠機體產(chǎn)生的免疫效應。以最佳疫苗接種劑量接種正常SD大鼠后,檢測大鼠血清IgG抗體滴度和脾分泌Th1類細胞因子IL-2、IFN-γ和Th2類細胞因子IL-4的情況。 3.建立慢性高眼壓大鼠模型和視神經(jīng)鉗夾傷大鼠模型,通過檢測眼壓、熒光金逆行染色視網(wǎng)膜神經(jīng)節(jié)細胞計數(shù),和視網(wǎng)膜血管滲透率檢測對兩種視網(wǎng)膜視神經(jīng)損傷模型進行鑒定。 4.制備Nogo66蛋白眼用疫苗并進行質(zhì)量控制。以殼聚糖為佐劑制備滴眼液形式的Nogo66蛋白疫苗,檢測其性狀、pH值、滲透壓、黏度值、含量和穩(wěn)定性。 5.檢測Nogo66蛋白眼用疫苗的安全性。按照眼刺激性試驗標準,進行Nogo66-CS疫苗眼刺激性評分,HE染色法檢測Nogo66-CS疫苗對大鼠視網(wǎng)膜、心、腦、睪丸等主要器官的病理損害,觀察Nogo66-CS疫苗的安全性。 6. Nogo66蛋白眼用疫苗的免疫原性研究。體外培養(yǎng)小膠質(zhì)細胞,免疫組化法Nogo66-CS疫苗對小膠質(zhì)細胞CD11b表達的影響;Nogo66-CS疫苗行正常大鼠結(jié)膜接種,檢測大鼠淚液及血清中IgG抗體滴度,檢測大鼠結(jié)膜組織抗原特異性IgG型漿細胞增生和淋巴細胞浸潤;免疫組化法檢測大鼠視網(wǎng)膜CD11b、MHC-Ⅱ、INOS、TNF-α表達,觀察Nogo66蛋白眼用疫苗免疫原性。 7.探討Nogo66蛋白眼用疫苗對大鼠視網(wǎng)膜視神經(jīng)損傷的保護作用及其機制。給予慢性高眼壓模型大鼠和視神經(jīng)鉗夾傷模型大鼠行結(jié)膜接種Nogo66蛋白眼用疫苗,0,21,35天各接種1次。49天時熒光金逆行標記視網(wǎng)膜神經(jīng)節(jié)細胞并進行計數(shù),免疫熒光法、免疫組化法檢測視網(wǎng)膜GAP43、CD3、BDNF和GDNF表達,免疫印記法檢測視網(wǎng)膜BDNF、GDNF表達,探討Nogo66蛋白眼用疫苗對視網(wǎng)膜視神經(jīng)損傷免疫保護作用及其機制。 主要結(jié)果及結(jié)論如下: 1.接種不同濃度Nogo66蛋白疫苗后均可誘導大鼠血清IgG抗體滴度增高和T細胞增殖,其中200μg組IgG抗體滴度和T細胞增殖顯著高于其他實驗組(P0.05)。所有實驗大鼠未發(fā)現(xiàn)任何類似實驗性自身免疫性腦脊髓炎的行為變化,且各器官病理檢查未見明顯異常。提示200μg/300μl可最佳程度誘導大鼠免疫反應。 2. Nogo66蛋白疫苗組大鼠脾細胞培養(yǎng)上清IL-2、IFN-γ、IL-4水平均增加,明顯高于對照組。其中Th1類細胞因子IL-2、IFN-γ增高的幅度顯著大于Th2類細胞因子IL-4增高幅度。提示Nogo66疫苗誘導的免疫反應以Th1細胞免疫,即T淋巴細胞介導的免疫效應為主。 3.慢性高眼壓大鼠造模后第3天眼壓開始升高,此后持續(xù)緩慢升高,1周時眼壓為(21.5±3.7)mmHg,與對照組存在顯著差異(P0.05)。第4周時達最高峰,為(24.8±3.2)mmHg;到12周時眼壓未見明顯下降,與對照組眼壓仍存在顯著差異。熒光金逆行染色RGCs發(fā)現(xiàn),高眼壓后1m至3m時SD大鼠RGCs視網(wǎng)膜上RGCs密度持續(xù)降低、數(shù)量持續(xù)減少,與相同時間正常對照組比較均差異顯著;視神經(jīng)鉗夾傷后1m時SD大鼠RGCs密度降低、數(shù)量顯著減少,與正常對照呈顯著性差異,3m時SD大鼠RGCs數(shù)量與1m時比較未見顯著差異。慢性高眼壓損傷后1、4、8周時熒光顯微鏡下觀察視網(wǎng)膜內(nèi)未見明顯伊文思藍滲透,視網(wǎng)膜滲透率較對照組無顯著差異。視神經(jīng)鉗夾傷后1天視網(wǎng)膜內(nèi)可見明顯的藍色熒光,且逐漸減弱。視網(wǎng)膜通透性較對照組均增強,存在顯著差異。提示本實驗建立的慢性高眼壓和視神經(jīng)鉗夾傷模型符合疾病特點,RGCs呈特征性數(shù)量減少;慢性高眼壓尚不能破壞大鼠血視網(wǎng)膜屏障。視神經(jīng)鉗夾傷早期即能引起血視網(wǎng)膜破壞,視網(wǎng)膜血管滲透性增強,血視網(wǎng)膜屏障的這種損傷狀態(tài)可持續(xù)至少1個月。 4.制備了Nogo66-CS眼用疫苗,經(jīng)檢測,其性狀、pH值、滲透壓、黏度、含量及穩(wěn)定性均符合滴眼液制劑的藥劑學要求,提示以殼聚糖為佐劑的Nogo66蛋白疫苗具有良好的理化性質(zhì)。 5.眼刺激性試驗顯示,點藥當時和點藥后1h、24h、48h、72h、4d、7d,Nogo66-CS疫苗組和生理鹽水組大鼠眼刺激性反應評分均3,裂隙燈下檢查眼前節(jié)無異常,且角膜熒光素鈉染色陰性,認為Nogo66-CS眼用疫苗和生理鹽水對眼均無刺激性。于第一次點藥后第16周行眼球視網(wǎng)膜、心、肝、腎、肺、腦、睪丸病理檢查未見明顯異常。提示Nogo66-CS疫苗無刺激性,對機體是安全的。 6. Nogo66蛋白眼用疫苗具有免疫原性。體外培養(yǎng)的小膠質(zhì)細胞,在Nogo66-CS疫苗或Nogo66蛋白刺激后表達大量CD11b,細胞活化;CS刺激后表達少量CD11b,細胞靜止;空白組未見CD11b表達。結(jié)膜HE染色顯示Nogo66-CS組大鼠結(jié)膜組織內(nèi)有大量淋巴細胞浸潤和IgG型陽性漿細胞增生;Nogo66組結(jié)膜組織可見少量淋巴細胞浸潤和IgG型陽性漿細胞;CS組結(jié)膜僅偶見淋巴細胞浸潤,未見IgG型陽性漿細胞存在。接種疫苗后,Nogo66-CS組淚液IgG抗體滴度從第20天開始持續(xù)增高,與對照組有顯著差異,血清IgG抗體滴度第34天開始增高,幅度較低;Nogo66組和CS組淚液和血清中IgG抗體滴度無顯著變化。Nogo66-CS組視網(wǎng)膜各層小膠質(zhì)細胞活化,表達CD11b和少量MHC-Ⅱ,未見明顯iNOS、TNF-α表達;CS組視網(wǎng)膜僅少量CD11b表達,未見iNOS、TNF-α表達。提示Nogo66-CS疫苗可激活粘膜免疫和系統(tǒng)免疫,并誘導視網(wǎng)膜小膠質(zhì)細胞活化,具有較強的免疫原性。 7. Nogo66蛋白眼用疫苗可促進視網(wǎng)膜視神經(jīng)損傷后RGCs的存活和再生。慢性高眼壓模型大鼠和視神經(jīng)鉗夾傷模型大鼠Nogo66-CS組RGCs數(shù)量顯著高于CS組和未接種組;Nogo66-CS組視網(wǎng)膜有大量GAP43,表明視網(wǎng)膜神經(jīng)元再生活躍。表明Nogo66蛋白眼用疫苗對受損的視網(wǎng)膜視神經(jīng)具有保護作用。 8、Nogo66蛋白眼用疫苗可誘導視網(wǎng)膜神經(jīng)營養(yǎng)因子表達增加。Nogo66蛋白眼用疫苗接種后,視網(wǎng)膜CD3陽性淋巴細胞浸潤,GDNF和BNDF表達上調(diào)。表明Nogo66蛋白眼用疫苗可誘導活化T細胞浸潤視網(wǎng)膜,推測T細胞和視網(wǎng)膜被活化的小膠質(zhì)細胞分泌多種視網(wǎng)膜神經(jīng)營養(yǎng)因子,對受損的視網(wǎng)膜視神經(jīng)起到了保護作用。
[Abstract]:Retinal ganglial cells (RGCs) is a major cause of blindness in the eyes of glaucoma and optic nerve injury. The main reason for the difficulty in survival or regeneration after RGCs is due to the existence of myelin protein, and the inhibitory factor Nogo is one of the important members of.Nogo in.Nogo. The normal central nervous system (central nervous system, CNS) has a small amount of expression. After the central nerve is damaged, the release of Nogo factor increases and the expression is enhanced. It not only inhibits the regeneration of the nerve fibers, but also initiates the process of neuronal apoptosis, which causes the neuronal death.Nogo to have a topological structure of 66 amino acid residues in the extracellular matrix, that is, Nogo66, which is Nogo. Active regions, which mediate the inhibitory activity of Nogo's central nerve regeneration, have shown that active or passive immunization repression of myelin or Nogo can induce CNS injured animals to produce autoimmune protection responses, reduce post damage degeneration and promote the regeneration of CNS neurons. The mechanism is not yet clear.
In the previous work, we purified the Nogo66 protein and prepared the Nogo66 protein FOS adjuvant vaccine. It was found that the Nogo66 protein vaccine could induce the high titer specific IgG antibody in the animal body, stimulate the activation and proliferation of the spleen T lymphocyte, and promote the survival and damage of the retinal ganglion cells (RGCs) in the chronic high intraocular pressure rats. After regenerative repair, the further damage of optic nerve fibers was reduced and the nerve function was protected. It was confirmed that the Nogo66 protein vaccine has the immunogenicity and the protection and repair effect after the optic nerve injury.
However, glaucoma and optic nerve injury are diseases that require long-term treatment. The duration of immunization after Nogo66 vaccine inoculation is shorter. It is necessary to strengthen immunity to maintain a certain antibody titer and to activate the number of T cells. It is obviously difficult to ensure that the patient is vaccinated by subcutaneous injection at high frequency for a long time. In addition, Nogo66 is a small molecular protein with a molecular weight of 7.53461kD, and a small dose of subcutaneous inoculation is difficult to activate the body's immune system. To obtain a better immune effect, it is necessary to increase the dose and to induce experimental autoimmune cerebrospinal myelitis (experimental autoimmune encephalomyelitis, EAE). Therefore, we must change the route of inoculation, reduce the dosage of protein in the vaccine, reduce the frequency of vaccination, so that the treatment method of neuroimmune protection can be realized.
The conjunctival vessels of the eyelid are densely distributed and rich in blood supply. There are 2 reticular lymphatic systems in the shallow and deep layers. There are important local lymphoid tissues in the conjunctival folds of the lower eyelids. The study confirms that the conjunctival lymphoid tissues have a variety of antigens to recognize and respond to the mucosal surface. It is an ideal route for vaccination. Since 60s of last century, conjunctival vaccination has been widely used in domestic animals.
Chitosan (CS), which is widely present in nature, has a series of special chemical and biological characteristics, such as non-toxic, good biocompatibility, low immune rejection and so on. And it has the activity of immune stimulation, and can enhance the penetration and absorption of drugs. It is a great potential mucosal immune release material and immune adjuvant.
On the basis of exploring the immune protective mechanism of Nogo66 protein vaccine on retinal optic nerve injury, we improved the adjuvant and inoculation of Nogo66 protein vaccine, and prepared a kind of Nogo66 protein vaccine in the form of eye drops, and studied its physical and chemical properties, immune properties and the mechanism of neuroprotective effect.
The main research contents include the following 7 parts:
1. the effects of different concentrations of Nogo66 protein vaccine on the immune system of rats and the evaluation of the immune status of rats. In normal SD rats, different concentrations of Nogo66 protein vaccine were inoculated. The serum IgG antibody titer and the proliferation rate of spleen T cells were detected at different time points after inoculation. The main organ pathology examination and the evaluation of EAE status were carried out.
The immune effect induced by 2. Nogo66 protein vaccine was induced in rats. After inoculation with the normal SD rats, the titer of serum IgG antibody and the secretion of Th1 cell factor IL-2, IFN- gamma and Th2 cell factor IL-4 in the spleen were detected.
3. the rat model of chronic ocular hypertension and the rat model of optic nerve clamp injury were established. By detecting intraocular pressure, counting retinal ganglion cells with fluorescent gold retrograde staining, and detecting retinal vascular permeability, two models of retinal optic nerve injury were identified.
4. the Nogo66 protein eye vaccine was prepared and the quality control was made. The Nogo66 protein vaccine in the form of eye drops was prepared with chitosan as the adjuvant, and its characters, pH value, osmotic pressure, viscosity value, content and stability were detected.
5. the safety of Nogo66 protein eye vaccine was detected. According to the standard of eye irritation test, the eye irritation score of Nogo66-CS vaccine and the pathological damage of Nogo66-CS vaccine on the main organs such as retina, heart, brain and testis of rats were detected by HE staining, and the safety of Nogo66-CS vaccine was observed.
The immunogenicity of 6. Nogo66 protein eye vaccine. The effect of microglia and immunohistochemistry Nogo66-CS vaccine on the expression of CD11b in microglia in vitro; Nogo66-CS vaccine was inoculated in the conjunctiva of normal rats, and the titer of IgG antibody in the tear and serum of rats was detected, and the antigen specific IgG plasma cell proliferation in conjunctival tissue of rats was detected. Immunohistochemical staining was used to detect the expression of CD11b, MHC- II, INOS and TNF- alpha in rat retina, and to observe the immunogenicity of Nogo66 protein ophthalmic vaccine.
7. to investigate the protective effect and mechanism of Nogo66 protein ophthalmic vaccine on retinal optic nerve injury in rats and to inoculate rats with chronic ocular hypertension model and optic nerve clamp injury model rats with Nogo66 protein eye vaccine. The fluorescent gold retrograde labeling retinal ganglion cells were counted at the time of 1.49 days of 0,21,35 days, and the immunization was counted. The expression of retina GAP43, CD3, BDNF and GDNF were detected by immunofluorescence, and the expression of BDNF and GDNF in retina was detected by immuno imprinting. The protective effect of Nogo66 protein eye vaccine on retinal optic nerve injury and its mechanism were discussed.
The main results and conclusions are as follows:
1. after inoculation with different concentrations of Nogo66 protein, the titer of serum IgG antibody and proliferation of T cells were induced in rats. The titer of IgG antibody and the proliferation of T cells in the 200 g group were significantly higher than those in the other experimental groups (P0.05). No obvious abnormalities were observed. It suggested that 200 mu g/300 l could induce immune response in rats.
The level of IL-2, IFN- gamma and IL-4 increased in the splenocytes culture of 2. Nogo66 protein vaccine group, which was significantly higher than that of the control group. The increase of Th1 cell factor IL-2, IFN- gamma was significantly greater than that of Th2 cell factor IL-4 increase. It suggested that the immune response induced by Nogo66 vaccine was Th1 cell immunity, that is, the immune effect mediated by T lymphocyte Mainly.
3. the intraocular pressure of the chronic high intraocular pressure rats began to rise after third days and then continued to increase slowly. The intraocular pressure was (21.5 + 3.7) mmHg at 1 weeks. There was a significant difference between the control group and the control group (P0.05). The peak was (24.8 + 3.2) mmHg at the fourth week, and the intraocular pressure of the control group was still significantly different from that of the control group at the 12 week. RGCs hair was stained with fluorescent gold retrograde. At the time of high intraocular pressure (1m to 3m), the density of RGCs on the RGCs retina of SD rats continued to decrease and the number continued to decrease, and the difference was significant compared with that of the normal control group. The RGCs density of SD rats was decreased and the number of SD rats decreased significantly after 1m clamp injury, and the number was significantly different from the normal control. The RGCs quantity of SD rats at 3M was not significant compared with that of 1m. There was no obvious Evans blue infiltration in the retina under the fluorescence microscope at 1,4,8 weeks after chronic ocular hypertension injury. There was no significant difference between the retina permeability and the control group. The apparent blue fluorescence was seen in the retina 1 days after the optic nerve clamp injury, and gradually weakened. The chronic high intraocular pressure and the optic nerve clamp injury model established in this experiment conformed to the characteristic of the disease. The characteristic number of RGCs decreased, and the chronic high intraocular pressure could not destroy the retinal barrier of the rat's blood. The retinal blood retinal barrier could be damaged in the early stage of the optic nerve clamp injury, the retinal vascular permeability increased, and the damage state of the blood retinal barrier could be held. Continue for at least 1 months.
4. the Nogo66-CS eye vaccine was prepared. The characteristics, pH value, osmotic pressure, viscosity, content and stability of the vaccine were in accordance with the pharmacology requirements of the eye drops, suggesting that the Nogo66 protein vaccine with chitosan as a adjuvant has good physical and chemical properties.
5. eye irritation tests showed that the eye irritation response scores of 1H, 24h, 48h, 72h, 4D, 7d, Nogo66-CS vaccine group and saline group were all 3, and there were no abnormalities in the anterior segment under the slit lamp, and the cornea fluorescein staining was negative. It was considered that Nogo66-CS eye vaccine and saline were not irritating to the eyes. After the first time, the drug was not irritating to the eye. There was no obvious abnormality in the retina, heart, liver, kidney, lung, brain and testis in sixteenth weeks. It suggested that the Nogo66-CS vaccine was not irritating and safe to the body.
The 6. Nogo66 protein eye vaccine was immunogenic. Microglia cultured in vitro expressed a large number of CD11b and cell activation after the stimulation of Nogo66-CS vaccine or Nogo66 protein. After CS stimulation, a small amount of CD11b was expressed and the cells were stationary. No CD11b expression was found in the blank group. The conjunctival HE staining showed a large number of lymphocyte infiltration in the conjunctival tissue of group Nogo66-CS rats. A small amount of lymphocyte infiltration and IgG type positive plasma cells were found in the conjunctival tissue of group Nogo66, and the conjunctiva of group CS was only infiltrated by lymphocyte and no IgG positive plasma cells existed. After vaccination, the IgG antibody titer of Nogo66-CS group began to increase continuously from twentieth days, which was significantly different from that of the control group, and the serum IgG resistance was significant. The titer of the body began to increase in thirty-fourth days, and the amplitude was lower. The IgG antibody titer in the tears and serum of the Nogo66 and CS groups had no significant changes. The microglia in the retina of the.Nogo66-CS group was activated, expressed CD11b and a small amount of MHC- II, and had no obvious iNOS, TNF- a expression, and a small amount of CD11b expressed in the retina of the CS group, and no iNOS, TNF- alpha expression was not found. Activation of mucosal immunity and systemic immunity, and activation of retinal microglia, have strong immunogenicity.
7. Nogo66 protein eye vaccine can promote the survival and regeneration of RGCs after retinal optic nerve injury. The number of RGCs in rat Nogo66-CS group of chronic ocular hypertension model rats and optic nerve clamp injury model rats is significantly higher than that of group CS and uninoculated group. The retina of Nogo66-CS group has a large number of GAP43, indicating that the regeneration of the optic nerve membrane neurons is active. It indicates Nogo66 protein eye use. The vaccine has protective effects on damaged retinal nerves.
8, Nogo66 protein eye vaccine can induce the expression of retina neurotrophic factor to increase the infiltration of CD3 positive lymphocytes in the retina and up regulation of the expression of GDNF and BNDF after immunization with.Nogo66 protein eye vaccine. It indicates that the Nogo66 protein eye vaccine can induce the activation of T cells to infiltrate the retina, and the secretion of the microglia of the activated T cells and the retina is more secreted. Retinal nerve growth factor has protective effects on damaged retinal nerves.
【學位授予單位】:第三軍醫(yī)大學
【學位級別】:博士
【學位授予年份】:2009
【分類號】:R392

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