本文關(guān)鍵詞： 脊髓損傷 載脂蛋白E 基因多態(tài)性 康復(fù)評定　出處：《昆明醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討載脂蛋白E (ApoE)基因多態(tài)性對脊髓損傷患者預(yù)后的影響及相關(guān)性。方法：1、采用限制性片段長度多態(tài)性聚合酶鏈反應(yīng)(PCR-RFLP)和基因測序法,對2014年3月-2015年2月就診于昆明醫(yī)科大學(xué)第二附屬醫(yī)院康復(fù)科的50例脊髓損傷患者進(jìn)行ApoE基因型檢測；2、根據(jù)患者的損傷程度、脊柱穩(wěn)定狀況及肢體功能等具體情況,對所有患者進(jìn)行綜合康復(fù)治療,采用藥物、營養(yǎng)神經(jīng)及改善微循環(huán)治療,呼吸訓(xùn)練、肌力訓(xùn)練、牽拉、耐力訓(xùn)練、平衡訓(xùn)練、關(guān)節(jié)活動范圍訓(xùn)練、轉(zhuǎn)移訓(xùn)練、輪椅操作及技巧訓(xùn)練、日常生活活動能力訓(xùn)練等康復(fù)治療,對不同損傷節(jié)段患者佩戴不同的矯形肢具配合治療。治療頻度：每日1次,每周5次。3、對入選患者按ASIA脊髓損傷分類標(biāo)準(zhǔn)進(jìn)行綜合評估�；颊叻謩e于入院時、治療1個月后進(jìn)行綜合評估,觀察其ASIA脊髓損傷程度、輕觸覺、針刺覺評分,運(yùn)動評分及日常生活活動能力(FIM)等方面的變化；4、采用SPSS 17.0軟件對ApoE基因分型結(jié)果和各項(xiàng)功能評估結(jié)果的變化情況進(jìn)行分析,分析ApoE基因多態(tài)性對脊髓損傷康復(fù)治療效果的影響。結(jié)果：1、實(shí)際收集病例47例,ApoE基因型檢測結(jié)果：ApoE ε 3/3型頻率最高(68%),ε2/3(15%)和ε3/4(11%)次之,ε4/4(2%)及ε2/2最少,患者中ApoE ε 4攜帶者8例(17%),非攜帶者39例(83%),ApoE基因型分布符合Hardy-Weinberg定律,符合自然人群的基因分布特點(diǎn)。2, ASIA評分變化：所有患者治療后1個月與治療前比較,輕觸覺、針刺覺及運(yùn)動評分均有改善,統(tǒng)計學(xué)處理差異有顯著性(P0.05)；運(yùn)動評分比較,ApoE ε 4攜帶組恢復(fù)情況較ε4非攜帶組稍差,差異有統(tǒng)計學(xué)意義；而輕觸覺和針刺覺恢復(fù)情況,兩組之間比較差異無統(tǒng)計學(xué)意義(P0.05)。3、日常生活活動能力(ADL)評定：兩組患者FIM評分較治療前1月均有提高,ApoE ε4攜帶者較￡4非攜帶者恢復(fù)情況差,兩組間比較差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論：1、脊髓損傷患者神經(jīng)功能的恢復(fù)與ApoE基因多態(tài)性相關(guān),但其具體的分子機(jī)制和詳細(xì)的作用還有待進(jìn)一步的研究。本研究可為未來開展基因治療脊髓損傷提供依據(jù)。2、攜帶ApoEε4的脊髓損傷患者運(yùn)動功能和日常生活能力恢復(fù)情況較差,在輕觸覺和針刺覺的恢復(fù)方面ApoEε4攜帶者和非攜帶者沒有顯著差異。3、在臨床治療過程中,對ApoEε4等位基因攜帶的脊髓損傷患者,注意加強(qiáng)其運(yùn)動功能的康復(fù)訓(xùn)練,促進(jìn)其運(yùn)動能力和日常生活能力的恢復(fù)。
[Abstract]:Objective: to investigate the effect of apolipoprotein E (ApoE) gene polymorphism on the prognosis of patients with spinal cord injury (sci). Restriction fragment length polymorphism polymerase chain reaction (PCR-RFLP) and gene sequencing were used. ApoE genotypes were detected in 50 patients with spinal cord injury from March 2014 to February 2015 in the Department of Rehabilitation, second affiliated Hospital of Kunming Medical University. 2. According to the degree of injury, the condition of spinal stability and limb function, all patients were treated with comprehensive rehabilitation, medicine, nutrition nerve and improved microcirculation, breathing training. Muscle strength training, traction, endurance training, balance training, joint range training, transfer training, wheelchair operation and skills training, daily life ability training and other rehabilitation treatment. Patients with different levels of injury were treated with different orthopaedic devices. Frequency of treatment: once a day, 5 times a week. The patients were evaluated according to the classification criteria of ASIA spinal cord injury. The patients were evaluated after one month of treatment on admission to observe the degree of ASIA spinal cord injury and light tactile. The changes of acupuncture sensation score, motor score and activity of daily life (ADL); 4. SPSS 17.0 software was used to analyze the changes of ApoE genotyping results and functional evaluation results. The effect of ApoE gene polymorphism on rehabilitation of spinal cord injury was analyzed. The results of ApoE genotypic analysis showed that the highest frequency of apo E 蔚 3/3 was 68%, 蔚 2 / 3 15) and 蔚 3 / 4 11). 蔚 4 / 4) and 蔚 2/2 were the least. Among the patients, 8 were ApoE 蔚 4 carriers and 39 were non-carriers. The distribution of ApoE genotypes obeys the law of Hardy-Weinberg, and accords with the characteristics of gene distribution of natural population. 2. The changes of ASIA score: the scores of light tactile, acupuncture and motor were improved 1 month after treatment in all patients, and there was significant difference between the two groups (P 0.05). The recovery of ApoE 蔚 4 carrying group was slightly worse than that of 蔚 4 non-carrier group, and the difference was statistically significant. However, there was no significant difference between the two groups in the recovery of light tactile and acupuncture sensation (P 0.05). Activity of daily living (ADL) evaluation: the FIM scores of the two groups were higher than those of the patients before treatment on January. The recovery of ApoE 蔚 4 carriers was worse than that of non-carriers. Conclusion the recovery of neural function in patients with spinal cord injury is related to the polymorphism of ApoE gene. However, its specific molecular mechanism and detailed role need to be further studied. This study may provide a basis for the future development of gene therapy for spinal cord injury (sci). The recovery of motor function and ADL in patients with spinal cord injury with ApoE 蔚 4 was poor. There was no significant difference between ApoE 蔚 4 carriers and non-carriers in the recovery of light tactile and acupuncture sensation. In the course of clinical treatment, the patients with spinal cord injury carrying ApoE 蔚 4 allele should pay attention to the rehabilitation training of their motor function and promote the recovery of their motor ability and daily living ability.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R651.2

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本文編號：1457187