本文選題：腹股溝疝　切入點：MMP-2基因　出處：《鄭州大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究背景與目的腹股溝疝是常見的普通外科疾病。據(jù)調(diào)查,腹股溝疝的病發(fā)率為3-5‰,而在60歲以上男性中,其病發(fā)率可高達l~5%。迄今為止,腹股溝疝的明確病因依然不清楚。多年來人們一致認為,腹腔內(nèi)壓的升高和腹壁強度的降低是腹股溝疝發(fā)生的兩個主要病因。近些年,有學者從生化角度探求腹股溝疝的病因,研究發(fā)現(xiàn):腹股溝疝患者體內(nèi)結(jié)締組織中I型膠原蛋白含量偏低、III型膠原蛋白含量相對升高,I/III型膠原蛋白比例失調(diào),使腹股溝后壁腹橫筋膜薄弱甚至缺損,最終引起腹股溝疝疾病發(fā)生,結(jié)果顯示膠原代謝紊亂與腹股溝疝的發(fā)生密切相關(guān)。膠原蛋白是細胞外基質(zhì)(ECM)中最主要的成分之一。其代謝主要受MMPs、TIMPs(MMPs的抑制因子)的共同調(diào)節(jié)。目前,MMP-2、TIMP-2與腹股溝疝發(fā)生的關(guān)系研究,國際與國內(nèi)報道甚少,有學者僅用免疫組化及RT-PCR方法研究報告結(jié)果。本試驗研究應用實時熒光定量PCR(Real-time quantitative polymerase chain reaction,Real-Time PCR)技術(shù),來探究和分析MMP-2 m RNA、TIMP-2 m RNA在腹股溝疝病人腹直肌前鞘中的表達與腹股溝疝發(fā)生的關(guān)系,從生物化學角度進一步探討腹股溝疝的病因,為之后研究該病的病機提供理論基礎(chǔ),及為后續(xù)的臨床治療提供理論依據(jù)。材料與方法本實驗設(shè)有實驗組和對照組,兩組均為男性手術(shù)患者。組織標本取自從2016年2月至2016年11月在我院行手術(shù)治療患者,取材部位:均為下腹部腹直肌前鞘,面積為5mm*10mm。所有病例取材前均已取得當?shù)貍惱砦瘑T會批準,并且得到患者自己的同意。實驗組:腹股溝疝患者48例,其中包括斜疝組32例,直疝組16例。對照組:無疝患者10例,組織標本取自接受其他下腹部手術(shù)的病人。吸煙者定為:每日吸煙l0支,煙齡10年。實驗組與對照組共58例中,吸煙者19例,非吸煙者39例。家族史:直系親屬中有兩人以上(包括患者本人)患有腹股溝疝者為有家族史,家族包括祖父母、外祖父母、父母、兄弟姐妹、子女以及孫子女。實驗組與對照組共58例中,其中有家族史者6例,無家族史者52例。排除標準:兩組中正在接受甾體類激素、其它免疫抑制劑治療患者(包括腫瘤化療)、有局部炎癥病史者、糖尿病及結(jié)締組織病患者等均應排除。用Real-Time PCR技術(shù)檢測腹股溝疝患者腹直肌前鞘中MMP-2、TIMP-2m RNA的表達水平。所得數(shù)據(jù)運用統(tǒng)計軟件SPSS21.0進行處理,計量均數(shù)用均數(shù)±標準差(x±s)表示。數(shù)據(jù)的相關(guān)分析采用Pearson方法,多組間均數(shù)比較應用單因素方差分析,采用t檢驗對兩組間均數(shù)進行比較,α=0.05為檢驗水準,即P0.05認為差異有統(tǒng)計學意義。結(jié)果1.實驗組(直疝組、斜疝組)和對照組中MMP-2 m RNA及TIMP-2 m RNA的表達。MMP-2 m RNA的表達:對照組為1.530±0.612。直疝組為3.098±1.289,與對照組比較P=0.035(0.05),差異有統(tǒng)計學意義。斜疝組為2.221±0.962,與對照組比較P=0.401(0.05),差異無統(tǒng)計學意義。直疝組與斜疝組比較P=0.016(0.05),差異有統(tǒng)計學意義。TIMP-2 m RNA的表達:對照組為1.021±0.395。直疝組為0.641±0.308,與對照組比較P=0.024(0.05),差異有統(tǒng)計學意義。斜疝組為0.687±0.324,與對照組比較P=0.608(0.05),差異無統(tǒng)計學意義。直疝組與斜疝組比較P=0.019(0.05),差異有統(tǒng)計學意義。2.吸煙者與非吸煙者中MMP-2 m RNA及TIMP-2 m RNA的表達。MMP-2m RNA的表達:吸煙組為2.710±1.058,呈高表達。非吸煙組為1.704±0.556,呈低表達。二者比較(t=3.241)p=0.005(0.05),差異有統(tǒng)計學意義。TIMP-2 m RNA的表達:吸煙組為0.628±0.223,呈低表達。非吸煙組為0.783±0.394,呈高表達。二者比較(t=2.489)p=0.023(0.05),差異有統(tǒng)計學意義。3.有家族史者與無家族史者中MMP-2 m RNA及TIMP-2 m RNA的表達。MMP-2 m RNA的表達:有家族史者為3.358±1.054,呈高表達。無家族史者為3.019±1.476,呈低表達。二者比較(t=1.391)p=0.032(0.05),差異有統(tǒng)計學意義。TIMP-2 m RNA的表達:有家族史者為0.507±0.224,呈低表達。無家族史者為0.758±0.358,呈高表達。二者比較(t=2.376)p=0.014(0.05),差異有統(tǒng)計學意義。結(jié)論1.腹股溝直疝患者腹直肌前鞘中MMP-2 m RNA呈高表達,TIMP-2 m RNA呈低表達,表明兩者同時參與了膠原代謝的過程,并與腹股溝直疝的形成顯著相關(guān)。與腹股溝斜疝的發(fā)生發(fā)展無明顯關(guān)系,而斜疝的發(fā)生可能與鞘狀突學說等其他因素有關(guān)。2.在吸煙者中MMP-2 m RNA表達較高、TIMP-2 m RNA表達較低,表明吸煙是腹股溝疝發(fā)生的重要因素之一。3.有家族史者MMP-2 m RNA呈高表達、TIMP-2 m RNA呈低表達,表明腹股溝疝的發(fā)生與遺傳因素有關(guān)。
[Abstract]:Background and objective inguinal hernia is a common disease in general surgery. According to the survey, the incidence of inguinal hernia was 3-5 per thousand, while men over the age of 60, the incidence of a disease can be as high as l~5%. so far, the etiopathogenisis of inguinal hernia is still not clear. People agreed that over the years, reducing intra-abdominal pressure and the increase of abdominal wall strength is the two main cause of the inguinal hernia. In recent years, some scholars found that the study of etiology, explore the inguinal hernia from biochemical angle: low inguinal hernia in patients with connective tissue type I collagen content of type III collagen type I/III collagen content increased relatively, in proportion to the groin after the wall of the transversalis fascia weakness or defect, resulting in inguinal hernia disease, results showed that the collagen metabolism and is closely related to the occurrence of inguinal hernia. Collagen is the extracellular matrix (ECM) in the main One of the ingredients. Its metabolism is mainly controlled by MMPs, TIMPs (MMPs inhibitor) Co regulation. At present, research on the relationship between TIMP-2 and MMP-2, inguinal hernia, international and domestic scholars have only rarely reported, using immunohistochemistry and RT-PCR method study. This study used real-time fluorescence quantitative PCR (Real-time quantitative polymerase chain reaction Real-Time PCR) technology, to explore and analyze the MMP-2 m RNA m RNA, the relationship between expression of TIMP-2 in inguinal hernia patients with anterior rectus sheath in the inguinal hernia, from the view of Biochemistry, to probe into the etiology of the inguinal hernia, and provide a theoretical basis for the pathogenesis of the disease after the study. For the clinical treatment and follow-up and provide a theoretical basis. Materials and methods in this experiment, with experimental group and control group, two groups of male patients. Tissue specimens were obtained from from February 2016 to November 2016 in our hospital Surgical treatment of patients with different parts: all abdominal anterior rectus sheath, area of 5mm*10mm. of all cases were taken before has been approved by the local ethics committee, and patients with their consent. The experimental group: 48 patients with inguinal hernia, including 32 cases of hernia hernia group, group of 16 cases. The control group: no hernia in 10 cases, tissue samples were taken from other abdominal surgery patients. Smokers as: daily smoking, l0, smoked for 10 years. The experimental group and the control group were 58 cases, 19 cases of non smokers, smokers in 39 cases. Family history: the immediate family has more than two people (including patients) patients with inguinal hernia were to have a family history of family, including grandparents, grandparents, parents, siblings, children and grandchildren. The experimental group and the control group were 58 cases, including 6 cases with family history, 52 cases without family history. Exclusion criteria: steroids are accepted in the two groups Other hormones, immunosuppressive therapy patients (including chemotherapy), local inflammatory disease, diabetes and connective tissue disease should be excluded. Using Real-Time PCR to detect patients with inguinal hernia anterior rectus sheath in MMP-2, the expression level of TIMP-2m RNA. The data using statistical software SPSS21.0, measurement of mean with the mean and standard deviation (x + s). Correlation analysis of data using Pearson method, many groups were compared using one-way ANOVA, t test was used to compare between the two groups were, a =0.05 for the standard test, P0.05 is considered statistically significant. Results the experimental group (1. direct inguinal hernia group) group. The expression of.MMP-2 m and RNA MMP-2 in the control group were m RNA and TIMP-2 m RNA: the control group was 1.530 + 0.612. hernia group is 3.098 + 1.289, compared with the control group P=0.035 (0.05), the difference was statistically significant. Hernia Group is 2.221 + 0.962, compared with the control group (P=0.401 0.05), the difference was not statistically significant. Compared with direct inguinal hernia group hernia group P=0.016 (0.05), the difference has statistical significance of.TIMP-2 m expression of RNA: the control group was 1.021 + 0.395. hernia group is 0.641 + 0.308, compared with the control group (0.05), P= 0.024 the difference was statistically significant. Hernia group is 0.687 + 0.324, compared with the control group (P=0.608 0.05), the difference was not statistically significant. Compared with direct inguinal hernia group hernia group P=0.019 (0.05), the difference has statistical significance in expression of.MMP-2m RNA.2. MMP-2 m in smokers and non-smokers RNA TIMP-2 and m RNA: smoking group 2.710 + 1.058 was highly expressed. Non smoking group is 1.704 + 0.556, showed low expression. The comparison between the two (t=3.241) p=0.005 (0.05), the difference has statistical significance.TIMP-2 m RNA expression: the smoking group is 0.628 + 0.223. The expression was low. Non smoking group is 0.783 + 0.394, was highly expressed. Two Comparison of (t=2.489) p=0.023 (0.05), the expression of.MMP-2 m RNA there was a significant difference between the.3. family history and those without family history of MMP-2 m RNA and TIMP-2 m RNA: a family history of 3.358 + 1.054, was highly expressed. No family history was 3.019 + 1.476, is low expression. The comparison between the two (t=1.391) p=0.032 (0.05), the difference has statistical significance.TIMP-2 m RNA expression: family history was 0.507 + 0.224, showed low expression. No family history was 0.758 + 0.358, was highly expressed. The comparison between the two (t=2.376) p=0.014 (0.05), there was statistically significant difference. Conclusion the high expression of 1. inguinal hernia patients with anterior rectus sheath in MMP-2 m RNA in TIMP-2 m, RNA expression was low, showed that both participate in the process of collagen metabolism, and the formation of direct inguinal hernia were significantly correlated. No obvious relationship with the occurrence and development of inguinal hernia, and oblique hernia may occur with sheathlike process theory Other factors such as the.2. MMP-2 m RNA in smokers was higher, TIMP-2 m RNA is low, that smoking is one of the important factors of inguinal hernia occurred.3. have a family history of MMP-2 m RNA showed high expression, TIMP-2 m expression of RNA is low, that of inguinal hernia is associated with genetic factors.

【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R656.21

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