發(fā)布時間：2018-04-26 06:27

  本文選題：腦源性神經(jīng)營養(yǎng)因子 + 中重度過敏性鼻炎�。� 參考：《山東大學(xué)》2017年博士論文

【摘要】：研究背景過敏性鼻炎(Allergic rhinitis,AR)是在鼻部黏膜接觸過敏原后,由特異性IgE介導(dǎo)的黏膜炎癥反應(yīng)。AR在全世界范圍內(nèi)的發(fā)病率約為10%～40%,不僅嚴(yán)重影響患者的生活質(zhì)量,也給社會帶來沉重的醫(yī)療負(fù)擔(dān)。近年來,AR的發(fā)病率呈逐年上升的趨勢。目前,AR的病因尚不完全清楚,但個體基因和環(huán)境之間復(fù)雜的相互作用是其發(fā)病的危險因素之一。在過去的幾十年中,AR基因相關(guān)研究是其病因?qū)W研究的熱點(diǎn)。腦源性神經(jīng)營養(yǎng)因子(BDNF)是一種分泌蛋白,是神經(jīng)營養(yǎng)因子家族中的一員。嗜酸性粒細(xì)胞是參與AR免疫反應(yīng)發(fā)生及發(fā)展的重要炎癥細(xì)胞,可生成BDNF蛋白并表達(dá)其相應(yīng)的受體TrkB。BDNF單核苷酸多態(tài)性(SNPs)已被證實(shí)與過敏性哮喘的發(fā)病密切相關(guān)。因此,BDNF可能與AR的發(fā)病密切相關(guān)。但目前,BDNF SNPs是否會增加中國區(qū)域人群過敏性鼻炎的患病風(fēng)險,以及BDNF遺傳變異對BDNF基因及蛋白表達(dá)水平的影響尚不清楚。研究方法本研究選取山東地區(qū)有典型過敏癥狀并且過敏原檢測陽性的481例中重度變應(yīng)性鼻炎患者作為實(shí)驗(yàn)組,健康對照組1735例;選取新加坡中國人群中典型過敏癥狀并且過敏原檢測陽性的522例中重度變應(yīng)性鼻炎患者作為實(shí)驗(yàn)組,健康對照組717例;提取受試者外周血DNA。自HapMap中國漢族人群(CHB)中篩選出BDNF標(biāo)簽SNP位點(diǎn),從每一樣本基因組DNA中取5ng進(jìn)行多重PCR擴(kuò)增,通過MassARRAY系統(tǒng)檢測標(biāo)簽SNP位點(diǎn),對受試者進(jìn)行基因分型,評估與AR患病風(fēng)險的關(guān)聯(lián)。最后,通過體外及體內(nèi)實(shí)驗(yàn)對BNDF遺傳變異所產(chǎn)生的功能效應(yīng)進(jìn)行驗(yàn)證。研究結(jié)果在山東人群及新加坡中國人群這兩個獨(dú)立的群體中,BDNFSNP rs10767664均與中重度變應(yīng)性鼻炎有顯著相關(guān)性(P=0.039,OR=1.17;P=0.0017,OR =1.324)。山東人群中風(fēng)險等位基因A在AR中的出現(xiàn)率為57%,高于對照組的53%。通過PLINKmeta分析將以上兩個獨(dú)立群體整合,BDNF SNP rs10767664仍與中重度變應(yīng)性鼻炎有顯著相關(guān)性(P = 0.000298,OR= 1.242)。BDNF非同義SNP rs6265與SNP rs10767664連鎖不平衡,遂使用rs6265進(jìn)行體外功能研究。Val/Met重組質(zhì)粒轉(zhuǎn)染HEK293T細(xì)胞,與空載體組相比,細(xì)胞裂解液中BDNF蛋白的表達(dá)水平均顯著增高。在體內(nèi),rs6265 CC基因型者外周血BDNF蛋白水平顯著高于CT型及TT型(P= 0.02,P= 0.03);rs6265 CC基因型者,外周血IgE水平顯著高于TT型(P0.05)。因此,rs10767664AA基因型者更易表現(xiàn)為中重度過敏性鼻炎,且其血漿中BDNF蛋白及總IgE水平更高。大樣本量數(shù)據(jù)eQTL meta分析顯示,BDNF SNPs與外周血BDNF mRNA的表達(dá)水平具有顯著相關(guān)性。結(jié)論BDNF SNPs增加了中重度過敏性鼻炎的患病風(fēng)險;BDNF rs10767664 AA基因型者外周血BDNF mRNA及蛋白的表達(dá)水平更高;BDNF SNP rs10767664與過敏性鼻炎的發(fā)生密切相關(guān)。研究背景上頜竇后鼻孔息肉(AntrochoanalPolyps,ACP)約占全部鼻腔息肉的4%～6%。與臨床上常見的雙側(cè)鼻息肉(bilateralnasalpolyps,BNP)相比,ACP的發(fā)病年齡較低,病變范圍較局限,臨床癥狀相對于BNP也較輕。在過去的幾十年中,對于傳統(tǒng)雙側(cè)鼻息肉發(fā)生的分子機(jī)制的基礎(chǔ)研究眾多,但對ACP病理改變及發(fā)病機(jī)制的研究極少。本研究旨在較大樣本量的中國人群ACP中進(jìn)行較為全面的組織病理學(xué)及炎性發(fā)病機(jī)制的相關(guān)研究,明確ACP的上皮重塑模式,對組織中常見炎癥細(xì)胞的浸潤進(jìn)行檢測,分析上皮重塑及炎細(xì)胞浸潤與ACP臨床特點(diǎn)的關(guān)系,檢測ACP中輔助性T細(xì)胞、調(diào)節(jié)性T細(xì)胞及其轉(zhuǎn)錄因子和相關(guān)炎性介質(zhì)的表達(dá),并比較其表達(dá)與對照組鼻腔黏膜的差異。研究方法收集上頜竇后鼻孔息肉ACP 33例,傳統(tǒng)雙側(cè)鼻息肉BNP 49例,以及行鼻中隔偏曲手術(shù)的下鼻甲黏膜50例作為對照組。通過HE及IHC染色,對組織的上皮重塑及嗜酸性粒細(xì)胞、中性粒細(xì)胞、巨噬細(xì)胞、肥大細(xì)胞、CD4+T細(xì)胞、CD8+T細(xì)胞和FOXP3+T-reg細(xì)胞的浸潤進(jìn)行評估和比較。提取21例ACP及34例對照組的mRNA,通過逆轉(zhuǎn)錄及實(shí)時定量PCR,檢測組織中Th1、Th2、Th17和T-reg細(xì)胞的轉(zhuǎn)錄因子及相關(guān)炎性介質(zhì)基因水平的表達(dá)。研究結(jié)果與BNP相比,ACP的上皮增生及杯狀細(xì)胞增生程度較輕。在本研究中,87.9%的后鼻孔息肉表現(xiàn)為中性粒細(xì)胞型鼻息肉,其中性粒細(xì)胞的浸潤程度顯著高于BNP及對照組:與對照組相比,ACP中巨噬細(xì)胞及CD8+ T細(xì)胞的浸潤顯著上調(diào),但肥大細(xì)胞的浸潤是下調(diào)的。在ACP組織中,FOXP3+調(diào)節(jié)性T細(xì)胞的浸潤數(shù)目與中性粒細(xì)胞、巨噬細(xì)胞、CD4+T細(xì)胞和CD8+T細(xì)胞的浸潤均呈顯著正相關(guān)性;嗜酸性粒細(xì)胞的浸潤程度與ACP患者的哮喘史具有顯著的正相關(guān)性;巨噬細(xì)胞的浸潤程度與上皮的增生程度及杯狀細(xì)胞的增生程度呈顯著負(fù)相關(guān)性;CD8+ T細(xì)胞的浸潤程度與鱗狀上皮化生呈顯著正相關(guān)性。與對照組相比,調(diào)節(jié)性T細(xì)胞T-reg的相關(guān)轉(zhuǎn)錄因子FOXP3及炎性介質(zhì)IL10在ACP中的表達(dá)顯著上調(diào)。此外,IL6、中性粒細(xì)胞相關(guān)基因MPO、嗜酸性粒細(xì)胞聚集基因CCL13和CCL18在ACP中的表達(dá)顯著上調(diào),但Th1/Th2/Th17的轉(zhuǎn)錄因子T-bet,GATA3和RORc的表達(dá)顯著下調(diào)。FOXP3的mRNA表達(dá)水平與T-bet和GATA3呈顯著正相關(guān)性,但與RORc無相關(guān)性;IL6的mRNA表達(dá)水平與T-bet、GATA3和FOXP3呈顯著正相關(guān)性;IL10的mRNA表達(dá)水平與T-bet呈顯著正相關(guān)性;此外,MPO的mRNA表達(dá)水平與CCL18呈顯著正相關(guān)性。IL10的mRNA表達(dá)水平與巨噬細(xì)胞的浸潤數(shù)量呈顯著正相關(guān);MPO的mRNA表達(dá)水平與CD4+ T細(xì)胞的浸潤個數(shù)呈顯著負(fù)相關(guān)性,與CD8+ T細(xì)胞的浸潤數(shù)量顯著負(fù)相關(guān)性;T-bet的mRNA表達(dá)水平與CD8+ T細(xì)胞的浸潤個數(shù)呈顯著正相關(guān)性;RORc的mRNA表達(dá)水平與CD4+ T細(xì)胞的浸潤數(shù)量呈顯著負(fù)相關(guān)性。結(jié)論ACP的上皮重塑特點(diǎn)、炎細(xì)胞浸潤和炎癥因子表達(dá)模式與BNP有所不同;ACP中涉及復(fù)雜的炎癥細(xì)胞浸潤,包括顯著上調(diào)的中性粒細(xì)胞、CD8+T細(xì)胞和巨噬細(xì)胞;IL6、IL10和FOXP3的mRNA的表達(dá)水平顯著上調(diào),并與其它細(xì)胞因子和炎癥細(xì)胞類型的表達(dá)具有一定的相關(guān)性,可能在ACP的發(fā)病過程中起到一定的調(diào)控作用,這為進(jìn)一步深入研究ACP的發(fā)病機(jī)制奠定了基礎(chǔ),也為ACP的診斷和治療提供新思路。
[Abstract]:Background allergic rhinitis (Allergic rhinitis, AR) is in the nasal mucosa after exposure to allergens, and the incidence of.AR in the whole world is about 10% ~ 40%, which is mediated by specific IgE, which not only seriously affects the quality of life of the patients, but also brings heavy medical burden to the society. In recent years, the incidence of AR has been increasing year by year. At present, the etiology of AR is not yet fully understood, but the complex interaction between the individual gene and the environment is one of the risk factors for its pathogenesis. In the past few decades, AR gene related research is a hot spot in its etiology. Brain derived neurotrophic factor (BDNF) is a secretory protein and is one of the family of neurotrophic factors. Eosinophils are important inflammatory cells involved in the occurrence and development of AR immunoreaction. BDNF protein can be generated and its corresponding receptor TrkB.BDNF single nucleotide polymorphism (SNPs) has been closely related to the pathogenesis of allergic asthma. Therefore, BDNF may be closely related to the pathogenesis of AR. But, at present, whether BDNF SNPs will increase or not The risk of allergic rhinitis in the regional population and the effect of BDNF genetic variation on the expression of BDNF gene and protein is not clear. The research method selected 481 cases of moderate and severe allergic rhinitis with typical allergic symptoms and positive allergen detection in Shandong as experimental group and 1735 healthy control group. 522 moderate and severe allergic rhinitis patients with positive allergic symptoms and positive allergen detection were used as experimental group and 717 healthy control group. The BDNF tag SNP site was selected from the peripheral blood DNA. from the Chinese Han population (CHB) of HapMap, and 5ng for multiple PCR amplification was obtained from each sample genome DNA. The MassARRAY system detected the label SNP loci, genotyping the subjects and assessing the association with the risk of AR disease. Finally, the functional effects of BNDF genetic variation were verified by in vitro and in vivo experiments. The results were both in the two independent groups of the Shandong population and the Chinese population in Singapore, and BDNFSNP rs10767664 was both in and in the middle of the population. There was a significant correlation between severe allergic rhinitis (P=0.039, OR=1.17; P=0.0017, OR =1.324). The incidence of A in AR was 57% in Shandong population, which was higher than that of the control group by PLINKmeta analysis to integrate the above two independent groups. BDNF SNP rs10767664 still had a significant correlation with moderate and severe allergic rhinitis (0.000298, 1.242).BDNF unsynonymous SNP rs6265 and SNP rs10767664 were unbalance, then rs6265 was used to study in vitro function of.Val/Met recombinant plasmid transfected to HEK293T cells, and the expression level of BDNF protein in the cell lysate was significantly higher than that in the unloaded body group. In the body, the level of the peripheral blood BDNF protein in the rs6265 CC base was significantly higher than that of the type of HEK293T. TT type (P= 0.02, P= 0.03); rs6265 CC genotype, the level of IgE in peripheral blood was significantly higher than that of the TT type (P0.05). Therefore, the rs10767664AA genotype was more likely to be a medium and severe allergic rhinitis, and the BDNF protein and IgE level in the plasma were higher. Significant correlation. Conclusion BDNF SNPs increased the risk of moderate to severe allergic rhinitis; the expression level of BDNF mRNA and protein in peripheral blood of BDNF rs10767664 AA genotype was higher; BDNF SNP rs10767664 was closely related to the occurrence of allergic rhinitis. Compared with common bilateral nasal polyps (bilateralnasalpolyps, BNP), the 4% ~ 6%. of meat is lower, the scope of the disease is relatively limited and the clinical symptoms are relatively light relative to BNP. In the past few decades, there are many basic studies on the molecular mechanism of the traditional bilateral nasal polyps, but the pathological changes and pathogenesis of ACP have been studied. The study is very rare. This study aims at a relatively comprehensive study of histopathology and inflammatory pathogenesis in the large sample size of Chinese population ACP, to identify the epithelial remodeling patterns of ACP, to detect the infiltration of common inflammatory cells in the tissues, to analyze the relationship between epithelial remodeling and inflammatory cell infiltration and the clinical characteristics of ACP, and to detect the complement of ACP. T cells, regulatory T cells and their transcriptional factors and related inflammatory mediators were expressed, and the difference between the expression and the control group was compared with the nasal mucosa in the control group. The methods collected 33 cases of ACP, 49 cases of traditional bilateral nasal polyps, 49 cases of traditional bilateral nasal polyps, and 50 cases of inferior turbinate mucosa with nasal septum deflection. Through HE and IHC The epithelial remodeling of tissue and the infiltration of eosinophils, neutrophils, macrophages, mast cells, CD4+T cells, CD8+T cells and FOXP3+T-reg cells were evaluated and compared. The mRNA of 21 cases of ACP and 34 control groups was extracted, and the transcription factors of Th1, Th2, Th17, and T-reg cells in the tissues were detected by reverse transcription and real-time quantitative PCR. In this study, 87.9% of the posterior nostril polyps showed a neutrophil type nasal polyp in this study. In this study, 87.9% of the nasal polyps were neutrophilic polyps, and the degree of infiltration of granulocytes was significantly higher than that of the BNP and the control group. Compared with the control group, the macrophage and CD in ACP were compared with the control group. The infiltration of 8+ T cells was significantly up-regulated, but the infiltration of mast cells was down. In ACP tissue, the number of FOXP3+ regulatory T cells was significantly correlated with the infiltration of neutrophils, macrophages, CD4+T cells and CD8+T cells, and the Jin Runcheng degree of eosinophils had a significant positive correlation with the history of asthma in ACP patients. There was a significant negative correlation between the degree of macrophage infiltration and the degree of epithelial proliferation and the degree of goblet cell proliferation; the degree of infiltration of CD8+ T cells was positively correlated with the squamous metaplasia. Compared with the control group, the expression of the related transcription factor FOXP3 of the regulatory T cell T-reg and the expression of inflammatory mediating IL10 in ACP was significantly up-regulated. In addition, IL6 The expression of neutrophil related gene MPO, eosinophil aggregation gene CCL13 and CCL18 in ACP was significantly up-regulated, but the expression level of Th1/Th2/Th17 transcriptional factor T-bet, GATA3 and RORc was significantly lower than that of T-bet and GATA3, but there was no correlation with T-bet and GATA3. There was a significant positive correlation with FOXP3, and the level of mRNA expression in IL10 was positively correlated with T-bet, and the mRNA expression level of MPO was positively correlated with CCL18, and the mRNA expression level of.IL10 was positively correlated with the number of macrophages, and mRNA expression level of MPO was negatively correlated with the number of infiltration of CD4+ cells. There was a significant negative correlation between the number of cell infiltration and the significant positive correlation between the mRNA expression level of T-bet and the number of infiltration of CD8+ T cells; the mRNA expression level of RORc was negatively correlated with the number of CD4+ T cells. Conclusion the epithelial remodeling characteristics of ACP, inflammatory cell infiltration and the expression pattern of inflammatory factors are different from BNP; ACP involved in the recurrence of BNP. The infiltration of mixed inflammatory cells, including the significantly up-regulated neutrophils, CD8+T cells and macrophages, the expression level of mRNA in IL6, IL10 and FOXP3 is significantly up-regulated, and has a certain correlation with the expression of other cytokines and inflammatory cell types, and may play a regulatory role in the pathogenesis of the pathogenesis of ACP, which is further in-depth study. The study laid a foundation for the pathogenesis of ACP, and provided new ideas for the diagnosis and treatment of ACP.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R765.21

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8 林士軍;王桂杰;劉玉春;徐繼慶;陳蘭春;;布地奈德鼻噴霧劑治療過敏性鼻炎的臨床觀察[A];中華醫(yī)學(xué)會第七屆全國哮喘學(xué)術(shù)會議暨中國哮喘聯(lián)盟第三次大會論文匯編[C];2010年

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