降钙素基因相关肽与重度颅脑损伤合并肢体骨折的预后相关性研究

发布时间：2018-03-10 16:09

本文选题：降钙素基因相关肽　切入点：重度颅脑损伤　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:从医学角度讲颅脑损伤是指致伤外力作用于头部,导致颅内血管,神经组织和颅内其他组织一系列破坏的原发性损伤,并表现为损伤组织自身功能缺失和受其支配的其他功能障碍。继发性损伤包括颅内组织损伤后炎性介质渗出,血管通透性改变等组织水肿所带来的颅内占位效应和炎症反应。继发性损伤与原发性损伤之间相互作用,共同形成颅内损伤的严重后果。CGRP(降钙素基因相关肽)是1982年由Rosenfeld等应用分子克隆技术从降钙素基因上选取的一个主要基因片段,由37个氨基酸残基组成。作为一种重要的神经源性血管活性肽,CGRP可以扩张血管,显著增加颅内缺血部位的血流量,一定程度上减少因缺血所造成的梗死灶的体积,改善早期血管痉挛带来的不利影响。CGRP可以刺激血管内皮细胞生长,改善血管内皮细胞的损伤,从而促进血管自身修复,还可以增强基底膜,保护血脑屏障避免功能紊乱,发挥神经组织保护作用。相关研究发现,重度颅脑损伤合并肢体骨折患者血清中CGRP表达水平升高。另有研究发现发现在小鼠皮质冲击伤模型中,受损伤的脑干部位CGRP表达明显增高;其他相关研究也报道说在小鼠颅脑损伤的实验模型中,CGRP的表达水平自损伤起始2小时开始逐渐增长,在第2天时达到高峰。随后逐渐下降至损伤前正常脑组织时CGRP的表达水平,不同研究者对于颅脑损伤后CGRP的表达变化存在一定的争议。方法:对入院患者入组,建立档案,签署知情同意书,进入研究。分为实验组和对照组。实验组分为重度颅脑伤组20例,重度颅脑伤合并肢体骨折组20例。入组标准:1有明确颅脑创伤或颅脑创伤合并肢体骨折2无明显手术指征者常规检查3患者及家属同意保守治疗4无脑膜炎5无其他疾病脏器严重合并疾病。患者入院后建立数据库,记录生命体征,GCS评分,血氧,血糖,影像学相关资料。无手术指征者,常规ICU监护治疗,对于GCS评分小于等于8分患者于D1,D3,D5,D7留取血液样本。所有患者入组后即刻抽静脉血入含有抗凝剂的无菌管中,4度1500g离心20分钟后收集血浆,-80度保存备用。应用ELISA方法检测各组患者血液内CGRP及其人受体活性修饰蛋白RAMP1的表达水平,并分析其对于患者预后的相关性。对照组血液样本来自体检正常健康人血样(20例)。应用SPSS13.0统计软件分析,计算资料均以均数+标准差,采用单因素方差分析比较组间整体差异,组间采用多个样本均数间多重比较的T检验,以P0.05作为检验标准,为差异具有统计学显著性意义。结果:CGRP表达水平:重度颅脑伤组患者从第1天CGRP表达水平开始升高,第3天时CGRP的表达水平到达高峰,随着时间延长CGRP表达水平逐渐下降。重度颅脑损伤合并肢体骨折组亦表现出同样的趋势,重度颅脑损伤组和重度颅脑损伤合并肢体骨折组第3天的CGRP表达水平显著高于其他时间点,差异具有统计学意义(P0.05)。重度颅脑损伤组和重度颅脑损伤合并肢体骨折组之间相同时间的CGRP表达量并无明显区别,差异不具有统计学意义(P0.05)。颅脑损伤患者外伤后第1天~第7天CGRP表达水平均大于对照组(P0.05)。差异具有统计学意义。RAMP1表达水平:重度颅脑损伤组患者从第1天RAMP1表达水平开始升高,第3天时RAMP1的表达水平到达高峰,随着时间延长RAMP1表达水平逐渐下降。重度颅脑损伤合并肢体骨折组亦表现出同样的趋势,重度颅脑损伤组和重度颅脑损伤合并肢体骨折组第3天的RAMP1表达水平显著高于其他时间点,差异具有统计学意义(P0.05)。重度颅脑损伤组和重度颅脑损伤合并肢体骨折组之间相同时间的RAMP1表达量并无明显区别,差异不具有统计学意义(P0.05)。颅脑损伤患者外伤后第1天~第7天RAMP1表达水平均大于对照组(P0.05)。差异具有统计学意义。结论:1重度颅脑损伤和重度颅脑损伤合并肢体骨折CGRP表达水平较正常人高。2重度颅脑损伤组和重度颅脑损伤合并肢体骨折之间CGRP表达水平并无明显区别。3 CGRP的阳性表达水平与重度颅脑损伤患者预后有密切关系。
[Abstract]:Objective: to speak from the medical point of craniocerebral injury refers to injuries caused by external force on the head, causing intracranial vascular, nerve tissue and tissue damage and a series of other intracranial primary injury, and the performance for their loss of function and tissue damage by other dysfunction at its disposal. The secondary injury including intracranial tissue injury after inflammatory exudation the change of intracranial vascular permeability, tissue edema caused by mass effect and secondary injury and inflammation. The interaction between the primary injury, forming.CGRP serious consequences of intracranial injury (CGRP) is a major gene fragment by Rosenfeld in 1982 by using molecular cloning technology is selected from the drop calcium gene, consisting of 37 amino acid residues. As an important neurogenic vasoactive peptide CGRP can dilate blood vessels, increase blood flow of intracranial ischemic area To a certain extent, reduce the infarct volume caused by ischemia, improve the adverse effects brought by.CGRP in the early stage of vasospasm can stimulate the growth of vascular endothelial cells, improve endothelial cell damage, thereby promoting vascular repair, but also can enhance the basement membrane, protect the blood-brain barrier to avoid dysfunction, play a protective role in nerve tissue. The study found that patients with severe craniocerebral injury complicated with limb increased the level of CGRP expression in the serum of patients with fracture. Another study found in mouse cortical injury model in the injured brain stem CGRP expression increased significantly; other studies reported in the experimental mouse model of traumatic brain injury in 2 hours, the expression level of CGRP from damage initiation began to increase, reached the peak at day second. The expression level then decreased gradually to normal brain tissue injury before CGRP, different researchers In a controversial change the expression of CGRP after traumatic brain injury. Methods: to establish the files of patients admitted into the group, and signed the informed consent to enter the study. Divided into experimental group and control group. The experimental group was divided into 20 cases of severe craniocerebral injury group, severe craniocerebral injury complicated with limb fracture group group 20 cases. 1: a clear brain injury associated with traumatic brain injury or limb fracture in 2 without obvious surgical indications routine examination in 3 patients and their families agree with conservative treatment in 4 without meningitis and 5 other diseases with severe disease. Organ database records of patients admitted to hospital, vital signs, GCS score, blood oxygen, blood glucose, related data imaging. Surgical indications, routine ICU care, for the GCS score less than or equal to 8 in patients with D1, D3, D5, D7 in blood samples. All patients immediately after the extraction of venous blood into the sterile tube containing anticoagulant, 4 degrees 20 minutes after receiving 1500g from the heart In plasma, -80 degrees to save standby. Expression level detected by ELISA CGRP and its receptor activity of blood serum in patients with modified RAMP1 protein, and to analyze the relationship between the prognosis of patients with the control group. Blood samples from normal healthy human blood samples (20 cases). SPSS13.0 software was used for the analysis, the calculation data were expressed by and the standard deviation were analyzed by using one-way ANOVA between groups differences, T test, multiple samples and multiple comparisons between the groups, with P0.05 as the test standard, statistically significant differences. Results: the expression level of CGRP: severe craniocerebral injury patients from the first day the expression level of CGRP began to increase. The third day the expression level of CGRP reached the peak with time gradually decreased. The expression level of CGRP in severe craniocerebral injury combined with extremity fracture group also showed the same trend, severe craniocerebral injury group and serious The other time points were significantly higher than those with limb fracture group third days, the expression level of CGRP of brain injury, the difference was statistically significant (P0.05). The merger between limb fracture group at the same time of severe craniocerebral injury group and severe traumatic brain injury. The expression of CGRP have no obvious difference, the difference was not statistically significant (P0.05) in patients with traumatic brain injury after trauma. The first day to the seventh day the expression level of CGRP was higher than that of the control group (P0.05). The difference was statistically significant.RAMP1 expression in severe craniocerebral injury patients from the first day the expression level of RAMP1 began to increase at third days, the expression level of RAMP1 reached the peak with time gradually decreased. The expression level of RAMP1 of severe craniocerebral injury complicated with limb fracture group also show the same trend, significantly higher than the other time with limb fracture group third days the expression level of RAMP1 in severe craniocerebral injury group and severe craniocerebral injury , the difference was statistically significant (P0.05). The merger between limb fracture group at the same time of severe craniocerebral injury group and severe traumatic brain injury. The expression of RAMP1 have no obvious difference, the difference was not statistically significant (P0.05). Patients with craniocerebral injury after trauma was first ~ seventh days the expression level of RAMP1 was higher than that of control group (P0.05). Significant difference. Conclusion: 1 severe craniocerebral injury and severe craniocerebral injury complicated with limb fracture limb between the expression level of CGRP and.3 showed no significant difference between CGRP positive expression and the prognosis of patients with severe craniocerebral injury fracture is closely related to the expression level of CGRP is higher than that of normal people.2 severe craniocerebral injury group and severe craniocerebral injury.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15;R683

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