强制性运动对脑缺血大鼠运动功能和脑内ERK表达的影响

发布时间：2018-10-10 16:12

【摘要】：第一部分强制性运动对脑缺血大鼠运动功能和脑内ERK表达的影响目的：研究强制性运动(constraint-induced movement therapy, CIMT)对脑缺血大鼠脑内细胞外调解蛋白激酶(extracellular regulated protein kinase, ERK)表达的影响,同时观察强制性运动后脑缺血大鼠前肢肢体功能的恢复情况。方法：将45只SD大鼠随机分为3组,分为假手术组、对照组及实验组(每组各15只)。对照组及实验组行大脑中动脉梗塞手术(middle cerebral artery occlusion, MCAO)。在MCAO术后第7天,实验组和假手术组大鼠以石膏固定健侧前肢进行强制性运动训练。在术前(d0),术后第7天(d7),术后第22天(d22)进行前肢功能评估。在术后第22天,测定梗死体积、ERK表达量和BrdU标记的新生神经细胞。所得的结果进行三组间比较。结果：在部分大鼠上观察到石膏强制限制后肢体有局部肿胀、关节僵硬等不良反应。使用石膏法强制限制健肢对大鼠体重增长造成一定损伤,可能是由于负重运动的原因。与对照组相比,实验组错步率显著降低,平衡木行走能力提高。实验组、对照组和假手术组在造模后第22天脑梗死体积分别为18.22%±8.29%、17.68%±6.45%和-1.32%±4.12%。实验组、对照组与假手术组比较,差异有统计学意义(p0.01),但实验组与对照组间差异无统计学意义。在术后第22天时,三组间总ERK表达量差异无统计学意义；而p-ERK在对照组的双侧海马和皮层中显著升高,与其他两组比较差异有统计学意义,实验组p-ERK与假手术组相近。免疫荧光显示,BrdU标记的新生神经细胞在实验组中可能较对照组多,但需进一步统计论证。结论：强制性运动可以明显提高患侧前肢的运动功能,并能降低双侧皮层和海马区p-ERK表达水平,可能与肢体功能恢复有关。第二部分脑出血后规范三级康复治疗对上肢痉挛和上肢功能的影响目的：研究脑出血后规范三级康复治疗对上肢痉挛和上肢功能的影响。方法：将364例脑出血患者随机分为对照组(n=181)和康复组(n=183)。康复组进行规范的三级康复治疗,包括早期床旁康复介入、恢复期在康复专科病房治疗、后期定期康复家访指导；对照组未进行规范的三级康复治疗。在入组时(Mo)、治疗1个月(M1)、3个月(M3)和6个月(M6)时对患侧上肢进行改良Ashworth评定(MAS)和Fugl-Meyer评定,对结果进行统计分析。结果：两组患者的基线资料差异无统计学意义。入组时,两组痉挛的发生率均约为23%,在M6时,康复组痉挛发生率为43%,对照组为60%。在M6时,两组MAS分布和评分差异均有统计学意义(p0.05)。两组Fugl-Meyer评分随时间均显著提高,差异有统计学意义(p0.05)。在M1、M3和M6时,康复组评分均高于对照组(康复组分别为24.71±19.80,39.83±19.50和48.87+18.25；对照组分别为17.13±16.46,24.87±18.36和30.68±19.41,p0.05)。结论：脑出血后进行规范三级康复治疗有助于减轻上肢痉挛程度,显著改善上肢功能。
[Abstract]:Part one the effect of compulsory exercise on motor function and ERK expression in the brain of rats with cerebral ischemia objective: to study the effect of mandatory exercise (constraint-induced movement therapy, CIMT) on the expression of extracellular protein kinase (ECK) (extracellular regulated protein kinase, ERK) in the brain of rats with cerebral ischemia. At the same time, the recovery of forelimb function in rats with cerebral ischemia after compulsory exercise was observed. Methods: 45 SD rats were randomly divided into 3 groups: sham operation group, control group and experimental group (15 rats in each group). (middle cerebral artery occlusion, MCAO). Of middle cerebral artery infarction in control group and experimental group On the 7th day after MCAO, the rats in the experimental group and sham operation group were trained with gypsum to immobilize the healthy forelimbs. Forelimb function was evaluated preoperatively (day 0), postoperative day 7 (day 7) and postoperative day 22 (day 22). On the 22nd day after operation, infarct volume, ERK expression and BrdU labeled neonate neurons were measured. The results were compared among the three groups. Results: local swelling and joint stiffness were observed in some rats. The use of gypsum to restrict the weight gain of healthy limbs may be due to weight-bearing exercise. Compared with the control group, the staggered rate of the experimental group was significantly reduced, and the walking ability of the balance beam was improved. The infarct volume of experimental group, control group and sham operation group were 18.22% 卤8.29 卤17.68% 卤6.45% and -1.32% 卤4.12% respectively. There was significant difference between the experimental group and the sham operation group (p0.01), but there was no significant difference between the experimental group and the control group. On the 22nd day after operation, there was no significant difference in total ERK expression among the three groups, but p-ERK was significantly increased in the bilateral hippocampus and cortex of the control group, which was significantly higher than that in the other two groups. P-ERK in the experimental group was similar to that in the sham operation group. Immunofluorescence showed that the number of BrdU labeled neonate neurons in the experimental group may be more than that in the control group, but further statistical proof is needed. Conclusion: compulsory exercise can significantly improve the motor function of the affected forelimb and decrease the expression of p-ERK in bilateral cortex and hippocampus, which may be related to the recovery of limb function. The second part: the effect of standard tertiary rehabilitation on upper limb spasm and upper limb function after intracerebral hemorrhage objective: to study the effect of standard three stage rehabilitation treatment on upper limb spasm and upper limb function after cerebral hemorrhage. Methods: 364 patients with intracerebral hemorrhage were randomly divided into control group (n = 181) and rehabilitation group (n = 183). The rehabilitation group received standard three-level rehabilitation treatment, including early bedside rehabilitation intervention, convalescent treatment in the rehabilitation specialized ward, and regular rehabilitation home visit guidance in the later stage, while the control group did not carry out the standard three-level rehabilitation therapy. (MAS) and Fugl-Meyer were evaluated by modified Ashworth at 1 month (M1), 3 months (M3) and 6 months (M6) after (Mo), treatment. The results were statistically analyzed. Results: there was no significant difference in baseline data between the two groups. The incidence of spasms in both groups was about 23. At M6, the incidence of spasms was 43 in the rehabilitation group and 60 in the control group. At M 6, there were significant differences in MAS distribution and score between the two groups (p0. 05). The Fugl-Meyer score of the two groups increased significantly with time, and the difference was statistically significant (p 0.05). At M1M3 and M6, the scores in the rehabilitation group were higher than those in the control group (24.71 卤19.80,39.83 卤19.50 and 48.87.18.25, respectively; in the control group, 17.13 卤16.46, 24.87 卤18.36 and 30.68 卤19.41, p0.05, respectively). Conclusion: standard three-level rehabilitation therapy after intracerebral hemorrhage is helpful to reduce the degree of upper limb spasm and improve the function of upper limb.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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