载脂蛋白E基因多态性对脊髓损伤患者预后的影响

发布时间：2018-01-23 08:31

本文关键词： 脊髓损伤载脂蛋白E 基因多态性康复评定　出处：《昆明医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨载脂蛋白E (ApoE)基因多态性对脊髓损伤患者预后的影响及相关性。方法：1、采用限制性片段长度多态性聚合酶链反应(PCR-RFLP)和基因测序法,对2014年3月-2015年2月就诊于昆明医科大学第二附属医院康复科的50例脊髓损伤患者进行ApoE基因型检测；2、根据患者的损伤程度、脊柱稳定状况及肢体功能等具体情况,对所有患者进行综合康复治疗,采用药物、营养神经及改善微循环治疗,呼吸训练、肌力训练、牵拉、耐力训练、平衡训练、关节活动范围训练、转移训练、轮椅操作及技巧训练、日常生活活动能力训练等康复治疗,对不同损伤节段患者佩戴不同的矫形肢具配合治疗。治疗频度：每日1次,每周5次。3、对入选患者按ASIA脊髓损伤分类标准进行综合评估。患者分别于入院时、治疗1个月后进行综合评估,观察其ASIA脊髓损伤程度、轻触觉、针刺觉评分,运动评分及日常生活活动能力(FIM)等方面的变化；4、采用SPSS 17.0软件对ApoE基因分型结果和各项功能评估结果的变化情况进行分析,分析ApoE基因多态性对脊髓损伤康复治疗效果的影响。结果：1、实际收集病例47例,ApoE基因型检测结果：ApoE ε 3/3型频率最高(68%),ε2/3(15%)和ε3/4(11%)次之,ε4/4(2%)及ε2/2最少,患者中ApoE ε 4携带者8例(17%),非携带者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点。2, ASIA评分变化：所有患者治疗后1个月与治疗前比较,轻触觉、针刺觉及运动评分均有改善,统计学处理差异有显著性(P0.05)；运动评分比较,ApoE ε 4携带组恢复情况较ε4非携带组稍差,差异有统计学意义；而轻触觉和针刺觉恢复情况,两组之间比较差异无统计学意义(P0.05)。3、日常生活活动能力(ADL)评定：两组患者FIM评分较治疗前1月均有提高,ApoE ε4携带者较￡4非携带者恢复情况差,两组间比较差异有统计学意义(P0.05)。结论：1、脊髓损伤患者神经功能的恢复与ApoE基因多态性相关,但其具体的分子机制和详细的作用还有待进一步的研究。本研究可为未来开展基因治疗脊髓损伤提供依据。2、携带ApoEε4的脊髓损伤患者运动功能和日常生活能力恢复情况较差,在轻触觉和针刺觉的恢复方面ApoEε4携带者和非携带者没有显著差异。3、在临床治疗过程中,对ApoEε4等位基因携带的脊髓损伤患者,注意加强其运动功能的康复训练,促进其运动能力和日常生活能力的恢复。
[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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.2

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