MMP-2和TIMP-2在腹股沟疝患者腹直肌前鞘中的表达及意义

发布时间：2018-03-04 11:00

本文选题：腹股沟疝　切入点：MMP-2基因　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景与目的腹股沟疝是常见的普通外科疾病。据调查,腹股沟疝的病发率为3-5‰,而在60岁以上男性中,其病发率可高达l~5%。迄今为止,腹股沟疝的明确病因依然不清楚。多年来人们一致认为,腹腔内压的升高和腹壁强度的降低是腹股沟疝发生的两个主要病因。近些年,有学者从生化角度探求腹股沟疝的病因,研究发现:腹股沟疝患者体内结缔组织中I型胶原蛋白含量偏低、III型胶原蛋白含量相对升高,I/III型胶原蛋白比例失调,使腹股沟后壁腹横筋膜薄弱甚至缺损,最终引起腹股沟疝疾病发生,结果显示胶原代谢紊乱与腹股沟疝的发生密切相关。胶原蛋白是细胞外基质(ECM)中最主要的成分之一。其代谢主要受MMPs、TIMPs(MMPs的抑制因子)的共同调节。目前,MMP-2、TIMP-2与腹股沟疝发生的关系研究,国际与国内报道甚少,有学者仅用免疫组化及RT-PCR方法研究报告结果。本试验研究应用实时荧光定量PCR(Real-time quantitative polymerase chain reaction,Real-Time PCR)技术,来探究和分析MMP-2 m RNA、TIMP-2 m RNA在腹股沟疝病人腹直肌前鞘中的表达与腹股沟疝发生的关系,从生物化学角度进一步探讨腹股沟疝的病因,为之后研究该病的病机提供理论基础,及为后续的临床治疗提供理论依据。材料与方法本实验设有实验组和对照组,两组均为男性手术患者。组织标本取自从2016年2月至2016年11月在我院行手术治疗患者,取材部位:均为下腹部腹直肌前鞘,面积为5mm*10mm。所有病例取材前均已取得当地伦理委员会批准,并且得到患者自己的同意。实验组:腹股沟疝患者48例,其中包括斜疝组32例,直疝组16例。对照组:无疝患者10例,组织标本取自接受其他下腹部手术的病人。吸烟者定为:每日吸烟l0支,烟龄10年。实验组与对照组共58例中,吸烟者19例,非吸烟者39例。家族史:直系亲属中有两人以上(包括患者本人)患有腹股沟疝者为有家族史,家族包括祖父母、外祖父母、父母、兄弟姐妹、子女以及孙子女。实验组与对照组共58例中,其中有家族史者6例,无家族史者52例。排除标准:两组中正在接受甾体类激素、其它免疫抑制剂治疗患者(包括肿瘤化疗)、有局部炎症病史者、糖尿病及结缔组织病患者等均应排除。用Real-Time PCR技术检测腹股沟疝患者腹直肌前鞘中MMP-2、TIMP-2m RNA的表达水平。所得数据运用统计软件SPSS21.0进行处理,计量均数用均数±标准差(x±s)表示。数据的相关分析采用Pearson方法,多组间均数比较应用单因素方差分析,采用t检验对两组间均数进行比较,α=0.05为检验水准,即P0.05认为差异有统计学意义。结果1.实验组(直疝组、斜疝组)和对照组中MMP-2 m RNA及TIMP-2 m RNA的表达。MMP-2 m RNA的表达:对照组为1.530±0.612。直疝组为3.098±1.289,与对照组比较P=0.035(0.05),差异有统计学意义。斜疝组为2.221±0.962,与对照组比较P=0.401(0.05),差异无统计学意义。直疝组与斜疝组比较P=0.016(0.05),差异有统计学意义。TIMP-2 m RNA的表达:对照组为1.021±0.395。直疝组为0.641±0.308,与对照组比较P=0.024(0.05),差异有统计学意义。斜疝组为0.687±0.324,与对照组比较P=0.608(0.05),差异无统计学意义。直疝组与斜疝组比较P=0.019(0.05),差异有统计学意义。2.吸烟者与非吸烟者中MMP-2 m RNA及TIMP-2 m RNA的表达。MMP-2m RNA的表达:吸烟组为2.710±1.058,呈高表达。非吸烟组为1.704±0.556,呈低表达。二者比较(t=3.241)p=0.005(0.05),差异有统计学意义。TIMP-2 m RNA的表达:吸烟组为0.628±0.223,呈低表达。非吸烟组为0.783±0.394,呈高表达。二者比较(t=2.489)p=0.023(0.05),差异有统计学意义。3.有家族史者与无家族史者中MMP-2 m RNA及TIMP-2 m RNA的表达。MMP-2 m RNA的表达:有家族史者为3.358±1.054,呈高表达。无家族史者为3.019±1.476,呈低表达。二者比较(t=1.391)p=0.032(0.05),差异有统计学意义。TIMP-2 m RNA的表达:有家族史者为0.507±0.224,呈低表达。无家族史者为0.758±0.358,呈高表达。二者比较(t=2.376)p=0.014(0.05),差异有统计学意义。结论1.腹股沟直疝患者腹直肌前鞘中MMP-2 m RNA呈高表达,TIMP-2 m RNA呈低表达,表明两者同时参与了胶原代谢的过程,并与腹股沟直疝的形成显著相关。与腹股沟斜疝的发生发展无明显关系,而斜疝的发生可能与鞘状突学说等其他因素有关。2.在吸烟者中MMP-2 m RNA表达较高、TIMP-2 m RNA表达较低,表明吸烟是腹股沟疝发生的重要因素之一。3.有家族史者MMP-2 m RNA呈高表达、TIMP-2 m RNA呈低表达,表明腹股沟疝的发生与遗传因素有关。
[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.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.21

【相似文献】