脑脊液CXCL12、PDGF及CXCL14水平和变化与视神经炎和视神经脊髓炎的关系

发布时间：2018-01-21 01:28

本文关键词： 趋化因子12 血小板源性生长因子14 视神经炎视神经脊髓炎髓鞘再生　出处：《中国人民解放军医学院》2014年硕士论文　论文类型：学位论文

【摘要】：【背景】视神经炎（ON）泛指累及视神经的炎性脱髓鞘疾病，它可作为视神经脊髓炎（NMO）的首发症状，在临床上早期往往很难将二者区分。有报道称，大约1/2的NMO患者以孤立视神经炎首发，并且约20%以双眼同时发病。NMO病情较重，急性期80%患者视力严重下降（0.1），60%患者在首次发病后7.7年内单眼或双眼视力丧失。近年来，髓鞘再生成为脱髓鞘疾病的研究热点，是脱髓鞘疾病发生后的重要修复方式，因此我们猜测可能是脑脊液（CSF）中某些与髓鞘再生相关的细胞因子，如血小板源性生长因子（PDGF）、趋化因子12（CXCL12）及趋化因子14（CXCL14）的缺乏或增多，从而导致该疾病的不同结果。【目的】通过检测ON和NMO患者脑脊液中CXCL12、PDGF及CXCL14的水平和变化，探索ON和NMO新的生物学标记物，，评估其髓鞘再生能力，为ON和NMO的预后及转归提供实验依据，并为其治疗提供新的思路。【方法】选取2012年9月至2013年9月期间就诊于解放军总医院神经眼科的ON患者35人，NMO患者10人及颅内静脉窦血栓形成（CVST）患者10人，收集其临床资料及脑脊液检测结果。用酶联免疫吸附剂测定（ELISA）方法检测脑脊液中CXCL12、PDGF及CXCL14的浓度。比较不同疾病、ON发病时期、ON磁共振成像扫描（MRI）表现及ON是否复发等脑脊液中CXCL12、PDGF及CXCL14含量的差异，同时对CXCL12、PDGF及CXCL14含量与白细胞数、IgG含量及蛋白含量等参数进行相关性分析。【结果】 ON组和CVST组脑脊液CXCL12、PDGF、CXCL14的水平均明显高于NMO组患者，其中CVST组患者脑脊液CXCL12、PDGF、CXCL14水平高于ON组；ON急性期组和CVST组脑脊液中CXCL12、PDGF水平比ON平稳期组高；35例ON患者中28例进行了颅脑或眼眶磁共振成像（MRI）检查，MRI检查阳性组的患者脑脊液CXCL12及PDGF水平高于阴性组的患者；此外，脑脊液中CXCL12与PDGF水平变化有显著相关性。【结论】脑脊液CXCL12、PDGF及CXCL14水平较低的患者中枢神经系统脱髓鞘更为严重，三者可能成为ON和NMO等中枢神经系统脱髓鞘疾病的新的生物诊断标记物；在ON的不同阶段，监测脑脊液CXCL12和PDGF可以评估其病情变化，判断预后情况；如果在ON急性期之后适当补充CXCL12或促进机体自身合成CXCL12，可能促使视功能更快地恢复；鞘内注射CXCL12和PDGF可能成为治疗中枢神经系统脱髓鞘疾病的新方法。
[Abstract]:[background]
Optic neuritis (ON) refers to the optic nerve involvement of inflammatory demyelinating diseases, it can be used as neuromyelitis optica (NMO) starting in the early clinical symptoms, it is often difficult to distinguish between the two. Reports about 1/2 NMO patients with isolated optic neuritis first, and about 20% in two eyes at the same time.NMO serious illness, serious loss of vision in 80% acute stage (0.1), 60% patients in 7.7 years in monocular or binocular vision loss for the first time after the onset of remyelination. In recent years, become a hot research topic in demyelinating diseases, is an important restoration after the occurrence of demyelinating diseases, so we speculate may be in cerebrospinal fluid (CSF) some remyelination related cytokines, such as platelet-derived growth factor (PDGF), chemokine 12 (CXCL12) and chemokine 14 (CXCL14) deficiency or increased, which lead to different results of the disease.
[Objective]
By detecting the levels and changes of CXCL12, PDGF and CXCL14 in cerebrospinal fluid of ON and NMO patients, we explored new biomarkers of ON and NMO, evaluated their myelin regeneration ability, and provided experimental evidence for prognosis and prognosis of ON and NMO, and provided new ideas for their treatment.
[method]
From September 2012 to September 2013 during the period of treatment in neuro ophthalmology of PLA General Hospital 35 ON patients, 10 NMO patients and cerebral venous sinus thrombosis (CVST) in 10 patients, the clinical data collection and detection. The results of cerebrospinal fluid were determined by enzyme linked immunosorbent assay (ELISA) method in CXCL12 detection of cerebrospinal fluid concentrations of PDGF. And CXCL14. Comparison of different diseases, the incidence of ON during the period of ON, magnetic resonance imaging (MRI) and ON is CXCL12 recurrence in the cerebrospinal fluid, the difference of PDGF and CXCL14 content, while the CXCL12, PDGF and CXCL14 content and the number of white blood cells, the correlation analysis of parameters of IgG content and protein content.
[results]
ON group and CVST group PDGF, cerebrospinal fluid CXCL12, CXCL14 levels were significantly higher than that of group NMO, group CVST PDGF, CXCL14 in cerebrospinal fluid of patients with CXCL12 were higher than ON group; ON group and CVST group in acute phase in cerebrospinal fluid CXCL12, PDGF levels than the ON stationary phase group; 35 cases of ON patients were 28 cases the brain or orbital magnetic resonance imaging (MRI) examination, examination of cerebrospinal fluid in patients with MRI positive group and PDGF negative group was higher than CXCL12 patients; in addition, there was a significant correlation between the changes of CXCL12 and PDGF in cerebrospinal fluid.
[Conclusion]
Cerebrospinal fluid CXCL12, demyelinating central nervous system in patients with PDGF and lower levels of CXCL14 is more serious, the three may be ON and NMO and other demyelinating disease of the central nervous system of new biological diagnostic markers; in different stages of ON, CXCL12 and PDGF can evaluate the monitoring of cerebrospinal fluid changes in their condition, prognosis; if after acute ON supplement CXCL12 or promote the body's own synthesis CXCL12, may cause visual function recover faster; intrathecal injection of CXCL12 and PDGF may become a new method for the treatment of demyelinating disease of the central nervous system.

【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R774.6

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