【作者】 刘宗宝；

【导师】 雷鹏；

【作者基本信息】 兰州大学 ， 外科学， 2009， 硕士

【摘要】 促红细胞生成素(recombinant human erythropoietin,r-huEPO)是一种通过使用重组DNA技术生产的、含有与天然分离的EPO完全相同氨基酸序列的糖蛋白,与天然EPO具有相同的生物学活性。已有不少的基础和临床研究发现r-huEPO在缺血性脑疾病中具有神经保护作用,也有基础研究证实了r-huEPO在颅脑创伤中通过各种机制对神经系统损伤产生保护作用,但临床研究很少报道。本研究以住院治疗的颅脑创伤患者为研究对象,通过双抗体央心酶联免疫(ELISA)法测定对照组、r-huEPO干预组患者血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)、S-100β蛋白、IL-10的表达。并行GCS评分,腰椎穿刺测定颅内压,颅脑CT检查测脑水肿情况,探讨r-huEPO对颅脑创伤患者的神经保护作用,评价其临床效果,为临床寻找新的有效治疗方法提供理论依据。目的:R-huEPO对颅脑创伤患者血清NSE、S-100β蛋白和IL-10表达的影响,并行GCS评分,腰椎穿刺测定颅内压,颅脑CT检查测脑水肿情况,综合评价其对颅脑创伤患者的神经保护作用,使r-huEPO在治疗颅脑创伤方面得出更加准确的结论。方法:纳入2008年3月至9月期间在我院住院治疗的颅脑创伤患者34例,随机分配到对照组与治疗组,其中治疗组于规定时间皮下注射r-huEPO,对照组不予r-huEPO处理,其他处理同治疗组,两组均在研究时间静脉采血,化验血常规、利用双抗体夹心酶联免疫(ELISA)法分析各组NSE、S-100β蛋白和IL-10变化,行GCS评分、颅内压测定、颅脑CT检查测定脑水肿情况。所有数据均用SPSS10.0软件包处理,计量资料用(?)±S表示,组间比较采用t检验,基于时间测量的各组数据采用重复测量设计资料的方差分析,P＜0.05认为有统计学意义。结果:1、伤后1开、4天两组患者血红蛋白差异无统计学意义(P＞0.05)。伤后7、10、14天,治疗组血红蛋白水平基本恢复正常。而对照组仍未恢复至正常水平,两组差异有统计学意义(P＜0.05)。2、伤后1天、4天两组患者血清NSE、S-100β蛋白和IL-10含量差异无统计学意义(P＞0.05)。伤后7、10、14天治疗组患者NSE、S-100β蛋白含量低于对照组(P＜0.05),IL-10含量高于对照组(P＜0.05),两组组间比较差异均有统计学意义(P＜0.05)。3、两组患者治疗前GCS评分、脑水肿情况差异无统计学意义(P＞0.05)。治疗7天及2周后两组比较,两组组间比较差异有统计学意义(P＜0.05)。结论:治疗组患者颅内压及脑水肿较对照组减轻,且GCS评分分值升高;血清S-100β蛋白、NSE含量低于对照组,IL-10含量高于对照组,差异均有统计学意义(P＜0.05)。利用r-huEPO进行红细胞动员,可通过多种机制抑制颅脑创伤后继发的病理损害及其过度炎症反应,对颅脑创伤具有神经保护作用。更多还原

【Abstract】 R-huEPO is a kind of glycoprotein through the use of recombinant DNA technology and contain natural EPO,which is identical to the separation of amino acid sequences.It has the same biological activity with the natural EPO.Many studies have confirmed that r-huEPO has protective effects in nervous system injury through a variety of mechanisms.And also a lot of studies confirmed that r-huEPO has neuroprotective effect in ischemic cerebrovascular diseases in animals. However,very little clinical research confirmed this.In this study, patients with traumatic brain injury as the research objects,Use enzyme-linked immunosorbent assay(ELISA) to measure the expression of NSE,S-100B protein,IL-10 in two groups.And evaluate its clinical effects,in order to find new and effective clinical treatment and provide a theoretical basis.Objective::To discuss the effect of r-huEPO to NSE,S-100B protein and IL-10 on the patients with traumatic brain injury,evaluate its clinical effects.Make r-huEPO in the treatment of traumatic brain injury reach more accurate conclusions.Methods:34 cases were assigned to treatment group and control group randomly.R-huEPO were injected to the treatment group in the study time.In the control group does not deal with r-huEPO,the other dealing with the same group.Check blood routine tests,NSE、S-100B protein and IL-10 were measured using Enzyme-linked immunosorbent Assay(ELISA) analysis in each groups.Check GCS score,intracranial pressure,use brain CT examination to check brain edema situation.All values were expressed as mans±SD,P＜0.05 was considered statistically significant.Statistics were using SPSS 10.0. Results:1、Hemoglobin increased significantly in the treatment group than the control group(P＜0.05).2、The expression of NSE、S-100βprotein in the treatment group were lower than the control group(P＜0.05),IL-10 were higher,the difference were statistically significant.3、The differences of GCS score、brain edema situation were insignificant between the treatment group and the control group before treatment(P＞0.05).It has statistical significaces after 7days and 2 weeks.(P＜0.05).Conclusion:The use of r-huEPO not only enhance the production of red blood cells to increase the oxygen content,are more likely to inhibit the secondary pathological damage and excessive inflammatory response of brain through a variety of mechanisms,which has a protective effect to the nervous system.更多还原