【作者】 庄志军；

【导师】 王如密； 王守森；

【作者基本信息】 福建医科大学 ， 外科学， 2006， 硕士

【摘要】 年龄是影响颅脑损伤预后的重要因素之一，在同类颅脑损伤中，未成年患者的预后通常优于成年患者，而老年颅脑损伤患者预后最差，目前人们对这一临床现象的病理生理学机制还报道甚少。2000年，Clark等报道：Bcl-2基因表达的增强可能是儿童颅脑损伤恢复较好的重要原因之一。2003年，高进喜等报道：液压打击脑损伤后，老龄大鼠脑组织中神经生长因子(NGF)表达和Bcl-2／Bax蛋白表达比率显著降低，并推测这可能是衰老动物颅脑损伤预后不良的重要原因。本研究利用免疫组化以及计算机显微图像分析技术，对老年、成年和未成年患者脑挫裂伤脑组织中的NGF、Bcl-2、Bax蛋白表达差异进行了分析和比较，试图由此探讨年龄对颅脑损伤预后影响的病理生理机制。 目的：研究不同年龄组患者颅脑损伤后脑挫裂伤脑组织中神经生长因子(NGF)和凋亡相关基因(Bcl-2，Bax)蛋白表达差异，探讨年龄因素对颅脑损伤患者预后影响的分子生物学机理。方法：收集临床脑挫裂伤患者手术切除的脑挫裂伤组织，应用免疫组化和数码医学图像分析技术，比较老年组(≥60岁)、成年组(19岁～59岁)和未成年组(≤18岁)患者脑损伤后3小时～9小时脑挫裂伤组织NGF、Bcl-2、Bax蛋白的表达水平的差异。结果：脑损伤后NGF、Bcl-2、Bax蛋白在脑挫裂伤组织中表达明显增强(P＜0.05)；老年组患者脑挫裂伤组织中NGF蛋白表达和Bcl-2／Bax蛋白表达比率显著低于未成年组和成年组(P＜0.05)；成年组患者脑挫裂伤组织中NGF蛋白表达和Bcl-2／Bax蛋白表达比率显著低于未成年组(P＜0.05)。结论：Bcl-2和Bax基因参与了人脑挫裂伤后迟发性神经元死亡(DND)，Bcl-2／Bax比率影响脑挫裂伤后神经元的转归。年龄因素影响创伤性颅脑损伤后患者脑组织中NGF、Bcl-2、Bax蛋白的表达，NGF表达水平下降和Bcl-2／Bax蛋白表达比率降低可能是老年颅脑损伤患者恢复不良的重要原因；而NGF表达水平较高和Bcl-2／Bax蛋白表达比率较高可能是未成年颅脑损伤患者预后较好的重要原因。更多还原

【Abstract】 In clinical studies, it is found that the outcome of traumatic brain injury(TBI) appears to be worsen with increasing age, elderly patients would experience much more neurological deficits, higher cognitive morbidity, slower recovery rates, and higher mortality rates than young patients. In 2000 years, Clark demonstrated that the increase of Bcl-2 gene expression might be an important reason of higher recovery rates in children after TBI. In 2003 years, Gao Jin Xi demonstrated that the expression of NGF, Bcl-2 and Bax protein after fluid percussion brain injury in rat was influenced by aging, the low level of NGF expression and the decrease of Bcl-2/Bax ratio maybe play an important role in the age-related neurological deficits after TBI. We observed brain injury in an effort to elucidate the pathophysiology of this sensitivity, and in particular to determined if there are susceptibility differences in the expression of nerve growth factor(NGF), Bcl-2 and Bax gene in the contusive and lacerated brain tissue of immature, mature and aged patients.Objective: To study the effect of age on the expression of NGF, Bcl-2 and Bax protein after traumatic brain injury(TBI), probing into the molecule biology mechanism of the effect that age brings to the prognosis of TBI patient. Methods: The expression of NGF, Bcl-2 and Bax protein during 3 hours to 9 hours in contusive and lacerated brain tissue of aged group (≥ 60 years), mature group(19 years～59 years) and immature group (≤ 18 years) was analyzed by immunohistochemistry and digital image analysis system. Results: In the contusive and lacerated brain tissue, the expression of NGF, Bcl-2 and Bax protein was increased after TBI in immature 、 mature and aged brain tissue. However, the level of NGF protein and the ratio of Bcl-2/Bax were obviously lower in aged contusive and lacerated brain tissue compared to that of the immature and mature (P<0.05); the level of NGF protein and the ratio of Bcl-2/Bax were obviously lower in mature contusive and lacerated brain tissue compared to that of the immature (P<0.05). Conclusion: Bcl-2 and Bax gene is involved in delayed neuron death after TBI, and the turnover of neuron is influenced by the ratio of Bcl-2/Bax after TBI. The study demonstrated that the expression of NGF, Bcl-2 and Bax protein after TBI was更多还原