神经生长因子对神经损伤后修复及结构重建的实验与临床研究

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1、中图分类号：硕士学位论文神经生长因子对神经损伤后修复及结构重建的实验与临床研究院（系）、所临床医学院研究生姓名张沛学科、专业神经病学导师姓名高励教授二Ο一二年四月目录1神经生长因子对神经损伤后修复及结构重建的实验与临床研究„„„„„„„„„„„„„„„„„„„„„„„„11.1中文摘要„„„„„„„„„„„„„„„„„„„„„31.2英文摘要„„„„„„„„„„„„„„„„„„„„„51.3前言„„„„„„„„„„„„„„„„„„„„„„„91.4材料与方法„„„„„„„„„„„„„„„„„„„

2、„111.5结果„„„„„„„„„„„„„„„„„„„„„„„151.6讨论„„„„„„„„„„„„„„„„„„„„„„„281.7结论„„„„„„„„„„„„„„„„„„„„„„„38优点与缺点„„„„„„„„„„„„„„„„„„„„391.81.9参考文献„„„„„„„„„„„„„„„„„„„„„401.10英汉缩略词对照表„„„„„„„„„„„„„„„„„442致谢„„„„„„„„„„„„„„„„„„„„„„„453神经生长因子对神经损伤后修复及结构重建的实验与临床研究（综述）„„„„„„

3、„„„„„„„„„„„„„„462神经生长因子对神经损伤后修复及结构重建的实验与临床研究摘要目的：结合大鼠坐骨神经损伤后神经修复，同期进行临床病例疗效观察，以期得到神经生长因子神经损伤修复动物模型疗效与临床疗效间相关性，给临床实践用药提供有益的参考。方法：用动物实验和临床实验进行研究。动物实验是将大鼠随机分为正常对照组、生理盐水组、维生素B1B12组、神经生长因子组四个组，除正常对照组外，其余各组均用0.5%戊巴比妥钠按30mg/kg腹腔内麻醉，进行神经电生理、神经行为学观测，并做大鼠坐骨神经光

4、镜HE染色和硝酸银染色。用大鼠坐骨神经传导速度及病理切片镜下形态作为观察指标。用SPSS13.0进行方差分析和最小显著差数分析法，正常组与干预组之间两两比较及各干预组之间两两比较。临床实验是以成都市第三人民医院神经内科2011年1月～12月收治的240例神经系统损伤患者为研究对象,在常规治疗基础上加神经生长因子肌肉注射，其中糖尿病周围神经损伤、特发性面神经麻痹、阿尔茨海默病、帕金森氏病各60例。用SPSS13.0进行卡方检验、独立样本t检验和配对t检验。结果：动物实验中，神经生长因子组电生理改善

5、明显高于其他组；维生素组电生理改善高于生理盐水组和正常组；生理盐水组和正常组电生理改善差异无统计学意义。大鼠坐骨神经病理切片观察到，正常对照组神经束100%连续，髓鞘100%完整，髓鞘无变性，间质炎症+，间质出血+；生理盐水组神经束20%连续，髓鞘20%完整，髓鞘80%变性，间质炎症++++，间质出血++++；维生素组神经束50%连续，髓鞘50%完整，髓鞘50%变性，间质炎症+++，间质出血+++；神经生长因子组神经束90%连续，髓鞘90%完整，髓鞘10%变性，3间质炎症++，间质出血++。临床

6、实验中，糖尿病周围神经病变治疗后改善情况采用独立样本t检验，对照组和治疗组之间差别有统计学意义；特发性面神经麻痹口轮匝肌患侧、健侧治疗后改善情况采用独立样本t检验，对照组和治疗组之间患侧差别有统计学意义，健侧差别无统计学意义；阿尔茨海默病治疗后改善情况采用独立样本t检验，对照组和治疗组之间差别有统计学意义；帕金森病治疗后改善情况采用独立样本t检验，对照组和治疗组之间差别有统计学意义。结论：病理观察发现，神经生长因子组神经束连续情况及髓鞘完整情况明显优于维生素组及生理盐水组，而髓鞘变性及间质炎症情

7、况则明显少于维生素组及生理盐水组。大鼠坐骨神经损伤后，给予神经生长因子、维生素B1B12及生理盐水分别干预后，经方差分析，并用LSD法进行两两比较，神经生长因子组电生理改善明显高于其他组，维生素组电生理改善高于生理盐水组和正常组，生理盐水组和正常组电生理改善差异无统计学意义。240例患糖尿病周围神经病变、特发性面神经麻痹、阿尔茨海默病及帕金森病患者，随机分组后，与对照组相比较，神经生长因子组疗效有统计学意义（P＜0.05），表明基础治疗虽有一定的疗效，但加用NGF治疗可显著促进神经损伤的恢复。关

8、键词：神经生长因子；神经损伤后修复；阿尔茨海默病4TheRepairoftheNerveGrowthFactoronNerveInjuryandtheStructuralReconstructionExperimentalandClinicalStudiesAbstract:objective:Tocombinetheexperimentoftheratnerverepairafteritssciaticnerveinjurywiththeobservationoftheefficacyofcl