| Objective:From the medical perspective,traumatic brain injury is the primary brain injury caused by external force in the head,resulting in the damage of blood vessels,nerve tissue and other tissues of the brain,manifested as their own functional loss and other disfunction subject to its dominance.Secondary brain damage is the mass effect and inflammatory response caused by tissue edema after brain issue damage,including inflammatory exudation,vascular permeability changes,etc.Secondary injury and primary injury interact with each other and further cause serious consequences of brain damage.CGRP,which consisted of 37 amino acid residues,was a major gene fragment selected from the calcitonin gene by Rosenfeld using molecular cloning technology in 1982.As an important neurogenic vasoactive peptide,CGRP can increase the blood flow significantly in the ischemic area by dilating the blood vessels,to a certain extent reduce the size of the infarct caused by ischemia,and improve the adverse effects of early vasospasm.CGRP can stimulate the growth of vascular endothelial cells,improve vascular endothelial cell damage,and therefore promote blood vessel self-repairing,enhance the basement membrane,and thus prevent the blood-brain barrier dysfunction,playing a protective role for nerve tissue.Related studies have discovered that patients of severe traumatic brain injury(TBI)with limb fractures have an elevated CGRP levels in the serum.Another study found that CGRP expression was significantly higher in the injured brain stem in the mouse cortical shock model;other related studies also reported that in the experimental model of brain injury in mice,the expression level of CGRP from the beginning of injury 2 hours began to grow gradually,reached peak on day 2.And then gradually decreased to the normalbrain tissue level before injury.there was some controversy among different researchers on the expression of CGRP after TBI.Method:Divide patients into groups,establish records,sign informed consent and then conduct study.Divided patients into experimental group and control group.The experimental group was divided into 20 cases of TBI group and 20 cases of TBI plus fracture group.Classification criteria: 1.Have clear brain trauma or brain trauma with limb fractures;2.No obvious indications of operation,shall conduct routine examination;3.Patients and their families agreed to conservative treatment;4.No meningoencephalitis;5.No other severe organs combined with disease.The patients were hospitalized to establish a database of vital signs,GCS scores,blood oxygen,blood glucose,and imaging data.For the patients without operation indications,routine ICU care;for the patients whose GCS less than or equal to 8 points,take blood samples in D1,D3,D5,and D7.All patients were immediately phlebotomized into the sterile tube containing anticoagulant after grouping.Collect serum in4 degrees 1500 g centrifuged after20 minutes,and reserve in-80 degrees for preservation.Test the levels of CGRP and human receptor activity modifying protein RAMP1 xpression by ELISA method,and analyze the correlation between the above data and patient prognosis.Blood samples from the control group were obtained from the normal healthy subjects(20 cases).Analyze overall difference between groups adopting the method of single factor analysis of variance using SPSS13.0 statistical software.The calculation of data shall be in the form of mean + standard deviation.Adopting T test,which uses multiple comparisons between the mean of multi samples,and with P <0.05 as a test Standard,for the difference was statistically significant.Result:CGRP expression level: the level of CGRP expression in the patients with severe traumatic brain injury began to increase from the first day,and the expression level of CGRP reached a peak on the third day,and then decreased gradually with the prolongation of time.Severe traumatic brain injury combined with limb fractures group also indicated the same trend.The level of CGRP expression in the severe traumatic brain injury group andsevere traumatic brain injury with limb fractures group was significantly higher than that in other time points.The difference was statistically significant(P <0.05).There was no significant difference in the expression level of CGRP between the severe traumatic brain injury group and the severe traumatic brain injury with limb fractures group.The difference was not statistically significant(P> 0.05).The mean expression level of CGRP was higher in the traumatic brain injury patients than that in the control group(P<0.05)from D1 to D7 after external damage.The differences were statistically significant.RAMP1 expression level: RAMP1 expression level began to increase from day 1 in severe traumatic brain injury group,reached peak at day 3 and then decreased gradually with time.Severe traumatic brain injury combined with limb fractures group also indicated the same trend.The expression of RAMP1 in severe traumatic brain injury group and severe traumatic brain injury with limb fractures group in D3 was significantly higher than that in other time points.The difference was statistically significant(P <0.05)There was no significant difference in the expression of RAMP1 between the severe traumatic brain injury group and the severe traumatic brain injury group with limb fractures group.The difference was not statistically significant(P> 0.05).The mean expression level of RAMP1 was higher in the patients with traumatic brain injury than that in the control group(P <0.05)D1 to D7 after external damage.The differences were statistically significant.Conclusions:1 The expression of CGRP in severe traumatic brain injury and severe traumatic brain injury with limb fractures was higher than that in normal subjects.2 There was no significant difference in the expression of CGRP between severe traumatic brain injury group and severe traumatic brain injury with limb fractures group.3 The positive expression level of CGRP was closely related to the prognosis of patients with severe traumatic brain injury. |
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