p53基因多态性和脑外伤预后及临床意义

目的：研究颅脑外伤患者中P53等位基因与基因型的频率分布,探讨其与脑损伤预后的关联性,为脑损伤患者预后提供部分参数依据。方法：选择各型颅脑损伤患者141例,正常对照者144人,患者按GCS格拉斯哥评分法进行分类;采用PCR基因型检测法检测P53等位基因,基因计数法计算等位基因频率;统计学分析等位基因和基因型在脑外伤组与正常对照组、预后良好组与预后不良组的频率分布的差异,并综合分析患者年龄、性别、GCS以及P53各等位基因等因素对脑外伤患者预后的影响。结果：在颅脑外伤患者和正常对照者中P53等位基因和基因型的频率分布,差异均无统计学意义（P〉0.05）;等位基因Arg相对于Pro的OR为1.140,基因型Arg/Pro、Arg/Arg相对于Pro/Pro的OR分别为0.890和1.170。在重型脑外伤患者（3≤GCS≤8分）86例中,预后良好31例,预后不良55例,基因型对预后不良的影响：非Pro/Pro相对于Pro/Pro的OR为0.417,非Arg/Pro相对于Arg/Pro的OR为0.419,非Arg/Arg相对于Arg/Arg的OR为3.667。在所有脑外伤患者中,预后良好组和预后不良组的患者年龄、性别差异均无统计学意义（P〉0.05）;GCS、P53等位基因差异具有显著统计学意义（P〈0.01）。结论：在重型颅脑患者中,基因型Arg/Arg有增加预后不良的风险;脑外伤预后与患者的年龄、性别无关联,与GCS、P53基因密切相关。

Research on the Relevance between P53 Gene Polymorphism and Brain Injury Prognosis and its Mechanism

Objective： Research in P53 allele and genotype frequency distribution in patients with craniocerebral trauma;discussed its relationship with brain damage prognosis;to provide some parameters according for the prognosis of patients with brain damage.Methods： Selected patients with craniocerebral injury 141 cases,normal controls were 144 people;classified according to the GCS Glasgow grading method;inspected P53 alleles by PCR genotype assay;calculated the allele frequency by gene counting method;by Statistical analysis,the differences alleles or genotype frequency distribution between traumatic brain injuries group and normal control group are analyzed,also between the prognosis good group and bad group;and comprehensive analysis the influence on the prognosis of patients with traumatic brain injuries by several factors such as age,sex,patient GCS and P53 alleles.Results： P53 alleles and genotype frequency distribution shows no statistically significant difference（P0.05） between patients with craniocerebral trauma and normal controls.OR for alleles Arg relative to the Pro is 1.140;OR for genotype Arg/Pro or Arg/Arg relative to Pro/Pro is respectively 0.890 and 1.170.In 86 cases patients with severe brain injury（3≤GCS≤8）,of 31 cases in good prognosis group and 55 cases in poor prognosis group;OR for the genotype non-Pro/Pro relative to Pro/Pro is 0.417,non-Arg/Pro relative to Arg/Pro is 0.419,non-Arg/Arg relative to Arg/Arg is 3.677.In all brain injury patients,the differences of patients age and gender between good prognosis group and poor prognosis group were not statistically significant（P0.05）;The differences of GCS and P53 alleles were statistically significant（P0.01）.Conclusion： Alleles Arg or genotype Arg/Arg is increasing brain trauma and risk of poor prognosis.The prognosis of patients with traumatic brain injuries has no relationship with age or sex;closely related with GCS,P53 gene.