舌下神经-面神经吻合术结合神经营养因子-3基因治疗完全性面瘫的实验研究

Hypoglossal- facial nerve reconstruction combined with NT- 3 gene therapy for complete facial palsy

目的观察舌下神经一面神经吻合术结合神经营养因子-3（NT-3）基因治疗完全性面瘫的治疗效果。方法30只大鼠分为四组，A组：对照组，不做任何处理；B组：离断面神经后不做任何处理；C组：移植预变性腓浅神经；D组：移植NT-3感染的预变性腓浅神经。鼻尖偏离指数实验检测面容对称性；神经电生理检测肌动作电位；荧光显微镜观察病毒载体转染效率；实时荧光定量PCR法检测NT-3mRNA表达。结果鼻尖偏离指数实验检测0l角度，D组比C组a角恢复明显（P〈0．01）；肌动作电位检测D组的振幅和峰面积值明显高于C组（P〈0．05）。实时荧光定量PCR法检测术后1周时神经移植物中D组NT-3mRNA表达量是c组GFP表达量的10倍，术后4个月时是4倍。结论舌下神经-面神经吻合术结合NT-3基因治疗，可促进舌下神经纤维再生和髓鞘形成，加速面瘫肌肉功能恢复。

Objective To study the hypoglossal -facial nerve anastomosis combined with neurotrophic factor gene therapy for the treatment of complete facial palsy in adult rats after facial nerve injury. Methods 30 adult male Fisher 344 rats were grouped into A （intact）, B （injury）, C （reconstruction） and D （reconstruction combined with NT- 3 gene therapy）. The treatment outcomes were assessed by the angle ot analysis and electrophysiological examination. The expression of NT - 3 gene was measured by the quantitative RT -PCR and the viral vector transduction was assessed through the fluorescence microscope. Resdts The group D was found a higher recovery of facial symmetry compared to group C （ P 〈 0. 01 ）. The NT- 3 mRNA expression in group D was 10 -fold higher than that measured in group C after 1 week of transduction. A reduction in NT -3 mRNA expression was detected in group D 4 months after transplantation from a 10 - fold increase to a 4 - fold increase compared with group C. MAPs displayed significantly greater amplitude and surface values in group D compared with group C （ P 〈 0. 05 ）. Conclusions The combination of hypoglossal - facial nerve anastomosis and NT - 3 gene therapy was promising for its potential application in treating facial palsy in humans.