血清白细胞介素-2和白细胞介素-4水平与卒中后抑郁的相关性

目的探讨急性脑梗死(ACI)患者早期血清白细胞介素-2(IL-2)和白细胞介素-4(IL-4)水平与卒中后抑郁(PSD)的关系。方法选择2018年2月10日至3月10日新乡医学院第一附属医院收治的80例ACI患者为研究对象,所有患者入院后随访3个月,根据汉密尔顿抑郁量表(HAMD)评分将患者分为PSD组(HAMD评分≥8分,n=43)和非PSD组(HAMD评分≤7分,n=37)。43例PSD患者中,轻度PSD 19例(轻度PSD组),中重度PSD 24例(中重度PSD组)。另选择同期进行健康体检者40例为对照组。ACI患者于入院第7天、对照组受试者于体检当日抽取空腹静脉血5 m L,采用酶联免疫吸附法(ELISA)检测血清IL-2和IL-4水平,对各组受试者血清IL-2及IL-4水平进行比较;采用受试者工作特征曲线(ROC)评价血清IL-2和IL-4水平预测PSD的敏感度和特异度,计算Youden指数,确定最佳截断值;采用线性相关分析血清IL-2和IL-4水平与PSD患者HAMD评分的相关性。结果 PSD组和非PSD组患者血清IL-2水平显著低于对照组,IL-4水平显著高于对照组(P <0. 01); PSD组患者血清IL-2水平显著低于非PSD组,IL-4水平显著高于非PSD组(P <0. 01)。中重度PSD组患者血清IL-2水平显著低于轻度PSD组,IL-4水平显著高于轻度PSD组(P <0. 01)。轻度PSD组和中重度PSD组患者NIHSS评分显著高于非PSD组(P <0. 01);中重度PSD组患者NIHSS评分显著高于轻度PSD组(P <0. 01)。ROC曲线分析显示,IL-2曲线下面积为0. 752(95%可信区间:0. 605～0. 899,P <0. 05),IL-2水平为7. 68μg·L-1时获得最大Youden指数0. 487,血清IL-2水平预测PSD的敏感度为75. 0%,特异度为26. 3%。IL-4曲线下面积为0. 706(95%可信区间:0. 541～0. 871,P <0. 05),IL-4水平为38. 38μg·L-1时获得最大Youden指数0. 529,血清IL-4水平预测PSD的敏感度为79. 2%,特异度26. 3%。血清IL-2水平与PSD患者HAMD评分呈显著负相关(r=-0. 773,P <0. 01),血清IL-4水平与PSD患者HAMD评分呈显著正相关(r=0. 764,P <0. 01)。结论 PSD患者血清IL-2水平降低,IL-4水平升高;血清IL-2水平与PSD患者抑郁程度呈负相关,血清IL-4水平与PSD患者抑郁程度呈正相关;血清IL-2和IL-4水平可在一定程度上预测ACI患者发生PSD的可能性。     

疏肝泻火汤治疗气郁化火型脑卒中后抑郁的临床疗效分析

  目的  探讨疏肝泻火汤治疗气郁化火型脑卒中后抑郁(PSD)的临床疗效。  方法  将浙江中医药大学附属温州中医院2017年8月—2019年12月期间治疗的120例气郁化火型PSD患者纳入研究,按照随机数字表法分为观察组和对照组,每组60例。对照组患者应用盐酸舍曲林片治疗,观察组患者应用疏肝泻火汤治疗,治疗周期为6周,随访观察2组患者HAMD评分、NIHSS评分、Barthel指数评分及中医症候评分,并对2组患者治疗期间不良反应发生情况进行比较分析。  结果  (1) 2组患者治疗前HAMD评分、NIHSS评分、Barthel指数评分及中医症候评分之间差异无统计学意义(均P＞0.05),治疗后均有所改善,且观察组改善程度显著优于对照组,差异有统计学意义(t_HAMD评分=-2.467,P=0.015;t_NIHSS评分=-5.707,P＜0.001;t_{Barthel指数评分}=36.258,P＜0.001;t_{中医症候评分}= -7.267,P＜0.001);(2)观察组患者治疗期间不良反应发生率为8.33%,对照组为10.00%,2组相比差异无统计学意义(χ2=0.100,P=0.752)。  结论  疏肝泻火汤治疗气郁化火型PSD疗效较好,在改善患者抑郁症状的基础上,对其神经功能康复具有一定作用,进一步提高患者生活质量,且治疗过程中未见严重药物不良反应和药物成瘾性。      

脑卒中后抑郁状态的临床观察

目的:观察脑卒中后抑郁的发生率及相关因素。方法:对169例诊断为急性脑卒中的患者,在入院后2、4周分别进行汉密尔顿抑郁量表(HAMD)、欧洲脑卒中量表(ESS)评分和日常生活能力评定(BI指数评定)。结果:脑卒中后抑郁67例,发生率为39.6%。其中轻度抑郁41例,占59.4%,中度抑郁23例,占33.3%;重度抑郁5例,占7.2%;病灶部位与卒中后抑郁有直接关系:提示基底带区病变患者易发生PSD,PSD发生与左右侧大脑半球病变无关;其BI指数评分显著高于无抑郁状态的患者,而且抑郁程度与神经功能缺损呈正相关。结论:卒中后抑郁是脑卒中常见的并发症,脑卒中后抑郁的发生与生物学、心理和社会因素有关。应高度重视脑卒中后抑郁的发生。     

老年急性缺血性脑卒中患者衰弱与卒中后抑郁的相关性研究

背景　随着我国人口老龄化进程的不断加剧,老年脑卒中患者的数量也逐年增加,卒中后抑郁（PSD）作为脑卒中的常见并发症之一,目前尚缺乏有意义的预测指标。目的　分析老年急性缺血性脑卒中患者衰弱与PSD的相关性,为早期临床评估及干预提供参考依据。方法　选取2017年6-12月在商丘市第一人民医院全科医学科、神经内科住院的符合研究标准的急性缺血性脑卒中患者118例。收集患者的一般资料〔性别,年龄,体质指数（BMI）,吸烟、饮酒情况,高血压、糖尿病、高脂血症、心房颤动发生情况〕、临床资料〔疾病共存（共存疾病≥5种）情况、入院时美国国立卫生研究院卒中量表（NIHSS）评分及改良Rankin量表（mRS）评分、TOAST分型〕。依据患者入院后24 h内衰弱筛查量表（FRAIL）评分分为无衰弱组（n=85,FRAIL评分<3分）和衰弱组（n=33,FRAIL评分≥3分）;依据患者发病后随访6~12个月时的美国精神病学会《精神障碍诊断与统计手册》第四版（DSM-Ⅳ）及汉密尔顿抑郁量表（HAMD）将患者分为无PSD组（n=73,HAMD评分<7分）和PSD组（n=45,HAMD评分≥7分）。采用多因素Logistic回归分析进行老年急性缺血性脑卒中患者发生衰弱、PSD的影响因素分析。结果　多因素Logistic回归分析结果显示,年龄〔OR=1.131,95%CI（1.055,1.211）,P<0.001〕和入院时mRS评分〔OR=4.626,95%CI（2.027,10.561）,P<0.001〕是老年急性缺血性脑卒中患者发生衰弱的影响因素;年龄〔OR=1.060,95%CI（1.005,1.118）,P=0.031〕、衰弱〔OR=2.855,95%CI（1.144,7.126）,P=0.025〕是老年急性缺血性脑卒中患者发生PSD的影响因素。无衰弱组患者 25例（29.4%）发生PSD,衰弱组患者 20例（60.6%）发生PSD,衰弱组患者PSD发生率高于无衰弱组（P=0.002）。随着PSD程度的增加,老年急性缺血性脑卒中患者衰弱发生率无明显趋势变化,差异无统计学意义（P>0.05）。结论　老年急性缺血性脑卒中患者的年龄、衰弱情况与其发生PSD密切相关,及时对其进行衰弱评估可预测PSD发生风险。     

老年脑卒中患者血清皮质醇水平与卒中后抑郁的相关性研究

目的 探讨老年脑卒中患者血清皮质醇水平与卒中后抑郁(PSD)是否具有相关性.方法 对41例老年卒中患者在发病后2周进行血清皮质醇检测,并在发病后3月对患者进行抑郁量表评定,观察皮质醇正常组以及皮质醇增高组卒中后抑郁发生率,并进行卡方检验,同时对各组内皮质醇水平和抑郁程度进行相关性分析.结果 皮质醇正常组和皮质醇增高组PSD发生率差异有显著性(χ2=4.11;P <0.05),皮质醇正常组平均汉密尔顿分值为(15.29±7.28)分,皮质醇增高组为(25.85±10.81)分,2组差异有显著性( P <0.01).皮质醇正常组皮质醇水平与抑郁程度无明显相关( r =0.295;P =0.194),皮质醇增高组皮质醇水平与抑郁程度明显相关( r =0.702;P =0.001).结论 老年人脑卒中后早期皮质醇水平增高提示患者发生抑郁可能性增大,检测皮质醇可以为PSD防治提供理论依据据.     

首次脑卒中后抑郁临床研究

目的:探讨首次脑卒中后抑郁(post-stroke depression,PSD)的发生率及其危险因素,为卒中后抑郁的干预及方法提供依据.方法:连续入组的发病72 h内入院的急性脑卒中患者127例,根据入院14d内汉密尔顿抑郁量表(17项)评分分为PSD组和非PSD组,分析并比较PSD与性别、婚姻状况、年龄、文化程度、卒中类型、病灶部位、高血压、糖尿病、冠心病、吸烟、饮酒、体质量指数(BMI)、卒中家族史、颈动脉斑块、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)和简易精神状态检查(MMSE)量表评分等临床因素的关系.结果:本组PSD发生率为36.2%(46例).PSD组男性、脑梗死比率、伴高血压病比率、伴糖尿病比率及伴冠心病比率、入院时BI明显低于非PSD 组(P<0.05或0.01).结论:脑卒中急性期患者PSD的发生率较高,男性、脑梗死、合并高血压、糖尿病、冠心病和入院时BI是PSD的独立危险因素.     

早期康复护理对急性脑卒中患者抑郁状态的影响

目的探讨早期康复护理对急性脑卒中患者抑郁状态(PSD)的影响。方法对61例首发脑卒中患者随机分成两组:康复组31例采用康复护理和心理疏导;对照组30例为常规护理组。观察两组患者住院期间发生抑郁状态的情况。结果两组SDS评分,入院时比较差异无统计学意义(t=0.92,P(0.05),而入院2周及4周时康复组SDS评分低于对照组,差异有统计学意义(t=2.38,3.44,P<0.05)。结论早期康复护理干预能能明显改善卒中患者的抑郁状态,改善预后。     

卒中后抑郁与卒中复发风险间的关联性

目的探讨卒中后抑郁(post-stroke depression,PSD)与卒中复发风险的关系。方法搜集2016年10月-2017年11月在华北理工大学附属医院住院治疗的急性缺血性脑卒中患者282例,采用汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评估PSD抑郁程度;采用卒中后抑郁预测量表,根据卒中患者发病一周内的临床指标,评估PSD抑郁风险;根据患者的临床资料对其进行Essen卒中复发风险量表(Essen Stroke Risk Score,ESRS)评分,按ESRS评分将患者分为卒中复发低危组(0-2分)及高危组(≥3分)。分析PSD及PSD风险与ESRS卒中复发风险评分的关系。结果 (1)卒中复发风险高危组与低危组年龄、高血压等比较差异有统计学意义(均P0.05);两组间性别、吸烟差异无统计学意义(均P0.05)。(2)卒中复发风险高危组与低危组空腹血糖比较差异有统计学意义(P0.05);两组间血清总胆红素、直接胆红素、甘油三酯等生化指标比较差异均无统计学意义(均P0.05)。(3)卒中复发风险高危组与低危组HAMD评分、PSD预测量表评分比较差异有统计学意义(P0.05)。(4)Pearson直线相关分析显示,HAMD评分与ESRS评分呈正相关(r=0.322,P0.05);PSD预测量表评分与ESRS评分呈正相关(r=0.597,P0.05)。结论 PSD与缺血性脑卒中复发风险间具有一定的关联性,在缺血性脑卒中二级预防中应予以重视。     

脑微出血与急性缺血性卒中后抑郁的相关性

目的: 探讨脑微出血与急性缺血性卒中患者卒中后抑郁(post stroke depression, PSD)的相关性。方法: 回顾性纳入初发或复发急性缺血性脑卒中患者,记录患者入院时的人口学及临床基线资料,纳入患者均入院3 d内完成头颅MRI检查,根据脑微出血位置将患者分为脑叶、深部和后颅窝(脑干和小脑)组,并记录每个部位的脑微出血总数。随访3个月时根据抑郁诊断标准分为PSD组和非PSD组,采用多元Logistic回归分析脑微出血与PSD的相关性。结果： 最终入组并完成随访者203例,其中PSD组67例,非PSD 组136例。单因素分析显示,受教育年限、基线NIHSS评分、3个月MMSE评分、3个月LSNS评分、额叶、深部以及脑干脑微出血、前额叶急性脑梗死与PSD发生显著相关(P均<0.05)。多因素回归分析显示,对相关因素调整后,深部(OR=2.091, 95%CI 1.061~4.138,P=0.036)以及脑干脑微出血(OR=2.235,95%CI 1.179~4.587,P=0.031)与PSD发生具有独立相关性;基线NHISS评分(OR=1.174, 95%CI=1.008~1.346,P=0.041),前额叶急性脑梗死(OR 4.326, 95%CI=1.074~14.371,P=0.045)也与PSD发生独立相关。结论： 在轻中度急性缺血性卒中患者中,脑干和深部脑微出血是缺血性脑卒中3个月发生PSD的独立危险因素。     

脑卒中后抑郁患者辅助性T细胞相关细胞因子水平变化及其临床意义

目的探讨脑卒中后抑郁(PSD)患者血清白细胞介素-2(IL-2)、白细胞介素-10(IL-10)、白细胞介素-17a(IL-17a)及干扰素-γ(IFN-γ)水平变化及其临床意义。方法选取2016年2～10月新乡医学院第一附属医院神经内科住院治疗的63例脑卒中患者为研究对象,所有患者均完成相应影像学检查,并给予常规内科治疗。根据汉密尔顿抑郁量表评分(HAMD)将患者分为PSD组(HAMD评分≥8) 30例和非PSD组(HAMD评分≤7) 33例,另选择同期在本院体检的性别、年龄相匹配的健康者30例为对照组;流式细胞术检测3组受试者血清IL-2、IL-10、IL-17a及IFN-γ的表达水平。结果 PSD组和非PSD组患者治疗后30、90 d血清IL-2、IL-10、IL-17a及IFN-γ表达水平高于对照组(P <0. 05)。PSD组和非PSD组患者治疗后90 d血清IL-2、IL-10、IL-17a及IFN-γ表达水平高于治疗后30 d(P <0. 05)。PSD组患者治疗后30、90 d血清IL-2、IL-10、IL-17a及IFN-γ表达水平高于非PSD组(P <0. 05)。中重度PSD患者治疗后90 d血清IL-2、IL-10、IL-17a及IFN-γ水平显著高于轻度PSD患者(P <0. 05)。结论血清IL-2、IL-10、IL-17a及IFN-γ在PSD患者血清中呈高表达,且与PSD患者抑郁程度相关。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.     

Development Is A High Level Inheritance for China Time-honored Brand Products

<正>As culture is the soul of a nation,the three books,"History of Chinese Philosophy,""History of Chinese Culture"and"History of Chinese Science and Technology"have demonstrated the superiority of our great Chinese culture,and its significant impact in the field of international culture.Both core value and practical value of the Chinese culture are very clear,reflected in the views of universe,nature,life,health,disease,and therapy and related considerations,concepts,and technical methods.