胰岛素抵抗、血脂异常与高血压合并脑梗死关系的研究

目的　研究胰岛素抵抗 (IR)、血脂异常与高血压合并脑梗死之间的关系。方法　测定 6 7例高血压合并脑梗死患者 (脑梗死组 33例 ,腔隙性脑梗死组 34例 )的血脂、血糖、血清胰岛素以及胰岛素敏感指数(ISI) ,并与 30名健康对照者进行比较。结果　高血压合并脑梗死患者血脂、血糖、胰岛素、ISI与对照组比较均有显著性差异 (均P <0 .0 1) ,其中腔隙性脑梗死组胰岛素明显高于脑梗死组 (P <0 .0 5 ) ,而ISI较脑梗死组明显减低 (P <0 .0 5 )。结论　高血压合并脑梗死存在IR ,IR可能是其独立危险因素之一。尤其腔隙性脑梗死可能与IR关系更密切     

高胰岛素血症与腔隙性脑梗死的相关性研究

目的 明确高胰岛素血症是否为腔隙性脑梗死的独立危险因素。并探讨其机制。方法 选取41例脑梗死患者，分为腔隙性脑梗死组和大血管病变组，并设立非脑血管病对照组。测定3组的空腹血糖，血脂及空腹血胰岛素等生化指标。采用成组t检验进行统计分析。结果 腔隙性脑梗死组空腹血胰岛素明显高于大血管病变组及对照组。甘油三酯明显高于对照组。结论 高胰岛素血症主要引起脑小血管病变，对大血管影响较小；高胰岛素血症可能是腔隙性脑梗死的独立危险因素；脂质代谢紊乱，特别是甘油三酯水平升高是高胰岛素血症重要致病机制之一。     

缺血性脑卒中患者血浆胰岛素、瘦素水平的改变及其临床意义

目的 探讨缺血性脑卒中患者血浆胰岛素、瘦素水平的改变及其临床意义。方法 测定31例动脉粥样硬化性血栓性脑梗死(ACI)、30例腔隙性脑梗死(LI)患者及21名健康对照者血浆胰岛素、瘦素、血糖及胰岛素敏感指数(ISI)等指标并作比较。结果 ACI组与对照组比胰岛素浓度(6.17±4.33μIU/ml)升高(P<0.05)、胰岛素敏感指数(-3.22±0.79)下降(P<0.05)。LI组与对照组比,无显著性差别(P>0.05)。血浆瘦素水平与胰岛素敏感指数呈负相关(男性r=-0.633、女性r=-0.503,均P<0.001)。伴高血压的男性脑梗死患者血浆瘦素水平显著高于男性对照组(P<0.05)。结论 胰岛素抵抗是ACI患者的危险因素,而高瘦素血症是胰岛素抵抗的重要组成部分。     

高胰岛素血症与腔隙性梗死的关系

目的明确高胰岛素血症为腔隙性梗死的独立危险因素。方法选取30例脑梗死患者，分为腔隙性梗死组和大血管病变组，并设立非脑血管病为对照组，测定3组的4次血胰岛素及血脂等生化指标。采用成组t检验进行统计分析。结果腔隙性梗死组4次血胰岛素明显大于大血管病变组及对照组，甘油三酯明显高于对照组。结论高胰岛素血症主要引起脑小血管病变，对大血管影响较小，高胰岛素血症可能是腔隙性梗死的独立危险因素，脂质代谢紊乱，特别是甘油三酯水平升高是高胰岛素血症重要致病机制之一。     

胰岛素抵抗,高脂血症与急性缺血性脑卒中

目的了解胰岛素抵抗和血脂异常是否是脑梗塞的致病因素。方法对４１例动脉硬化性血栓性脑梗塞（ＡＴＣＩ）、３４例腔隙梗塞、２４例脑栓塞病人急性期作血糖、胰岛素动态测定及血脂、脂蛋白、载脂蛋白测定，并与２３例健康对照组比较。结果三组病人血胰岛素均增高，ＡＴＣＩ、腔隙梗塞组血糖比对照组和脑栓塞组显著增高。增高的血糖、胰岛素随病程进展而逐渐下降。ＡＴＣＩ病人ＴＧ、ＬＤＬＣＨ、ＡｐｏＢ比对照组、脑栓塞组明显增高，ＡｐｏＡ则明显降低。结论ＡＴＣＩ患者急性期存在代偿性高胰岛素血症和应激性高血糖；胰岛素抵抗和血脂异常可能作为一重要病因参与脑梗塞的形成     

脑梗死与代谢综合征的相关性研究

目的 探讨代谢综合征(metabolic syndrome,MS)及其各单一组分危险因素对不同类型脑梗死(cerebral infarction, CI)的影响.方法 选择符合纳入标准的脑梗死454例,其中血栓性脑梗死(cerebral thrombosis,CT)244例,腔隙性脑梗死(lacunar infarct, LI)210例及对照组300例.分析各组MS的患病率,MS及其各单一组分危险因素与不同类型脑梗死的相关性.结果 (1)脑梗死组MS患病率50.22%(228/454),CT组及LI组分别为54.10%(132/244)、45.71%(96/210),均显著高于对照组25.33%(76/300).(2)CT组除肥胖外,MS各单一组分危险因素的患病率均高于对照组,LI组仅高血压、高血糖、甘油三酯(TG)增高及高密度脂蛋白胆固醇(HDL-C)降低的患病率高于对照组,且两类脑梗死的高血糖、高血压患病率有显著差异.(3)调整年龄、性别和其他脑卒中危险因素后,代谢综合征依然增加脑梗死患病的危险,按CDS标准对上述两类脑梗死的OR 值分别为2.84 (95%CI : 1.85～5.62)、2.02 (95%CI: 1.32～4.13).(4)两类脑梗死的胰岛素抵抗指数均(HOMAIR)高于对照组,随着组成MS危险因素的增加,HOMAIR逐渐升高.结论 MS与脑梗死患病危险增加相关,这种关系独立于脑卒中的其他危险因素.MS及其各单一组分的危险因素对不同类型脑梗死所起作用有所差别.MS的发生与胰岛素抵抗有关.     

动脉粥样硬化性脑梗死与胰岛素抵抗的相关性研究

目的探讨胰岛素抵抗与动脉粥样硬化性脑梗死的关系。方法选取动脉粥样硬化性脑梗死患者76例,分为神经功能缺损轻型组和中重型组,健康对照者48例;各组分别检测空腹血糖、空腹血清胰岛素、血脂、尿酸,计算胰岛素敏感指数,采用SPSS软件进行统计学分析。结果动脉粥样硬化性脑梗死组空腹血糖、空腹血清胰岛素、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、胰岛素敏感指数与对照组比较差异均有统计学意义(P<0.05);动脉粥样硬化性脑梗死神经功能缺损,中重型组空腹血糖、空腹血清胰岛素、胰岛素敏感指数与轻型组比较差异均有统计学意义(P<0.05)。结论动脉粥样硬化性脑梗死患者存在胰岛素抵抗,胰岛素抵抗可能是动脉粥样硬化性脑梗死的危险因素;胰岛素抵抗与神经功能缺损的严重程度有关。     

脑卒中急性期血管病与血脂的相关性研究

目的探讨脑卒中患者急性期的血管病变同血脂异常情况的相关性。方法选取脑卒中(脑梗死、脑出血)发病24～48h患者,采空腹静脉血5mL,以全自动的生化分析仪选酶法、酶联免疫法和比浊法对患者血脂测定后分析,并与对照组比较。结果血脂在脑梗死、脑出血组显着高于对照组,差异有统计学意义(P<0.05),在脑梗死、脑出血组间比较差异无统计学意义(P>0.05);动脉粥样硬化性脑梗死或大血管病组血脂各项显著高于对照组,(P<0.05);腔隙性脑梗死或小血管病组除LDL-C、ApoA、ApoB、Lp(a)外余血脂各项显著高于对照组(P<0.05);动脉粥样硬化性脑梗死与腔隙性脑梗死组间比较仅Tc与Lp(a)差异有统计学意义。结论血脂异常为脑血管病变最重要的因素,通过有效控制血脂,能够预防患者脑卒中发生。     

辛伐他汀对腔隙性梗死患者脂代谢的影响

目的比较腔隙性梗死患者与健康对照组血脂的差异及辛伐他汀对脂代谢的影响。方法将30例腔隙性梗死患者作为脑梗死组，30例健康体检者作为对照组，比较两组血脂差异，并观察脑梗组服用辛伐他汀后血脂水平的变化。结果脑梗死组与对照组TC、LDL—C有显著差异（P〈0．05），经辛伐他汀治疗4周后与对照组比较无明显差异（P〉0．05）。结论脂代谢异常是腔隙性梗死的危险因素，辛伐他汀可以改善腔隙性梗死患者的血脂水平。     

腔隙性脑梗死与脉压和脉压指数之间的关系

目的探讨腔隙性脑梗死与脉压和脉压指数之间的关系。方法回顾性分析我院2013-01—12收治的126例高血压患者的临床资料,根据头部CT和MRI检查结果或据MRI检查结果将62例腔隙性脑梗死患者作为观察组,将64例非腔隙性脑梗死组作为对照组,2组患者实施24h动态血压监测。结果观察组的脉压、脉压指数(PPI)和收缩压(SBP)均比对照组升高明显(P0.05)。结论腔隙性脑梗死与脉压、脉压指数及收缩压升高有关,控制血压可以预防腔隙性脑梗死的发生。     

Detection of cerebral degeneration in amyotrophic lateral sclerosis using high-field magnetic resonance spectroscopy

BACKGROUND: Clinical assessment is insensitive to the degree of cerebral involvement in amyotrophic lateral sclerosis (ALS). Regional brain concentrations N-acetylaspartylglutamate (NAA) plus myo-inositol (Ins), as measured by magnetic resonance spectroscopy, are respectively decreased and increased, suggesting that these compounds may provide a biomarker of the degree of cerebral involvement in ALS. OBJECTIVE: To test the hypothesis that the NAA/Ins ratio may provide an index of cerebral involvement in patients with ALS. DESIGN: High-field (3.0-T) magnetic resonance spectroscopy was performed to determine the NAA/creatine plus phosphocreatine (NAA/Cr), NAA/choline (NAA/Cho), Ins/Cr, and NAA/Ins ratios in the motor cortex. PARTICIPANTS: Seventeen patients with ALS and 15 healthy control subjects were studied. RESULTS: In patients with ALS, the greatest abnormality was a 22% decrease in NAA/Ins (71% sensitivity and 93% specificity, P = .001); Ins/Cr was increased 18% (88% sensitivity and 53% specificity, P = .04), NAA/Cr was decreased 10% (88% sensitivity and 47% specificity, P = .04), and NAA/Cho was decreased 14% (53% sensitivity and 87% specificity, P = .047). Correlation of the ALS Functional Rating Scale with NAA/Ins approached statistical significance (R = 0.43, P = .07). CONCLUSION: The NAA/Ins ratio may provide a meaningful biomarker in ALS given its optimal sensitivity and specificity profile.     

增龄相关性脑小血管病谱系的病理基础及其影像学特点

增龄相关性脑小血管病谱系（spectrum o f a ge-related cerebral small vessel diseases， ArCSVDS）是指随着年龄的增长，脑小动脉、微动脉、毛细血管、微静脉、小静脉出现老化的一组脑 小血管病（cerebral small vessel disease，CSVD），包括深穿支动脉病（deep perforating arteriopathy，DPA） 和β淀粉样蛋白（β-amyloid，Aβ）有关的脑淀粉样血管病（cerebral amyloid angiopathy，CAA）。以往的 研究往往将这两种疾病视为独立的实体，然而最近的研究发现，无论从年龄、高血压等相似的脑血 管病危险因素，还是从潜在的相互作用角度出发，DPA与CAA是一组ArCSVDS疾病，血脑屏障（blood brain barrier，BBB）破坏、内皮细胞损伤、血管周围Aβ是连接DPA与CAA的共同发病机制，而且有 30%～68%的患者两者可以重叠发病。     

解偶联蛋白2基因-866G/A,Ala55Val及Ins/Del多态性与宁夏回族人群脑缺血发病风险的相关性研究

目的 探讨UCP2基因多态性在回族人群中的分布特点及UCP2SNP与脑缺血发病风险的相关性。方法 收集宁夏地区回族正常人群及回族脑缺血患者外周血样本,提取外周血基因组DNA,采用聚合酶链反应-限制性片断长度多态性方法检测各样本UCP2基因-866G/A,Ala55Val及Ins/Del多态性。结果 UCP2基因-866G/A,Ala55Val及Ins/Del多态性在宁夏地区回族正常人群与脑缺血患者中分布频率无明显差异(P>0.05)。结论 UCP2多态性与宁夏地区回族脑缺血发病无相关性。     

脑小血管病与眼底血管网络参数的相关性研究

目的利用计算机辅助的全自动眼底照相分析技术,研究脑小血管病与眼底血管网络参数的相关性。方法连续性纳入能坐位行眼底照相的脑小血管病患者80例,大动脉粥样硬化性脑梗死患者41例,比较两组患者的一般临床资料和眼底血管网络参数。同时行logistic回归分析脑小血管病患者的危险因素。结果脑小血管病组在男性比例、吸烟史发生率、血尿酸水平方面均低于大动脉粥样硬化性脑梗死组[(55%vs.75.6%);(20%vs.39%);(308.33±85.30 vs.367.79±113.60)],差异均有统计学意义(P0.05)。脑小血管病组小静脉分支系数和不对称性指数均小于大动脉粥样硬化性脑梗死组,[(1.37±0.04 vs.1.39±0.05);(0.80±0.02 vs.0.81±0.02)],差异均有统计学意义(P0.05)。Logistic回归分析显示,调整血管危险因素后,减小的小静脉不对称性指数与脑小血管病相关,是其危险因素(OR值=1.16,95%CI:1.05-1.38,P0.05)。结论减小的小静脉不对称性指数与脑小血管病相关,是其危险因素,可作为其早期诊断指标。     

Inositol 1,4,5-trisphosphate binding sites in the brain: Regional distribution,characterization, and alterations in brains of patients with Parkinson's disease

[3H]Inositol 1,4,5-trisphosphate [( 3H]Ins-(1,4,5)P3) binding studies were done on the human brain obtained at autopsy. The specific [3H]Ins(1,3,4,5)P3 binding sites in the cerebral and cerebellar cortices consisted of a single component with a high affinity (Kd = 11.3 and 16.5 nM, Bmax = 0.8 and 6.4 pmol/mg protein, respectively). The binding of [3H]Ins(1,4,5)P3 was potently inhibited by Ins(1,4,5)P3, in a nanomolar concentration, while other inositol phosphates and inositol were either much less potent or did not inhibit binding. The binding sites for [3H]Ins(1,4,5)P3 were discretely localized and were in the order: cerebellum much greater than basal ganglia, cerebral cortex greater than rhinencephalon greater than diencephalon, mesencephalon. There was an age-related loss of [3H]Ins(1,4,5)P3 binding in the frontal cortex. In the brains of patients with Parkinson's disease, [3H]Ins(1,4,5)P3 binding sites were reduced by about 50% in the caudate nucleus, putamen, and pallidum, while there were no differences in the frontal cortex, as compared to findings in the age-matched controls. Our findings suggest that [3H]Ins(1,4,5)P3 binding sites are closely linked to neural elements in the human brain.     

Hhcy对脑小血管病患者认知功能的影响

目的探讨高同型半胱氨酸血症(Hhcy)对脑小血管病(SVD)患者认知功能的影响。方法 142例SVD患者根据认知功能分为痴呆组、认知功能障碍非痴呆组、认知功能正常组,测定研究对象血浆同型半胱氨酸(Hcy)水平及MMSE、画钟测验评分。结果 (1)Hcy水平痴呆组明显高于认知功能障碍非痴呆组(P<0.05),认知功能障碍非痴呆组高于认知功能正常组。(2)Logistic回归分析得出Hcy水平升高是小血管病患者认知功能损害的独立危险因素。(3)Hhcy对MMSE总评分、定向功能、语言功能以及反应视空间功能、动作的计划性和执行功能画钟测验均有独立的危险性,其OR值分别为1.044、1.057、1.040、1.251。结论 Hcy水平升高是脑小血管病认知功能损伤的独立危险因素,对总体认知功能、定向功能、语言功能以及视空间功能、动作的计划性和执行功能有独立影响作用。     

Cerebellar DNA and tissue water changes in the brain of diabetes insipidus brattleboro rats are already present at birth

Homozygous (HOM) Brattleboro rat newborns, congenitally lacking vasopressin, weighed less than heterozygous controls born from HOM females and reared as 9-pup litters. Whole brain and specific brain regions (cerebral cortex, medulla oblongata and colliculi but not the cerebellum) were also reduced in weight. Decreased tissue water content was observed in the regions affected in weight. In the cerebellum, on the other hand, a 20% lower DNA content was measured, which points to a prenatal origin for the impaired cerebellar neurogenesis which is known to exist postnatally.     

颈内动脉系统短暂性脑缺血发作患者颅内血管狭窄程度和ABCD2评分与近期预后的关系

目的探讨颈内动脉系统短暂性脑缺血发作(TIA)患者颅内血管狭窄和ABCD2评分与近期预后的关系。方法对64例颈内动脉系统TIA患者行MRI、MR血管成像(MRA)检查及ABCD2评分,并分析其与近期预后的关系。结果 MRA结果显示,47例(73.4%)患者有不同程度的颅内血管狭窄或闭塞,其中正常或轻度狭窄组37例,中度狭窄组16例及重度狭窄组11例;根据ABCD2评分结果,低危组22例,中-高危组42例。发病7 d内14例(21.9%)发生脑梗死,中度狭窄组(12.5%)及重度狭窄组(7.81%)脑梗死发生率显著高于正常及轻度血管狭窄组(1.6%)(均P<0.05)。中-高危组中重度血管狭窄率及脑梗死发生率显著高于低危组(均P<0.05)。结论颈内动脉系统TIA患者颅内血管狭窄程度及ABCD2评分对TIA的近期预后评估有重要的意义。     

Body mass index and risk of stroke mortality among a random sample of Japanese adults: 19-year follow-up of NIPPON DATA80

BACKGROUND: The relationship between body mass index (BMI) and stroke mortality remains unclear. The aim of the present study was to elucidate the relationship between BMI and stroke death in a representative cohort of Japanese men and women. METHODS: We analyzed a database of 9,526 men and women aged 30 years and older who were randomly selected throughout Japan in 1980. These individuals had no history of stroke and were followed for 19 years. Hazard ratios (HR) and their 95% confidence intervals (CI) of deaths due to total stroke, cerebral infarction, and intracerebral hemorrhage were examined using Cox's proportional hazards regression models of BMI levels. RESULTS: A U-shaped association between BMI and cerebral infarction mortality was observed. Participants with the highest BMI category (BMI > or = 30.0) showed a significantly highest HR for cerebral infarction (HR 2.46, 95% CI 1.01-5.99). The excess risk at the lower extreme of the BMI was confined to men. These associations did not change after excluding deaths occurring in the first 2 years of follow-up. CONCLUSIONS: In the Japanese general population, a U-shaped association between BMI and cerebral infarction mortality was found and the excess risk at the lower extreme of the BMI was confined to men.     

Impaired development of individual cerebellar lobules in the diabetes insipidus Brattleboro rat

The size differences in the midsagittal cerebellum, its individual lobules and its layers are studied in homozygous diabetic (HOM) and heterozygous Brattleboro rats on postnatal days 12, 24 and 180. As has been reported for total cerebellar weight, no significant reduction in cerebellar size in HOM rats occurs at day 12, whereas from day 12 onwards the cerebellar growth in HOM rats is significantly stunted. The HOM cerebellum shows a particular structural etiology: not all cerebellar lobules are equally affected and in 180-day-old rats a sexually dimorphic effect is found.