血管性帕金森综合征患者血浆β-内啡肽的变化及其临床意义

目的　探讨血管性帕金森综合征 (VP)患者血浆β-内啡肽 (β- EP)的变化及其临床意义。方法　采用放射免疫法 (RIA)检测 42例 VP、35例帕金森病 (PD)、30例多发性脑梗死 (MCI)患者及 30名正常对照者血浆β- EP含量并对照分析。结果　 1VP与 PD组血浆β- EP含量较 MCI及正常对照组明显降低 (P<0 .0 5 )。 2 VP组血浆β- EP含量降低不如 PD组明显 ,但差别不明显 (P>0 .0 5 )。 3高龄、病情重、伴痴呆和抑郁的 VP患者 ,血浆β- EP含量降得更明显 (P<0 .0 5 )。 4MCI组血浆β- EP含量较正常对照组低 ,差别亦不明显 (P>0 .0 5 )。结论　 VP患者血浆β- EP含量明显降低 ,其机理可能与基底节区 MCI导致多巴胺系统功能降低、慢性脑血管病脂质过氧化和自由基损伤、免疫功能异常、应激能力减弱和炎症反应有关。其意义在于判断病情程度、监测疾病进展、估计预后及指导治疗。     

纳络酮对脑梗死患者血浆神经肽Y、β-内啡肽含量的影响及其促抑郁作用的观察

目的 探讨纳络酮对脑梗死患者血浆神经肽Y（NPY）、β－内啡肽（β-EP）含量的影响及其促抑郁的作用。方法 采用放免法测定70例不伴抑郁症的脑梗死患者治疗前后血浆NPY、β－EP水平并评定治疗后抑郁症的发病情况。结果 纳络酮治疗组发生抑郁11例，常规治疗组发生抑郁3例。纳络酮组治疗后的血浆NPY及β－EP水平低于对照组（P＜0．01）。结论 纳络酮能改变血浆NPY、β－EP水平，有促抑郁作用。     

帕金森病患者的事件相关电位研究

为探讨帕金森病（PD）患者认识功能障碍的电生理改变，分别对32例PD非痴呆患者，30例PD痴呆患者及28例健康人的事件相关电位（ERP）进行了分析。结果显示PD痴呆患者N2，P3潜伏期明显延长（P＜0．05），P3。潜伏期与其简易精神状态量表评分存在显著位负相关（P＜0．05）．另外，0对PD痴呆患者ERP及CT的对比研究表明，PD痴呆患者ERP阳性检出率高于CT。认为ERP能客观地反映出PD痴呆患者认知功能的损害．     

偏头痛患者血浆和脑脊液中甲硫氨酸脑啡肽及β-内啡肽的变化

为探讨偏头痛与甲硫氨酸脑啡肽（MEK）和β-内啡肽（β-EP）含量变化的关系,检测了30例偏头痛患者血浆及脑脊液MEK、β-EP在同一偏头痛患者不同时期的含量及21例健康正常人血浆MEK、β-EP的含量,做统计学处理。结果发现：偏头痛患者脑脊液中MEK、β-EP含量的变化与血浆的变化基本一致;偏头痛患者间歇期MEK浓度显著低于发作期（P＜0．001）及健康对照组（P＜0．001）;β-EP含量普遍降低,在无先兆性偏头痛（COM）组发作期明显低于间歇期（P＜0．05）;同时发现间歇期血浆β-EP含量在COM与健康组相似,在先兆性偏头痛（CLM）组则有较明显降低。结果表明：偏头痛患者存在鸦片类肽系统紊乱,MEK降低可导致偏头痛发作;β-EP含量减少可能是偏头痛发作的诱因之一,偏头痛发作与β-EP进一步降低有关。     

帕金森病患者的抑郁及其相关因素

目的：探讨帕金森病（PD）患者的抑郁发生及相关因素。方法：对50例PD和40例糖尿病（对照组）患者,用汉密顿抑郁量表（HAMD）调查抑郁的发生情况及症状特点。结果：PD组抑郁发生率（485）明显高于对照组（10％）（P＜0．005）,PD组轻度抑郁占58％,中－重度抑郁占42％,抑郁病人病情统一评级标准（UPDS）平均分值57．14;无抑郁病人为35．47（P＜0．01）,Hoehn-YahrⅢ期以上发生抑郁占645;病程＞5年的抑郁发生率为69％,病程＜5年的抑制发生率为11％（P＜0．001）。结论PD患者中有较高的抑郁发生率,其与PD症状严重程度密切相关,病程长者发生率更高。     

多发性脑梗死性痴呆及脑梗死患者血清载脂蛋E测定及意义

目的 检测多发性脑梗死性痴呆（MID）及脑梗死（CI）患者血清载脂蛋白E（ApoE)含量，探讨ApoE测定的临床意义。方法 选取20例、24例CI患者及24例正常对照者，分别运用单克隆抗体ELISA法测定血清ApoE含量，同时测定血清TC、TG、HDL－C、LDL－C、ApoA和ApoB含量，并进行相关分析。结果 与对照组比较，MID和CI患者血清ApoE,ApoB及LDL－C含量显著升高（P＜0．05），HDL－C和ApoA含量显著降低（P＜0．01），TC及TG含量升高，但无统计学意义（P＞0．05）。结论 MID和CI患者均有脂代谢异常，血清ApoE可作为检测其脂代谢异常的重要指标。     

纳洛酮治疗急性脑梗死48例临床分析

目的 观察急性脑梗死患者血浆β－内啡肽变化和纳洛酮的治疗效果。方法 将我院1999年6月－2000年12月住院的98例急性脑梗死患者分成两组，治疗前后分别采取空腹静脉血2ml，用放免法检测β－EP的含量，同时对患者的神经系统功能缺失进行评分，评价临床疗效。结果 （1）治疗组总有效率89．58％，对照组总有效率58％，治疗组的疗效明显高于对照组（P＜0．01）。（2）急性期2组患者血浆β-内啡肽均升高，随着临床症状的好转，β－EP含量均有明显下降，治疗组下降更为明显（P＜0．01）。结论 纳洛酮应早期应用，其作用迅速、疗效好，价格低廉，且无不良反应。     

脑内牛磺酸含量的降低可减弱针刺抗脑缺血作用

目的：用β－丙氨酸（β-Alanine,β-Ala）降低脑内牛磺酸（Taurine,Tau）含量后，在大鼠大脑中动脉栓塞／再灌模型上观察了Tau含量的降低对脑缺血及针刺抗脑缺血作用的影响。方法：脑组织匀浆内Tau含量应用高压毛细管电泳－电化学检测法检测。结果：（1）β-Ala使大脑皮质，海马，纹状体Tau含量比正常组分别降低了55．9％，52．05％和31．62％。（2）Tau含量的降低未加重脑缺血损伤：牛磺酸未消耗鼠与牛磺酸消耗鼠的缺血组相比，脑梗死面积及细胞残存率未见显著差别，（3）电针对脑缺血损伤具有明显的保护效应；牛磺酸朱消耗鼠中，缺血＋针刺组比单纯缺血组梗死面积减小（P＜0．05），纹状体细胞残率增大（P＜0．05）。（4）牛磺酸消耗后，电针的抗脑缺血损伤作用显著减弱，与牛磺酸未消耗鼠缺血＋电针组相比，脑梗死面积增大（P＜0．05），纹状体细胞残存率降低（P＜0．05）。结论：牛磺酸可能在针刺的抗脑缺血效应中发挥重要作用。     

梗死面积及出血量不同的急性脑血管病患者血浆D—二聚体水平及其临床意义

目的 探讨梗死面积及出血量不同的脑血管病（CVD）患者血浆D－二聚体（D－D）水平及其临床意义。方法 对206例急性CVD患者进行血浆D－D含量测定,并与对照组比较。结果 （1）脑梗死、腔隙性脑梗死、大量及小量脑出血患者血浆D－D水平显著高于对照组（P＜0．01）。（2）脑梗死组血浆D－D含量显著高于腔隙性脑梗死组（P＜0．05）。（3）大量脑出血与小量脑出血组、脑梗死与大量脑出血之间血浆D－D水平比较均无显著性差异（P＞0．05）。（4）小时脑出血患者血浆D－D含量显著高于腔隙性脑梗死组（P＜0．05）。结论 D－D可作为急性CVD一个比较特异的指标,对临床鉴别小量出血与腔隙性脑梗死有一定的帮助。     

脑白质疏松症患者认知功能与血浆生长抑素含量的变化

目的 探讨脑白质疏松症（LA）患者认知功能和血浆生长抑素（SS）含量的关系。方法 研究对象分为LA痴呆组26例,LA非痴呆组47例和正常对照组38例。3组均接受长谷川痴呆量表（HDS）评定及血浆SS含量的检测。结果 与对照组比较,LA患者（包括痴呆组和非痴呆组）HDS评分和血浆SS含量均明显下降（均P＜0．001）;LA痴呆组与LA非痴呆组比较,HDS评分也明显下降（P＜0．001）;血浆SS含量虽有下降,但没有显著差异（P＞0．05）。结论 LA可影响认知功能,在患者尚未发生痴呆之前,血浆SS含量就已下降,推测LA患者认知功能障碍可能与体内SS下降有关。     

Cardiovascular and renin responses to head-up tilt tests in parkinsonism

Objectives - We investigated cardiovascular and renin responses to head-up tilt tests in patients with Parkinson's disease (PD), multiple system atrophy (MSA), and in controls to determine variables for the assignment of parkinsonism to the potential underlying neurologic condition. Patients and methods - Sequential changes in sympathetic-mediated circulatory variables such as heart rate, blood pressure, and plasma renin concentration during head-up tilt tests were studied in 14 patients with PD and 11 patients with MSA. Twelve subjects with normal autonomic functions were studied as controls. Results - Head-up tilt resulted in significant differences in blood pressure and heart rate responses between PD, MSA, and controls. The baseline plasma renin concentration was significantly lower in MSA than in controls. Twenty min head-up tilt revealed significant differences in plasma renin concentration between PD, MSA, and controls. Conclusion - We conclude that investigating sequential changes in mean arterial blood pressure, heart rate, and plasma renin concentration during head-up tilt test can potentially support differential diagnosis of PD and MSA.     

Resistance of beta-endorphin to dexamethasone inhibition in Parkinson's and Alzheimer's diseases.

The response of plasma beta-endorphin (beta-EP) to dexamethasone suppression was studied in 14 patients with Alzheimer's disease (AD), 14 patients with Parkinson's disease (PD), and 13 age-matched controls in order to evaluate whether an impairment of the opiate system is present in these neurodegenerative disorders. Basal circulating beta-EP was in normal range in all subjects, although the mean concentration was slightly reduced in the patients compared to controls. After 1 mg dexamethasone given at 11:00 p.m. the night before, plasma beta-EP concentration measured at 08:00 a.m. and 04:00 p.m. was not inhibited in AD and PD patients while it was significantly reduced in controls. Circulating ACTH and cortisol were similar in patients and controls and a normal inhibition of plasma cortisol after dexamethasone was observed in 13/14 AD and 12/14 PD patients. The resistance of beta-EP to dexamethasone inhibition is consistent with previous clinical and experimental data indicating a disorder of the opiate system in brain degenerative diseases.     

原发性帕金森病患者的血浆尿酸水平分析

目的：探讨帕金森病（PD）患者的血浆尿酸（UA）水平,以及血浆UA水平与PD病程长短、病情程度分级间的关系。方法：采用回顾性调查,以2000至2008年在温州医学院附属第二医院神经内科住院治疗的汉族PD患者239例中符合入选标准的55例PD患者为PD组（排除可能影响尿酸代谢的其他疾病）,另设对照组55例（非PD患者）。检测病例组和对照组的身高、体重、血浆UA等指标。结果：PD组血浆UA水平[（260±49）lamol·L^-1]明显低干对照组[（324±48）μmo·L^-1]（P〈0．001）。PD病情分级和病程长短与血浆UA水平均无明显相关。PD组体重指数（BMI）较对照组低,差异有统计学意义（P〈0．05）,但PD组BMI与UA两者间无明显相关性。结论：PD患者血浆UA水平降低,且低血浆UA水平存在于病程的各个阶段,提示低血浆UA水平可能与PD的发病机制关系密切。     

Cabergoline scavenges peroxynitrite enhanced by l-DOPA therapy in patients with Parkinson''s disease

Long-term or high-dose L-DOPA therapy in patients with Parkinson's disease (PD) may accelerate degeneration of dopaminergic neurons, possibly by increasing oxidative stress. To investigate the effects of cabergoline on peroxynitrite-mediated oxidative damage caused by L-DOPA, the concentration of 3-nitrotyrosine in cerebrospinal fluid (CSF) of 18 PD patients was compared with that in 20 normal controls. The concentration of 3-nitrotyrosine in patients following L-DOPA therapy was significantly higher than in untreated PD patients and controls. On the other hand, the concentration in PD patients after cabergoline therapy was significantly lower than in PD patients after L-DOPA therapy alone. These data suggest that cabergoline scavenges peroxynitrite induced by L-DOPA in patients with PD.     

Hydroxyl radical and superoxide dismutase in blood of patients with Parkinson's disease: relationship to clinical data

Hydroxyl radical (·OH) levels in blood, superoxide dismutase (SOD) activity in plasma (plasma-SOD) and in red blood cells (RBC) relative to Cu,Zn-SOD (SOD1) protein (RBC-SOD/SOD1), SOD1 protein in RBC (SOD1/RBC) and plasma (SOD1/plasma), and Mn-SOD protein in plasma (SOD2/plasma) were measured in patients with Parkinson’s disease (PD), multiple-system atrophy (MSA) with parkinsonism, and in control subjects. Patients with PD had significantly higher ·OH and plasma-SOD values and significantly lower RBC-SOD/SOD1 and SOD1/RBC values than the corresponding MSA and control values. In PD, RBC-SOD/SOD1 values were significantly lower in older patients and were negatively correlated with age. ·OH levels were significantly higher in PD patients with early onset, a long period of illness or severe Yahr stage, and were negatively correlated with onset and positively correlated with duration of illness. RBC-SOD/SOD1 values in PD patients who received pergolide therapy were significantly higher than those in PD patients who received neither pergolide nor bromocriptine therapy. Therefore, the higher ·OH level and the lower SOD1 activity may play a role in the onset and progression of PD, and pergolide may act neuroprotectively by inducing SOD1 activity.     

焦虑症的生化病理机制探讨

目的：从神经递质与神经内分泌角度探讨焦虑症的生化病理机制。方法：采用高效液相色谱法及放射免疫测定法，分别测定25例焦虑症患者和28例正常对照者血小板5—羟色胺(5—HT)含量及血浆催乳素(PRL)含量、地塞米松抑制实验(DST)皮质醇含量。结果：广泛性焦虑(GAD)组血小板5—HT水平高于正常对照组，惊恐障碍(PD)组与正常对照组无显著差异；GAD组与对照组血浆PRL均极显著低于PD组；GAD组与PD组血浆基础皮质醇含量均显著高于正常对照组，两组DST阳性率均为20％，正常对照组为14．3％，3组阳性率无显著性差异；汉密尔顿焦虑量表(HAMA)评分与血浆皮质醇浓度呈显著正相关。结论：焦虑症患者存在神经递质和神经内分泌功能的紊乱，但不同亚型间可能存在不同的病理机制，皮质醇浓度可能是焦虑水平的标志因子。     

抑郁症患者单胺类神经递质与血脂的相关性

目的：探讨抑郁症患者血浆单胺类神经递质与血脂的关系。方法：检测55例抑郁症患者和21例正常人的血浆去甲肾上腺素(NE)、5—羟色胺(5—HT)、血清总胆固醉(CH0)、甘油三酯(TG)、高密度脂蛋白—胆固醇(HDL-C)和低密度脂蛋白—胆固醇(LDL-C)。结果：抑郁症患者的血浆5—HT浓度和血清CH0浓度显著低于正常对照组，血浆NE浓度显著高于正常对照组；抑郁症患者的血浆5-HT浓度和血清CH0浓度呈显著正相关，血浆NE浓度与血清HDL-C浓度呈显著正相关。结论：抑郁症患者的血脂代谢异常与血浆单胺类神经递质有关。     

偏头痛患者血中神经肽含量的观察

目的　观察偏头痛患者血中代表交感、副交感及感觉神经系统的神经肽以及内源性类阿片肽的变化。方法　用放射免疫分析的方法 ,对三批共 15 6例偏头痛患者血浆中 β-内啡肽 (β- EP)、神经肽 Y(NPY)、P物质 (SP)、血管活性肠肽 (VIP)、降钙素基因相关肽 (CGRP)、亮啡肽 (L EK)及强啡肽 A(Dyn A)含量进行了测定。结果　与对照组 (β- EP40 7.5± 2 5 7.4ng/ L,NPY2 6 .38± 15 .99ng/ L,CGRP110 .10± 49.6 0 ng/ L,SP2 2 7.6 5± 10 9.45 ng/ L,VIP173.0 0± 12 4.75 ng/ L)相比 ,头痛间歇期患者 β- EP降低 (2 39.0± 15 6 .4ng/L,P<0 .0 1) ,NPY升高 (35 .5 5± 17.98ng/ L,P <0 .0 5 ) ;头痛缓解 4天内的患者 CGRP(82 .45± 6 3.5 0 ng/L,P<0 .0 5 )、SP(16 3.95± 95 .90 ng/ L,P<0 .0 5 )、VIP(116 .15± 79.45 ng/ L,P<0 .0 5 )降低。病人组的 L EK与 CGRP含量变化呈正相关 (r=0 .342 6 ,P<0 .0 5 )。结论　感觉、交感及副交感神经系统均参与偏头痛的发病 ,在此过程中有多种与血管舒缩有关的肽类含量改变 ,同时伴有部分内源性阿片肽的相关变化及 β- EP的降低。     

Free radical toxicity and antioxidants in Parkinson's disease

Erythrocyte lipid peroxidation, oxidative hemolysis, erythrocyte antioxidant enzymes, viz. superoxide dismutase, glutathione reductase, glutathione peroxidase, catalase and plasma antioxidants, viz. vitamin A, vitamin E, vitamin C and ceruloplasmin have been determined by spectrophotometric methods in 15 patients with Parkinson's disease (PD) and in 50 controls. Lipid peroxidation, oxidative hemolysis and plasma ceruloplasmin were significantly higher in PD patients as compared to normals. Erythrocyte antioxidants in PD patients were not significantly different from the controls. However, plasma vitamin C in PD patients was significantly lower than the controls. It is concluded that these patients are under oxidative stress which points to a possible involvement of free radicals in PD.     

早期帕金森病患者血浆谷氨酸、天冬氨酸和γ-氨基丁酸水平的改变及其诊断价值的研究

目的探索早期帕金森病(PD)患者血浆谷氨酸、天冬氨酸和γ-氨基丁酸(GABA)水平的改变及其潜在的早期诊断价值。方法选择病程3年的早期PD患者52例(早期PD组),年龄性别与PD组匹配的健康对照者52名(对照组),采用高效液相色谱-荧光检测法(HPLC-RF)检测所有研究对象的血浆谷氨酸、天冬氨酸和GABA水平,并量化分析两组间差异。运用受试者特征曲线(ROC)评价血浆氨基酸神经递质识别早期PD的能力。采用Spearman秩相关分析血浆氨基酸神经递质水平和早期PD患者临床特征的关联。结果早期PD组的血浆谷氨酸、天冬氨酸和GABA水平均明显低于对照组。ROC分析提示3种氨基酸均可以有较高的敏感度(76.9%~100%)和特异度(59.6%~100%)识别早期PD和健康者。相关性分析提示血浆天冬氨酸、GABA水平和早期PD患者的临床特征密切相关。结论血浆氨基酸神经递质水平下降是早期PD患者的外周生化基础的一部分,可以为PD的早期识别提供一些帮助。