睡眠障碍与产后抑郁症之间的关联

目的 评估女性产后睡眠障碍和产后抑郁症的发生率，并探讨产后睡眠障碍对产后抑郁 症发生的影响。方法 采用横断面的研究设计，对2017 年1 月至2018 年12 月于解放军空军军医大学西 京医院进行分娩后复查的252 名产妇进行基础资料调查。采用匹兹堡睡眠质量量表（PSQI）和爱丁堡产 后抑郁量表（EPDS）评估睡眠质量和产后抑郁症状。EPDS ＞ 9.5 分定义产后抑郁症，根据产妇产后是否 发生抑郁症，将252 名产妇分为产后抑郁组与非抑郁组。结果 本研究中产妇睡眠障碍和产后抑郁症 的发生率分别为36.1%（91/252）和25.8%（65/252）。单因素分析中，产后抑郁组产妇PSQI 总分显著高于 非抑郁组［（8.43±2.37）分比（5.76±1.84）分；t=9.293，P＜ 0.01］；除睡眠时间分量表外，产后抑郁组PSQI 各分量表得分均高于非抑郁组产妇（均P＜ 0.01）；产后抑郁组产妇睡眠障碍（PSQI ＞ 7 分）发生率明显高 于非抑郁组产妇［52.3%（34/65）比30.5%（57/187）；χ2=9.960，P=0.002］。多因素Logistic 回归分析结果显 示，在调整了社会人口统计学变量、围产期变量和妊娠期疾病变量后，产后睡眠质量和产后抑郁症之间 的关联仍然显著（OR=2.35，95%CI：1.32～4.21）。结论 产后睡眠障碍与产后抑郁症存在正向关联，对 于存在产后睡眠障碍的产妇，应尽早提供干预措施，以减少抑郁症的发生风险。     

橄榄体脑桥小脑萎缩听觉P300认知电位的研究

目的 观察P300检查在橄榄体脑桥小脑萎缩中的应用价值及影响因素.方法 应用P300检查和认知能力筛选量表(CASI)对34例橄榄体脑桥小脑萎缩患者和与其年龄、性别相匹配的正常对照组进行检测.结果 患者不同年龄组P300潜伏期较对照组明显延长(t=2.682～4.983,P<0.05～0.01),患者不同年龄组CASI评分比正常对照组明显降低(t=2.486～5.241,P<0.01),患者组P300潜伏期与CASI评分之间呈负相关(r=-0.48,P<0.005),病情轻组[(348.68±21.47) ms]与重组[(363.27±30.15) ms]和脑萎缩明显组[(354.46±26.98) ms]与不明显组[(338.74±23.56) ms]之间P300潜伏期均差异有显著意义 (P<0.01).结论 评价橄榄体脑桥小脑萎缩的认知功能状态,P300检查是一项有价值的客观指标,其异常程度与病情轻、重和脑萎缩程度有关.     

丙戊酸钠合并氟哌啶醇治疗难治性Tourette综合征

目的 探讨丙戊酸钠合并氟哌啶醇治疗难治性Tourette综合征(TS)的临床疗效和安全性.方法 将93例难治性TS患儿按病例编号分为试验组(58例)和对照组(35例).试验组予丙戊酸钠(400～600 mg/d或15 mg·kg-1·d-1)合并氟哌啶醇(2～6 mg/d)治疗,对照组采取常规治疗[单一或联合使用氟哌啶醇(6～16 mg/d)、泰必利(400～600 m/d)、可乐定(0.15～0.6 mg/d)、安定类药物],共治疗8周.采用YGTSS、国际TS临床信息调查表、儿童行为量表(CBCL)及副反应量表,于治疗前、治疗后第1,3,8周末对两组进行评估.结果 治疗第8周末,试验组的有效率为93%,高于对照组(80%;Z=-4.310,P<0.001);试验组YGTSS总分[(3.50±4.59)分]低于对照组[(7.86±7.03)分;P<0.01],减分率[(83.11±15.13)%]高于对照组[(63.81±27.87)%;P<0.01];试验组的CBCL评分[(11.43±5.27)分]低于对照组[(14.77±6.75)分;t=-2.139,P<0.05];治疗第1周末两组副反应差异无显著性(P>0.05);从第3周末开始试验组副反应评分[(9.26±3.15)分]低于对照组[(11.69±5.51)分;P<0.01],并持续至第8周末.结论 丙戊酸钠合并氟哌啶醇治疗难治性TS,疗效肯定,副反应相对较轻.     

心理治疗中治疗关系利用状况的初步调查

目的 探讨心理治疗中治疗关系的利用情况.方法 采用一般资料问卷、治疗关系利用指数(EI)和半定式问卷调查95名心理治疗师.结果 EI显示,在大城市(城市人口>200万)工作的治疗师中,性的问题[(11.11±2.50)分]和表现欲望[(6.84±1.88)分]得分高于在小城市(城市人口≤200万)工作的治疗师[(9.55±2.10)分和(6.00±1.89)分],差异有显著性(t=2.929,P<0.01)和接近显著性(t=1.94,P＝0.06);男治疗师的EI总分[(55.68±9.50)分]、性的问题[(10.80±2.33)分]、依赖倾向[(4.65±1.37)分]、贪多收入[(7.35±1.56)分]得分,高于女治疗师[分别为(分)50.82±9.84,9.71±2.48,3.91±1.26,6.00±1.02];P<0.05,P<0.01.半定式问题答案认为,社会、文化和经济等因素对治疗关系均有影响;中国的治疗关系更重人情.结论 被调查对象存在治疗关系利用不当,并有所在城市大小和性别的差异;社会、文化和经济等因素的影响值得注意.     

血浆同型半胱氨酸水平及N5,N10-亚甲四氢叶酸还原酶基因多态性与老年期抑郁症的关联研究

目的探讨血浆同型半胱氨酸(Hcy)水平及N5,N10-亚甲四氢叶酸还原酶(MTHFR)基因多态性与老年期抑郁症发病的关系.方法采用毛细管电泳-紫外检测法、聚合酶链反应-限制性片段长度多态性技术测定60例老年期抑郁症患者(抑郁症组)和80名正常人(对照组)的血浆总Hcy水平和MTHFR基因多态性.患者入组时评定汉密尔顿抑郁量表(HAMD),治疗第6周末评定疗效(HAMD减分率≥50%为有效,<50%为无效).结果 (1)抑郁症组的血浆Hcy水平[(17±6)μmol/L]明显高于对照组[(12±4)μmol/L],差异有统计学意义(P<0.01).<60岁首次发病(以下简称首发)患者(n=30)的血浆Hcy水平[(16±5)μmol/L]与≥60岁首发患者[n=30,(19±6)μmol/L]的差异无统计学意义(P>0.05);单次发作患者(n=17)的血浆Hcy水平[(18±6)μmol/L]与反复发作患者[n=43,(17±5)μmol/L]的差异无统计学意义(P>0.05);伴心脑血管疾病患者(n=27)的血浆Hcy水平[(19±6)μmol/L]与不伴心脑血管疾病患者[n=33,(16±5)μmol/L]的差异无统计学意义(P>0.05);治疗有效患者(n=40)的血浆Hcy水平[(18±5)μmol/L]与治疗无效患者 [n=20,(17±6)μmol/L]的差异无统计学意义(P>0.05).(2)抑郁症组治疗前后HAMD评分的减分率与血浆Hcy水平无显著相关性(P>0.05).(3)MTHFR C677T基因型有3种,即纯合子突变型(T/T)、杂合子突变型(T/C)和野生型(C/C).抑郁症组的基因型及等位基因频率与对照组比较,差异均无统计学意义(P>0.05).抑郁症组患者的首发年龄、发病次数、是否伴发心脑血管疾病及抗抑郁药治疗第6周末的疗效与MTHFR C677T基因型分布均无关联(P>0.05).(4)不同基因型的受试者(不论是抑郁症组还是对照组)血浆Hcy水平的差异无统计学意义(P>0.05).结论血浆Hcy水平升高可能是老年期抑郁症发病的一个独立危险因素.     

抑郁症首次发病患者认知功能的研究

目的探讨抑郁症首次发病(以下简称首发)患者的认知功能特点及其影响因素。方法采用韦氏成人智力量表、韦氏记忆量表、威斯康星卡片分类测验(WCST)分别评定116例首发抑郁症患者(抑郁症组)和41名健康人(对照组)的认知状况,采用汉密尔顿抑郁量表(24项,HAMD)评定病情严重程度。对影响神经心理学测验成绩的临床症状进行逐步多元回归分析。结果(1)抑郁症组的长时记忆[(35.28±7.27)分]、短时记忆[(51.32±13.41)分]、记忆商数[(89.46±17.84)]、语言智商数[(110.96±13.72)]、操作智商数[101.90±15.98)]、智商数[(107.41±15.78)]均明显低于对照组[长时记忆(44.05±5.06)分,短时记忆(71.41±8.51)分,记忆商数(121.90±11.26),语言智商数(117.49±10.99),操作智商数(117.24±10.54),智商数[(118.98±10.95)],差异均有统计学意义(均P<0.01)。抑郁症组的WCST总测验数[(74.70±27.96)个]、持续错误数[(26.07±15.31)个]、随机错误数[(24.46±17.54)个]均明显高于对照组[WCST总测验数(60.15±23.05)个,持续错误数(17.56±11.44)个,随机错误数(17.73±14.27)个],差异有统计学意义(P<0.01或<0.05)。抑郁症组长时记忆成绩、短时记忆成绩和记忆商数低于对照组2个标准差。(2)逐步多元回归分析显示,抑郁症患者的长时记忆成绩及记忆商数与绝望感因子分均呈负相关(均P=0.00),短时记忆成绩和即刻记忆成绩与阻滞因子分均呈负相关(均P=0.00),语言智商与焦虑/躯体化因子分呈负相关(P=0.01),操作智商及智商与HAMD总分均呈负相关(均P=0.01),WCST总测验数和持续错误数与HAMD总分均呈正相关(P=0.01,P=0.02),随机错误数与阻滞因子分呈正相关(P=0.02)。结论首发抑郁症患者急性期的记忆、语言智商、操作智商和执行功能明显减退,临床症状严重程度影响认知功能的改变。     

生育二胎妇女产后6个月抑郁症及相关因素调查

目的:调查生育二胎妇女产后6个月的抑郁症及相关因素。方法:对380例生育二胎的产妇于产后6个月完成产后抑郁症筛查量表中文版(PDNSS)、艾森克人格问卷简式量表中国版(EPQRSC)、归因方式问卷(ASQ)及应付方式问卷(CSQ)调查及评估;以PDNSS分≥60定义为产后抑郁症;采用非条件Logistic回归分析产后抑郁症的影响因素。结果:179例(47.11%)PDNSS分≥60归入病例组,201例归入对照组。病例组EPQ中精神质(t=3.57)、神经质(t=-17.52)、ASQ中负性事件总体指标(t=3.75)、持久性(t=2.77)、整体性(t=2.18)及CSQ中自责(t=8.62)、退避(t=12.93)评分明显高于对照组;ASQ中的正性事件整体性评分明显低于对照组(P0.05或P0.001)。Logistic回归显示,神经质(OR=1.817,95%CI:1.562~2.112)、负性事件总体指标(OR=3.733,95%CI:1.617~8.62)、自责(OR=1.677,95%CI:1.3~2.162)、退避(OR=1.962,95%CI:1.602~2.402)进入方程,回归系数β分别为0.597、1.317、0.517、0.674(P均0.01)。结论:生育二胎妇女产后6个月抑郁症发生率较高,其相关因素包括神经质人格、负性事件的总体归因及退避、自责的应付方式。     

精神分裂症患者细胞色素P450 2D6酶基因多态性与利培酮治疗效应的关系

目的研究精神分裂症患者细胞色素P450 2D6酶(CYP2D6)多态性是否与利培酮治疗效应有关.方法采用阳性和阴性症状量表(PANSS)、大体评定量表(GAS)、治疗时需处理的副反应量表(TESS)以及锥体外系副反应量表(RSESE)对52例精神分裂症[PANSS基线分(105.59±17.30)分;GAS基线分(31.75±3.32)分]患者,分别在利培酮治疗前及治疗[(5±3)mg/d]第1～8周末各进行一次药物反应评定,采用聚合酶链反应技术对CYP2D6 exon Ⅰ C/T188和CYP2D6 G/A1934两个多态性位点进行检测.根据CYP2D6 exonI C/T188基因型将患者分为三组(C/C组 13例,C/T组20例,T/T组19例);采用治疗前后PANSS 30%减分率为标准 ,将52例患者分为治疗有效组和治疗无效组,比较组间药物治疗效应的差异.结果从利培酮治疗后第5周末开始,三组之间PANSS评分的差异有显著性(P<0.01);两两比较发现,C/C组PANSS分低于T/T组(P<0.01);三组之间GAS评分的差异从第6周开始出现显著性(P<0.01),其中C/C组GAS分明显高于T/T组(P<0.01).多因素方差分析显示,三组的PANSS总分 (F=2.64, P<0.01)及GAS评分(F=1.85,P<0.05)差异有非常显著性;CYP2D6 exon Ⅰ C/T188多态性基因型频率(χ2＝6.56,P<0.05)和等位基因频率(χ2＝5.03,P<0.05,相对风险＝2.54,95%可信区间＝1.40～8.32).利培酮治疗有效组与无效组之间的差异有显著性.样本中未发现CYP2D6 G/A1934多态性.结论中国人群精神分裂症CYP2D6 exon Ⅰ C/T188多态性可能是影响利培酮临床疗效的遗传易感因素.     

苏州市某社区产后抑郁流行病学调查及相关危险因素

目的调查苏州市某社区产后抑郁的检出率及相关危险因素,为产后抑郁的防治提供参考。方法选取苏州市某社区88例产妇,采用爱丁堡产后抑郁量表(EPDS)评定其产后抑郁情况,采用艾森克人格问卷(EPQ)和社会支持评定量表(SSRS)评定产妇的个性特征及社会支持情况。以EPDS评分9分为界将产妇分为产后抑郁组和正常组,分析影响产后抑郁的相关因素。结果苏州市某社区产后抑郁检出率为21.6%;产后抑郁组EPQ神经质(N)维度评分高于正常组,差异有统计学意义[(88.45±8.07)分vs.(37.16±8.22)分,t=2.625,P0.05]。产后抑郁组与正常组SSRS总评分与各维度评分比较差异均无统计学意义(t=-1.411~-0.590,P均0.05)。产后抑郁组SSRS客观支持及主观支持评分与EPDS评分均呈负相关(r=-0.471、-0.459,P均0.05)。结论苏州市某社区产后抑郁的检出率较高,产妇的神经质人格特质与产后抑郁有关。     

脑卒中后抑郁及相关因素的研究

目的探讨脑卒中后抑郁(PSD)的发生机制及相关因素.方法对81例脑卒中(卒中组)和 70例糖尿病(对照组)患者用汉密尔顿抑郁量表(HAMD)调查抑郁的发生情况及临床特点.结果脑卒中组的抑郁发生率(59.26%)明显高于对照组(10%)(P<0.01).日常生活能力评定(ALD)量表,抑郁患者80±4.5,非抑郁患者84±6.2(P<0.01).欧洲脑卒中评分(ESS)标准,抑郁组 63.05±4.3,非抑郁组 69.17±9.6(P<0.01).伴言语困难者抑郁发生率(86.67%)明显高于不伴言语困难者(50.0% )(P<0.05).结论 PSD的发生与日常活动能力(ADL)依赖程度及神经功能缺损严重程度有关,伴言语困难者抑郁发生率显著升高.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

广西农村壮族妇女精神分裂症患者生活质量状况调查

目的研究农村壮族妇女精神分裂症患者的生活质量及影响因素。方法前瞻性的队列研究。采用随机分层抽样法分为农村壮族妇女精神分裂症组、农村汉族妇女精神分裂症组、农村正常妇女对照组,应用“世界卫生组织生存质量测定报告”(WHOQOL-100)及PANSS量表调查其生活质量和疾病的严重程度。结果农村壮族妇女精神分裂症患者生活质量明显低于农村汉族妇女精神分裂症患者,影响其生活质量的相关因素是生活环境及精神支柱/个人信仰。结论经济贫困、环境条件、缺乏有效的医疗服务和社会保障是农村壮族妇女精神分裂症患者生活质量低的关键。因此,建立农村壮族社区精神卫生服务网络势在必行。     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

The origins of innervation of the esophagus of the dog

This study defined the origins of extrinsic efferent and afferent innervation of the normal canine esophagus. When all the layers of the wall of the 3 esophageal regions (cervical, thoracic and abdominal) were injected with horseradish peroxidase (HRP), labeled nerve cells were found in the nucleus ambiguus (NA) and parasympathetic nucleus of X (PX) of the brainstem. Most labeled cells in the NA were located in the compact column (retrofacial nucleus) while labeled cells in the PX were located in separate rostral and caudal areas. There was no somatotopic organization in either the NA or PX. Labeled sympathetic postganglionic neurons were found in the cranial cervical, middle cervical, cervicothoracic, thoracic sympathetic trunk and celiacomesenteric ganglia. The HRP injection of the esophageal wall labeled sensory cell bodies in the glossopharyngeal, proximal and distal vagal, and C2-T6 spinal ganglia. There was no discernible pattern of distribution of labeled cells in the autonomic or sensory ganglia. When the HRP injections were confined to the mucosa-submucosa layers of the thoracic esophagus, a small number of labeled cells were identified in the NA; however, no labeled cells were found in the NA when injections were confined to the mucosa-submucosa of either the cervical or abdominal esophageal regions. With these confined injections, the labeled nerve cells appeared in the rostral part of the PX. Thus, it appeared that the internal tunics of the esophagus (i.e., the mucosa and submucosa) were innervated by neurons in the rostral PX while the muscular tunic was innervated by neurons in the caudal PX and the rostral NA. After mucosa-submucosa injections, labeled sympathetic neurons appeared in the same ganglia that were identified after whole wall injections and these had a similar random distribution. These injections also labeled neurons in the glossopharyngeal, proximal vagal, and distal vagal ganglia, but unlike the whole wall injections there was no labeling in the spinal ganglia. This suggested that the labeled cells of the spinal ganglia seen after whole wall injections conveyed impulses from the tunica muscularis and serosa.     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.