神经活检在周围神经疾病诊断中的意义及与电生理检查相关性分析

目的探讨神经活检在周围神经疾病诊断中的意义,以及神经活检与电生理检查的相关性。方法 12例周围神经病患者均予腓肠神经活检、神经电生理检查,比较二者对轴索、髓鞘损害的诊断情况,统计电生理检查与神经活检诊断的符合率。结果 (1)电生理检查结果检出轴索损害/髓鞘损害9例,神经活检结果发现11例患者伴有髓鞘或轴索损害。(2)神经活检对于周围神经疾病诊断有决定性意义有3例,其余9例也均起到了证实临床诊断的作用。(3)光镜诊断、电镜诊断与电生理检查结果比较无明显差异(P>0.05)。结论神经活检技术对于发现间质改变及亚临床、亚电生理神经损害有明显优势,对于判断周围神经疾病患者的损害类型仍需联合电生理检查进行综合诊断。     

帕金森病患者周围神经病变与血清叶酸维生素B_(12)水平的相关性

目的分析帕金森病患者周围神经病变与血清叶酸、维生素B12水平的相关性。方法随机选取100例帕金森病患者为病例组,同时选取与病例组性别、年龄、身体条件、生活区域相似的100例健康人为对照组,比较2组周围神经病变的发病情况以及血清叶酸、维生素B12水平。结果病例组周围神经病变发病率42.0%,对照组为16.0%,病例组明显高于对照组(P0.05)。病例组尺神经、正中神经传导速度虽较对照组有所降低,但差异无统计学意义(P0.05);病例组周围神经受损者的腓肠神经、胫神经传导速度明显较对照组低(P0.05),但病例组无周围神经受损者的腓肠神经、胫神经传导速度较对照组虽有所降低,但只与对照组无周围神经受损者差异有统计学意义(P0.05)。对照组维生素B12以及叶酸的浓度较病例组高,且其浓度与病例组患者的周围神经受损程度有明显的正相关性;病例组无周围神经受损者的维生素B12以及叶酸浓度较对照组中周围神经受损者低(P0.05)。结论帕金森病患者周围神经病变与血清叶酸、维生素B12水平呈负相关,患者血清叶酸、维生素B12水平越低,发生周围神经病变的可能性越大,病情越重。     

血浆同型半胱氨酸水平与帕金森病周围神经损害的病例对照研究

目的探讨同型半胱氨酸(Hcy)与帕金森病(PD)周围神经损害之间的关系。方法对58例PD伴周围神经损害的患者及58例PD无周围神经损害的患者进行病例对照分析。周围神经损害以肌电图(EMG)测定为准。同时抽取空腹静脉血测定Hcy、维生素B_(12)及叶酸水平,并记录患者的性别、年龄、病程及左旋多巴每日用量,比较各因素在两组之间的差异。另选取同时期的年龄性别匹配的健康体检者50例作为健康对照组。结果病例组病程、左旋多巴用量、Hcy水平明显高于对照组,病例组、对照组Hcy水平明显高于健康对照组。病例组及对照组年龄、性别、维生素B_(12)及叶酸水平无明显差异。相关分析显示,血浆Hcy与左旋多巴用量呈正相关(r=0.442,P=0.000)。结论血浆Hcy升高可能是PD周围神经损害的危险因素,血浆Hcy水平升高与左旋多巴用量相关。     

帕金森病患者血清同型半胱氨酸、氧化应激与周围神经病变的相关性分析

目的探究帕金森病(PD)患者血清同型半胱氨酸(Hcy)、氧化应激与周围神经病变的相关性。方法随机选择自2015年8月至2016年12月在本院因PD就诊的患者40例作为观察组,选取同期健康成年人40例作为对照组。分别测定两组血清Hcy及其代谢产物,体内氧化、抗氧化因子含量,胫神经传导速度、波幅、潜伏期等情况,并分析其中血清Hcy代谢、氧化应激与周围神经病变是否存在相关性。结果观察组血清Hcy、氧化、抗氧化因子含量、传导速度、波幅、潜伏期与对照组比较,差异有统计学意义(P0.05)。经相关性分析发现,Hcy水平、氧化应激程度与周围神经病变存在相关性。结论 PD患者血清Hcy水平、氧化应激程度与周围神经病变存在相关性,可以为PD的治疗提供新途径。     

自身压迫致周围神经损伤12例临床分析

目的:探讨自身压迫致周围神经损伤的临床特点.方法:回顾性分析12例自身压迫致周围神经损伤患者的临床资料.结果:本组患者均为急性起病,因饮酒后睡眠中上肢受压至桡神经损害9例,因长时间(22-25h)下蹲至两侧胫神经损害3例;肌电图检查均为神经源性损害,神经电生理检查示6例右侧、3例左侧挠神经和3例两侧胫神经的远端运动潜伏期延长、复合动作电位波幅降低,感觉传导速度和运动传导速度明显减慢.所有患者均给予糖皮质激素、神经营养药和扩血管药治疗.治疗后,9例桡神经损害的患者中7例基本痊愈,2例显著好转;3例两侧胫神经损害的患者中2例好转,1例无效.结论:自身压迫致周围神经损伤的病因有特殊性,起病急;及时用糖皮质激素治疗效果好,大多预后较好.     

中性粒细胞/淋巴细胞比值与帕金森合并周围神经病变的相关性分析

目的中性粒细胞/淋巴细胞比值(NLR)与帕金森病(PD)合并周围神经病变之间的关系。方法对97例患者进行肌电图检查,其中38例合并周围神经病的帕金森病患者为病例组; 59例不合并周围神经病的帕金森病患者为对照组。检测两组患者血常规,记录中性粒细胞及淋巴细胞计数,计算中性粒细胞/淋巴细胞比值,并记录患者的性别、年龄、病程及Hoehr-Yahr(H-Y)分级,比较各因素在两组之间的差异。结果病例组中性粒细胞/淋巴细胞比值均高于对照组(P 0. 05),病例组及对照组性别、年龄、帕金森病程无明显差异(P 0. 05)。结论中性粒细胞/淋巴细胞比值升高可能是帕金森周围神经损害的危险因素。     

神经梅毒40例临床分析

目的 探讨神经梅毒的临床特点.方法 对40例神经梅毒患者的临床资料进行回顾性分析.结果 本组首发症状为:痴呆(12例)、共济失调(6例)、无症状性神经梅毒(4例)、癫痫(4例)、精神异常(3例)、脑神经损害(2例)、周围神经损害(3例)、颅高压(2例)、急性脑梗死(2例)、脊髓病变(2例).40例患者血清及脑脊液梅毒螺旋体血凝试验(TPHA)均阳性.颅脑CT和/或MRI检查未见明显异常1例、脑萎缩、脑积水13例,脑内多发异常信号灶29例.以癫痫和精神异常起病的7例患者脑电图呈中～重度异常;以周围神经损害起病的2例患者有神经肌电图异常.本组患者经大剂量青霉素治疗后34例病情有显著改善,2例无效.结论 神经梅毒的临床表现复杂多样,神经系统各部位都可受累,青霉素治疗有效;结合病史及血清、脑脊液梅毒抗体检测及电生理、影像学检查有助于诊断.     

慢性酒精中毒患者周围神经损害的临床与神经电生理研究

目的：探讨总结慢性酒精中毒患者周围神经损害的临床与神经电生理改变特点。方法对55例慢性酒精中毒患者的神经电生理（肌电图、运动传导速度、感觉传导速度）检测结果进行分析,并同期选择55例健康受试者作为对照,对比观察2组检测指标的差异。结果55例酒精中毒患者主要表现为对称性肢带肌萎缩、肌力减退和肢体麻木等,与健康受试者相比,慢性酒精中毒患者肌电图在静息状态、轻收缩相、重收缩相各相异常发生率较高,2组肌电图异常发生率比较差异均有统计学意义（P＜0.05）;神经传导速度比较,慢性酒精中毒患者组无论是MCV还是SCV传导速度减慢率均高于对照组,差异有统计学意义（ P＜0.05）。结论慢性酒精重度患者常出现周围神经损害,以神经末端损害为主,表现为对称性肢带肌萎缩、肌力减退和感觉障碍等,神经电生理改变以肌电图异常、感觉神经、运动神经的传导速度降低最为典型,可作为早期诊断的重要手段。     

腓骨肌萎缩症的临床、电生理和遗传学特点(附1家系报告)

目的 探讨腓骨肌萎缩症(CMT)的临床、电生理和遗传学特点.方法 对1例CMT患者的临床资料及其家系调查资料进行回顾性分析.结果 本例患者主要表现为先天性慢性进行性双下肢远端肌无力和肌肉萎缩,伴有双上肢受累;腱反射减弱或消失,下肢感觉障碍.神经电生理检查示周围神经损害.家系调查显示为常染色体显性遗传.结论 CMT的临床特点为下肢远端肌无力、萎缩,神经电生理检查为周围神经损害,主要呈常染色体显性遗传.     

多发性硬化症周围神经损害的临床及神经电生理分析

目的 研究多发性硬化症(multiple sclerosis,MS)合并周围神经系统损害的临床特点及诊治体会,提高对MS的认识.方法 回顾性分析1999-01～2007-12收治的15例MS合并周围神经系统损害患者的临床资料. 结果所有病例除有中枢神经系统脱髓鞘表现外,都合并有周围神经损害的症状及体征,神经电生理检查提示外周神经病变.结论 MS部分病例可以合并周围神经系统损害     

红核黑质波谱分析在帕金森病中的应用价值

目的 探讨黑质氢质子磁共振波谱分析（1H-MRS）在帕金森病中的应用价值.方法 采用Philips Achieva 1.5 T双梯度磁共振扫描仪,对29例帕金森病患者（早期11例,晚期18例）和16例健康志愿者行颅脑MRI和黑质1H-MRS检查,观察NAA、Cr、Cho浓度和NAA/（Cho±Cr）、NAA/Cr和NAA/Cho值.分别对帕金森病患者左侧、右侧与正常健康组黑质的NAA/（Cho±Cr）、NAA/Cr和NAA/Cho值进行t检验,分析两者之间有无统计学差异.结果 早、晚期帕金森病患者和健康组左、右侧黑质的NAA/（Cho±Cr）值分别为0.63±0.10、0.51±0.10、0.79±0.07、0.64±0.11、0.50±0.12、0.80±0.06,帕金森病组患侧与正常侧、对照组比较差异有统计学意义（P＜0.05）,而正常侧与对照组比较差异无统计学意义（P＞0.05）.以NAA/（Cho±Cr）值来对早、晚期帕金森病进行分期,灵敏度曲线呈现低→高→低的变化,在0.59时,灵敏度最高.结论 1H-MRS不仅能对早、晚期帕金森病进行分期,而且能对帕金森病进行定侧.     

美多巴单用及联合二氢麦角隐亭治疗帕金森病的临床疗效

目的 探讨兰美多巴单用及联合二氢麦角隐亭治疗帕金森病的临床疗效.方法 选择我院收治的中晚期帕金森病患者94例,随机分为观察组和对照组,2组均给予美多巴进行治疗,观察组联合给予二氢麦角隐亭治疗,比较2组临床治疗效果.结果 观察组总有效率为74.47%,对照组总有效率为46.81%,2组治疗效果比较经统计学分析比较,差异有统计学意义（P＜0.05）.2组治疗后帕金森氏病综合评分均较治疗前降低,观察组较对照组明显,经统计学分析比较,差异有统计学意义（P＜0.05）.2组不良反应发生情况比较,差异无统计学意义（P＞0.05）.结论 美多巴联合二氢麦角隐亭治疗中、晚期帕金森病疗效满意且安全,值得临床推广使用.     

Temporal prolongation of decreased skin blood flow causes cold limbs in Parkinson’s disease

To unravel the pathogenesis of cold limbs in Parkinson’s disease, we evaluated cutaneous vasomotor neural function in 25 Parkinson’s disease patients with or without cold limbs and 20 healthy controls. We measured resting skin sympathetic nerve activity, as well as reflex changes of skin blood flow and skin sympathetic nerve activity after electrical stimulation, with the parameters including skin sympathetic nerve activity frequency at rest, the amplitude of reflex bursts, the absolute decrease and percent reduction of blood flow, and the recovery time which was calculated as the interval from the start of blood flow reduction until the return to baseline cutaneous blood flow. The resting frequency of skin sympathetic nerve activity was significantly lower in patients with Parkinson’s disease than in controls (p < 0.01). There were no significant differences between the patients and controls with respect to the amplitude of skin sympathetic nerve activity and the absolute decrease or percent reduction of blood flow volume. In the controls, the recovery time (9.4 ± 1.2), which was similar to Parkinson’s disease patients without cold limbs (9.0 ± 0.7), while the recovery time ranged (15.7 ± 3.2) in Parkinson’s disease patients with cold limbs. Recovery was significantly slower in these patients compared with the other groups (p < 0.05). It is possible that cold limbs might arise due to impaired circulation based on prolonged vasoconstriction by peripheral autonomic impairments, in addition to central autonomic dysfunction in Parkinson’s disease.     

安理申对帕金森病后抑郁患者认知功能的影响

目的探讨安理申对帕金森病后抑郁患者认知功能的作用。方法通过对本院2007-01-2011-01并发抑郁症的帕金森患者32例随机分成2组,均采取帕金森常规治疗,治疗组16例在常规治疗基础上口服安理申,对比2组治疗前、治疗8周后的汉密顿（HAMA）和简易精神状态检查（MMSE）量表的评分。结果治疗8周后治疗组的HAMD评分及MMSE评分与对照组比较差异有统计学意义（P〈0.05）。结论安理申对抑郁症帕金森患者的认知功能有明显改善作用,建议临床进一步推广。     

Actigraphically-defined sleep disturbance in Parkinson’s disease is associated with differential aspects of cognitive functioning

The frequency of sleep disturbance and cognitive impairment in Parkinson’s disease has led to the suggestion that these processes might share common neural circuitry. This study aimed to identify the relationships between measures of cognitive functioning and an objective measure of sleep disturbance. Ninety-five patients with idiopathic Parkinson’s disease and 48 healthy controls underwent neurological and neuropsychological examination. They wore an actigraphy watch for 2 weeks, from which a measure of nocturnal sleep efficiency was calculated. Multiple regression models showed that working memory and verbal memory consolidation were significantly associated with sleep efficiency, as well as education and age. By contrast, verbal fluency and attentional set-shifting were not associated with sleep efficiency, after accounting for age and education. These findings reveal that nocturnal sleep disturbance in Parkinson’s disease is associated with specific cognitive difficulties, rather than a global pattern of cognitive dysfunction. This may in part reflect common neural underpinnings.     

胚胎干细胞分化的神经前体细胞移植治疗帕金森病的实验研究

目的探讨胚胎干细胞（embryonic stemcell,ESC）来源的神经前体细胞（Neural precursorcell）移植治疗帕金森病的可能性。方法将胚胎干细胞诱导分化到神经前体细胞阶段后移植到大鼠帕金森病模型纹状体中,并设生理盐水组做对照研究,观察两组移植后行为学改变及检查纹状体内DA、DOPAC的含量。结果移植组在2～4周后与对照组相比行为学上有明显改善（P〈0．01）,纹状体内DA、DOPAC的含量显著提高（P〈0．01）。结论胚胎干细胞经诱导分化成神经前体细胞可用于帕金森病的修复治疗,胚胎干细胞是良好的干细胞移植治疗用细胞来源。     

Retinal nerve changes in patients with tremor dominant and akinetic rigid Parkinson’s disease

Parkinson disease is a multisystem neurodegenerative disease which involves not only basal ganglia and extrapyramidal system but also many other neurologic systems such as retinal ganglion cells. Optical coherence tomography (OCT) is a non-invasive method for assessment of retinal nerve fiber layer (RNFL) thickness and its changes in different diseases. To evaluate the RNFL thickness in patients with Parkinson disease (PD), we performed OCT in patients with PD and compared it with a control group. From October 2010 to July 2011, 27 PD patients (54 eyes) and 25 healthy persons (50 eyes) were entered to this analytical cross-sectional study according to the defined criteria. PD patients were categorized into two groups “akinetic rigid (AR) and tremor dominant (TD)”. RNFL was divided into four quadrants and was assessed by OCT. Afterwards; the data were analyzed by bivariate and multivariate models. The RNFL thickness in PD was significantly lower than the control group. Also, the thicknesses of inferior and nasal quadrants of RNFL in TD group were significantly more than AR group. According to these findings, OCT can be used as a sensitive and objective marker for assessment of early neurodegenerative changes of PD and early initiation of neuroprotective treatments. Future studies with adequate sample sizes are recommended to investigate interactions between age, distribution of the disease and type of PD as well as the effects of individual factors.     

Analysis of the retinal nerve fiber and ganglion cell – Inner plexiform layer by optical coherence tomography in Parkinson’s patients

AimTo measure and evaluate the thickness of the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) in patients with Parkinson’s disease using optical coherence tomography (OCT).Methods58 eyes of 30 patients with Parkinson’s disease and 60 eyes of 30 healthy individuals were enrolled to this study according to defined criteria. RNFL thickness, central macular thickness (CMT) and ganglion cell-inner plexiform layer (GC-IPL) thickness were measured in these groups. The Parkinson’s patient group was also subjected to Unified Parkinson’s Disease Rating Scale (UPDRS) and Mini Mental Status Exam (MMSE).ResultsNo difference was found between the two groups with respect to age, sex and the best corrected visual acuity (BCVA). Mean, superior, and inferior quadrant RNFL values in the Parkinson’s patients were found statistically significantly lower than those in the control group (P < 0.001, P < 0.049, P < 0.001, respectively). While CMT was statistically similar between the groups, GC-IPL thickness was statistically significantly lower in Parkinson’s patients (p = 0.028). There was no significant correlation between the duration of Parkinson’s disease and RNFL thickness. While there was not any correlation between UPDRS total and motor scores and superior and temporal quadrant RNFL thicknesses, a significant negative correlation was established between RNFL nasal, inferior quadrant and RNFL mean thicknesses (P = 0.022; P = 0.035; P = 0.002, respectively). A significant positive correlation was found between MMSE and nasal and mean RNFL thicknesses (P = 0.046; P = 0.019, respectively).ConclusionRNFL and GC-IPL thicknesses were found lower in Parkinson’s patients. These parameters may be useful to evaluate neurodegeneration and to monitorize neuroprotective therapies.     

重复经颅磁刺激治疗帕金森病后抑郁的疗效观察

目的观察重复经颅磁刺激(rTMS)对帕金森病(PD)后抑郁的临床疗效。方法将我院收治的68例PD后抑郁的患者随机分为2组,对照组给予常规抗PD治疗药物,治疗组在对照组治疗基础上联合rTMS治疗,采用汉密尔顿抑郁量表(HAMD)及统一帕金森病评定量表(UPDRS)对治疗前后2组患者抑郁状态及生活、运动功能进行对比。记录治疗组患者rTMS治疗的不良反应。结果治疗组治疗前后HAMD及UPDRS评分显著降低;治疗组HAMD评分较对照组显著降低(P<0.05);治疗组不良反应轻微。结论 rTMS治疗PD后抑郁安全有效,值得临床推广。     

人软骨糖蛋白39与帕金森病相关性研究

目的探讨人软骨糖蛋白39（YKL-40）在帕金森病诊断中的临床价值。方法酶联免疫吸附试验检测63例帕金森病患者血清YKL-40表达水平,统一帕金森病评价量表（UPDRS）和Hoehn—Yahr分期评价患者日常生活活动能力、运动功能和病情严重程度,Spearman秩相关分析比较YKL-40表达水平与帕金森病之关联性,受试者工作特征（ROC）曲线评价YKL-40诊断帕金森病敏感性和特异性。结果帕金森病组患者血清YKL-40表达水平[（3．72±0．10）ng／ml]高于对照组[（2．92±0．18）ng／ml]且差异有统计学意义（t=4．141,P=0．000）。血清YKL-40表达水平与UPDRS评分（n=0．872,P=0．000）和Hoehn—Yahr分期（n=0．704,P=0．000）均呈正相关。ROC曲线显示YKL-40诊断帕金森病之灵敏度为95．26％、特异度73．34％。结论血清YKL-40表达变化与帕金森病病情严重程度有关,可以作为诊断帕金森病的实验室参考指标之一。