额颞叶退行性的发病机制与治疗

额颞叶退行性变包括3种临床综合征:行为变异额颞叶型痴呆即狭义的额颞叶痴呆或额颞叶痴呆额叶型、语义性痴呆和进行性非流利性失语。本文综述额颞叶退行性的病因、病理、诊断和治疗的最新进展。     

碘乙酰胺对Aβ海马注射AD模型大鼠认知及生化作用的研究

目的:探讨胰岛素降解酶激动剂碘乙酰胺对AD模型大鼠认知、病理及生化指标的影响。 方法:采用立体定向海马CA3区注射Aβ42建立AD大鼠模型，外周皮下注射碘乙酰胺干预，观察大鼠morris水迷宫逃避潜伏期和穿越平台次数的变化，同时进行Aβ免疫组化和ELISA定量测定。 结果:Aβ+碘乙酰胺组海马Aβ沉积明显少于Aβ组（23.9%），Aβ含量亦少（24%），水迷宫认知测试表现优于Aβ组。 结论:碘乙酰胺可显著减少AD模型大鼠的脑内Aβ沉积，改善其认知水平。     

吗啡给药途径及其新剂型的研究进展

吗啡（Morphine）是一种阿片受体激动剂，它具有强烈的镇痛、镇静作用，能够抑制呼吸中枢，降低其对二氧化碳的敏感性；可以抑制咳嗽中枢产生镇咳的作用；可以兴奋消化道平滑肌，致使便秘，并使胆道、输尿管、支气管平滑肌张力增加；     

老年人不同程度脑白质损害脑血流定量研究

目的 观察老年人不同部位脑白质损害(WML)的严重性是否与脑缺血相关.方法 采用改良Fazelsa量表,将头颅磁共振FLAIR序列显示的WML分为2个部位:侧脑室周边区域及半卵圆区;4个等级:0级;1级;2级及3级.应用氙气增强CT技术测定不同级别脑白质损害者病损区域内及大脑各部位的局部脑血流(rCBF).结果 侧脑室周边区域、右侧及左侧半卵圆区病损区域内平均rCBF(ml·100 g-1·min-1)在0级分别为20.8±2.8,22.3±1.9,22.2±2.1;1级分别为20.3±2.5,21.3±1.0,21.0±1.8;2级分别为16.3±2.0,15.6±1.7,15.9±0.9;3级分别为14.1±2.6,14.5±2.2,14.2±1.9.无论是脑白质周边区域,还是半卵圆区,病损越严重,局部脑血流越低(P＜0.05).进一步分析发现,0级与1级之间各自质部位病损区域内rCBF差异无统计学意义;但2级和3级WML各白质部位病损区域内rCBF与0级和1级WML相比,差异有统计学意义(P＜0.05).我们还发现双侧颞叶及豆状核局部脑血流下降与白质病损程度有关(P＜0.05).结论 无论是半卵圆区,还是侧脑室周边区域,脑白质损害病损程度均与病损区域内局部脑血流显著相关.     

华山命名测验的编制与效度分析

目的 为研制适合中国文化背景的命名检测方法,编制了"华山命名测验(Huashan Naming Test,HNT)",并通过对遗忘型轻度认知损伤(aMCI)和轻度阿尔茨海默病(AD)记忆力下降差异的检测,来分析其试用效度.方法 100名来自社区的正常老人组、100名aMCI组和95名轻度AD组(受教育程度均在初中及以上)被试完成包括MMSE、听觉词语学习测验和华山命名测验在内的8种神经心理测验.人组MCI和AD患者均完成大脑核磁共振检查.HNT的图片包括动物20张、蔬菜10张、水果10张、工具20张、家庭用品20张、交通工具10张、文具10张,共100张.结果 1.HNT项目的 确定:第1步:删除3组比较没有显著差异的项目22个;第2步:删除8个在正常中老年人组中完成率低于75%的项目;第3步:根据方差分析的F值大小,删除10个F值最小的项目;第4步,在余下的60个项目中,进行完成率大小排列,按照奇偶数分割为2个版本,分别为HNT-1和HNT-Ⅱ.2.HNT的特点:正常老人组HNT-Ⅰ和HNT-Ⅱ的得分与年龄、性别没有显著相关性,但与受教育程度、MMSE得分显著相关(P＜0.05).以自发命名正确数≤26分作为划界分,HNT-Ⅰ识别aMCI的敏感性为44%,识别轻度AD的敏感性为84%,特异性均为84%;HNT-Ⅱ识别aMCI的敏感性为56%,识别轻度AD的敏感性为83%,特异性均为80%.结论 HNT是一种符合我国文化背景的、耗时短、效度好的命名测验,值得进一步推广应用.

Abstract：

Objective To present the development of the Naming test tool ( Huashan Naming Test, HNT)for Chinese cultural and by amnestic mild cognitive impairment ( aMCI ) and mild Alzheimer' s disease (AD) between the detection of memory decline,and to analyze the validity of its trial.Methods 100 normal elders from communities in Shanghai, 100 patients with amnestic mild cognitive impairment (aMCI), and 95 patients with mild Alzheimer's disease (AD) who received an education of junior high school or above and were evaluated by neuropsychological tests including mini mental state examination ( MMSE), auditory verbal memory test, Huashan Naming tests etc.8 cognitive tests.The groups of MCI and AD patients finished cranial MRI.100 items with HNT including 20 animals,10 vegetables,10 fruits ,20 tools ,20 household , 10 vehicles, 10 stationery.Results 1.HNT items to determine: 22 items were excluded due to the completion of the three groups were not significantly different; 8 items were excluded due to the completion of the normal elderly group was lower than 75%; 10 items were excluded from the analysis of variance Fvalue of the minimum value.The remaining 60 items,according to the size of the arrangement and completion rates were divided into two versions of odd and even, respectively HNT-Ⅰ and HNT-Ⅱ.2.HNT characteristics:in normal elderly group age, sex were found to had no significant factors affecting overall scores of HNT-Ⅰ and HNT-Ⅱ but level of education, MMSE score was significantly correlated (P ＜0.05).As cut-off score ≤ 26 for spontaneous naming of HNT,the sensitivities of HNT-Ⅰ for aMCI ,mild AD were 44%, 84% respectively, specificities were all around 84%; the sensitivities of HNT-Ⅱ for aMCI , mild AD were 56% ,83% respectively,specificities were all around 80%.Conclusion HNT is a Chinese cultural background,time-consuming short and good name validity test,and it is worth further promoting the application.     

中文卡片分类测验的编制和效度检验

目的 编制适用于中国老年人群简短而有效的执行能力测验--中文卡片分类测验(CCST).方法 选择不同亚型的轻度认知损害和阿尔茨海默病患者完成中文卡片分类测验等一系列的神经心理学测验,并与正常对照受试者进行比较,评价其临床适用性和检测效度.结果 (1)阿尔茨海默病组、轻度认知损害组与正常对照组受试者比较,3套卡片评分差异均具有统计学意义(P<0.01).(2)所有受试者均较少采用"数量"维度.(3)当CCST总评分≤6分时,识别阿尔茨海默病的敏感度可达94.32%,特异度为74.24%;当CCST总评分≤5分时,识别阿尔茨海默病的敏感度为74.35%,特异度为89.52%.(4)在轻度认知损害各亚组中,以非遗忘型轻度认知损害组受试者CCST总评分最低(4.25±2.07),单认知域遗忘型轻度认知损害组总评分最高(6.68±1.65),而多认知域遗忘型轻度认知损害组介于二者之间(5.16±2.26),组间差异具有统计学意义(P<0.01).结论 虽然中文卡片分类测验材料不同,由于设计的分类维度相同,故对3组受试者的鉴别力颇为接近;受试者完成率高、耗时短,而且其总评分有助于鉴别遗忘型和非遗忘型轻度认知损害,鉴别效度良好,是一种有效、快速的执行能力检验方法,值得进一步推广应用.     

额颞叶痴呆的发病机制与治疗

广义的额颞叶痴呆(FTD)亦被称为额颞叶退行性变(FTLD),是一组以行为和人格改变、失语为特征性表现的疾病.根据美国的流行病学调查和病理学分类,额颞叶痴呆是仅次于阿尔茨海默病(AD)、路易体痴呆(DLB)的第3种痴呆类型.发病年龄为45～70岁,绝大部分患者在65岁之前发病;病程2～20年,平均约8年[1,2].     

药物咨询工作心得探析

药物咨询工作是药剂科的窗口,是门诊药房开展药学服务的新形式和新方法。药物咨询工作的好坏关系到药剂科的工作质量和整体形象,也关联患者享有的医疗服务质量。那么如何来做好药品咨询工作呢?这正是我们药剂科全体同志学习和工作的新方向。     

基于体素的遗忘型轻度认知障碍和轻度阿尔茨海默病全脑白质MR扩散张量成像分析

目的 采用基于体素的分析(VBA)方法研究遗忘型轻度认知障碍(aMCI)患者和轻度阿尔茨海默病(AD)患者全脑白质微观结构改变的特点及其与灰质萎缩模式的关系.方法 选取33例aMCI患者(aMCI组)、32例轻度AD患者(轻度AD组)和31名正常老年人(健康对照组),对全脑进行3.0 T DTI及三维快速扰相梯度反转回波(3DFSPGR)脉冲序列扫描.采用统计参数图(SPM)5软件对被试者的结构图像及各向异性(FA)图进行预处理,然后采用t检验对aMCI组、轻度AD组和正常对照组的全脑灰质体积及FA值进行基于体素的统计学比较,计算出有统计学意义的脑区.结果 与正常对照组比较,aMCI组的双侧额颞叶和左侧枕叶白质、左侧扣带前部、左侧顶下小叶、右侧脑室三角区外上方白质的FA值减低;轻度AD组的双侧额颞枕叶、海马旁白质、扣带前部、胼胝体、侧脑室三角区旁白质、顶下小叶、左侧颞于、左侧丘脑、右侧楔前叶FA值减低.基于体素的形态测量学(VBM),分析发现,aMCI患者组左侧海马、海马旁回、舌回、颞上回,双侧岛叶、颞中回出现了灰质萎缩;轻度AD患者组双侧海马、海马旁回、杏仁核、丘脑、额叶、颞叶、顶叶、枕叶皮质出现了灰质萎缩.aMCI与轻度AD患者组全脑白质FA值减低的模式与灰质萎缩模式不同.aMCI组与轻度AD组比较未发现具有统计学意义的FA值减低脑区.aMCI、轻度AD患者组全脑白质FA值与简易智能精神状态检查量表(MMSE)评分没有相关性.结论 基于体素的MR DTI全脑白质分析能够较全面、客观地揭示aMCI、轻度AD的脑白质损害的模式.aMCI、轻度AD患者白质损害的模式与灰质不同,提示脑白质病变是多种病理机制导致的.aMCI患者向轻度AD进展过程中,脑白质各向异性改变不显著,脑白质FA值的改变可能无法反映患者认知功能障碍的严重程度.

Abstract：

Objective To evaluate the microstructural integrity of white matter (WM) in patients with amnestic mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD) using voxel-based analysis (VBA), and investigate the relationship between WM abnormalities and gray matter(GM) atrophy.Methods Thirty-three cases with aMCI, 32 cases with mild AD and 31 normal aging volunteers as control subjects were scanned on a 3.0 T MR system using diffusion tensor imaging (DTI) and three-dimensional spoiled gradient-recalled(3DSPGR) sequences. Fractional anisotropy (FA) maps and morphological images were preprocessed by SPM5 and voxel-based comparisons between the 2 patient groups and the control group were performed by t test. Results Relative to the control group, patients with aMCI showed significantly reduced FA value in bilateral frontal, temporal and left occipital WM, left anterior part of cingulum, left inferior parietal lobule, and the W M adjacent to the triangular part of the right lateral ventricle(k≥20 voxels).In mild AD,significantly reduced FA value was found in bilateral hippocampal,inferior parietal lobular,frontal,temporal,and occipital WM,bilateral corpus callosum,anterior part of cingulums,the WM adjacent to the triaangular part of the bilateral lateral ventricles,left temporal stem,left thalamus,right precuneus(k≥20 voxels).Significantly reduced GM volume was found in left hippocampus,parahippocampal gyrus,lingual gyrus and superior temporal gyrus,bilateral insulae and middle temporal gyri in aMCl group whencompared with control group(k≥50 voxels).In mild AD,significantly reduced GM volume was found in bilateral hippoeampi,parahippocampal gyri,amygdalae,thalami,temporal,parietal,frontal,occipital cortex(k≥50 voxels).The pattern of areas with reduced FA differs;from that of the GM volumetric reduction.No areas with significantlv reduced FA was detected in aMCl compared with mild AD. There was no significant correlation between FA value of WM in patient groups and Mini-Mental State Examination(MMSE)scores.Conclusions Voxel-based MRI DTI analysis of whole brain white matter can objectively reveal widespread white matter abnormalities in early-stage AD.The difierence between WM FA reduction pattern and GM volumetric reduction pattern indicates that the pathological WM changes in earlyslage AD were caused by multiple mechanisms. FA did not vary significantly in patients pr0gressing from aMCI to mild AD and can hardly reflect the severitv of cognitive function damage in these patients.     

抗生素的合理应用

合理使用药物与减少药源性疾病,在21世纪是一项提高药学服务质量的巨大系统工程.中国是世界上使用抗生素最为广泛的国家之一.正确合理地使用抗生素可以快速有效地控制病情,反之不仅会直接降低药物疗效,同时还会让不良反应和细菌耐药变得更加严重,最后使得患者的病痛和经济负担都加重.如果不对滥用抗生素进行遏制,人类或许某一天会进入＂后抗生素时代＂,当出现严重感染时或许会发生无药可用的情况.因此如何合理地使用抗生素是一个需要迫切解决的问题.