蝮蛇抗栓酶治疗缺血性脑血管病的甲襞微循环及血液流变性观察

对使用蝮蛇抗栓酶、维脑路通的缺血性脑血管病患者各５０例进行甲襞微循环和血液流变指标的检测。结果表明：蝮蛇抗栓酶组用药后，微循环和血液流变各项异常指标显著下降（Ｐ＜０．０１～０．０５）。而维脑路通对脑血栓的微循环障碍、血液粘度、β－脂蛋白、甘油三酯、血小板聚集等异常指标改善不大（Ｐ＞０．０５）。提示：蝮蛇抗栓酶是优于维脑路通的降粘药物。     

早期综合疗法对缺血性中风的临床应用

目的：探讨早期综合疗法对缺血性中风的临床应用效果。方法：筛选缺血性中风患者67例，随机分两组，对照组予以常规治疗；观察组在常规治疗基础上服用益气养阴活血中药，加以情志调理、按摩、肢体功能锻炼、药浴等综合康复措施治疗，疗程为6周。进行神经功能缺损、病残程度和疗效比较分析。结果：治疗后观察组神经功能缺损明显轻于对照组（P＜0.01）；病残程度明显低于对照组（P＜0.05）；临床疗效明显优于对照组（P＜0.05）。结论：早期综合疗法能有效促进肢体运动功能康复、降低病残程度，对缺血性中风治疗有较好的临床应用价值。     

T cell responses to orbital antigens in thyroid-associated ophthalmopathy.

Thyroid-associated ophthalmopathy (TAO) is most likely to be a T cell-mediated disease, in which cytokines released in the extraocular muscles activate fibroblasts, increasing glycosaminoglycan production. The nature of the orbital antigen recognized by the infiltrating T cells is unclear, although it is possible that there is cross-reactivity between this and a thyroid autoantigen to explain the close association with thyroid autoimmunity. We have tested the ability of human and porcine eye muscle antigen preparations to stimulate proliferation of circulating T cells from healthy subjects and patients with TAO or Graves' disease without clinical TAO. Occasional responses were seen, particularly after depletion of CD8+ T cells, and two out of 10 TAO patients responded to eye muscle proteins of 25-50 kD after fractionation of antigens on gels and subsequent elution. There was no disease-specific response of T cells to R1, R14, D1 and 1D3, recombinant proteins identified from screening an eye muscle cDNA library with sera from patients with autoimmune thyroid disease. We have also found that interferon-gamma (IFN-gamma) production by T cells from TAO patients was not stimulated by eye muscle membrane antigens or by 1D3. These results suggest that the frequency of circulating T cells responding to eye muscle antigens in TAO is low, and that several candidate orbital antigens, including the 64-kD protein 1D3, are unlikely to be important T cell autoantigens in this condition.     

缺血性脑血管病与颈动脉粥样硬化及其危险因素的关系

目的探讨缺血性脑血管病(ICVD)与颈动脉粥样硬化及其危险因素的关系。方法对186例ICVD患者与194例非脑血管病患者和正常体检者(对照组)行颈部血管超声检查和血液生化检查;比较两组间的颈动脉硬化程度及脑卒中危险因素的差异。结果ICVD组年龄[(69±7)岁]和患有高血压(66.1%)、糖尿病(53.4%)、代谢综合征患者(44.6%)的比率非常明显高于对照组[(61±5)岁、48.8%、15.2%、12.9%](均P<0.001)。ICVD组颈动脉粥样硬化分级计分≥2分(斑块发生率)、≥3分(血管狭窄发生率)分别为69.3%、20.4%,明显高于对照组的33.5%和5.1%(均P<0.05)。结论颈动脉粥样硬化是ICVD的危险因素之一;各种危险因素的聚集对ICVD的发生起重要作用。     

解毒降浊、益气活瘀是治疗老年缺血性卒中的主要治则

老年缺血性卒中在病因病机、治疗方法等方面迥异于老年前期缺血性卒中患者。根据老年人的生理病理特点结合临床实际，认为正虚血瘀为本，浊毒内蕴为标，毒损脑络为老年脑缺血损伤的终结；正虚血瘀、浊毒内蕴是老年脑缺血损伤的根本原因；解毒降浊、益气活血是治疗老年缺血性卒中的重要方法之一。     

脑活素治疗新生儿缺氧缺血性脑病27例疗效分析

本文对27例新生儿缺氧缺血性脑病(HIE)在常规治疗基础上加用脑活素与常规治疗相比较,发现两组治疗结果在统计学上比较差异有显著性(P<0.05),提示脑活素对治疗HIE有一定疗效,可提高治愈率,减少后遗症的发生。     

粉防己碱在急性缺血性肾损伤中的作用及与磷脂酶A_2的关系

采用双肾完全缺血45分钟大鼠模型，观察粉防已碱在急性缺血性肾损伤中的保护性作用及其与磷脂酶A2的关系。结果表明：肾损伤治疗组血清磷脂酶A2（PLA2）、肌酐（Cr）、尿素氮（BUN）水平均明显低于缺血肾损伤组，肾小球滤过率（GFR）及肾血浆流量（RPF）则明显高于缺血肾损伤组；且PLA2与BUN、Cr呈正相关，而与GFR、RPF呈负相关。提示：粉防已碱可通过抑制PLA2活性的机制对急性缺血性肾损伤产生保护性作用。     

ONE-STAGE ARTERIOVENOUS REVERSAL FOR REVASCULARIZATION OF SEVERELY ISCHEMIC LIMBS

Staged arteriovenous reversal has been successfully established forrevascularization of severely ischemic limbs since 1984. The authors tried to constrict thecentral venous limb immediately after the arteriovenous fistula formation to make the pres-sure distal to the anastomosis raising to its maximum to shorten the time required for thedistal valves to become incompetent. Thus, the revascularization of the severely ischemiclimbs may be established much sooner than the staged arteriovenous reversal, and more di-seased limbs will be saved. Forty-two patients with a total of 60 upper and lower limbshave been operated on with good results.     

Ischemic stroke in infancy,childhood, and adolescence

The authors studied 34 patients with juvenile ischemic cerebrovascular disease over a 15-year period. Of the 34 patients, 23 had intracranial occlusions attributed to cerebral thrombosis or embolism and 11 had occlusions resulting from moyamoya disease. Clinicopathological features were evaluated in the 23 cases with ischemic stroke, but not those with moyamoya disease. The cause of the arterial occlusion remained undetermined in 11 patients and was found to be an embolism based on congenital heart disease in 8, on trauma in 3, and on infection in 1. Cerebral angiography was performed in 21 patients. Of these, 17 had stenoses or occlusions corresponding to their symptoms. CT scans were performed in 10 patients; the lesion in question showed no stenosis or occlusion with cerebral angiography. With regard to prognosis, patients with unknown etiology had good outcomes compared with those with congenital heart disease. With respect to acute infantile hemiplegia, 10 patients had convulsive seizures and 4 had a history of an earlier infection. Angiography and CT scans in patients with congenital heart disease demonstrated arterial occlusive sites in the middle cerebral artery region. Three patients had abscesses after their ischemic lesions.