Cerebrospinal fluid cells in multiple sclerosis and other neurological diseases: an immunocytochemical study

Summary Determinations of mononuclear cell subsets in cerebrospinal fluid (CSF), using monoclonal antibodies against surface antigens which identified pan T-cells, helper/inducer T-cells, cytotoxic/suppressor T-cells and Ia-positive cells, were performed in patients with multiple sclerosis (MS), other neuroimmunological diseases (NID), infectious diseases (INF) of the central nervous system and with other neurological diseases. Whereas there was an elevated helper T/suppressor T ratio in CSF of patients with NID (Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, cerebral vasculitis), no other significant differences could be detected between the different groups of patients. Our results suggest that analysis of these mononuclear cell subsets in CSF is not helpful in discriminating between MS and other neurological diseases and that in MS patients changes in disease activity are not clearly indicated by fluctuations in the different CSF cell subsets. Further studies will be needed to confirm our findings in NID patients and to understand the diagnostic and theoretical implications.     

乳腺癌改良根治术后皮下积液的预防措施

目的 探讨乳腺癌术后皮下积液的防治方法。方法 回顾北京友谊医院普外科2002年1月～2004年12月收治的女性乳腺癌患者312例。比较皮下引流管接持续高负压吸引组（A组）与持续低负压引流组（B组），乳腺癌改良根治术后皮下积液的发生率。结果 A组160例患者拔管前合计引流量220～350ml，平均270ml。35例发生皮下积液，积液发生率为21．8％。同时伴皮瓣坏死5例。B组152例患者拔管前合计引流量160～250ml，平均180ml。17例发生皮下积液，积液发生率为11．2％。皮瓣坏死3例。B组与A组比较皮下积液发生率有显著性差异（P=0．011）。结论 乳腺癌改良根治术后引流管接持续低负压吸引有助于减少皮下积液的发生率。     

干细胞经脑脊液移植后在损伤脊髓的早期变化观察

目的观察神经干细胞经脑室注射后在损伤脊髓的早期动态变化。方法取转录有绿色荧光蛋白（GFP）基因的孕16天SD鼠胚脑海马组织，培养成神经干细胞球，注射到损伤脊髓鼠第四脑室（实验组），观察其在脊髓的存活、分化状况。结果移植细胞在脊髓表面形成细胞团。分布于损伤区头侧。细胞团的面积背侧小于腹侧；数目背侧多于腹侧。这种分布和增殖形式见于损伤脊髓正常部分和无损伤脊髓（对照组）。1周时细胞侵入损伤区，GFAP表达呈阳性。2～3周时与宿主细胞良好整合。结论移植细胞通过脑脊液能广泛分布于脊髓表面。保持黏附、增殖和分化能力。并可迁移、整合到损伤脊髓组织中。     

咳嗽变异型哮喘多项检测指标的Bayes判别分析

目的探讨咳嗽变异型哮喘（CVA）肺功能、气道弹性阻力、支气管激发试验、最大呼气峰流量（PEF）日内波动率[△PEFR（％）]、支气管肺泡灌洗液（BALF）细胞学以及血清IgE的变化特点及诊断意义。方法对22例CVA、20例慢性阻塞性肺病（COPD）稳定期患者以及20名健康成年人进行最大呼气流量-容积曲线（MEFV曲线）、气道弹性阻力、支气管激发试验、[△PEFR（％）]、BALF细胞学分析以及血清IgE测定。结果（1）CVA患者呼气流量指标[PEF、一秒用力呼气容积（FEV1）、FEV，／FVC、最大呼气中段流量（MMEF）]与健康对照组比较差异无统计学意义（P〉0．05）。CVA组气道弹性阻力增高，与健康对照组比较差异有统计学意义（P〈0．01），但与COPD组比较差异无统计学意义（P〉0．05）；（2）CVA组患者气道反应性明显增高，支气管激发试验阳性，Mch—PC20-FEV1明显降低、[APEFR（％）]增大（〉20％）、BALF中嗜酸性粒细胞明显增高、血清IgE明显增高与健康对照组及COPD组比较差异有统计学意义（均P〈0．01）。结论气道弹性阻力、支气管激发试验、[APEFR（％）]、BALF细胞学以及血清IgE的测定有助于CVA的诊断且与COPD等的鉴别。根据Bayes判别结果，鉴别CVA与COPD的上述病因学指标作用大小依次为Mch—PC20-FEV1、JgE、[△PEFR（％）]、BALF嗜酸性粒细胞计数、FEV1／FVC、FEV1、PEF、MMEF和气道弹性阻力，其中主要为Mch—PC20-FEV1、IgE、[APEFR（％）]、BALF嗜酸性粒细胞计数。     

双侧侧脑室外引流并脑脊液置换术治疗原发性脑室出血23例

我科自1995年1月至2005年1月共收治原发性脑室出血23例，经双侧侧脑室外引流并脑脊液置换术冶疗取得较好效果，现报道如下。     

非控制性出血休克大鼠早期低压液体复苏的理想复苏压力研究

目的利用大鼠非控制性出血休克模型,探讨早期低压复苏的理想复苏压力。方法W istar大鼠64只,基础平均动脉血压(MAP)为(129.9±14.3)mmHg,断脾法复制非控制性出血休克模型,将血压(MAP)降至40或50mmHg,分为3个处理时段,第1时段模拟院前救治时段,用2∶1乳酸林格氏液和6%的右旋糖酐输注分别将MAP维持在40、50、60、70、80、100mmHg,维持1小时;第2时段模拟医院确定性处理情况,结扎脾动脉止血,输血输液将MAP恢复至100mmHg,维持2小时;第3时段,观察第1时段不同压力复苏对大鼠休克复苏效果的影响。观察指标包括动物存活情况、血压、液体输注量、血细胞比容及动脉血气等。结果院前急救采用高压复苏(80、100mmHg),动物存活时间短,在第1时段末就有50%的动物死亡,需要的液体输注量大,血液稀释严重,代谢性酸中毒明显,血气指标差;而以<70mmHg(50、60、70mmHg)的血压复苏,动物存活时间延长,液体输注量小,血液稀释轻,血气指标正常或接近正常;以50、60mmHg血压输注效果最好,但太低的输注压力(40mmHg)也不利于休克复苏,在第三时段末动物死亡率为75%。结论对非控制性出血休克及活动性出血,止血前采用高压复苏会增加血液丢失及血液稀释,明显影响休克复苏效果,适当低压复苏有利于动物的后期恢复,输注压力以50、60mmHg最好,但太低的输注压力(40mmHg)也不利于休克复苏。     

冰片开放血-脑脊液屏障对实验性细菌性脑膜炎治疗影响的研究

目的 探讨冰片开放血-脑脊液屏障（BCB）对实验性细菌性脑膜炎治疗的影响。方法 采用日本大耳白兔作为实验动物，随机分为对照组、冰片组和脑膜炎组。经枕大池注入肺炎球菌悬液建立脑膜炎模型，以冰片作为开放BCB的制剂。以连续静脉注射丙戊酸钠后不同时间点的脑脊液中丙戊酸钠浓度变化作为判断BCB通透性的指标；硝酸镧示踪法观察脑组织表现作为BCB通透性的形态指标。给予脑膜炎动物头孢吡肟或冰片＋头孢吡肟治疗，记录动物存亡情况；取脑脊液（CSF）进行细胞计数及生化检查。取脑组织作常规病理染色，以观察冰片开放BCB对实验性细菌性脑膜炎治疗的影响。结果 给药后对照组CSF中丙戊酸钠浓度基本保持稳定，冰片组CSF中丙戊酸钠浓度于给药后0．5h时即高于对照组并逐渐上升，至6h时达高峰，然后开始下降，14h时浓度仍高于对照组。脑组织超微结构显示，对照组无硝酸镧颗粒通过BCB，脑膜炎组硝酸镧颗粒分布于毛细血管基底膜外，冰片组弥漫性分布于神经细胞间隙和轴突周围。给予头孢吡肟治疗后，脑膜炎＋冰片组动物存活率（9／12，75％）明显高于脑膜炎组（6／18，66．7％）（P〈0．05），但两组间CSF细胞数及蛋白、葡萄糖水平差异无统计学意义。近皮层脑组织HE染色显示，脑膜炎组可见脑组织大量炎症细胞渗出和软化坏死灶,血管“套袖”现象明显，而脑膜炎＋冰片组脑组织内炎症细胞渗出较少，无血管“套袖”现象，无明显坏死软化灶。结论 冰片确实能明显增加BCB的通透性并具有可逆性特点，抗生素联合冰片能改善实验性细菌性脑膜炎治疗效果，为细菌性脑膜炎的治疗提供了新的思路。     

Penetration of fusidic acid and rifampicin into cerebrospinal fluid in low-grade inflammatory meningitis caused by Staphylococcus epidermidis

Cerebrospinal fluid (CSF) concentration-time curves of rifampicin and fusidic acid were studied in a patient with post-operative meningitis caused by Staphylococcus epidermidis. The patient was treated with this combination of antimicrobial agents because of a severe hypersensitivity reaction to vancomycin. Peak CSF concentrations of rifampicin exceeded the MIC by > 60-fold, while those of fusidic acid just reached the MIC. CSF concentrations of fusidic acid were relatively stable within the range reported for patients with uninflamed meninges, but serum levels were surprisingly low. An increase in the metabolism of fusidic acid induced by rifampicin cannot be excluded.     

A prospective study of the association of cerebrospinal fluid monoamine metabolite levels with lethality of suicide attempts in patients with bipolar disorder

Objectives:  Bipolar disorder is a severe illness that is associated with suicidal behavior. A biological predictor of highly lethal suicide attempts in patients with bipolar disorder would be valuable. We hypothesized that cerebrospinal fluid (CSF) monoamine metabolite levels are related to lethality of suicide attempts in bipolar patients and examined the relation between CSF 5-hydroxyindolacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) levels and maximum lethality of suicide attempts at baseline and during a 2-year follow up.
Methods:  Twenty-seven bipolar depressed patients participated in the study. Demographic and clinical parameters were examined and recorded. Lumbar punctures were performed and CSF 5-HIAA, HVA, and MHPG were assayed by high-performance liquid chromatography with electrochemical detection. Following discharge, patients were evaluated after 3 months, 1 year, and 2 years. Each follow-up interview included an in-depth assessment of suicidal behavior during the intervening time period.
Results:  Six subjects made suicide attempts during the 2-year follow-up. Bipolar patients who attempted suicide during the follow-up period had higher aggression and hostility scale scores compared to bipolar subjects who did not make a suicide attempt during the follow-up period. CSF 5-HIAA, HVA, and MHPG levels were negatively correlated with the maximum lethality of suicide attempts during the 2-year follow-up period.
Conclusions:  Our finding is the first observation that CSF monoamine metabolite levels may be predictors of lethality of suicide attempts in patients with bipolar disorder. Further studies are necessary to answer the question whether CSF monoamine metabolite levels are clinically useful biochemical predictors of highly lethal suicide attempts or completed suicides.     

奈替米星体液浓度测定的方法学研究

通过对国产硫酸奈替米星注射后人体血尿中药物浓度测定，建立了奈替米星体液浓度测定的微生物法，该方法的检测限为０．０３７５～０．０７５１μｇ，最低检测浓度为０．２５～０．５μｇ／ｍｌ，回收率为８８．８％±３．６３％～９８％±１４．４０％，重复性试验相对标准差为２．２２％～５．３４％；并对１０例健康受试者用药后血标本１００余份进行了微生物法测定和高压液相色谱法测定，对两种方法测定结果的比较发现：微生物法测定的血药浓度明显高于ＨＰＬＣ法（Ｐ＜０．０１），而ＨＰＬＣ法由于需复杂的样品预处理和特殊的色谱条件，测定的血药浓度较低，回收率仅７１．９８％～７６．９６％。不过，两种方法测定结果的相关性较好。本研究结果提示：微生物法测定奈替米星体液浓度简便、易操作、结果准确可信，适用于体液药物浓度测定。