辛醇预处理对红藻氨酸诱导的癫(癎)大鼠海马神经元凋亡和胶质纤维酸性蛋白表达的影响

目的 观察缝隙连接阻断剂辛醇预处理对红藻氨酸(KA)诱导的癫(癎)大鼠海马神经元凋亡和胶质纤维酸性蛋白(GFAP)表达的影响.方法 160只雄性SD大鼠随机分为KA组、辛醇组、生理盐水(NS)组和二甲基亚砜(DMSO)组,应用KA右侧杏仁核注射制作癫(癎)大鼠模型;制模前30 min辛醇组腹腔注射辛醇溶液;制模后3h、6h、12 h、24 h和7d应用原位末端标记(TUNEL)法和免疫组化染色法分别检测各组大鼠海马CA3区TUNEL和GFAP阳性细胞数.结果 KA组制模后6h海马CA3区有TUNEL阳性细胞表达,并逐渐增多,7d达高峰;辛醇组制模后在6 h～7 d TUNEL阳性细胞数明显少于KA组(均P＜0.01);KA组海马CA3区GFAP阳性细胞数随时间而逐渐增多,各时间点明显多于辛醇组(均P＜0.01).结论 辛醇神经保护作用的机制可能与抑制细胞缝隙连接间通讯,切断凋亡信号传播,以减少神经元凋亡有关.     

DSA对老年性颈内动脉重度狭窄或闭塞患者侧支循环的应用价值

Objective To investigate the diagnostic value of aortocranial DSA in collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotid artery. Methods Twenty-three elderly patients with serious stenosis or occlusion of the internal carotid artery, admitted to our hospital from August 2008 to July 2010, were chosen; their DSA findings and prognoses were retrospectively analyzed. Results Of these 23 patients, the collateral circulation was seen in 18(78.3%), including compensations from anterior communicating artery (n=16), posterior communicating artery (n=6), anterior together with posterior communicating artery (n=3), anterior choroidal artery (n=5),meningina artery between anterior cerebral artery and posterior cerebral artery (n=5), meningina artery between posterior cerebral artery and middle cerebral artery (n=4), ophthalmic artery (n=15), blood vessel between posterior cerebral artery and superior cerebellar artery (n=3), and blood vessel among superior cerebellar artery, anterior inferior cerebellar artery and posterior inferior cerebellar artery (n=2); after conservative treatment and long time follow-up (1 to 22 months with a mean of 11.2 moths),disappearance of clinical symptoms and no recurrence were found in these 18 patients. Five patients were noted without compensatory collateral circulation: the 2 paralysis patients could not take care of themselves even with the improvement of myodynamia from grade 0 to grade Ⅲ; the 2 patients with disturbance of consciousness showed no recovery and died from lung infection; the left 1 patient was having aphasia. Conclusion DSA can accurately define ways and compensative ability of collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotidartery, which can put forward reliable evidences for their treatments and prognoses.     

DSA对老年性颈内动脉重度狭窄或闭塞患者侧支循环的应用价值

目的 探讨DSA对老年性颈内动脉重度狭窄或闭塞患者侧支循环的诊断价值.方法 广西右江民族医学院附属医院神经内科自2008年8月至2010年7月收治一侧颈内动脉重度狭窄或闭塞的缺血性脑血管病患者23例,回顾性分析患者的DSA表现与预后.结果 DSA显示有充分侧支循环代偿18例(78.3%),其中前交通动脉代偿16例,后交通动脉代偿6例,前交通动脉和后交通动脉代偿3例,脉络膜前动脉代偿5例,大脑前动脉和大脑中动脉之间的软脑膜动脉代偿5例,大脑后动脉和大脑中动脉之间的软脑膜动脉代偿4例,眼动脉代偿15例,大脑后动脉与小脑上动脉之间吻合3例,小脑上动脉、小脑前下动脉和小脑后下动脉之间吻合2例;随访1～22个月,患者临床症状全部消失并未再复发.无侧支循环代偿5例,其中2例瘫痪患者肌力由0级恢复到Ⅲ级,生活无法自理;2例意识障碍没有恢复,因肺部感染而死亡;1例患者失语无法恢复.结论 DSA可以准确判断老年性颈内动脉重度狭窄或闭塞患者侧支循环的存在方式和代偿能力,为治疗方法的选择和预后的判断提供可靠依据.

Abstract：

Objective To investigate the diagnostic value of aortocranial DSA in collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotid artery. Methods Twenty-three elderly patients with serious stenosis or occlusion of the internal carotid artery, admitted to our hospital from August 2008 to July 2010, were chosen; their DSA findings and prognoses were retrospectively analyzed. Results Of these 23 patients, the collateral circulation was seen in 18(78.3%), including compensations from anterior communicating artery (n=16), posterior communicating artery (n=6), anterior together with posterior communicating artery (n=3), anterior choroidal artery (n=5),meningina artery between anterior cerebral artery and posterior cerebral artery (n=5), meningina artery between posterior cerebral artery and middle cerebral artery (n=4), ophthalmic artery (n=15), blood vessel between posterior cerebral artery and superior cerebellar artery (n=3), and blood vessel among superior cerebellar artery, anterior inferior cerebellar artery and posterior inferior cerebellar artery (n=2); after conservative treatment and long time follow-up (1 to 22 months with a mean of 11.2 moths),disappearance of clinical symptoms and no recurrence were found in these 18 patients. Five patients were noted without compensatory collateral circulation: the 2 paralysis patients could not take care of themselves even with the improvement of myodynamia from grade 0 to grade Ⅲ; the 2 patients with disturbance of consciousness showed no recovery and died from lung infection; the left 1 patient was having aphasia. Conclusion DSA can accurately define ways and compensative ability of collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotidartery, which can put forward reliable evidences for their treatments and prognoses.     

老年脑梗死患者高同型半胱氨酸血症和氧化应激及炎性反应的关系研究

目的探讨老年脑梗死患者高同型半胱氨酸(Hcy)血症和氧化应激及炎性反应之间的关系及颈动脉粥样硬化的发病机制。方法有颈动脉狭窄的动脉粥样硬化相关性老年脑梗死患者72例(脑梗死组),其中轻度狭窄33例,中度狭窄24例,重度狭窄15例;另选健康体检者38例(对照组)。对2组血浆Hcy、血清超氧化物歧化酶(S()D)、丙二醛、单核细胞趋化蛋白1(MCP-1)、白细胞介素8(IL-8)进行检测,分析其变化规律及其相关性。结果脑梗死组患者Hcy、丙二醛、MCP-1和IL-8含量明显高于对照组,而SOD明显低于对照组(P<0.01);轻、中、重度狭窄患者Hcy、丙二醛、MCP 1和IL 8含量随颈动脉狭窄程度加重,呈逐渐升高的趋势,而SOD呈逐渐降低(P<0.01)。脑梗死组血浆Hcy水平与SOD、丙二醛、MCP-1和IL-8含量有相关性;丙二醛含量与MCP-1和IL-8含量有相关性。结论老年脑梗死患者高Hcy血症和氧化应激及炎性反应之间是一种复杂的相互作用关系,高Hcy血症介导氧化应激和炎性反应机制参与了颈动脉粥样硬化的发生和发展。     

老年脑梗死患者血清对氧磷酸酯酶-1和氧化型低密度脂蛋白的关系及其在动脉粥样硬化中的作用

目的探讨老年脑梗死患者血清对氧磷酸酯酶-1(PON-1)和氧化型低密度脂蛋白(ox-LDL)的关系及其在动脉粥样硬化中的作用。方法通过DSA检查确诊有颈动脉狭窄的老年脑梗死患者72例作为研究对象(脑梗死组,其中轻度狭窄33例,中度狭窄24例,重度狭窄15例),以非脑血管病健康体检者38例作为对照组,用分光光度计法测定PON-1活性,用ELISA法测定ox-LDL含量,分析PON-1活性与ox-LDL及血脂各项指标的相关性。结果脑梗死组患者血清PON-1活性显著低于对照组(P<0.01),而ox-LDL含量显著高于对照组(P<0.01),各狭窄组患者PON-1活性与ox-LDL含量差异均有统计学意义(P<0.01),随颈动脉狭窄程度加重,PON-1活性呈逐渐下降的趋势,而ox-LDL含量呈上升趋势。相关分析表明PON-1活性与ox-LDL呈负相关(r=-0.6 8,P<0.01)。结论合并动脉粥样硬化的脑梗死患者PON-1活性降低,脂质过氧化增强,血管易于损伤,PON-1和ox-LDL相互作用共同参与动脉粥样硬化的发生发展。     

辛醇对红藻氨酸诱导癫痫大鼠海马Caspase-3表达的影响

癫痫可引起急性和持久性中枢神经系统损害,易致海马神经元损伤.细胞凋亡是癫痫发作后神经元死亡的主要形式之一.研究表明,癫痫发作后导致持续长时间的神经元凋亡可能是癫痫发作脑损害的重要机制[1].     

重症病毒性脑炎患者血清甲状腺激素和皮质醇变化的临床意义

目的探讨重症病毒性脑炎（SVE）患者血清甲状腺激素、皮质醇变化的临床意义。方法采用化学发光分析法检测SVE患者（SVE组）及查体健康者（对照组）的血清甲状腺激素、皮质醇水平,比较治疗前后SVE患者血清甲状腺激素、皮质醇变化及其与病情改善程度的相关性。结果与对照组比较,SVE组治疗前血清甲状腺激素水平下降（P〈0．05）,血清皮质醇水平明显升高（P〈0．01）;治疗10d后,除4例死亡者外,其余病情改善者的血清甲状腺激素水平升高,且与病情改善程度呈正比（r=0．76,P〈0．05）;血清皮质醇水平明显下降,且与病情改善程度呈反比（r=-0．81,P〈0．05）。结论及时检测SVE患者的血清甲状腺激素及皮质醇变化,对指导患者治疗及评估预后有重要临床意义     

血小板内皮细胞黏附分子-1基因单核苷酸多态性及单倍型与缺血性脑卒中的相关性研究

缺血性脑卒中(IS)是一种多基因、多因素综合作用而导致的一种常见疾病.随着人类基因组计划的迅速发展,IS相关基因的定位和识别已成为研究热点.血小板内皮细胞黏附分子-1(PECAM-1)是新近发现的一种免疫球蛋白超家族的黏附分子,它可促进神经炎症反应,与血脂代谢紊乱、动脉粥样硬化形成等脑卒中危险因素密切相关"[1-3].     

老年脑梗死患者血清P-选择素及淀粉样蛋白A与颈动脉粥样硬化相关性

颈动脉粥样硬化性狭窄已成为老年脑梗死独立危险因素,血清P-选择素(P-selectin,Ps)作为血小板活化的标志及炎症反应的介质,在介导动脉粥样硬化形成、发展的各个时期中发挥了主要作用[1].血清淀粉样蛋白A(SAA)为急性炎症反应时的一种主要时相蛋白,研究发现其在糖尿病患者的肾血管病变过程中发挥重要作用[2].最近研究表明,Ps和SAA与冠状动脉硬化发病密切相关[3].本研究对合并颈动脉狭窄的老年脑梗死患者的Ps和SAA进行检测,分析其与颈动脉粥样硬化的关系.     

三七总皂甙对急性脑梗死患者血清TNF-α和IL-6水平的影响

目的：观察三七总皂甙（PNS）对急性脑梗死患者血清TNF-α和IL-6水平的影响。探讨三七总皂甙的脑保护机制。方法：选择发病7d内的脑梗死患者62例，随机分为PNS干预组（常规药物治疗加三七总皂甙）32例。对照组（常规药物治疗）30例。采用放射免疫分析法测定血清细胞因子TNF-α，IL-6含量，观察两组治疗前后血清细胞因子TNF-α、IL-6活性水平；美国国立卫生研究院卒中量表（NIHSS）及Barthel指数评分法分别评估两组治疗前后神经功能缺损评分及日常生活活动能力评分。结果：治疗前，PNS组和对照组血清TNF-α，IL-6活性水平相比差异无显著性（P〉0．05），两组NIHSS评分、Barthel指数评分之间差异无显著性意义（P〉0．05）；治疗3周后，PNS组血清TNF-α，IL-6活性水平比对照组显著降低（P〈0．05），NIHSS评分比对照组显著改善（P〈0．01），Barthel指数评分则明显比对照组高（P〈0．01）。PNS组的血清TNF-α，IL-6活性水平与NIHSS评分呈明显正相关（分别为r=-0．741，P〈0．05；r=0．732，P〈0．05），与Barthel指数评分显著负相关（分别为r=-0．767，P〈0．05：r=-0．809，P〈0．05）。结论：三七总皂甙可能通过抑制脑梗死后TNF-α，IL-6介导的炎症反应，促进功能恢复。