活血利水方对急性缺血性中风患者神经功能、肿瘤坏死因子相关蛋白表达的影响

目的:探讨活血利水方对急性脑梗死患者神经功能、肿瘤坏死因子的影响。方法:选取138例急性脑梗死患者,随机分为观察组和对照组,每组69例。对照组给予常规西医治疗,治疗组在对照组用药基础上给予活血利水方治疗,比较两组患者的疗效以及在治疗前后神经功能缺损程度及生活质量、大脑中动脉血流动力学参数、氧化应激指标、血管内皮指标、补体1q/肿瘤坏死因子相关蛋白(CTRP)表达水平以及出现的不良反应情况。 结果:治疗后治疗组总有效率为91.3%,对照组为78.3%,组间比较差异有统计学意义(P<0.05)。两组患者的NIHSS和mRS评分降低,BI评分升高,且治疗组的NIHSS和mRS评分较对照组更低,BI评分较对照组更高,组间比较差异有统计学意义(P<0.01)。治疗组患者大脑中动脉收缩期血流速度、舒张末期血流速度和平均血流速度较对照组均更高,差异具有统计学意义(P<0.05)。治疗组患者血清丙二醛和内皮素-1水平较对照组更低,治疗组患者血清超氧化物歧化酶和一氧化氮水平较对照组更高,差异有统计学意义(P<0.05)。治疗后,治疗组患者CTRP9表达水平较对照组高,CTRP3表达水平较对照组低,差异有统计学意义(P<0.05)。结论:活血利水方治疗急性脑梗死具有更好的临床疗效,有助于改善患者的临床症状,升高CTRP9表达水平同时降低CTRP3表达水平,促进脑血管生成,保护患者脑神经。     

急性缺血性脑卒中患者血浆趋化因子12与白细胞介素-33和泛素羧基末端水解酶-1水平变化及意义

目的探讨急性缺血性脑卒中患者血浆趋化因子12(CXC chemokine ligand-12,CXCL-12)、白细胞介素-33(interleukin-33,IL-33)、泛素羧基末端水解酶-1(ubiquitin carboxyl-terminal hydrolase-L1,UCH-L1)水平变化,及其与病情严重程度、预后的关系。方法急性缺血性脑卒中患者89例为观察组,依据美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分分为轻度患者27例、中度患者42例,重度患者20例;患者入院后均给予抗血小板聚集、改善侧支循环等常规处理或溶栓治疗,并依据改良Rankin量表(modified Rankin scale,mRS)评分分为预后良好组46例和预后不良组43例;同期60例体检健康者为对照组。采用ELISA法检测观察组和对照组入院时血浆CXCL-12、IL-33及UCH-L1水平,并进行比较;Spearman法分析血浆CXCL-12、IL-33及UCH-L1与NIHSS评分、mRS评分的相关性。结果观察组入院时血浆CXCL-12[(7.47±1.71)ng/L]、IL-33[(62.91±11.33)ng/L]及UCH-L1[0.17(0.09,0.23)μg/L]水平均高于对照组[(3.24±1.29)ng/L、(34.26±9.45)ng/L、0.06(0.03,0.11)μg/L](P0.05);观察组轻、中、重度患者血浆CXCL-12[(5.61±0.75)、(7.61±0.58)、(9.70±1.38)ng/L]、UCH-L1[0.12(0.07,0.18)、0.18(0.13,0.22)、0.25(0.23,0.29)μg/L]水平均逐渐升高(P0.05),血浆IL-33水平在轻度患者[(66.29±10.55)ng/L]、中度患者[(64.05±11.60)ng/L]均高于重度患者[(58.64±10.52)ng/L](P0.05),轻度患者与中度患者比较差异无统计学意义(P0.05);预后良好组血浆CXCL-12[(6.21±0.93)ng/L]、UCH-L1[0.16(0.09,0.20)μg/L]水平均低于预后不良组[(8.23±1.26)ng/L、0.22(0.13,0.26)μg/L],血浆IL-33[(65.23±11.49)ng/L]水平高于预后不良组[(60.43±10.72)ng/L](P0.05);Spearman相关分析结果显示,观察组血浆CXCL-12、UCH-L1与NIHSS评分(r=0.794,P0.001;r=0.638,P0.001)及mRS评分(r=0.422,P0.001;r=0.215,P=0.043)均呈正相关,血浆IL-33与NIHSS评分(r=-0.289,P=0.006)和mRS评分(r=-0.256,P=0.015)均呈负相关。结论急性缺血性脑卒中患者血浆CXCL-12、IL-33及UCH-L1水平均升高,且与病情严重程度及预后密切相关。     

轻度认知功能障碍的诊治进展

主要对轻度认知功能障碍(MCI)的诊断、治疗的现状及进展,特别是对MCI的亚型:稳定型MCI (SMCI)和进展型MCI(PMCI)的诊断鉴别及MCI向AD的转化等做一综述,对指导AD的预防具有较大的临床意义.     

非匹配负波对遗忘型轻度认知障碍诊断和预后的价值

目的 前瞻性探讨事件相关电位-非匹配负波(event-related potential mismatch negativity,ERP-MMN)在评估遗忘型轻度认知障碍(amnestic mild cognitive impairment,aMCI)患者的诊断和预后的价值.方法 181例研究对象分为aMCI组102例、对照组79名,所有研究对象均进行神经心理虽表、头颅影像学和MMN检奁,分析其峰潜伏期和波幅.随访1年,依据神经心理量表及临床表现等评估MMN在aMCI预后中的价值.结果 aMCI组MMN的峰潜伏期[(312.7±25.7)ms]较对照组[(285.1±28.8)ms]明显延长(t=6.81,P<0.01),波幅[(3.48±1.32)μV]较对照组[(4.66 ±1.12)μV]明显降低(t=-6.37,P<0.01).转化为阿尔茨海默病(AD)的aMCI亚组MMN的峰潜伏期[(332.2±24.1)ms]较未转化为AD的aMCI亚组[(307.5±24.0)ms]明显延长(t=2.75,P=0.007);转化的aMCI亚组MMN的神经心理量表检查和波幅较未转化的aMCI亚组差异无统计学意义.结论 MMN能辅助诊断aMCI并判断其预后,反映和监测aMCI患者认知功能状态的改变.     

非匹配负波对遗忘型轻度认知障碍诊断和预后的价值

Objective To evaluate the value of event-related potential mismatch negativity(ERP-MMN)for diagnosis and prognosis of amnestic mild cognitive impairment(aMCI).Methods 181 people were enrolled in this study,including 102 aMCI patients and 79 normal people and all of them underwent the clinical symptom and performance of neuropsychologieal measures and cranium imaging and examination of MMN.aMCI patients were judged to progress to Alzheimer's disease(AD)or not by clinical symptom and performance of neuropsychological measures during 1 year follow-up period.Through analysis of peak latency (PL)and amplitude(Amp),the value of MMN in diagnosis of aMCI and normal subjects was assessed,judging aMCI progress to AD or not.Results In contrast to normal control subjects(NC),PL of MMN in subjects of aMCl was significantly longer and Amp was significantly shorter,PL of MMN(312.7±25.7)ms vs(285.1±28.8)ms(t=6.81,P<0.01),Amp(3.5 ±1.3)μV vs(4.7±1.1)μV(t=-6.37,P<0.01).Moreover,PL of MMN in subjects of aMCl which would progress to AD was significantly longer than of subjects of aMCI which would not progress,(332.2±24.1)ms vs(307.5 ±24.0)ms(t=2.75,P=0.007).However.significantly difference was not observed in Amp of MMN and neuropsychological measures between subjects of aMCI would progress and not.Conclusions MMN can be used in auxiliary diagnosis and judging prognosis of aMCI.It is appropriate when is required to reflect and monitor periodic cognitive state of subjects of aMCI.     

非匹配负波对遗忘型轻度认知障碍诊断和预后的价值

Objective To evaluate the value of event-related potential mismatch negativity(ERP-MMN)for diagnosis and prognosis of amnestic mild cognitive impairment(aMCI).Methods 181 people were enrolled in this study,including 102 aMCI patients and 79 normal people and all of them underwent the clinical symptom and performance of neuropsychologieal measures and cranium imaging and examination of MMN.aMCI patients were judged to progress to Alzheimer's disease(AD)or not by clinical symptom and performance of neuropsychological measures during 1 year follow-up period.Through analysis of peak latency (PL)and amplitude(Amp),the value of MMN in diagnosis of aMCI and normal subjects was assessed,judging aMCI progress to AD or not.Results In contrast to normal control subjects(NC),PL of MMN in subjects of aMCl was significantly longer and Amp was significantly shorter,PL of MMN(312.7±25.7)ms vs(285.1±28.8)ms(t=6.81,P<0.01),Amp(3.5 ±1.3)μV vs(4.7±1.1)μV(t=-6.37,P<0.01).Moreover,PL of MMN in subjects of aMCl which would progress to AD was significantly longer than of subjects of aMCI which would not progress,(332.2±24.1)ms vs(307.5 ±24.0)ms(t=2.75,P=0.007).However.significantly difference was not observed in Amp of MMN and neuropsychological measures between subjects of aMCI would progress and not.Conclusions MMN can be used in auxiliary diagnosis and judging prognosis of aMCI.It is appropriate when is required to reflect and monitor periodic cognitive state of subjects of aMCI.     

依那普利致过敏性休克1例

患者，男，50岁，因突发头痛、呕吐，伴左侧肢体无力12小时，于2003年1月21日入院，既往有高血压病，间断服用复方罗布麻片治疗。无青霉素等药物及食物过敏史。入院时查：血压172／90mmHg，左侧中枢性面瘫，左侧肢体轻偏瘫，余无阳性体征。头颅CT：右外囊脑出血，量约20ml。余辅查无阳性发现。诊断：高     

依那普利致过敏性休克1例

1　病例简介患者 ,男 ,5 0岁 ,因突发头痛、呕吐 ,伴左侧肢体无力12小时 ,于 2 0 0 3年 1月 2 1日入院 ,既往有高血压病史 ,间断服用复方罗布麻片治疗。无青霉素等药物及食物过敏史。入院时查体 :血压 2 3/ 13kPa,左侧中枢性面瘫、左侧肢体轻偏瘫 ,余无阳性体征。颅脑CT :右外囊脑出血 ,量约 2 0ml,余辅助检查无阳性结果出现 ,诊断为高血压病、脑出血。予吸氧、心电监护、硝苯地平、甘露醇等治疗后病情逐渐稳定 ,但血压仍在 2 2 / 14kPa左右波动。入院第 3日将心痛定改为依那普利治疗。第 1次服用依那普利 5mg,约 2 0分钟后 ,患者出现心慌…     

亚低温联合丁基苯酞对溶栓时间窗外急性大脑中动脉闭塞患者预后的影响

目的 探讨亚低温（mild hypothermia,MHT）联合丁基苯酞（dl-3n-butyphthalide,NBP）对溶栓时间窗外 急性大脑中动脉闭塞（middle cerebral artery occlusion,MCAO）且出现进展性运动功能缺损（progressive motor deficit,PMD）患者的脑侧支循环和短期预后的影响。 方法 纳入溶栓时间窗外且合并PMD的急性MCAO患者,随机分为常规治疗组、MHT组和MHT+NBP 组。比较3组患者入院时基线资料、治疗14 d时Fugl-Meyer运动功能评分、美国国立卫生研究院卒中量 表（National Institute of Health Stroke Scale,NIHSS）评分、出血性转化以及经颅多普勒超声检测的脑 侧支循环通路开放情况、患侧与健侧大脑前动脉（anterior cerebral artery,ACA）收缩期峰值流速比 值（RVaca）和大脑后动脉（posterior cerebral artery,PCA）收缩期峰值流速比值（RVpca）;治疗90 d时 改良Rankin量表（modified Rankin scale,mRS）评分、90 d死亡率。 结果 入组本研究且完成随访的患者共69例,其中常规治疗组23例,MHT组21例,MHT+NBP组25 例。MHT+NBP组14 d Fugl-Meyer运动功能评分、前交通动脉通路开放、后交通动脉通路开放、RVaca及 RVpca均高于MHT组和常规治疗组,差异有统计学意义（均P <0.05）。MHT+NBP组14 d NIHSS评分、90 d mRS评分低于MHT组和常规治疗组,差异有统计学意义（均P <0.05）。MHT+NBP组14 d出血性转化低 于常规治疗组（P <0.05）。MHT组14 d RVaca、RVpca及90 d mRS评分低于常规治疗组（均P <0.05）。3组 90 d死亡率的差异无统计学意义。 结论 MHT联合NBP治疗可以改善溶栓时间窗外急性MCAO且出现PMD患者的脑侧支循环,并改善患 者的短期预后。     

无症状性颈内动脉中重度狭窄患者发生进展性运动功能缺损的危险因素分析

目的探讨无症状性颈内动脉中重度狭窄患者发生进展性运动功能缺损(PMD)的危险因素。方法选取2017年6月至2017年12月入住海口市人民医院神经内科的无症状性颈内动脉中重度狭窄60例患者作为研究对象,根据有无发生PMD的结果分为两组,记录各组患者的临床资料。结果 PMD组和非PMD组在高血压、梗死部位、病变血管、颈动脉粥样硬化不稳定斑块等方面比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示放射冠区梗死部位、大脑中动脉中重度狭窄及颈动脉粥样硬化不稳定斑块是无症状性颈内动脉中重度狭窄患者发生PMD的高危因素(P<0.05)。结论放射冠区梗死部位、大脑中动脉中重度狭窄及颈动脉粥样硬化不稳定斑块是无症状性颈内动脉中重度狭窄患者发生PMD的独立危险因素。