青年人脑梗死与脑出血患者的病因、危险因素及预后:293例对比分析

目的:为进一步认识和防治青年脑卒中,对比分析青年人脑梗死和脑出血的病因、危险因素及预后。方法:回顾性分析147例青年脑梗死和146例青年脑出血患者临床资料。结果:147例脑梗死患者有明确病因者133例(90.5%),病因不明者14例(9.5%),其中动脉粥样硬化84例(57.1%)、炎症性血管病20例(13.6%)、凝血机制障碍7例(4.8%)、先天性血管畸形7例(4.8%)、心源性栓塞4例(2.7%)、偏头痛诱发2例(1.4%)。147例中经治疗痊愈114例(77.6%),显著进步27例(18.4%),死亡6例(4.1%)。146例脑出血患者有明确病因者115例(78.8%),病因不明者31例(21.2%),其中先天性血管畸形57例(39.0%),动脉粥样硬化52例(35.6%),烟雾病4例(2.7%),脑静脉血栓形成引发脑出血2例(1.4%)。146例中经治疗痊愈106例(72.6%),显著进步19例(13.0%),死亡21例(14.4%)。结论:动脉粥样硬化是青年人脑卒中最常见的病因,血管炎及先天性血管畸形分别为脑梗死、脑出血患者另一常见病因。主要危险因素是高血压、吸烟、高脂血症。一般预后好,治愈率高,致残率低。脑出血的死亡率明显高于脑梗死。     

天麻治疗血管性头痛及其对脑血管的作用

1979年以来,我们应用南京中医学院研制的栽培天麻注射液治疗血管性头痛共54例,其中18例观察了脑血流图(REG)的改变,并对天麻治疗血管性头痛的机制作了初步探讨。对象一、病例选择:选择从青年期起病,正处,发作期且症状比较重或反复发作未得以控制的发作性头痛。疼痛位于一侧或双侧,呈搏动性痛,常伴有恶心呕吐,间歇期完全正常。神经系统检查正常并排除了其它原因引起的头痛。二、一般资料;男18例,女36例。年龄16—71岁,平均年龄35.4岁。病程6个月—     

高血糖对颅脑损伤患者预后的影响

近几年在临床治疗各种颅脑疾病患者的过程中,发现不少患者病程中出现高血糖,影响到救治的成功率。我院ICU病房2002年10月~2005年8月收治247例重症颅脑疾病患者,现分析其高血糖的发生率及其对预后的影响。对象与方法1.对象:我院监护室2002年10月~2005年8月收治的各种颅脑损伤病人共247例,其中男136例、女111例,年龄5~92岁,平均年龄(63.18±12.40)岁,病程1~115,平均病程(13.83±15.35)天。其中脑梗死73例,脑出血87例,脑栓塞36例,颅内感染25例,颅内静脉血栓形成8例,脑外伤18例。病程中血糖正常者172例;血糖高者75例,其中既往有糖尿病史者30例…     

妥泰治疗特发性全面性强直阵挛发作的疗效观察

目的 探讨妥泰治疗特发性全面性强直阵挛发作（ＧＴＣＳ）的效果。方法 将６４例ＧＴＣＳ患者随机分为两组,分别使用妥泰２００ｍｇ／ｄ、３００ｍｇ／ｄ治疗１６周观察其疗效。结果 ６４例患者中发作减少≥５０％者为６４．０６％,妥泰２００ｍｇ治疗组中发作减少≥５０％者为６２．５％,发作减少≥７５％者为５３．１３％,发作停止者为４３．７５％。３００ｍｇ治疗组中发作减少≥５０％者为６５．６２％,发作减少≥７５％者为５３．１３％,发作停止者为４６．８７％。两组间无显著性差异（Ｐ〉０．０５）。结论 妥泰单药治疗特发性ＧＴＣＳ两组不同剂量均有良好的疗效,２００ｍｇ／ｄ可作为常规治疗剂量。     

NINJ2基因多态性及相关血清因子与卒中的相关性研究

目的 研究中国汉族人群中NINJ2基因多态性与卒中的相关性以及肿瘤坏死因子-α(TNF-α)、神经生长因子(NGF)、白细胞介素-6(IL-6)、P-选择素(P-Selectin)在恢复期患者和正常人群中含量的差别. 方法 选择大动脉粥样硬化性(LAA)脑梗死患者52例、小动脉闭塞性(SAO)脑梗死患者85例、脑出血(ICH)患者50例及正常对照者66例,采用聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)技术检测NINJ2基因两个SNP位点(rs12425791、rs11833579)的基因型,比较各组间的基因型及等位基因分布频率是否存在差异.采用多类结果变量的logistic回归分析法计算各患者组基因型的OR值,并给出95%CI.采用ELISA法检测TNF-α、NGF、IL-6及P-Selectin4种血清因子的含量,并比较组间及组内不同基因型间血清因子含量的差别. 结果 (1)对于rs12425791位点,LAA组及SAO组AG型频率及AA+AG型频率明显高于对照组,比较差异有统计学意义(P＜0.05),但ICH组与对照组比较差异无统计学意义(P＞0.05);SAO组A等位基因频率明显高于对照组,比较差异有统计学意义(P＜0.05),但LAA组及ICH组与对照组比较差异无统计学意义(P＞0.05).对于rs11833579位点,各患者组的基因型及等位基因分布频率与对照组相比差异无统计学意义(P＞0.05).(2)多类结果变量的logistic回归分析显示,在校正了其他危险因素的影响后,对于rsl2425791位点,LAA组AG型和SAO组AG型、AA+AG型仍与卒中发病呈相关关系(其OR值分别为4.298、3.923及2.937,相应的95%C1分别为1.430～12.922、1.417～10.860及1.119～7.710);而对于rs11833579位点,各患者组基因型与卒中发病无相关关系.(3)各患者组血清IL-6、TNF-α、NGF及P-Selectin含量与对照组相比差异无统计学意义(P＞0.05).对于rs12425791位点,LAA组不同基因型间TNF-α含量差异有统计学意义(P＜0.05),ICH组不同基因型间P-Selectin含量差异有统计学意义(P＜0.05);对于rs11833579位点,LAA组不同基因型间NGF含量差异有统计学意义(P＜0.05). 结论 中国汉族人群中NINJ2基因SNP位点rs12425791与卒中发病显著相关,其A等位基因增加罹患该病的风险,SNP位点rs11833579与卒中发病没有显著关系.恢复期患者4种血清因子的含量与正常对照者相比没有明显差别.

Abstract：

Objective To investigate the relationship between NINJ2 gene polymorphism and stroke, and the differences of serum levels of tumor necrosis factor-αt (TNF-α), NGF, interleukin-6 (IL-6)and P-Selectin in healthy controls and patients under recovery stage. Methods Fifty-two patients with large-artery atherosclerosis (LAA) infarction, 85 patients with small-artery occlusion lacunar (SAO)infarction, 50 patients with intracerebral hemorrhage (ICH) and 66 healthy controls were included in this study. Genotypes of the 2 single nucleotide polymorphism (SNP) sites (rs12425791 and rs11833579) in NINJ2 gene were examined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RLFP) method. The differences of genotypes and alleles frequencies of the 2 SNP sites between each 2 different groups were analyzed and compared. Multinomial logistic regression was used to calculate the odds ratio (OR) of genotypes in each patient group, and 95% confidential interval (95% CI)was given. The serum levels ofTNF-α, NGF, IL-6 and P-Selectin were tested by ELISA method, and compared between groups and within group classified by genotypes. Results In regard to rs12425791 site, the frequencies of AG and AA+AG genotypes in LAA and SAO groups were significantly higher than those in control group (P＜0.05), while this difference was not found between the ICH group and control group (P＞0.05); the frequency of A allele in the SAO group was significantly higher than that in the control group (P＜0.05), while this difference was not found between the control group and both the LAA and ICH groups (P＞0.05). In regard to rs11833579 site, no significant differences in the genotypes and alleles were noted between all the patient groups and control group (P＞0.05). After adjusting the influence of other risk factors, the multinomial logistic regression analysis showed that the onset of stroke was still significantly associated with the AG genotype at rs12425791 site in the LAA group (OR=4.298,95%CI=1.430-12.922) and AG, AG+AA genotypes at rs12425791 site in the SAO group (OR=3.923 and 2.937, 95%CI= 1.417- 10.860 and 1.119-7.710). Neither genotypes in rs 11833579 site were significantly associated with the onset of stroke. No significant differences of serum levels of TNF-α, NGF, IL-6 and P-Selectin were noted between each patient group under recovery stage and control group (P＞0.05); in regard to rs12425791 site, the serum level of TNF in LAA group with different genotypes was significantly different (P＜0.05) and the serum level of P-Selectin in ICH group with different genotypes was significantly different (P＜0.05); in regard to rs11833579 site, the serum level of NGF in LAA group with different genotypes was statistically different (P＜0.05). Conclusion This SNP site (rs12425791)is significantly associated with ischemia stroke and the A allele increases the risk of being susceptible to this disease in Chinese Han population. That SNP site (rs1 1833579) is not significantly associated with stroke. No significant differences of TNF-α, NGF, IL-6, P-Selectin serum levels are noted between patients under recovery stage and controls.     

血栓通注射液联合依达拉奉治疗急性脑梗死疗效观察

目的 观察血栓通注射液联合依达拉奉治疗急性脑梗死的疗效及不良反应.方法 对98例发病3d内的脑梗死患者随机分为两组,对照组50例进行常规基础治疗,血栓通注射液4mL静脉滴注,每日1次;治疗组48例在对照组的基础上,以依达拉奉30mg静脉滴注,2次/日,连用14d.2周后行神经功能缺损评分,记录用药的不良反应.结果 治疗组神经功能缺损评分较对照组下降明显,治疗组总有效率为91.67%,对照组总有效率为82.00%,两组比较有统计学意义（P〈0.05）.各项安全性指标检测在正常范围.结论 血栓通注射液联合依达拉奉治疗急性脑梗死的疗效显著安全.     

高渗性非酮症糖尿病昏迷合并急性肝衰竭1例

患者女，34岁，内退在家，因急起呼之不应5h于2009年7月15日入院。患者7月14日晚8点左右出现胡言乱语，说话颠三倒四，家人未引起重视，自服思诺思2片后安静入睡。15日晨起床时行走不稳，跌跌撞撞，一直卧床休息。大约上午10点左右，家人呼其不应，无肢体抽搐，无口吐白沫，身旁无呕吐物。既往有糖尿病史一年，未正规服药；     

急性胰腺炎的病因分析

目的 分析急性胰腺炎的主要原因,探讨胆源性胰腺炎的主要致病因素.方法 总结急性胰腺炎589例,分析主要病因所占比例着重分析胆源性胰腺炎中胆囊小结石所占比率,并与单纯胆结石病例中胆囊小结石所占比率进行比较.结果 (1)本科统计胆源性致病因素所占比率偏高于国内统计数据.(2)胆源性胰腺炎中小结石所占比率明显高于单纯胆结石病例中小结石所占比率(P＜0.05).结论 胆囊小结石是胆源性胰腺炎的主要致病因素之一.     

高钠血症对颅脑疾病患者预后的影响

目的探讨高钠血症对颅脑疾病患者预后的影响。方法分析247例颅脑疾病患者的临床资料，每天检测一次（或多次）血钠值，分析其与预后的关系。结果高钠血症的发生率与疾病种类无关；高钠血症患者的病死率明显高于正常血钠者；同时持续性高钠血症患者得到纠正与未得到纠正的预后比较差异无显著性。结论高钠血症的出现提示颅脑疾病患者病情的加重，且预后不佳。     

高钠血症对脑部疾病患者预后的影响

目的探讨高钠血症对脑部疾病患者预后的影响。方法分析247例脑部疾病患者的临床资料,每天检测一次(或多次)血钠值,分析其与预后的关系。结果高钠血症的发生率与疾病种类无关;高钠血症患者的死亡率明显高于正常血钠者;高钠血症得到纠正与未得到纠正患者的预后比较差异无显著性。结论出现高钠血症提示脑部疾病病情严重,预后不佳。