动脉硬化性脑小血管病与阿尔茨海默病认知功能损害特征的比较

目的 比较动脉硬化性脑小血管病（arteriosclerotic cerebral small vessel disease，aCSVD）与阿尔茨海 默病（Alzheimer’s disease，AD）患者认知功能损害特征。 方法 回顾性收集2017年9月-2019年5月中山大学附属第三医院神经内科临床诊断为aCSVD及AD患 者的一般资料、认知功能评估量表（MMSE及MoCA），比较两组患者的血管危险因素及认知功能损害 特征的差异。 结果 aCSVD组共纳入106例，AD组88例。aCSVD组患者年龄较低、BMI较高、高血压患者比例较 高，差异均具有统计学意义。MMSE量表各子项评分比较，aCSVD组的注意力与计算力、执行评分低于 AD组，AD组的定向力、延迟回忆、复述、理解及书写评分低于aCSVD组；MoCA量表各子项评分比较， aCSVD组的视空间与执行功能、数字递减评分低于AD组，AD组的命名、数字重复、语言能力、抽象能 力、延迟回忆及定向力评分低于aCSVD组，差异均具有统计学意义。 结论 aCSVD认知障碍发病年龄低于同等认知程度的AD组。aCSVD认知损害维度以注意力与计算力、 视空间与执行功能损害为主，而AD以定向力、延迟回忆、语言能力损害为主。     

急性播散性脑脊髓炎与经典多发性硬化的临床对比分析

目的 寻找临床上鉴别急性播散性脑脊髓炎(acute disseminated encephalumyelitis,ADEM)与经典多发性硬化(classical multiple sclerosis,CMS)的方法.方法 回顾性分析20例ADEM和24例CMS患者的流行病学特点、临床症状、实验室检查和MRI,对各定性资料进行卡方检验,定量资料进行两独立样本的Wilcoxon秩和检验.结果 ADEM患者起病年龄[(27±15)岁]较CMS患者[(37±13)岁,Z=-2.218,P=0.027]小.ADEM患者通常有前驱感染史(75%),发热(65%)、脑膜刺激征(40%)、癫痫(25%),较CMS者常见(x2=23.652、18.609、9.189、4.514,均P＜0 05),脑病更多见于ADEM患者.ADEM患者血白细胞[(11 9±5.8)×109/L,Z=-2.030,P=0.042]、C反应蛋白(2.74 mg/L,Z=-3.028,P=0.002)、红细胞沉降率(11.00 mm/h,Z=-2 406,P=0.016)、脑脊液白细胞(9×106/L,Z=-2.781,P=0.005)较CMS患者[上述指标分别为(8.0±3.2)×109/L、0.49 mg/L、7.00 mm/h、2 ×106/L]高,脑脊液蛋白(ADEM组0.19 g/L,CMS组0.17 g/L)及寡克隆带(OCB)阳性率(ADEM组4/20,CMS组11/24)在两者间差异无统计学意义.在MRI上,ADEM患者更多见皮质灰质病灶(14/20,x2=15.213,P=0.000)、基底节区灰质病灶(14/20,x2=8.910,P=0.003)和脑干病灶(14/20,x2=5.867,P=0.015),脊髓病灶多近中央分布(83%,x2=11.542,P=0 001),病灶边界模糊(95%,x2=21.787,P=0.000);CMS患者更多见近皮质白质病灶(21/24,x2=17.628,P=0.000)、侧脑室旁病灶(21/24,x2=15.213,P=0.000)和胼胝体病灶(14/24,x2=8.640,P=0.003),脊髓病灶多呈偏心分布(85%),病灶边界清楚(75%).结论 ADEM与CMS无论在流行病学特点、临床症状,还是在脑脊液和MRI检查方面都有一定差异.

Abstract：

Objective To improve differential diagnosis between acute disseminated encephalomyelitis ( ADEM) and classical multiple sclerosis ( CMS).Methods All 20 cases of ADEM and 24 cases of CMS were examined.Their epidemiological and clinical findings,laboratory features and magnetic resonance imaging ( MRI) data were analyzed using x2 test for categorical variables,Wilcoxon Rank-Sum tests for continuous variables.Results ADEM and CMS showed no sex predominance.Patients with ADEM ((27 ±15) years) were younger than CMS ((37 ±13) years,Z= -2.218,P =0.027).The following findings were more commonly seen in ADEM compared with CMS:predemyelinating infectious disease (75% vs 4%,x2 =23.652,P = 0.000),fever (65% vs 4%,x2 =18.609,P = 0.000),meningeal irritation sign (40% vs 0,x2 = 9.189,P =0.002),seizure (25% vs 0,x2 =4.514,P = 0.034),and encephalopathy.ADEM patients were more likely to present with blood leucocytosis ( (11.9 ± 5.8) ×109/L vs (8.0±3.2) ×109/L,Z= -2.030,P=0.042),high C-reactive protein (2.74 mg/L vs 0.49 mg/L,Z = - 3.028,P = 0.002),increased erythrocyte sedimentation rate (11.00 mm/h vs 7.00 mm/h,Z= -2.406,P =0.016),and cerebrospinal fluid leucocytosis (9 × 106/L vs 2×106/L,Z =- 2.781,P = 0.005).There were no differences in cerebrospinal fluid protein and oligoclonal band between the two groups.The following MRI lesions were more commonly seen in ADEM patients:cortical gray matter lesions (14/20,x2=15.213,P=0.000),basal ganglia gray matter lesions (14/20,x2 =8.910,P = 0.003),and brainstem lesions ( 14/20,x2 = 5.867,P = 0.015).In contrast,lesions in subcortical white matter (21/24,x2 = 17.628,P =0.000),periventricular area (21/24,x2 =15.213,P=0.000) and corpus callosum ( 14/24,x2 = 8.640,P = 0.003 ) were more common in the MRI image of CMS patients.The lesions in spinal cord were usually centrally distributed in ADEM (83% ),while peripherally in CMS (85%,x2 = 11.542,P = 0.001).The lesions had poorly defined margins in ADEM (95%),but well defined margins in CMS (75%,x2 =21.787,P = 0.000).Conclusion There are differences in epidemiological and clinical findings,laboratory features and MRI appearances between ADEM and CMS.     

急性播散性脑脊髓炎、多发性硬化及视神经脊髓炎脑深部灰质病灶MRI影像比较

目的 探讨并比较急性播散性脑脊髓炎(ADEM)、多发性硬化(MS)及视神经脊髓炎(NMO)脑深部灰质病灶的MRI影像学特征. 方法 自2004年8月至2012年10月在中山大学附属第三医院神经内科住院的ADEM、MS、NMO患者共353例,筛选出其中MRI显示有脑深部灰质病灶者95例(包括ADEM 12例,MS 60例,NMO 23例),对这些病灶的大小、数量、部位等特征进行分析. 结果 3组患者丘脑、尾状核、苍白球受累的病例数比例比较差异均无统计学意义(P=0.154,P=0.438,P=0.697).ADEM组壳核受累的病例数比例明显高于MS组、NMO组,差异有统计学意义(P=0.002,P=0.013).NMO组下丘脑受累的病例数比例则明显高于ADEM组、MS组,差异有统计学意义(P=0.033,P=0.001).ADEM组丘脑的病灶直径明显大于NMO组,差异有统计学意义(P=0.027),但和MS组相比差异无统计学意义(P=0.116),而MS组和NMO组丘脑的病灶直径比较差异亦无统计学意义(P=0.209).3组尾状核、壳核、苍白球、下丘脑的病灶直径比较差异均无统计学意义(P＞0.05).3组的病灶分布对称性比较差异无统计学意义(P=0.335). 结论 丘脑受累对于ADEM和MS的鉴别诊断可能意义不大,壳核受累可能是将ADEM区别于MS和NMO的一个鉴别点,下丘脑受累是NMO的特异性表现.病灶直径大小在这三种疾病的鉴别诊断中价值不大.     

Splenectomy protects experimental rats from cerebral damage after stroke due to anti-inflammatory effects

Background A recent study demonstrated that the inflammatory response accompanying necrotic brain injury played an important role in stroke. Thus, inhibition of this response may help to stop the expansion of infarcts. It has also been shown that the spleen, a major peripheral immune organ, plays a role in stroke-induced immune responses. This study aimed to establish rat models of middle cerebral artery occlusion (MCAO) and to investigate the effect of splenectomy and possible mechanisms in that rat models. Methods Infarct size in a stroke model was measured with the Nissl body staining method, numbers of inflammatory cells in ischemic regions were detected by immunofluorescence staining, and inflammatory factors were assayed by enzyme-linked immunosorbent assay and real-time PCR in brain homogenates and sera. The significance of differences was determined by one-way analysis of variance followed by the least significant difference post hoc test. Results Infarct size in the brain of rats that underwent splenectomies 2 weeks before permanent MCAO (34.93±3.23%) was over 50% smaller than those of rats subjected to the stroke surgery alone (74.33±2.36%, P < 0.001; 77.30±2.62%, P < 0.001). Lower numbers of T cells, neutrophils, and macrophages in brain tissue and lower levels of pro-inflammatory cytokines, such as IL-1β and TNF-α, were observed in rats that underwent splenectomies, compared with the two other groups, but splenectomized rats showed higher levels of the anti-inflammatory factor IL-10 in the brain. Conclusions The mechanism(s) by which splenectomy protects brain from damage induced by stroke may correlate with the decreased numbers of inflammatory cells and changes in inflammatory cytokines.     

急性有机磷中毒患者体内β2-微球蛋白检测的临床意义

有机磷中毒可引起中枢神经、肾脏、呼吸系统、胃肠道等多脏器形态和功能的改变，尤以中枢神经抑制和肾功能衰竭病死率较高，故早期发现并检测肾脏损害状况对急性中毒患者的治疗及预后具有重要意义。为此，笔者检测血液、尿液β2-微球蛋白，旨在探讨有机磷中毒患者早期肾功能的改变，现将检测结果分析报告如下。     

2248名无受血史的孕妇梅毒检测情况分析

我国自1964年后梅毒已较罕见,但近年来有逐渐增加的趋势。为做好梅毒的防治工作,特别是胎传梅毒的防治工作,避免院内交叉感染,明确病因,减少医疗纠纷,并使一些无临床症状的母婴得到及时有效的治疗,我院自2002年开始对足月孕妇产前进行梅毒的检测。现将2002年1月至2003年5月2248名足月孕妇梅毒检测情况报告如下。     

高同型半胱氨酸、高纤维蛋白原等与Binswanger病脑白质疏松严重程度的相关性

目的 探讨高同型半胱氨酸(Hcy)、高纤维蛋白原(Fib)等对Binswanger病(BD)脑白质疏松(LA)严重程度的影响.方法 对自2005年1月1日至2011年5月9日在中山大学附属第三医院住院且确诊为BD的患者进行血清Hcy、Fib、低密度脂蛋白(LDL)、载脂蛋白A(Apoa)、载脂蛋白B(Apob)、高密度脂蛋白(HDL)检测,并将BD患者按LA头颅MRI表现严重程度分为轻、中、重3型,单因素分析及有序Logistic回归法分析Fib、Hcy等因素与LA严重程度的关系.结果 单因素分析结果显示:LA不同严重程度组间性别、年龄、高血压病、卒中史、高脂血症比较差异有统计学意义(P＜0.05).LA严重程度与Hcy、Fib存在正向的等级相关关系(P＜0.05).有序Logistic回归分析结果显示:女性LA程度比男性更严重;年龄越大,有卒中史和Fib测定值越大,LA程度更严重(P＜0.05).结论 Fib水平是BD恶化的一个重要因素,降低Fib水平可能对延缓BD病情进展有效.     

视神经脊髓炎合并干燥综合征及远端肾小管酸中毒一例

1病例报告患者女性,19岁,因"突发双下肢乏力伴排尿困难5 d"于2009-04入院。入院神经科查体:双眼视力下降,左眼0.3、右眼0.1,眼底镜检查示双侧视神经萎缩,双上肢肌力4级,双下肢肌力3级,第3颈椎平面以下感觉减退。EDSS评分7.0分。入院第3天行头颅MRI检查示:颅内多发高信号影,位于右基底节区、胼胝体、中脑。脊     

脾切除对大脑中动脉闭塞大鼠脑梗死体积的影响

目的 探讨脾切除对脑缺血大鼠脑梗死体积的影响及其可能机制.方法 18只雄性Sprague- Dawley大鼠随机分为脾切除组、假脾切除术组和对照组,每组6只.脾切除2周后,采用线检法建立大鼠大脑中动脉闭塞(middle cerebral artery occlusion,MCAO)模型,24h后灌注固定并取脑.尼氏染色...     

40名坦克乘员训练后脑干听觉诱发电位改变

脑子听觉诱发电位已被广泛用于对脑子听觉传导路损害的诊断。1994年5月～1995年10月，我们用脑干听觉诱发电位诊断仪，对40名坦克乘员训练前后的听觉传导路改变情况进行测试，结果报告如下。1对象和方法1．l对象40例受试者均为男性，年龄18～23岁。驾驶员10名，炮手10名，电台指挥10名，车长IO名。训练前身体健康。听力测试两耳均在正常范围。训练后2～4h内测试两耳。1，2仪器和方法用国产WD－4000型神经诱发电位诊断仪，在安静铜网屏蔽室内检查。受试者取坐位，记录电极在头顶正中，参考电极在耳后乳突部，地电极在前额正中部。用短声分…