神经免疫性疾病患者糖皮质激素治疗前后白细胞介素2和15变化的临床意义

目的　探讨糖皮质激素 (GC)对神经免疫性疾病 (IND)患者血浆和脑脊液 (CSF)白细胞介素 (IL) 2和IL 15的影响。方法　用双抗体夹心酶联免疫法 (ELISA)检测 2 2例急性期IND患者GC治疗前后血浆和CSFIL 2、IL 15水平 ,与 2 0例脑梗死 (NIND)患者、18例手术 (OP)患者、11例未用GC的重症肌无力患者 (NMG)进行对比。结果　治疗前 4组 (IND ,NIND ,OP和NMG)组间血浆和CSF中IL 2和IL 15比较 ,差异有显著意义 (IL 2 :血浆P <0 0 5 ,CSFP <0 0 1;IL 15 :血浆P <0 0 5 ,CSFP <0 0 5 ) ;治疗前IND组显著高于NIND组和OP组 (P <0 0 1) ,而与NMG组比较 ,差异无显著意义 (P >0 0 5 ) ;GC治疗后IND组IL 2和IL 15低于治疗前 (P <0 0 5 )。结论　急性期IND患者血浆和CSF中的IL 2和IL 15有上升趋势 ,GC治疗后IL 2和IL 15水平降低。GC可能通过影响患者免疫细胞产生IL 2和IL 15 ,而发挥治疗IND的作用。     

脑心通对脑梗死患者血流动力学、血凝及纤溶系统的影响

目的:研究脑心通对脑梗死患者血流动力学、血凝及纤溶系统的影响。方法:收集该院住院部2014年4月—2016年4月100例患者,随机数字法分为观察组和对照组各50例,两组均予以控制血压、血糖,调整血脂、稳定斑块、脑保护等治疗,观察组在此基础上加用脑心通胶囊,观察两组治疗前后NIHSS评分、血流动力学、凝血及纤溶系统的变化。结果:(1)治疗后两组患者NIHSS评分与其治疗前相比,P0.05差异具有统计学意义;治疗后两组NIHSS评分组间比较,P0.05,差异具有统计学意义。(2)观察组治疗后其全血黏度、血浆黏度、红细胞压积、红细胞聚集指数均明显少于治疗前(P0.05,差异具有统计学意义),而对照组则无明显变化(P0.05,差异无统计学意义)。观察组治疗后其血流动力学各指标均明显低于对照组(P0.05,差异具有统计学意义)。(3)观察组治疗后其PT、APTT、INR、T-PA均明显高于治疗前,Fg、PAL-l则低于治疗前(P0.05,差异具有统计学意义),对照组则无明显变化(P0.05,差异无统计学意义)。观察组治疗后其PT、APTT、INR、T-PA均明显高于对照组,Fg、PAL-l则低于对照组(P0.05,差异具有统计学意义)。结论:脑心通可改善脑梗死患者血流动力,改善患者血液高凝状态,且安全有效。     

曲克芦丁脑蛋白水解物注射液治疗急性脑梗死的随机、单盲和安慰剂对照研究

目的探讨曲克芦丁脑蛋白水解物注射液治疗急性脑梗死的疗效及安全性。方法选取符合入组条件的急性脑梗死患者456例,按1∶3比例随机分为对照组和治疗组,其中治疗组共342例给予曲克芦丁脑蛋白水解物注射液治疗14d,对照组共114例给予灭菌注射用水,两组基础治疗一致。主要疗效观察指标为两组患者发病90d时的改良Rankin量表评价分析无明显残障(0~2级)患者的比例,次要疗效指标为治疗7d、14d后美国国立卫生院神经功能缺损评分(NIHSS)评分较基线降低≥7分者所占百分比和治疗14d、发病后90d Barthel指数评价≥75分者所占百分比。结果治疗组发病90d后无明显残障病例(改良Rankin量表评分0~2级)百分比明显高于对照组(83.92%νs.69.3%,P0.01);用药14d时治疗组NIHSS评分降低≥7分者所占百分比明显高于对照组(31.37%νs.4.08%,P0.01);治疗组发病90d后Barthel指数≥75者所占百分比高于对照组(85.38%νs.76.32%,P0.05)。治疗组和对照组分别发生26例(7.28%)、11例(9.17%)不良反应(一般不良事件),组间比较差异无统计学意义(P0.05)。结论曲克芦丁脑蛋白水解物注射液可改善急性脑梗死患者的神经功能缺损程度,促进功能恢复,且不良反应少,安全性较好,值得临床推广。     

海口市公立与私立学校中学生主观生存质量及心理健康状况调查

有关中学生的主观生存质量因素的影响如何，心理健康状况如何，如何提高学生的心理健康水平和指导学生正确处理心理矛盾、心理障碍等等这些问题都是值得医务工作者深入探讨的问题。为此文章对海口市公立与私立学校中学生主观生存质量及心理健康学生进行了抽样调查。１对象与方法１．１对象海南省海口市两所公立和两所私立中学的２０００名在校的学生。回收１９１２份调查表，回收率为９５．６％。其中公立学校学生１０００名（５２．３％），高中学生５０９人，初中学生４９１名。私立学校学生９１２名（４７．７％），高中学生４２０名，初…     

RNA干扰技术阻断α-synuclein过表达诱导的细胞凋亡

BACKGROUND： Overexpression of α-synuclein can induce cell apoptosis. RNA interference （RNAi） may block specific gene function and cause gene silencing. OBJECTIVE： To construct a specific and effective RNAi plasmid for the α-synuclein gene and investigate if RNAi can block apoptosis in HEK293 cells, induced by overexpression of wild-type α-synuclein.
DESIGN, TIME AND SETTING： A contrast experiment based on genetically engineered cytobiology was performed at the State Key Lab of Medical Genetics of China, Xiangya Medical College of Central South University, between October 2004 and October 2008.
MATERIALS： HEK293 cells and pBSHH1 plasmid were provided by the State Key Lab of Medical Genetics of China; OligDNA sequence by Sagon Bioengineering Company, Shanghai; Lipofectamine 2000 by Invitrogen, USA; α-synuclein monoclonal antibody, Hoechst 33258, and MTT by Sigma, USA; Horseradish peroxidase-coupled goat anti-rat IgG by KPL, USA; FACSan flow cytometry by BD, USA.
METHODS： Four target sites were used to construct hairpin RNA pBSHH1 vectors - pSYNi-1, pSYNi-2, pSYNi-3 and pSYNi-4 - which were cloned in the pBSHH1 plasmid. HEK293 cells were transfected using Lipofectamine 2000. In addition, a non-transfect group and a negative plasmid transfect group were established. The cultured HEK293 cells were processed as follows： transfection of blank plasmid （blank control group）, transfection of α-synuclein-pEGFP and RNAi negative vector （negative control group）, and transfection of α-synuclein-pEGFP and pSYNi-1 （transfection group）. Cells in all groups were transfected with Lipofectamine 2000 for 48 hours.
MAIN OUTCOME MEASURES： Expression of α-synuclein mRNA and protein were detected by RT-PCR and Western blot. Cell morphology was observed under an inverted fluorescence microscope; cell viability was measured using MTT method; and cell apoptosis was determined with Annexin V-PE flow cytometry.
RESULTS： α-synuclein mRNA and protein expressions were significantly decreased in the pSYNi-1 group when compared with the non-transfect and negative plasmid transfect groups （P 〈 0.05）. The expressions were partially decreased in the pSYNi-2 group, but there was no significant difference in the pSYNi-3 and pSYNi-4 groups. Hoechst staining indicated that cell nuclei were enlarged in the negative control group, coloring was not uniform, and chromatin was accumulated and appeared spot-like. The nucleus coloring was uniform in the transfection group compared to negative control group. Cell viability in the negative control group was significantly lower than blank control group with cell apoptosis being significantly increased （P 〈 0.05）. In comparison with negative control group, cell viability was significantly increased in the transfection group and cell apoptosis was significantly decreased （P 〈 0.05）.
CONCLUSION： pSYNi-1 can inhibit α-synuclein gene expression and block apoptosis of HEK293 cells induced by overexpression of wild-type α-synuclein.     

激肽释放酶—激肽系统与脑缺血

激肽系统即激肽释放酶-激肽系统（Kallikrein-kinin system,KKS）广泛存在于动物体内的多个系统内。近年来,许多基础实验和临床研究表明,在脑缺血后激肽释放酶-激肽系统被激活,通过促进局部血管再生和神经再生、抑制细胞凋亡、促进神经胶质细胞迁移等作用,对急性缺血性脑血管疾病有保护作用。深入研究KKS的作用为缺血性脑血管病的治疗提供了又一新的途径。     

老年帕金森病患者血尿酸水平及其与认知功能的关系

目的 探讨老年帕金森病(PD)患者血尿酸水平与认知功能的关系,并对相关因素进行分析.方法 回顾性分析60例老年PD患者的病历资料,选择性别、年龄相匹配的60例健康体检者作为对照,记录性别、年龄、病程、Hoehn&Yahr分期(H-Y分期)、尿酸、简易智能量表(MMSE)评分,并进行比较和相关性分析.结果 老年PD组血浆尿酸水平[(262±53)μmol/L]明显低于对照组[(332±45)μmol/L],差异有统计学意义(t=-6.724,P＜0.001).PD组男性血浆尿酸水平[(271±48)μmol/L]均值略高于女性水平[(254±39)μmol/L],但差异无统计学意义(t=3.282,P=0.058).PD组男性血浆尿酸水平明显低于对照组男性尿酸水平[(353±62)μmol/L],差异有统计学意义(t=-5.625,P＜0.001).PD组女性血浆尿酸水平低于对照组女性尿酸水平[(294±59)/μmol/L],差异有统计学意义(t=-4.721,P=0.012).老年PD各亚组间血尿酸水平无显著差异,但与对照组比较差异均有统计学意义(F=22,039,P＜0,01).老年PD组血尿酸水平与病程长短无明显相关性(r=0.961,P＞0,05).老年PD患者存在认知功能障碍,其MMSE评分与H-Y分期(r=-0.577,P=0.019)、年龄(r=-0.333,P=0.034)呈负相关,与血尿酸水平呈正相关(r=0.789,P=0.000),与病程(r=-0.333,P=0.027)、体质指数(BMI)(t=-0.410,P=0.115)无相关性.结论 老年PD患者血尿酸水平降低,低尿酸水平可能与老年PD患者的认知功能障碍有关.

Abstract：

Objective To explore the relationship between uric acid (UA) level and cognitive function in elderly patients with Parkinson,s disease (PD) and analyze the cognition related factors.Methods The clinical data of 60 elderly PD cases in our hospital from 2001 to 2009 were retrospectively analyzed. The 60 healthy people receiving medical examination in our hospital and matched by gender and age, were as control group. The information including gender, age, illness duration, Hoehn & Yahr stage (H-Y stage), serum UA level and Mini-Mental State Examination (MMSE) scale were recorded. Results The serum UA level was significantly lower in PD group than in control group [(262±53) μmol/L vs. (332±45) μmol/L, t=-6.724, P＜0.001]. In PD group, the serum UA level was slightly higher in males than in females [(271 ±48) μmol/L vs.(254±39) μmol/L, t=3. 282, P=0. 058]. The serum UA level was significantly lower in male PD patients than in male controls [(353± 62) μmol/L, t=- 5. 625, P＜0. 001], and was lower in female PD patients than in female controls [( 294 ± 59) μmol/L, t = - 4. 721, P = 0. 012]. There were no significant differences in serum UA level among different H-Y stage subgroups (P＞0. 05), but the serum UA level was lower in different H-Y stage subgroups than in control group (F=22. 039, P＜0. 01 ). There was no correlation between the UA level and the illness duration (r=0. 961, P＞0.05).The MMSE score had significant difference between elderly PD group and control group (t= -3. 168,P＜0. 001). In PD patients, the MMSE score was positively correlated with serum UA level (r=0. 789, P= 0. 000), and was negatively correlated with H-Y stage (r= - 0. 577, P = 0. 019 ), age (r= -0. 333, P=0. 034), but was not correlated with illness duration (r= -0. 333, P=0. 207) and BMI (t=- 0. 410, P= 0. 115). Conclusions The level of serum UA is lower in elderly patients with PD than in normal controls. There is correlation between the serum UA level and cognitive impairment. Lower serum UA level predicts worse cognitive scores.     

脂质沉积性肌病诊断及随访分析

自1973年Engel和Angelini首次报道脂质沉积性肌病(Lipid storage myopathy,LSM)以来,关于该病的散发报道日渐增多,我们总结了7例LSM患者临床及随访资料并复习文献,以加深对此病的认识。     

核因子-κB在盐酸法舒地尔诱导大鼠骨髓间充质干细胞分化为神经细胞的作用

目的探讨核因子-κB信号通路在大鼠骨髓间充质干细胞（MSCs）向神经元分化中的作用。方法实验分为无血清培养基对照组、盐酸法舒地尔组。采用盐酸法舒地尔诱导大鼠MSCs分化为神经元。免疫细胞化学法检测神经元烯醇化酶（NSE）、神经微管结合蛋白（MAP-2）、胶质纤维酸性蛋白（GFAP）的表达变化及核因子-κB亚基p65核移位情况。结果①盐酸法舒地尔可以诱导MSCs向神经元分化,NSE、MAP-2的表达率高,但对照组无类似情况（P〈0．05）。②盐酸法舒地尔组MSCs的p65核移位明显受抑制,与对照组相比差异有统计学意义（P〈0．05）。结论盐酸法舒地尔可以抑制核因子-κB活化,可能有利于MSCs向神经细胞分化。     

瞳孔变化的某些临床意义

从整体来看，瞳孔不仅是可调节人的视野，它的变化还是标志着生命存活，对很大疾病的诊断及定位都具有不可替代的临床意义。在某些疾病的治疗中，还可根据它的变化来调整药物剂量。譬如：有机磷农药中毒、脑疝等。这是因为它与机体组织器官有密切的联系。因而有人将它喻为人体改变的特殊“晴雨表”。所以，临床医生如能对瞳孔变化了解得多一些，在