ABC－ELISA法检测重症肌无力患者三种自身抗体的研究

本文利用ＡＢＣ－ＥＬＩＳＡ法检测了９７例ＭＧ病人血清内三种抗体：ＡｃｈＲａｂ、Ｐｒ－Ｍａｂ、ＣＡＥａｂ。结果发现：（１）全身型ＡｃｈＲａｂ、ｐｒ－Ｍａｂ阳性率明显高于眼肌型（Ｐ＜０．０１）；ＡｃｈＲａｂ与Ｐｒ－ＭａｂＰ／Ｎ值呈线性正相关（ｒ＝０．７９７Ｐ＜０．０１）。（２）合并胸腺异常者ＣＡＥａｂ阳性率为８４．２％，明显高于对照组（Ｐ＜０．０１）；此组病人ＡｃｈＲａｂ与ＣＡＥａｂＰ／Ｎ值呈显著正相关，Ｐｒ－Ｍａｂ与ＣＡＥａｂＰ／Ｎ值呈非常显著正相关。（ｒ＝０．５１２和ｒ＝０．５９８Ｐ＜０．０１）。（３）８例病人作了治疗前后抗体检测。激素治疗后或切除异常胸腺后，抗体滴度多数下降或有转阴趋势。     

多发性硬化患者白细胞糖皮质激素受体改变的研究

目的明确多发性硬化患者白细胞糖皮质激素受体改变，阐明其改变与病因学的联系及在治疗中的作用。方法应用放射免疫法和放射配体结合法测定了１５例多发性硬化患者血浆皮质醇和外周血白细胞ＣＲ。结果ＭＳ患者的Ｆ和ＧＲ分别为３９０．３３±２８２.０３ｎｍｏｌ／Ｌ和１０００±７８０位点／细胞。Ｆ与对照组比较无显著性差异（４７８．６０±９６．８１ｎｍｏｌ／Ｌ，Ｐ＞０．０５）；ＧＲ明显低于对照组（５４２０±７７５位点／细胞，Ｐ＜０．００１）。ＭＳ患者ＧＲ与Ｆ无相关性（ｒ＝０．２５８，Ｐ＞０．０５）。结论提示ＭＳ存在有ＧＣ－ＧＲ系统的紊乱，与ＭＳ疾病有关联。ＧＲ含量低，ＧＣ治疗仍有效，提出ＭＳ患者白细胞上可能存在低亲和力受体。     

重症肌无力患者体感诱发电位的研究

３０例ＭＧ患者作了正中神经Ｍ－ＳＥＰ额顶同步描记，有延髓以上ＣＮＳ功能异常１４例（４６．７％），以一侧Ｐ２２波ＡＭＰ降低或消失最多见。８例治疗后复查，７例的异常恢复，１例临床好转但ＥＰ未变且对侧又异常。胸腺瘤术后３月始恢复。６例原ＥＰ正常者治疗后复查有１例一度又有异常。异常主要与症状及胸腺瘤有关。与ＥＥＧ结果比较一致，但阳性率明显为高。认为此项检查有助探讨ＭＧ的ＣＮＳ损害和指导治疗。     

重症肌无力患者红细胞免疫功能的变化

为了探讨重症肌无力（ＭＧ）患者红细胞免疫功能的变化，我们测定了２０１例ＭＧ患者外周血ＲＢＣ－Ｃ３ｂ受体花环率（ＲＢＣ－Ｃ３ｂＲＲ）和ＲＢＣ－ＩＣ花环率（ＲＢＣ－ＩＣＲ）和５０名正常人进行对照。结果为ＭＧ患者的ＲＢＣ－Ｃ３ｂＲＲ（７．５８±３．４％）明显低于正常对照组（１２．８７±５．０７％）（Ｐ＜０．０１），ＲＢＣ－ＩＣＲ（５．８３±４．６２％）稍高于正常对照组（５．０３±３．８４％）（Ｐ＞０．０５），ＭＧ全身型组ＲＢＣ－Ｃ３ｂＲＲ（５．２５±１．８５％）明显低于眼肌型组（８．５９±３．１９％）（Ｐ＜０．０１），强的松治疗前组（７．９８±４．０１％）与治疗后组（１１．６４±４．３５％）有明显差异（Ｐ＜０．０１），强的松治疗前后ＲＢＣ－ＩＣＲ的变化无统计学意义。上述结果表明ＭＧ患者红细胞免疫粘附功能低下与ＭＧ发病有一定的相关性。ＭＧ的发病不仅有体液免疫功能障碍，还可能有红细胞免疫功能障碍，我们的资料为ＭＧ免疫病原学发病机理提供了一项新的实验依据，也可为免疫治疗ＭＧ评定疗效提供客观辅助指标。     

脑血管病患者SOD、MDA检测意义及其相关性研究

检测８７例脑血管病（ＣＶＤ）患者血清超氧化物歧化酶（ＳＯＤ）同工酶活性、丙二醛（ＭＤＡ）含量，并对其中３４例患者红细胞内ＳＯＤ（ＲＢＣ－ＳＯＤ）活性进行检测，对其相互间的关系进行了探讨。结果表明，血清总ＳＯＤ（Ｔ－ＳＯＤ）、Ｍｎ－ＳＯＤ活性和ＭＤＡ含量明显高于正常对照组，ＣｕＺｎ－ＳＯＤ活性无变化或显著降低及ＲＢＣ－ＳＯＤ活性均明显低于对照组。其相关性表现为Ｔ－ＳＯＤ及Ｍｎ－ＳＯＤ与ＭＤＡ的改变呈显著正相关（ｒ＝０．９３２３，Ｐ＜０．００１；ｒ＝０．９２１５，Ｐ＜０．００１），ＣｕＺｎ－ＳＯＤ与ＭＤＡ的改变呈显著负相关（ｒ＝－０．８８６１，Ｐ＜０．００１）。提示这些变化可作为判断脑血管病变发展和严重程度的重要参数。     

国产氟西汀片及其胶囊治疗抑郁症的疗效观察

目的 比较国产氟西汀片剂及其胶囊治疗抑郁症的疗效和副反应。方法 收集符合ＣＣＭＤ－２－Ｒ抑郁症诊断标准的病例６０例，随机分为氟西汀片剂组和氟西汀胶囊组，各３０例。于治疗前及治疗后１周、２周、４周及６周末分别ａｍｉｌｔｏｎ抑郁量表（ＨＡＭＤ）、临床疗效总评定量表（ＣＧＩ）及副反应量表（ＴＥＳＳ）评定。结果 氟西汀片剂组与胶囊组的各次ＨＡＭＤ评分均无明显差异（Ｐ〉０．０５）；二组总有效率均为８３．３％     

格林—巴利综合征患者血清和脑脊液中白细胞介素6检测及其意义

采用生物学方法检测了３０例ＧＢＳ患者血清及脑脊液中ＩＬ－６水平，结果表明ＧＢＳ患者血清及脑脊液中ＩＬ－６检出率及水平明显高于非炎症性神经病组及正常对照组（均Ｐ＜０．０１）；１４例血清和脑脊液均可检出ＩＬ－６的ＧＢＳ患者中，血清ＩＬ－６水平与脑脊液中ＩＬ－６水平之间无相关性（Ｐ＞０．０５）；血清ＩＬ－６检测阳性的ＧＢＳ患者中，血清免疫球蛋白水平（ＩｇＧ、ＩｇＭ、ＩｇＡ）明显高于血清ＩＬ－６检测阴性的ＧＢＳ患者及正常对照组（均Ｐ＜０．０１），而血清ＩＬ－６检测阴性的ＧＢＳ患者血清免疫球蛋白水平与正常对照组比较无明显差别（Ｐ＞０．０５）。提示ＩＬ－６与ＧＢＳ发病有关。     

多发梗塞性痴呆患者血浆和脑脊液中若干神经肽含量的变化

用放射免疫法测定了３０例多发梗塞性痴呆（ＭＩＤ）、３５例无痴呆多发脑梗塞患者（ＭＣＩ）及３０名健康人的血浆生长抑素（ＳＳ）、精氨酸加压素（ＡＶＰ）及β－内啡肽（β－ＥＰ）含量，同时测定了部分ＭＩＤ和ＭＣＩ患者脑脊液（ＣＳＦ）中ＳＳ、ＡＶＰ、β－ＥＰ含量。发现ＭＩＤ患者血浆ＳＳ、ＡＶＰ含量比ＭＣＩ组和健康对照组均降低（Ｐ＜０．０５），且随痴呆程度的加重，其含量有递减趋势。而血浆中β－ＥＰ在这三组间差异无显著性意义（Ｐ＞０．０５）。ＭＩＤ组ＣＳＦ中ＳＳ、β－ＥＰ含量低于ＭＣＩ组（Ｐ＜０．０５），而ＣＳＦ中ＡＶＰ含量在两组间无差异（Ｐ＞０．０５），ＣＳＦ中ＡＶＰ含量与痴呆的关系有待进一步研究。     

阻塞性睡眠呼吸暂停综合征患者事件相关电位研究

目的　研究阻塞性睡眠呼吸暂停患者事件相关电位Ｐ３ 的变化，探讨可能的机制。方法　入组受试者分为阻塞性睡眠呼吸暂停患者组（ｎ ＝ ３０） 及正常对照组（ｎ ＝ ３０） ，均进行睡眠多导仪、听觉诱发事件相关电位（Ｐ３） 、临床记忆量表检查及神经系统查体。结果采用ｔ 检验和Ｓｐｅａｒｍａｎ 等级相关分析。结果　阻塞性睡眠呼吸暂停患者组记忆商（ＭＱ）为９０ ±１２ ，Ｐ３ 潜伏期为（３５９±３０） 毫秒（Ｆｚ 记录点） ，（３６５±３１） 毫秒（Ｃｚ 记录点） ；正常对照组ＭＱ为１０４±１６，Ｐ３ 潜伏期为（３３７±２９） 毫秒（Ｆｚ记录点） ，（３３９±３１）毫秒（Ｃｚ 记录点） 。阻塞性睡眠呼吸暂停患者组与正常对照组的Ｐ３ 潜伏期和记忆商差异存在显著性意义（Ｐ＜ ０．０５）。结论　阻塞性睡眠呼吸暂停患者有认知功能损害，夜间低氧血症可能起重要作用。     

大鼠脑针刺损伤引起的碱性成纤维细胞生长因子变化与5‘—甲基？…

系统观察大鼠ＣＮＳ针刺损伤后表达ｂＦＧＦ、ＦＧＦ受体（ＦＧＦＲ）和ＧＦＡＰ的细胞种类、时相以及相互影响，探讨ＦＧＦＲ抑制剂－－５’－ＭＴＡ对体内反应生形胶质化的影响。将７５只ＳＤ雄性大鼠均分１５组：伤后０．５ｈ￣３０ｄ处死的实验组与对照组。将２０只雄性Ｗｉｓｔａｒ大鼠均分２大组。甲组伤后４ｄ处死（５只加药鼠），乙组伤后８ｄ经（５只加药鼠）；其中非加药鼠作相应单纯损伤对照组。ＨＥ染色和免疫组化染色观     

Predicting the course of myasthenic weakness following double filtration plasmapheresis

OBJECTIVE: To evaluate the clinical course of patients with myasthenia gravis (MG) up to 3 months after double filtration plasmapheresis (DFP). MATERIAL AND METHODS: We recorded the MG score and measured the level of acetylcholine receptor antibody (AchRAb) at baseline and day 1 (D1), week 1 (W1), 1 month (M1), 2 (M2) and 3 months (M3) after DFP in 16 MG patients. Based on the difference in score during follow-up, we divided our patients into clinical improvement (CI) and clinical worsening (CW) groups. RESULTS: The MG score decreased in all courses from a mean of 8.1 at baseline to 5.6 at D1, and to 4.7, 4.0, 3.8, and 3.7 at W1, M1, M2, and M3, respectively. In the CW group, AchRAb levels were significantly higher at M1 (P = 0.022). The AchRAb level at W1 correlated significantly with the MG score at M3 (P = 0.027) and the changes of MG score from W1 to M1 (P = 0.029). The ratio of AchRAb levels of M1 to W1 correlated well with MG score at W1 (P = 0.032), at M3 (P = 0.001), and the changes of MG score from W1 to M1 (P = 0.004). CONCLUSION: Excessive rebounds of AchRAb level at W1 may suggest clinical worsening and further increases in AchRAb level at M1 predict poorer outcome after DFP.     

抑郁症、焦虑症患者事件相关电位对照研究

目的:探讨抑郁症、焦虑症患者脑诱发电位的变异特点及临床应用价值.方法:共有46例抑郁症患者(抑郁症组)、41例焦虑症患者(焦虑症组)及42名健康志愿者(正常组),使用美国Nicolet Bravo脑电生理仪进行事件相关电位P300(P300)和关联性负变化(CNV)的检测.并于治疗2个月时对两患者组进行相同项目的随访.结果:与治疗前比较,抑郁症组P300靶N2、P3潜伏期缩短(P＜0.05),靶P3波幅升高(P＜0.01),CNV潜伏期M1缩短(P＜0.01),波幅M1、M2升高(P均＜0.05).焦虑症组P300靶P3潜伏期缩短(P＜0.05),CNV波幅M1下降(P＜0.05),指令信号后负变化(PINV)的出现率下降(P＜0.05).治疗后与正常组比较,抑郁症组P300非靶P2波幅偏低(P＜0.01),P300的双峰P2波和CNV的PINV出现率均偏高(P＜0.05～0.01);焦虑症组CNV的潜伏期M2缩短(P＜0.01).抑郁症组与焦虑症组治疗后比较在P300非靶P2波幅、双峰P2波出现率,CNV潜伏期M2和PINV出现率等指标之间差异有显著性(P均＜0.01).结论:抑郁症、焦虑症患者脑诱发电位有自己的变异特点,在诊断和鉴别诊断方面有一定的价值.     

重症肌无力患者血清白细胞介素—6水平测定

目的探讨重症肌无力(MG)与白细胞介素-6(IL-6)的关系.方法采用双抗体夹心ELISA法对30例MG患者用糖皮质激素(GC)治疗前、治疗2个月后和22例正常对照血清IL-6、乙酰胆碱受体抗体(AchRab)水平进行检测.结果MG患者组血清IL-6水平显著高于对照组(P＜0.01),MG患者组血清IL-6水平在用GC治疗2个月后显著降低(P＜0.01),其血清IL-6与血清AchRab水平呈正相关(r=0.693,P＜0.01).结论IL-6与MG发病密切相关,IL-6参加了MG的免疫病理过程;检测血清IL-6水平对MG临床有重要价值;GC可抑制IL-6合成及AchRab产生.     

Usefulness of p300 in subjective memory complaints: a prospective study.

The existing studies about the utility of P300 latency for diagnostically classifying patients in preclinical stages of dementia are cross-sectional rather than longitudinal in design, and their results are inconclusive. The authors investigated the P300 value in a series of patients with subjective memory complaints using a prospective design. The study was performed in a consecutive series of 116 outpatients with subjective memory complaints as the predominant symptom. P300 (auditory oddball task) was performed immediately after the first clinical evaluation, and at 12 and 24 months. Final cognitive syndrome diagnosis (mean follow-up period, 27.7 months) was then made by a neurologist who was blinded to the neurophysiologic results. Diagnosis at the end of follow-up was 30 cases of normal cognition, 30 cases of mild cognitive impairment, 28 cases of dementia of Alzheimer's type (DAT), five cases of vascular dementia, and one case of frontotemporal dementia; 22 patients were lost to follow-up. P300 latency was significantly higher for the DAT group (analysis of variance: P=0.023) throughout the study. The diagnostic value of P300 latency at baseline examination for DAT had a sensitivity of 52.9% and a specificity of 76.9%; the odds ratio was 3.75 (95% confidence interval, 1.23-11.41). Findings from the present study suggest that assessment of evoked related potentials may contribute to the early detection of DAT.     

High-dose intravenous immunoglobulin therapy for myasthenia gravis

The objective of this open, retrospective study was to investigate whether intravenous immunoglobulin (IVIg) could induce a clinically obvious improvement in patients with generalized myasthenia gravis (MG), as judged by MG functional status. Fourteen patients with generalized MG were treated during at least one episode with 0.4 g IVIg per kilogram body weight per day for 5 consecutive days. Patients with confounding variables were excluded; this left 11 patients (16 episodes) to be further analysed. We defined improvement as at least a one-step improvement in MG functional status (according to the University of Virginia’s Modification of Osserman’s classification). Of the treatment episodes, 56% were classified as positive responses. If improvement occurred, onset of improvement started after 3 (1–12) days and peak effect was reached after 7 (4– 30) days (median and range). All four patients who required artificial ventilation could be weaned from it 8.5 (6–11) days after the start of IVIg (median and range). Of the patients treated on two occasions, only one patient had a positive response during both. In MG functional status 5, improvement was observed during five of seven episodes. None of the patients with MG functional status 3 responded. Patients with an acute relapse of MG seemed to respond equally well to IVIg compared with patients with subacute deterioration/ chronic-static state (50% versus 60%). The MG functional status at the start of IVIg and on the day of maximal improvement was compared for all episodes together, and significant improvement was noted (P = 0.0052). We did not see any serious side-effects after IVIg treatment. This retrospective analysis suggests that high-dose IVIg is an effective therapy in some patients with deterioration of generalized MG. If improvement occurs, it starts within a few days of the onset of IVIg and the effect seems to peak within 2 weeks. Received: 4 March 1997 Received in revised form: 28 August 1997 Accepted: 1 September 1997     

散发性重症肌无力患者267例维生素D受体基因多态性

目的 探讨中国汉族人维生素D受体(VDR)基因Fok Ⅰ和Apa Ⅰ位点多态性与重症肌无力(MG)的关系.方法 采用聚合酶链反应-限制性内切酶片段多态性(PCR-RFLP)法检测VDR基因Fok Ⅰ和Apa Ⅰ位点的多态性,比较基因型和等位基因在健康对照组及各MG亚组中的分布,并观察其与MG严重程度和激素短期疗效的关系.结果 Fok Ⅰ和Apa Ⅰ位点的基因型和等位基因频率在MG组和对照组间以及MG各亚组间的分布差异无统计学意义.Fok Ⅰ位点的基因型和等位基因频率在激素短期疗效好和疗效差组间的分布差异亦无统计学意义;但Apa Ⅰ位点的A等位基因频率在两组间差异有统计学意义,疗效好者(55/186,29.6%)高于疗效差者(7/48,14.6%,OR=2.46,95%CI 1.04～10 43,x2=4.400,P=0.036);激素短期疗效好者中携带基因型AA及Aa的频率(48/93,51.6%)高于疗效差者(7/24,29.2%,OR=2.59,95% CI 0.98～14.60,x2=3.858,P=0.049).结论 在我国汉族人散发性MG患者的VDR基因中,未发现Fok Ⅰ和Apa Ⅰ变异位点显著增加MG的患病风险,但携带Apa Ⅰ位点的A等位基因的MG患者激素短期疗效可能较好.

Abstract：

Objective To explore the associations between vitamin D receptor ( VDR) Fok- Ⅰ and Apa- Ⅰ polymorphisms and myasthenia gravis (MG) in Chinese Han population.Methods Polymorphisms of VDR Fok- Ⅰ and Apa-Ⅰ were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.The frequencies of genotypes and hyplotypes were compared among 286 normal controls and 267 MG patients in different subgroups classified by gender,age of onset,presence of thymoma,and Osserman classification sat maximal severity in the follow-up.The association between the genotypes and maximal severity of MG and short-term glucocorticoid treatment were also investigated.Results There were no significant differences in frequencies of genotypes and hyplotypes of both Fok-Ⅰ and Apa-Ⅰ between MG group and control group,and among subgroups of MG.The Fok- Ⅰ showed no statistical difference between the patients with better and less improvement after short-term treatment of glucocorticoid.The frequency of Apa-Ⅰ alleles in the patients with better improvement (55/186,29.6% ) significantly differed from the less improved group ( 7/48,14.6%,OR = 2.46,95% CI 1.04-10.43,x2 = 4.400,P = 0.036).The patients with the genotype A A/Aa were more likely to improve better after the treatment(48/93,51.6%) than in the worse group(7/24,29.2%,OR =2.59,95% CI 0.98-14.60,x2 =3.858,P= 0.049).Conclusions Alleles and genotypes of VDR-Fok- Ⅰ and Apa-Ⅰ were not found to be related with MG onset and severity.MG patients with VDR-Apa-A allele may have better improvement short-term treatment of glucocorticoid.     

重症肌无力患者图形翻转视觉诱发电位的研究

目的了解重症肌无力(MG)是否存在视觉传导通路的损害。方法;对28例MG患者和30名年龄与之匹配的正常人进行图形翻转视觉诱发电位(PRVEP)的检测。结果MG组55只眼检查有32只眼存在视觉传导功能异常。MG组P100波潜伏期(PL)和波幅(Amp)较正常对照组显著延长或降低。MGP100波PL和Amp的改变与病情的轻重密切相关,而与年龄和性别无关。10例复查结果表明,吡啶斯的明+地塞米松或强的松治疗能明显改善PRVEP。结论;MG可出现视觉传导通路的损害,可通过PRVEP早期发现之,并且PRVEP有可能成为MG疗效监测的一种手段。     

P300 in Behcet's patients without neurological manifestations

OBJECTIVE: Behcet's disease is the association of recurrent aphthous stomatitis with genital ulceration and eye disease. Neurologic involvement patterns include meningomyelitis, a brain stem syndrome, pyramidal and extrapyramidal abnormality and stroke. In the present study, subclinical involvement was investigated by using P300 in Behcet's patients without neurological manifestation. METHODS: Fifteen patients and 15 healthy volunteers were accepted for the study. P300 from vertex (Cz) electrode sites of the 10-20 system using electrodes and motor response time were recorded. RESULTS: Patients had significantly prolonged latencies of P300 as compared to normal controls (p=0.013) but no significant differences in amplitude (p=1.000). Patients showed a significantly delayed motor response time than controls (p=0.006). Nine patients (60%) had P300 latency and eight patients (53.3%) had motor response time values exceeding the mean of controls by two standard deviations. CONCLUSION: The findings suggest that the P300 measures and motor response time may reflect subclinical neurologic involvement in Behcet's disease.     

精神分裂症患者事件相关电位P300与临床症状关系的研究

目的　探讨精神分裂症P3 0 0 主要指标尤峰间潜伏期的变化及其与临床症状的关系。方法　检测 4 0例精神分裂症患者 (患者组 )和 36名正常人 (对照组 )CZ、C3 、C4电极位置的P3 0 0 ,并用阳性和阴性症状量表 (PANSS)评定患者临床症状。结果　与正常对照组相比 ,在CZ、C3 、C4三点 ,患者组P3波幅低 (P <0 0 1) ,并与阴性症状分呈负相关 (r=- 0 4 0 3,- 0 4 30 ,- 0 35 7) ;N2 潜伏期长 (P <0 0 1) ;P2 N2 峰间潜伏期长 (P <0 0 5和P <0 0 1) ,并与PANSS量表总分、阳性症状、思维障碍、激活性等多种症状分呈负相关 (P <0 0 1～ 0 0 5 ) ;N2 P3 峰间潜伏期短 (P <0 0 1) ,在CZ 点与PANSS量表总分(r=- 0 36 3)和一般症状分 (r=- 0 392 )呈负相关。结论　精神分裂症患者的P3 波幅、N2 潜伏期、P2 N2 、N2 P3 峰间潜伏期有明显异常 ,其中P3 波幅、P2 N2 、N2 P3 峰间潜伏期与多种临床症状呈相关性