不同血脂水平的原发性高血压患者血浆高敏C-反应蛋白检测及临床分析

目的 探讨不同血脂水平高血压病患者炎症因子血浆高敏C-反应蛋白(hsCRP)的表达水平及临床意义.方法 我们对86例高血压病患者根据不同血脂水平分为正常血脂组(NC组)和高血脂症组(HC组),另选45例体检健康对照组用CRP检测仪和全自动生化分析仪检测hsCRP、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)浓度进行单因素方差分析.结果 NC、HC组与健康对照组相比,hsCRP明显升高(P＜0.05),而HC组与NC组比较hsCRP也明显升高(P＜0.05).HC组中CH 、LDL-C、TG 明显高于NC组与健康对照组(P＜0.05),NC组与健康对照组相比,CH 、LDL-C、TG均未见显著差异(P＞0.05).3组中HC组HDL-C明显低于NC组与健康对照组(P＜0.05),NC组与健康对照组之间HDL-C未见显著差异(P＞0.05).结论 炎症参与了高血压的进展,对不同血脂水平高血压患者hsCRP将会成为反映高血压进展程度,预测未来风险的一个良好指标.     

急性脑梗死患者血清抵抗素水平及相关性研究

目的 探讨脑梗死患者血清抵抗素水平变化及其与糖代谢、脂质代谢、超敏C反应蛋白(hs-CRP)等的相关性.方法 采用酶联免疫吸附法测定82例脑梗死患者血清抵抗素水平,同时检测血清瘦素、胰岛素、空腹血糖(FBG)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及hs-CRP水平,计算定量胰岛素敏感性检测指数(QUICKI).另收集健康体检者50名为对照组.对所有受试者进行身高、体质量、腰围、臀围、收缩压(SBP)、舒张压(DBP)测量,并计算体质量指数(BMI)及腰臀比(WHR).结果(1)两组间性别比、年龄和BMI差异无统计学意义(P＞0.05),脑梗死组WHR、SBP和DBP均明显高于对照组(P＜0.01).(2)脑梗死组血清抵抗素、瘦素、胰岛素、FBG、LDL-C及hs-CRP均明显高于对照组(P＜0.05),而血清HDL-C和QUICKI均低于对照组(P＜0.05),两组间TC和TG比较差异无统计学意义(P＞0.05).(3)单因素直线相关分析结果显示,抵抗素与BMI、SBP、DBP、胰岛素、FBG、LDL-C和hs-CRP呈正相关(P＜0.05),与QUICKI和HDL-C呈负相关(P＜0.05),与WHR、瘦素、TC和TG无相关性(P＞0.05).(4)多元逐步回归分析结果显示,抵抗素与BMI、SBP、LDL-C和hs-CRP呈正相关(P＜0.05),而与HDL-C和QUICKI呈负相关(P＜0.05).结论 急性脑梗死患者血浆抵抗素水平明显升高,提示抵抗素在动脉粥样硬化性脑梗死的发生过程中具重要调控作用.抵抗素不但参与糖代谢紊乱和脂质代谢紊乱的发生,而且与高血压、肥胖以及动脉粥样硬化炎性反应等有关.     

LDL-C/HDL-C比值与急性脑梗死危险因素的关系及在疗效评估中的价值

目的探讨低密度脂蛋白(LDL-C)与高密度脂蛋白(HDL-C)比值与急性脑梗死危险因素的关系及其对急性脑梗死疗效的评估价值。方法选取我院2012-06—2014-06神经内科收治的68例急性脑梗死患者为研究对象,另选取60例正常体检者为对照组,测定2组收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、甘油三脂(TG)、总胆固醇(TC)、低密度脂蛋白(LCL-C)、高密度脂蛋白(HCL-C)、载脂蛋白B(APOB)、颈动脉内-中膜厚度(IMT),并计算LDL-C/HDL-C比值。急性脑梗死患者入院后给予阿托伐他汀钙片治疗,分析治疗效果及LDL-C/HDL-C对疗效的评估价值。结果急性脑梗死组患者SBP、DBP、FBG、HbA1c、TG、TC、LCL-C、APOB、APOA1、IMT及LDL-C/HDL-C水平均高于对照组(P0.05),而HDL-C水平低于对照组(P0.05)。经Person相关因素分析,LDL-C/HDL-C与SBP、LCL-C、HDL-C、IMT水平呈正相关(P0.05)。经Logistic多因素分析,LDL-C/HDL-C、IMT、SBP为急性脑梗死的独立危险因素。与治疗前相比,急性脑梗死患者美国国立卫生院神经功能缺损评分(NIHSS)显著下降,且与LDL-C/HDL-C、IMT呈正相关(P0.05)。结论LDL-C/HDL-C比值是急性脑梗死独立危险因素,且与患者NIHSS具有密切的关系,可与IMT作为患者预后的评价指标。     

他汀类药物联合缓释烟酸的调脂疗效及对高血压并发脑梗死患者动脉硬化的作用

目的 研究阿托伐他汀联用缓释烟酸对高血压并发脑梗死患者血脂调节和防止动脉硬化的影响.方法 96例高血压并发脑梗死患者随机分为2组:(1)对照组(48例),给予阿托伐他汀20 mg/d;(2)治疗组(48例),给予阿托伐他汀20 mg/d和烟酸缓释片1000 mg/d.分别于入院第2天空腹查血脂、肝功能,入院1～2周内查颈动脉超声,6个月后复查血脂、凝血功能、肝功能和颈动脉超声,比较治疗前后2组血清总胆固醇(TC)、血清甘油三酯(TG)、血清低密度脂蛋白(LDL-C)和高密度脂蛋白(HDL-C)水平、颈总动脉内膜中层厚度(IMT)、颈动脉斑块面积(Smax)变化.结果 (1)经过6个月治疗,2组患者LDL-C水平较治疗前比较均有明显降低(3.52±0.80 mmol/L vs 1.81±0.51 mmol/L,3.54±0.63 mmol/L vs 2.32±0.63 mmol/L,P<0.05),治疗组较对照组降低更加显著(1.81±0.51 mmol/L vs.2.32±0.63 mmol/L,P<0.05).而HDL-C水平较治疗前有所升高,具有统计学意义(0.91±0.30 mmol/L vs 1.49±0.31 mmol/L,0.96±0.28 mmol/L vs 1.25±0.55 mmol/L,P＜0.05),治疗组较对照组升高更加显著(1.49±0.31 mmol/L vs 1.25±0.55 mmol/L,P＜0.05),2组TC、TG均有明显下降(P＜0.05),但治疗组较对照组下降更显著(P<0.05).6个月随访均未发现明显肝酶升高等并发症及不良反应发生.(2)治疗6个月后,2组IMT、Smax均有不同程度下降,较治疗前比较差异有统计学意义(P＜0.05);阿托伐他汀联合烟酸缓释片治疗组较单用阿托伐他汀组IMT、Smax下降更明显,2组比较差异有统计学意义(P＜0.05).结论 两种治疗方法均有明显的调脂、降脂作用,缓释烟酸对升高HDL-C作用更明显,阿托伐他汀联用缓释烟酸更有利于全面调脂,延缓颈动脉粥样硬化并缩小斑块面积,且具有良好的安全性和耐受性.     

脑梗死患者血尿酸水平与颈动脉粥样硬化的关系

目的 探讨脑梗死患者血尿酸水平与颈动脉粥样硬化之间的关系.方法 对159例在我院住院的脑梗死患者,记录一般临床资料.同时检测血尿酸、血脂水平、血糖、血尿素氮、血肌酐,应用彩色多普勒超声检测其颈总动脉、颈内动脉及其分叉处的内膜中层厚度、斑块数,将其分为有颈动脉粥样硬化组和无颈动脉粥样硬化组,对影响动脉硬化发生的因素进行多因素Logistic回归分析,并比较各组间血尿酸水平.结果 动脉硬化组92例,无动脉硬化组67例,2组患者的性别、年龄、BMI、SUA、TC比较,差异均有统计学意义(P＜0.05),2组患者的吸烟、高血压、糖尿病发生率及TG、HDL-C、LDL-C水平比较,差异无统计学意义(P＞0.05).Spearman相关分析结果显示,脑梗死患者SUA水平与BMI、LDL-C、TC、Cr及IMT呈正相关,与BG呈负相关,差异均有统计学意义(P＜0.05).Logistic回归分析表明,年龄、高血压、糖尿病、吸烟、SUA水平是AS的危险因素,差异均有统计学意义(P＜0.05).结论 脑梗死患者血尿酸水平与颈动脉粥样硬化的发生有相关性,血尿酸水平是颈动脉粥样硬化的独立危险因素.     

补阳还五汤对脑卒中患者血脂及动脉粥样硬化的影响

目的 观察和评价补阳还五汤辅助治疗脑卒中对患者血脂和动脉粥样硬化情况的影响.方法 选取102例脑卒中患者为研究对象,随机分为观察组和对照组各51例,对照组给予常规西医治疗,观察组在此基础上加用补阳还五汤进行辅助治疗.对2组患者治疗前后血清总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平、颈动脉内膜中层厚度（IMT）和颈动脉血管阻力指数（RI）进行检测和记录.结果 2组血清TC、TG、HDL-C、LDL-C治疗后均显著改善（P＜0.05）,2组比较差异有统计学意义（P＜0.05）;观察组血清TC、TG、LDL-C水平显著低于对照组,HDL-C水平显著高于对照组;2组颈动脉IMT厚度均较治疗前有所下降,但差异无统计学意义（P＞0.05）;2组颈动脉RI均较治疗前显著下降（P＜0.05）,且观察组下降更为明显（P＜0.05）.结论 补阳还五汤对纠正脑卒中患者的脂代谢异常有积极作用,可在一定程度上改善患者动脉粥样硬化的症状,可作为脑卒中辅助治疗手段予以推广应用.     

血脂、血尿酸及凝血功能与急性脑梗死 和脑出血的相关性

目的 探讨血脂、血尿酸（UA）及凝血功能与急性脑梗死（ACI）和脑出血（ICH）的相关性。 方法 测定同期住院的62例ACI和50例ICH患者的血脂、UA及凝血功能等指标，并以同期住院的50例非 脑血管病患者为对照进行相关分析。 结果 ACI组总胆固醇（TC）、甘油三酯（TG）水平显著高于对照组（P＜0.01），载脂蛋白A1（ApoA1）水平 显著低于对照组（P＜0.01）；高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋 白B（ApoB）水平与对照组比较差异无统计学意义（P＞0.05）。ACI组血UA、纤维蛋白原（Fib）显著高于对 照组和ICH组（P＜0.01）；ICH组血脂指标、血UA、Fib与对照组比较差异无统计学意义（P＞0.05）。 结论 血脂代谢紊乱、高尿酸血症、高纤维蛋白原血症与脑梗死明显相关，是脑梗死的危险因素，与 ICH则无明显相关性。     

急性脑梗死患者血清尿酸水平与颈动脉粥样硬化的关系研究

目的探讨脑梗死患者血清尿酸(uric acid,UA)水平与颈动脉粥样硬化(Carotid artery atherosclerosis,CAA)斑块及脑梗死的关系。方法检测78例脑梗死患者的血清尿酸(UA)、总胆固醇(total cholesterol,TC)、甘油三酯(Triglycerides,TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(Low-density lipoprotein,LDL-C)水平,并应用彩色多普勒超声检测其颈动脉内中膜厚度(intimal-medial wall thickness,IMT)及斑块。结果脑梗死组患者血清UA水平及IMT值高于对照组(P0.05),脑梗死组内高尿酸(HUA)组TG、LDL水平较尿酸正常组显著增加(P0.05)。脑梗死组内颈动脉粥样硬化亚组尿酸水平比较,IMT增厚组、斑块形成组尿酸水平较IMT正常组高(P0.05)。结论 HUA血症可能是脑梗死重要危险因素,且与颈动脉粥样硬化形成有关。     

阿尔茨海默病及血管性痴呆患者血清胆固醇、 Vit B12和叶酸变化的临床研究

目的探讨阿尔茨海默病(AD)和血管性痴呆(VaD)与血清胆固醇、血脂、Vit B12和叶酸的关系.方法对35例AD、35例VaD和16例健康对照组血清胆固醇、血脂、叶酸及Vit B12进行测定,并进行组间对比研究.结果AD组和VaD组血清胆固醇、甘油三酯明显高于对照组(P＜0.05),并且VaD组甘油三酯水平与对照组相比差异更明显(P＜0.01),而AD和VaD之间无显著性差异(P＞0.05),VaD组叶酸水平显著低于AD组和正常对照组(P＜0.05).Vit B12水平各组间相比无显著性差异(P＞0.05).结论血清叶酸水平降低可能与VaD发病有关,AD和VaD血清总胆固醇和甘油三酯明显增高,降低胆固醇及血脂可能对AD和VaD预防和治疗有益.     

缺血性脑卒中患者与糖尿病 血脂及颈动脉斑块形成的相关性分析

目的探讨缺血性脑卒中患者与糖尿病血脂颈动脉斑块形成的关系。方法选择本院收治的300例确诊为缺血性脑卒中患者作为研究对象,根据是否合并糖尿病分为糖尿病组、非糖尿病组,检测并比较2组血脂、颈动脉内膜中层厚度(IMT)的差异,并比较2组的颈动脉斑块阳性患者检出率差异。结果糖尿病组的HDL-C值显著低于非糖尿病组(P0.05),LDL-C、Apo(b)、hs-CRP、IMT显著的高于非糖尿病组,差异具有统计学意义(P0.05);2组TG、TC值差异无统计学意义(P0.05)。糖尿病组的颈动脉斑块阳性率为79.59%(78/98),显著高于非糖尿病组的67.33%(136/202),差异具有统计学意义(P0.05)。IMT值与HDL-C、Apo(a)呈显著负相关性(P0.05),与LDL-C、Apo(b)呈显著正相关性(P0.05)。结论缺血性脑卒中患者合并糖尿病可能会进一步增加颈动脉斑块的形成,这一因素与患者血脂指标进一步不良改变有关。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.