胰岛素对急性血栓性脑梗死神经缺陷与认知障碍的治疗作 …

目的 探讨小剂量胰岛素对急性血栓性脑梗死神经缺损与认知障碍的治疗作用及其机制。方法 以小剂量胰岛素治疗血糖正常的急性血栓性脑梗死患者，一般用药组做对照，通过对患者治疗过程中血糖、血去甲肾上腺素（ＮＥ）、多巴胺（ＤＡ）、乙酰胆碱（Ａｃｈ）、Ｐ３００、神经缺陷评估、记忆评估的比较进行客观评价。结果 治疗组血糖变化不明显，ＤＡ、Ａｃｈ无变化，ＮＥ变化有显著，Ｐ３００之Ｎ２、Ｐ３波替代期缩短、波幅增高，变     

高血糖对脑梗死患者预后影响的临床研究

目的　探讨高血糖与脑梗死患者预后的关系。方法　检测了 14 2例脑梗死急性期 (发病小于 2 4小时 )内患者的首次空腹血糖 ,并分为单纯应激性高血糖组、糖尿病组、血糖正常组。结果　入院 2周内单纯应激性高血糖组、糖尿病组神经功能缺损评分明显高于血糖正常组 ,有显著差异 (P <0 .0 5 ) ;脑梗死病死率单纯应激性高血糖组、糖尿病组较血糖正常组高 ,有显著差异 (P <0 .0 5 ) ;脑梗死急性期预后血糖正常组好于单纯应激性高血糖组、糖尿病组 ,有显著差异 (P <0 .0 5 )。结论　血糖检测可作为急性脑梗死患者评估病情、选择治疗方法的手段之一。     

小柴胡汤改善抑郁症状及相关神经递质与神经营养因子分析

目的探索小柴胡汤对抑郁症状患者的疗效及脑内神经递质、神经营养因子变化关系。方法选取2013年4月~2015年4月于我院治疗的抑郁症状患者共计96例进行研究。按照入院顺序分为观察组和对照组,观察组患者应用小柴胡汤进行治疗,对照组患者应用西药进行治疗。观察两组患者治疗后的临床疗效及脑内神经递质、神经营养因子的变化。结果在接受治疗后,观察组患者的临床疗效显著,其总有效率达87.5%,明显高于对照组治疗后的总有效率41.67%,两组比较差异具有统计学意义(P0.05)。两组患者在接受治疗后均出现不同情况的副作用,但是观察组的不良反应发生率(4.17%)明显少于对照组的不良反应发生率(58.33%),两组比较差异具有统计学意义(P0.05);患者在应用小柴胡汤治疗后,两组患者的Ach、5-HT、NE及DA值在治疗前后差异具统计学意义(P0.05),且在5-HT、NE及DA值方面,观察组较对照组变化更显著,在Ach上,两组患者治疗效果无显著统计学差异(P0.05);两组患者治疗前后神经营养因子变化情况差异具有统计学意义(P0.05),观察组患者的神经营养因子的变化较对照组更大。结论小柴胡汤治疗抑郁症状的临床疗效显著,有抗抑郁作用,并对脑内神经递质、神经营养因子有一定的影响。     

脑梗死急性期血清胰岛素测定及意义

检查30例脑梗死急性期患者和20例正常人的血清胰岛素和血糖含量。结果,脑梗死组血清胰岛素显著高于对照组（P＜0．01）,而血糖与对照组比较无显著差异（P＜0．05）。提示脑梗死急性期患者血清胰岛素升高,存在高胰岛素血症及胰岛素抵抗。胰岛素抵抗可能为脑梗死发病的独立危险因素。     

不同剂量尿激酶溶栓治疗急性脑梗死的疗效观察

目的 :探讨急性脑梗死溶栓治疗中尿激酶大、小剂量与疗效、出血并发症的关系。方法 :急性脑梗死患者 6 0例 ,随机分成两组 ,小剂量组 30例 ,大剂量组 30例 ,分别予尿激酶 1万u/kg及 1 7万u/kg静滴 ,比较两组的疗效及出血并发症。结果 :大剂量组疗效优于小剂量组 (P <0 0 5 )出血并发症发生率与小剂量组相比无显著差异 (P >0 0 5 )结论 :尿激酶 1 7万u/kg是治疗急性脑梗死的较适宜剂量     

急性脑梗死患者血清钙、镁离子及血糖浓度变化的临床意义

目的探讨急性脑梗死患者血清钙、镁离子、血糖浓度变化及其临床意义。方法采用全自动生化分析仪检测485例急性脑梗死患者（脑梗死组）血清钙、镁离子及血糖浓度，并与对照组及治疗2周后进行比较。结果（1）脑梗死组血清钙、镁浓度明显低于对照组（P〈0．001），血糖浓度则明显高于对照组（P〈0．001）；（2）脑梗死组治疗2周后血清钙、镁浓度升高，但仍低于对照组（P〈0．01），血糖浓度降低，但也高于对照组（P〈0．01）；（3）脑梗死组疴隋越重，血清钙、镁浓度越下降，血糖浓度则越升高。结论血清钙、镁离子与血糖浓度变化与急性脑梗死患者病情有一定关系，它们的含量变化可作为判断其病情及评估其预后的一项指标，对急性脑梗死患者早期补充镁制剂对其治疗及预后具有重要临床意义。     

不同检测手段在脑梗死患者临床评估中的价值

目的 :探讨神经心理学量表、脑电生理及 MRI检查在脑梗死患者临床评估中的价值。方法 :对 5 5例脑梗死患者发病后一个月进行神经心理学上脑高级功能的评估 ,并进行了常规脑电图 ,P30 0及 MRI检查。其中神经心理学量表的检查包括 MMSE、韦氏智力及临床记忆量表检查。结果 :智商、临床记忆量表得分及 P30 0潜伏期检查患者组较对照组下降有明显差异。MRI所显示的病变大小与患者的认知功能和短时记忆明显相关。P30 0潜伏期不仅与认知功能明显相关 ,而且与韦氏智力有一定的相关性。结论 :合理的应用神经心理学量表检查可以全面地反映不同脑梗死患者脑功能障碍的不同侧面。脑梗死面积大小明显影响患者的认知功能和短时记忆。P30 0可以作为脑梗死患者认知功能评估的敏感指标。     

胰岛素干预治疗非高血糖急性脑梗死的临床研究

目的 研究胰岛素对非高血糖(血糖≤7.0mmol/L)急性脑梗死的治疗作用及预后的影响.方法 将75例不合并高血糖的急性脑梗死患者随机分为对照组和治疗组,治疗组40例给予常规治疗加胰岛素治疗即每2～4g低浓度糖注射液中加入1U胰岛素治疗10～14d,对照组35例患者只给予常规治疗,两组所有患者都于入院当日、治疗7d、治疗30d用中国卒中量表对神经系统症状和体征进行评估,根据评分比较两组疗效.结果 治疗7d和30d治疗组有效率分别为52.5%、92.5%.对照组分别为28.6%、68.6%,经统计学处理治疗组与对照组疗效有差异性(P均<0.05).结论 胰岛素干预治疗对非高血糖急性脑梗死病情的恢复和改善预后有积极影响.     

胰岛素治疗急性脑梗死的疗效观察

目的 观察胰岛素对于急性脑梗死的治疗效果。方法 105例急性脑梗死住院患者，随机分为两组，治疗组予5％葡萄糖氯化钠加普通胰岛素、10％氯化钾静滴，对照组予生理盐水加10％氯化钾静滴，其它的治疗方法两组均相同。以治疗前及用药后1、3、7、14、21d的血糖浓度，治疗前和用药后14、21d脑卒中的临床神经功能缺损程度评分为观察指标。结果 治疗21d后，两组患者的临床神经功能缺损程度评分有显著差异（P〈0．05）。两组患者治疗后的血糖浓度无显著性差异（P〉0．05）。结论 胰岛素具有脑保护作用，能减轻急性脑梗死患者神经功能缺损程度，提高生活质量。     

急性脑梗死患者简易胰岛素抵抗指数水平的临床研究

目的观察急性脑梗死患者的甘油三酯血糖指数(简易胰岛素抵抗指数TyG)和稳态模型评估的胰岛素抵抗指数(HOMA-IR)特点,并分析两指数的相关性。方法采用放射免疫法测定46例急性脑梗死(ACI)及40例健康对照者的空腹血胰岛素、空腹血糖、TG水平,计算简易胰岛素抵抗指数(TyG)和稳态模型评估法胰岛素抵抗指数(HOMA-IR)。结果急性脑梗死组TyG和HOMA-IR均较对照组增高(P0.05);急性脑梗死组和对照组TyG和HOMA-IR具有良好的相关性(分别为r=0.34,P0.05;r=0.27,P0.05)。结论急性脑梗死患者存在胰岛素抵抗,TyG评价胰岛素抵抗是一种简单准确的方法。     

首发精神分裂症患者脑电超慢涨落图分析

目的探讨脑电超慢涨落图（ET）与阴性、阳性精神分裂症异质性的关系。方法对首次发作未用药精神分裂症患者50例进行阳性阴性临床症状量表（PANSS）评定和脑电超慢涨落图检测。结果阴性、阳性精神分裂症组与正常对照组相比，NE、5-HT活动显著降低，DA活动显著升高，差异具有统计学意义。阴性、阳性精神分裂症组两组比较，GABA和Glu、AchR、DA活动明显异常，差异具有统计学意义。PANSS总分与Ach、DA有相关性，阳性量表分与GABA、Ach、AchR、DA有相关性，阴性量表分与Glu、5-HT、DA有相关性，精神病理分与AchR、DA有相关性。结论阳性症状可能与GABA、Ach、AchR、DA具有相关性，阴性症状可能与Glu、5-HT、DA具有相关性。ET检测可作为诊断精神分裂症的依据之一。     

Metabolic and neurochemical correlates of glucoprivic feeding

Various hypotheses are reviewed concerning the mechanisms of feeding induced by insulin or 2DG. New data are presented to show that elevated plasma ketone levels are not sufficient to suppress 2DG feeding, suggesting that nourishment of the brain either does not occur or is not sufficient to stop 2DG feeding. We find that both acetoacetate and hydroxybutyrate suppress spontaneous feeding. Another series of studies investigated the effects of 2DG and insulin on catecholamine turnover in several brain regions of animals that do (rat, mouse) or do not (hamster) eat in response to these stimuli. The effects of glucoprivic stimuli on NE turnover were minimal; however, 2DG did appear to inhibit DA turnover, especially in nucleus accumbens. Thus, brain NE does not seem specifically involved in glucoprivic feeding, data which are supported by a lack of additivity of feeding induced by 2DG and by clonidine. Finally, to resolve some of the disparate data concerning the effects of glucose infusion on insulin-induced feeding, we examined the time course for effects on feeding and for glucose tolerance. It appears that glucose strongly inhibits feeding only when it is utilized.     

Methylphenidate preferentially increases catecholamine neurotransmission within the prefrontal cortex at low doses that enhance cognitive function.

BACKGROUND: Low doses of psychostimulants, such as methylphenidate (MPH), are widely used in the treatment of attention-deficit/hyperactivity disorder (ADHD). Surprisingly little is known about the neural mechanisms that underlie the behavioral/cognitive actions of these drugs. The prefrontal cortex (PFC) is implicated in ADHD. Moreover, dopamine (DA) and norepinephrine (NE) are important modulators of PFC-dependent cognition. To date, the actions of low-dose psychostimulants on PFC DA and NE neurotransmission are unknown. METHODS: In vivo microdialysis was used to compare the effects of low-dose MPH on NE and DA efflux within the PFC and select subcortical fields in male rats. Doses used (oral, 2.0 mg/kg; intraperitoneal, .25-1.0 mg/kg) were first determined to produce clinically relevant plasma concentrations and to facilitate both PFC-dependent attention and working memory. RESULTS: At low doses that improve PFC-dependent cognitive function and that are devoid of locomotor-activating effects, MPH substantially increases NE and DA efflux within the PFC. In contrast, outside the PFC these doses of MPH have minimal impact on NE and DA efflux. CONCLUSIONS: The current observations suggest that the therapeutic actions of low-dose psychostimulants involve the preferential activation of catecholamine neurotransmission within the PFC.     

Effect of insulin excess and deficiency on norepinephrine turnover in rats

Summary To examine whether insulin enhances norepinephrine (NE) turnover, an index of sympathetic nerve activity, the effects of excess insulin and streptozotocin (STZ) induced insulin deficiency were examined in Sprague-Dawley rats. Exogenous insulin caused hyperphagia and elevated (approximately 300%) urinary epinephrine excretion, but did not alter cardiac NE content or turnover. STZ-induced insulin deficiency caused hyperglycemia and hyperphagia, but also did not alter cardiac NE content or turnover. Insulin deficiency reduced hepatic NE content 18%, but did not affect NE turnover or content of kidney or spleen. These data do not support the hypothesis that insulin influences cardiac sympathetic nerve activity in rats.     

阿立哌唑和奎硫平对首发精神分裂症患者认知功能影响的临床研究

目的研究阿立哌唑和奎硫平对首发精神分裂症患者认知功能的影响。方法将44例符合CCMD--3的首发精神分裂症患者在治疗前用韦氏记忆量表（WMS）和事件相关电位P300进行相关评定;在正常人群中选取22例作为对照组。将44例首发精神分裂症患者按随机数字表分为两组,即阿立哌唑组24例和奎硫平组20例,分别给予阿立哌唑和奎硫平治疗6周后再次用WMS和事件相关电位P300进行相关评定。结果首发精神分裂症患者的长时记忆、短时记忆、瞬时记忆及记忆商数（MQ）受损较为明显,P300电位成分中P2、P3波幅明显降低,P2、N2及P3潜伏期明显延长,与对照组比较差异有统计学意义（P〈0．05）。阿立哌唑组和奎硫平组患者WMS的再认、联想、理解及MQ在治疗前后差异有统计学意义（P〈0．05）,而P300各指标在治疗前后差异无统计学意义（P〉0．05）。治疗后两组间WMS各项目、P300各指标之间比较差异无统计学意义（P〉0．05）。结论首发精神分裂症患者存在着认知功能障碍,阿立哌唑及奎硫平能改善首发精神分裂症的认知功能。     

高频重复经颅磁刺激对早期帕金森病轻度认知功能障碍的疗效观察

目的 探讨高频重复经颅磁刺激(rTMS)治疗对早期帕金森病(PD)患者轻度认知功能障碍(MCI)的临床疗效.方法 将60例早期PD伴发MCI患者随机分为rTMS组和对照组,每组30例.以左前额叶背外侧皮质为刺激区域,rTMS组予以10 Hz高频rTMS,对照组予以伪刺激处理.比较两组治疗前后蒙特利尔认知评估量表(MoC...     

高压氧对帕金森小鼠模型脑递质及认知障碍的影响

目的:研究帕金森小鼠模型认知功能障碍及脑递质变化,高压氧对它们的影响。方法:应用1-甲基-4-苯基- 四氢吡啶(MPTP)皮下注射老年C57BL小鼠制作帕金森模型,在高压氧治疗前后用水迷宫及跳台试验检测其认知功能, 用高效液相色谱仪测定多巴胺(DA),乙酰胆碱(Ach),乙酰胆碱酯酶(Ache)含量变化。结果:小鼠模型DA,Ach,Ache 含量减低,水迷宫试验及跳台试验成绩较差,与空白对照组比有统计学意义(P<0.005);高压氧治疗后小鼠模型DA, Ach,Ache含量增加,水迷宫试验及跳台试验成绩改善,与模型对照组比有统计学意义(P<0.05)。结论:MPTP帕金森小鼠模型有认知功能障碍,可能与Ach,Ache含量降低有关,高压氧对其有治疗作用。     

Longitudinal study of cognitive dysfunction in multiple sclerosis: neuropsychological,neuroradiological, and neurophysiological findings

OBJECTIVE: (1) To assess cognitive function and cerebral magnetic resonance imaging (MRI) involvement in relapsing-remitting multiple sclerosis; (2) to monitor disease evolution, cognitive dysfunction, and cerebral lesion burden over time (mean 8.5 year follow up period); (3) to study the relation between clinical, neuropsychological, and MRI data. On follow up assessment, visual and auditory oddball event related potentials (ERPs) were recorded as psychophysiological evaluation of cognitive status. Correlations between neuropsychological, MRI, and ERP data were also analysed. METHODS: Neuropsychological study assessed verbal and non-verbal IQ, deterioration index (DI) from WAIS subtests, conceptual reasoning, attention, verbal and visuospatial short-term and long term memory. MRI assessment detected presence of demyelinating lesions by using a semiquantitative method as well as cortical and subcortical atrophy over time. RESULTS: Attention, short-term and long term visuospatial memory were mildly impaired at baseline and remained unaltered longitudinally. At retesting a significant worsening of verbal long term memory (p=0.023), DI presence (p=0.041) and the increase of supratentorial and subtentorial MRI lesions load (p=0.001) emerged. Expanded disability status scale score correlated significantly with total lesion burden at both evaluations (p=0.043 and p=0.024 respectively). Temporal, occipital, and frontal horn lesions as well as cortical atrophy correlated significantly with attention and memory tests at baseline. Follow up assessment revealed significant correlation between cortical atrophy and attention as well as visuospatial short-term memory; spatial long term memory correlated significantly with lesions in body of lateral ventricle and frontal lobe. ERP study showed P300 latency abnormalities in 75% of patients, involving specifically more visual P300 (58.4 % of cases) than auditory wave (41.6 %). Visual P300 latency and amplitude correlated significantly with DI and auditory P300 latency with frontal horn and brain stem lesions. CONCLUSIONS: These findings revealed mild cognitive impairment in MS patients particularly consistent with slowing information processing over time. Increased MRI lesions do not correlate with the clinical course of the disease and cognitive deficit evolution. Thus, cognitive dysfunction could be related to disease peculiarity and not to the time course. Correlations between P300, neuropsychological, and MRI findings provide further information about ERP application to examine cognitive impairment in MS and probably to investigate their neural origin.     

Hypothalamic lesions in the weanling rat alter pancreatic response to glucose

Circulating levels of insulin and glucagon were monitored daily in weanling rats bearing bilateral radiofrequency lesions of the hypothalamic region comprising the ventral pole of the dorsomedial nucleus and at least one third of the dorsal pole of the ventromedial nucleus (V-DMH). Plasma insulin levels in the animals with lesions were significantly elevated by the eighth post-lesion day while plasma glucagon levels were significantly reduced by the 13th day. An intravenous glucose bolus administered to conscious unrestrained animals with lesions had no significant effect on circulating insulin levels but resulted in a dramatic increase in circulating glucagon levels. The IV glucose injections had no significant effect on circulating glucagon levels in the sham-lesioned and unoperated controls while the plasma insulin levels in both control groups were significantly elevated. After a glucose challenge in vitro (300 mg%), insulin release by islets from the lesioned animals showed only a slight increase whereas glucagon release was paradoxically increased. These results provide evidence for an abnormal glucose-sensing function of the pancreatic islet after hypothalamic lesions.     

帕金森病外科治疗的综合评价与相关基础研究

目的通过综合研究对帕金森病(PD)外科治疗的价值和疗效进行全面评价。方法采用医学心理学测验(WAISRC)、临床记忆量表(MMPI)、神经生理学检测(听觉P300地形图)、神经电生理学(体感诱发电位SEP)和神经生化检查的脑脊液中多巴胺(DA)、5羟色胺(5HT)、去甲肾上腺素(NE)及其代谢产物)等对手术前后患者进行综合研究,并设对照组。结果手术前后智能和精神症状无显著性差异(P>0.05);手术后SEP的N20波峰潜伏期较术前缩短,统计学处理有差异(P左<0.005,P右<0.05),手术侧较非手术侧峰潜伏期缩短(P<0.05)。伴发抑郁患者组CSF中单胺类神经递质5HT的代谢产物5羟吲哚乙酸(5HIAA)和NE的代谢产物3甲氧基4羟基苯乙二醇(MHPG)低于对照组(P<0.01),患者组DA、高香草酸(HVA),5HT,5HIAA、NE、MPHG低于正常对照组(P<0.001),手术组上述各项均高于手术前组(P<0.001);结论手术不会加重智能和精神障碍;听觉P300地形图可作为诊断和疗效判定的客观指标之一;帕金森病及伴发抑郁症状均具有相应生化病理学基础。