帕金森病患者外周血白细胞中时钟基因Bmal1和Bmal2的表达

目的研究帕金森病患者时钟基因的表达,探讨帕金森病的分子时钟机制。方法实验对象为17例帕金森病（PD）患者（9例男性,8例女性）和16例正常人对照（9例男性,7例女性）,分别在夜间21：00、00：00、06：00和09：00四个时间点取血样,用实时定量RT—PCR检测时钟基因Bmal1和Bmal2的mRNA表达水平。结果PD患者中,Bmal1在21：00、00：00、06：00的表达水平与正常对照差异具有显著性：21：00[（22．17±4．09）,（51．14±8．31）,P=0．003];00：00[（30．30±5．45）,（100．00±24．71）,P=0．008];06：00[（19．02±3．33）,（65．61±14．11）,P=0．002]。Bmal2在21：00、00：00的表达水平与正常对照差异有显著性：21：00[（48．09±7．40）,（84．96±9．34）,P=0．005];00：00[（65．85±7．88）,（100．00±11．78）,P=0．025]。结论PD患者的周围分子时钟发生了改变。PD患者时钟基因Bmal1和Bmal2在外周血的相对表达水平明显减低,为疾病监控和研究疾病对药物的反应性提供分子基础。     

Gastrointestinal tract

<正>209328 Fast track surgery in elective operation for colorectal carcinoma/Yang Dongjie(杨东杰,Dept Gastrointest Pancreas Surg,1st Affil Hosp,Sun Yat-sen Univ,Guangzhou 510080)…∥Chin J Gen Surg.-2009,24(6).-477～479Objective To investigate the clinical application of fast track surgery in patients undergoing elective colorectal carcinoma surgery.Methods Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups:fast-track group(35 cases) and conventional care group(35 cases).Results Sixty-two patients finished the study,32 cases in fast-track group and 30 cases in conventional care group.The median and average time to the first passage of flatus(2±1 vs.4±2,P<0.01),the first passage of stool (3.8±1.6 vs. 6.4±2.5,P=0.000 7),resumption of normal diet[(4±2)vs.(8.2±2.2),P<0.01]and the length of postoperative stay (6±1 days vs. 11.7±3.8 days,P<0.01)were much shorter in the fast-track group than in the conventional care group.The preoperative incidence of thirst (2/32 vs.23/30,P<0.01),hunger (5/32 vs.20/30,P<0.01) and postoperative infectious complications (2/32 vs.8/30,P=0.04)were much lower in the fast-track group than in the conventional care group.Conclusion Fast track surgery in patients undergoing elective colorectal resetion was safe and effective.12 refs,1 tab.     

Effects of Baduanjin (八段锦) Exercise on Knee Osteoarthritis: A One-Year Study

Objectives:Knee osteoarthritis(OA) is a major cause of pain and functional limitation.Short-term Baduanjin(八段锦) exercise had been testified to be beneficial to the disease.This study conducted an initial assessment of the one-year Baduanjin exercise on knee OA.Methods:The recruited patients practiced Baduanjin at the community recreational center.Sessions were held for 30 min five times a week for one year.Knee pain, stiffness,physical disability,general health,knee extensors and flexors strength,and aerobic ability were measured using the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),the Medical Outcomes Study Short Form-36(SF-36),the 6-Minute Walk Test(6-MWT),and the Isokinetic Strength of the Knee Extensors and Flexors(ISKEF).Body mass index(BMI) was also calculated before and after the study period for comparison. Results:Twenty-eight patients signed the informed consent.Six patients withdrew from the trial.Twenty-two patients(29 knees) completed the one-year study.After one-year Baduanjin exercise,WOMAC pain(132.0±69.6 vs.56.2±67.6,P=0.000),stiffness(64.7±54.8 vs.22.3±34.6,P=0.000),and physical function subscales (386.1±275.8 vs.182.0±235.7,P=0.003);SF-36 body pain(45.7±20.0 vs.57.4±17.9,P=0.005),general health (50.5±20.0 vs.62.1±16.1,P=0.004),role emotional(64.4±26.1 vs.73.5±21.3,P=0.047),and health transition (3.3±1.0 vs.2.6±1.0,P=0.008);BMI(25.0±2.9 vs.24.4±2.9,P=0.032);6-MWT(565.7±94.6 vs.610.5±66.7, P=0.036);and ISKEF Peak Torque(the Knee Extensors:60.5±25.5 vs.76.8±31,P=0.000;the Knee Flexors: 29.3±15.9 vs.37.1±15.8,P=0.001) were significantly improved.No adverse effects resulted from the exercise. Conclusions:It suggested that the long-term Baduanjin could be a feasible and safe exercise option for knee OA.     

Shenfu Injection (参附注射液) inhibits inflammation in patients with acute myocardial infarction complicated by cardiac shock

Objectives: To investigate the effect of Shenfu Injection(参附注射液, SFI) on inflammatory factors in patients with acute myocardial infarction complicated by cardiogenic shock(CS) treated with and intra-aortic balloon pump(IABP). Methods: This study enrolled 60 patients with ST-segment elevation myocardial infarction(STEMI) complicated by CS. Patients underwent IABP and emergency percutaneous coronary intervention(PCI) were randomly divided into two groups by random number table with 30 cases in each group, one given SFI treatment(100 m L/24 h), one not. The two groups were then compared in a clinical setting for left ventricular function, biochemical indicators and Inflammatory factors, including C-reactive proteins(CRP), interleukin-1(IL-1) and tumor necrosis factor alpha(TNF-α). Major adverse cardiac and cerebrovascular events(MACCE) events were compared between patients of the two groups both in-hospital and in follow-ups. Results: The IABP support treatment times of patients in the IABP+SFI group were significantly shorter than the IABP group(52.87±28.84 vs. 87.45±87.31, P=0.047). In the patients of the IABP+SFI group, the CRP peak appeared in 24 h after PCI operation. The CRP peak in the patients of the IABP+SFI group was significantly lower than that in the IABP group(31.27±3.93 vs. 34.62±3.47, P=0.001). The increases in range of TNF-α in the patients of the IABP+SFI group were significantly lower than those of the IABP group(182.29±22.79 vs. 195.54±12.02, P=0.007). The increases in range of IL-1 in the patients of the IABP+SFI group were significantly lower than those of the IABP group(214.98±29.22 vs. 228.60±7.03, P=0.019). The amplitude elevated TNF-α 72 h after admission was an independent risk factor of in-hospital MACCE events(OR 0.973, 95% CI 0.890–0.987, P=0.014) in patients with STEMI and CS. Conclusion: Patients with STEMI complicated by CS treated by IABP and SFI had a reduced inflammatory reaction, a reduced dependence of CS on IABP and shortened the course of disease.     

Dissociation between source and item memory in Parkinson’s disease

Background Episodic memory includes information about item memory and source memory.Many researches support the hypothesis that these two memory systems are implemented by different brain structures.The aim of this study was to investigate the characteristics of item memory and source memory processing in patients with Parkinson＇s disease （PD）,and to further verify the hypothesis of dual-process model of source and item memory.Methods We established a neuropsychological battery to measure the performance of item memory and source memory.Totally 35 PD individuals and 35 matched healthy controls （HC） were administrated with the battery.Item memory task consists of the learning and recognition of high-frequency national Chinese characters; source memory task consists of the learning and recognition of three modes （character,picture,and image） of objects.Results Compared with the controls,the idiopathic PD patients have been impaired source memory （PD vs.HC：0.65±0.06 vs.0.72±0.09,P=0.001）,but not impaired in item memory （PD vs.HC：0.65±0.07 vs.0.67±0.08,P=0.240）.Conclusions The present experiment provides evidence for dissociation between item and source memory in PD patients,thereby strengthening the claim that the item or source memory rely on different brain structures.PD patients show poor source memory,in which dopamine plays a critical role.     

不同起搏模式对缓慢性心律失常患者心脏重构及远期预后影响的随访观察

目的 评价单腔起搏(VVI)和双腔起搏(DDD)对缓慢性心律失常患者心脏重构及远期预后的影响.方法 回顾性分析1991年1月至2003年1月植入永久性起搏器的患者的随访资料,评价VVI和DDD两种不同起搏方式患者左心系统重构与瓣膜反流、心脏功能、血栓与心房颤动事件发生率、病死率等影响情况.结果 对DDD组患者57例和VVI组患者59例,长期随访(97±27)个月、(107±44)个月发现,DDD组患者左心房、左心室内径同术前比差异无统计学意义[(37±5)mm比(35±5)mm,P=0.07;(47±7) mm比 (47±5)mm,P=0.32],三尖瓣反流率显著增加(42.1%比10.5%,P<0.01);VVI组左心房[(45±12)mm比(39±12)mm,P<0.01]、左心室[(53±11) mm比( 50±9)mm,P=0.01)]舒张末期内径较术前明显增加且三尖瓣反流率(42.4% 比 16.9%,P<0.01)显著增加;DDD组[(57±7)%比(59%±9)%,P=0.11]和VVI组患者末次随访左心室射血分数[(53±10)%比(56±11)%,P=0.05]同术前比无明显变化;末次随访时DDD组和VVI组心房颤动发生率(5.4% 比 22.0%,P=0.14)、再住院率(26.3%比33.9%,P=0.08)和病死率(10.5%比11.9%,P=0.77)差异无统计学意义.结论 两种起搏模式均不能阻止心脏电重构与机械重构的发生.提示现有的房室顺序起搏模式基础上,有必要寻求更加生理性的起搏部位或最小化心室起搏、优化房室间期等方式提高患者的预后.

Abstract：

Objective To assess the effects of VVI (ventricular demand) and DDD (dual-chamber) pacing models on cardiac remodeling and the long-term clinical outcome of patients with symptomatic bradycardia.Methods All patients with DDD and VVI pacing models at our hospital from January 1991 to January 2003 were retrospectively analyzed.Results After a follow-up period of over 8 years in DDD and VVI groups (97±27, 107±44 months), left atrial diameter [(45±12) mm vs (39±12) mm, P<0.01] and left ventricular end-diastolic diameter[ (53±11) mm vs (50±9)mm, P=0.01] in 57 patients with VVI pacing model were markedly enlarged than those at pre-implantation. And tricuspid regurgitation increased (42.4% vs 16.9%, P<0.05). But in 59 patients with DDD pacing model, except for increased tricuspid regurgitation(42.1% vs 10.5%, P<0.01), left atrial diameter [(37±5) mm vs. (35±5)mm, P=0.07] and left ventricular end-diastolic diameter[(47±7)mm vs (47±5)mm, P=0.32] were not significantly different. Mitral regurgitation significantly increased only in the VVI group (P<0.01). The increases of left ventricular end-diastolic diameter (P=0.04), mitral valve (P=0.02) and tricuspid regurgitation (P<0.01) were much more pronounced in the VVI group than those in the DDD group. Left ventricular ejection fraction (LVEF) showed no difference with that at pre-implantation (P=0.11 in DDD group, P=0.05 in VVI group). But the LVEF value was lower (P=0.04) while the incidence of thrombolism was higher (P=0.03) in the VVI group than those in the DDD group at post-implantation. However, the incidence of atrial fibrillation (P=0.14), hospitalization (P=0.08) and survival (P=0.77) showed no significant difference between two groups.Conclusion DDD pacing offers more benefits over VVI pacing through improving cardiac functions and arresting left ventricular remodeling. However, neither groups showed any difference in decreasing mortality rate and hospitalization.Moreover, both pacing modes fail to reverse cardiac electrical and anatomical remodeling. It is imperative to explore more physiological pacing site and rational atrioventricular (AV) interval to improve the prognosis of patients.     

Volumetric intravascular ultrasound comparisons of drug-eluting stent thrombosis and in-stent restenosis

Objectives We compared intravascular ultrasound (IVUS) findings of drug-eluting stent (DES)-treated lesions that developed stent thrombosis versus in-stent restenosis (ISR) to identify underlying mechanical differences. Methods IVUS findings in 15 post-DES thrombosis patients were compared with 45 matched ISR patients who had no evidence of stent thrombosis. Results Minimum stent area [MSA, (3.7±0.8) mm2 vs (4.9±1.8) mm2, P=0.01], minimum stent diameter [(1.9±0.3) mm vs (2.3±0.4) mm, P=0.005], mean stent area [(5.2±0.8) mm2 vs (7.2±2.1) mm2, P<0.01], and both focal [MSA/reference lumen area, (54.7±15.9)% vs (75.0±20.1)%, P=0.001] and diffuse stent expansion [mean stent area/reference lumen area, (76.6±23.0)% vs (110.3±23.3)%, P<0.01] were significantly smaller in the stent thrombosis group (vs the ISR group). An MSA <4.0 mm2 (73.3% vs 35.6%, P=0.01) or <5.0 mm2 (86.7% vs 53.3%, P=0.02) was more often found in the stent thrombosis group (vs the ISR group). The MSA site occurred more frequently in the proximal stent segment within the stent thrombosis group compared to the ISR group (60% vs 24.4%, P=0.01). There were no differences in edge dissection, stent fracture, or stent-vessel wall malapposition between the two groups. Independent predictors of stent thrombosis were diffuse stent expansion (OR=1.5, P=0.03) and proximal location of the MSA site (OR=12.7, P=0.04). Conclusion DES-treated lesions that develop thrombosis or restenosis are often underexpanded. Underexpansion appears to be more severe in DES-thrombosis lesions. Lesions with diffuse underexpansion and a proximal (vs distal) underexpanded MSA site are more predisposed to thrombus formation than ISR.     

Intravascular ultrasound assessment of the incidence and predictors of edge dissections and intramural hematomas after drug-eluting stent implantation

Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Methods We studied 887 patients with 1 045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging, and compared the dissected stent end to the non-dissected stent end. Results Eighty-two dissections were detected; 51.2% (42/82) involved the proximal and 48.8% (40/82) the distal stent edge. When compared to the non-dissected stent end, residual plaque area [(8.0±4.3) mm2 vs (5.2±3.0) mm2, P<0.01], plaque burden [(52±12)% vs (36±15)%, P<0.01], plaque eccentricity (8.4±5.5 vs 4.0±3.4, P<0.01), and stent edge symmetry (1.17±0.11 vs 1.14±0.08, P=0.02) were larger; plaque burden≥50% was more frequent (62% vs 17%, P<0.01) and calcium deposits (52.5% vs 35.6%, P=0.03) more common; and the lumen/stent area (0.86±0.16 vs 1.02±0.18, P<0.01) was smaller in the stent dissected end. Independent predictors of stent edge dissection were residual plaque eccentricity (OR=1.3, P<0.01) and residual plaque burden≥50% (OR=7.3, P<0.01). Intramural hematomas occurred in 34.1% (28/82) of dissections.Independent predictors of intramural hematomas were plaque eccentricity (OR=1.4, P=0.005), plaque burden≥50% (OR=7.1, P=0.02), and mean lumen diameter to stent diameter ratio (OR=0.37, P=0.04).Concluslon IVUS identified edge dissections after 9.4% of DES implantations. Residual plaque eccentricity and significant plaque burden predicted coronary stent edge dissections. Dissections in less diseased reference segments with an arc of normal vessel wall (greater plaque eccentricity) more often evolved into an intramural hematoma.     

Intravenous Contrast Material Administration at High-pitch Dual-source CT Coronary Angiography: Bolus-tracking Technique with Shortened Time of Respiratory Instruction Versus Test Bolus Technique

Objective To investigate the feasibility of acquiring the similar homogeneous enhancement using bolus-tracking techniques with shortened respiratory time in prospectively electrocardiogram-gated high-pitch spiral acquisition mode (Flash mode) coronary computed tomography angiography (CCTA) compared with test bolus technique. Methods One hundred and eighty-four consecutive patients with mean heart rate ≤65 beats per minute undergoing CCTA were prospectively included in this study. The patients were randomly divided into two groups. Patients in the group A (n=92) instructed to shorten respiratory time received CCTA using bolus-tracking technique with high-pitch spiral acquisition mode (Flash mode), while those in the group B (n=92) underwent CCTA with test bolus technique. The attenuation in the ascending aorta, image noise, contrast-to-noise ratio and radiation doses of the two groups were assessed. Results There were no significant differences in the mean attenuation values in the ascending aorta (483.18±59.07 HU vs. 498.7±83.51 HU, P=0.183), image noise (21.4±4.5 HU vs. 20.9±4.3 HU, P=0.414), contrast-to-noise ratio (12.1±4.2 vs. 13.8±5.1, P=0.31) between the groups A and B. There were no significant differences in the radiation dose of dynamic monitoring scans (0.056±0.026 mSv vs. 0.062±0.018 mSv, P=0.068) and radiation dose of angiography (0.94±0.07 mSv vs. 0.96±0.15 mSv,P=0.926) between the two groups, while 15 mL less contrast material volume was administered in the group A than the group B. Conclusion Bolus-tracking technique with shortened time of respiratory in Flash mode of dual-source CT yields the similar homogeneous enhancement with less contrast material in comparison to the test bolus technique.     

Plasma Homocysteine and Gene Polymorphisms Associated with the Risk of Hyperlipidemia in Northern Chinese Subjects

To examine the relationship between occurrence of hypedipidemia,plasma homocysteine and polymorphisms of methylenetetra hydrofolate reductase (MTHFR) gene and methionine synthase (MS) gene.Methods A total of 192 hyperlipidemia patients were selected and divided into hypercholesterolemia group,hypertriglyceridemia group,and combined hyperlipidemia group.Another 208 normal individuals were selected as control.Total plasma homocysteine (tHcy)concentration was measured by high-performance liquid chromatography (HPLC).Lipid profiles were measured for all subjects.The polymorphisms of MTHFR gene C677T and MS gene A2756G were analyzed by PCR-RFLP.Results The tHcy concentration in the combined hyperlipidemia patients was significantly higher than that in the control (15.95 μmol/L vs 13.43 μmol/L,P＜0.05).The prevalence of hyperhomocysteinemia (Hhcy) in the combined hyperlipidemia group was significantly higher than that in the control (42.2% vs 23.0%,P=0.015),with the odds ratio (OR) of 3.339 (95%CI:1.260-8.849).The hyperlipidemia patients with Hhcy had a higher concentration of total cholesterol (TC) than that in the normal they patients (5.67±0.95 mmol/L vs 5.47±0.92 mmol/L,P=0.034).There was no significant difference in genotype or allele frequencies of MTHFR C677T between the hyperlipidemic and control groups.The hyperlipidemia patients with MTHFR CT/TT genotype had a higher concentration of triglyceride (TG) than those with CC genotype (2.24±1.75 mmol/L vs 1.87±0.95 mmol/L,P＜0.05).Individuals with CT/TT genotype had a higher concentration of tHey than those with 677CC genotype both in the hyperlipidemia group (12.61±1.24 μmol/L vs 11.20±1.37 μmol/L,P＜0.05) and in the control group (14.04±1.48 μmol/L vs 12.61±1.24 μmol/L,P＜0.05).The percentage of MS 2756 GG/AG genotype in the combined hyperlipidemia group was significantly higher than that in the control (26.7% vs 13.0%,P=0.012),with the OR of 3.121 (95%CI:1.288-7.651).The hyperlipidemia patients with MS 2756AG/GG genotype had a higher concentration of TC (5.87±0.89 mmol/L vs 5.46±0.93 mmol/L,P＜0.05) and LDL-C (3.29±0.81 mmol/L vs 2.94±0.85 mmol/L,P＜0.05)than those with AA genotype.However,individuals with 2756AG/GG genotype showed no significant difference in tHcy among those with AA genotype.Conclusion Hhcy and MS A2756G mutation may be the risk factors for combined hyperlipidemia.Further study is needed to confirm the role of Hhcy and MS A2756G mutation in the development of hyperlipidemia.     

小鼠纹状体时钟基因表达的生后发育

目的 研究小鼠纹状体中时钟基因表达的生后发育.方法 选新生早期(P3)、断奶前期(P14)和成年(P60)小鼠,光照1h[01 Hour-After-Light-On (HALO)＝09:00]起取纹状体,连续24h取材,取材时间间隔6h.实时定量RT-PCR检测时钟基因Bmal1,Clock,Cry1,Per1和Rev-erbα Mrna水平.结果 P3组中,5种时钟基因表达均无明显波动;P14组仅有Rev-erb αmRNA表达随时间变化(P=0.027),表达高峰在19-01HALO;而P60组,各基因表达均表现明显波动[Bmal1(P=0.004)、Clock(P=0.004)、Per1(P=0.004)、Rev-erbα(P=0.004)],Bmal1,Clock和Cry1的高峰在01HALO, Per1和Rev-erbα分别在13HALO和07HALO.此外每种基因的总体表达水平出生后也呈动态变化,Bmal1,Clock,Per1和 Rev-erb表达丰度随发育而增加,P3组相似文献   

中国南极越冬队员外周血生物钟基因Clock和Bmal1昼夜性节律表达赴南极前后对比

观察中国南极考察队越冬队员外周血淋巴细胞钟基因Clock和Bmal 1表达昼夜节律性变化。方法在中国第25次南极考察队越冬队员中选择8名队员,平均年龄38岁,均为男性,在1个昼夜周期内设立6个时点(ZT):02:00、06:00、10:00、14:00、18:00和22:00,每一时点采集外周静脉血6mL,采集赴南极前后2组血样。用实时定量RT-PCR方法,测定不同昼夜时点(ZT)样品中核心钟基因Clock和Bmal 1的mRNA表达量,通过余弦法和Clock Lab软件获取节律参数,进行赴南极前后对比。结果赴南极前,8个样本Clock和Bmal 1的mRNA表达均有显著昼夜节律特征(P<0.05),Clock的峰值相位位于-335.85±13.80,Bmal 1的峰值相位位于-307.12±8.17。赴南极后,仅2例Clock和3例Bmal 1表达还存在显著昼夜节律变化。Clock的峰值相位移位到-42.28±5.27,Bmal 1的同峰值相位移位到-184.58±29.58。结论南极特殊周期环境对人体生物钟基因表达的昼夜节律会产生影响。     

阿尔茨海默病和额颞叶痴呆患者徘徊行为落日现象的比较分析

目的 探索阿尔茨海默病和额颞叶痴呆患者徘徊行为的落日现象,并比较该现象在两痴呆亚型之间的差异.方法 利用电子示踪监测系统对2008年9月至2009年9月入住大阪浅香山医院,符合纳入标准的27例阿尔茨海默病及7例额颞叶痴呆患者进行连续30 d的步行活动监测,分析并比较两者24h标准化活动水平的变化.结果 经Huynh-Feldt Epsilon(H-F)校正后的重复测量方差分析显示两组24h标准化活动水平差异无统计学意义(F=3.74,P=0.06),分组因素与时间因素无交互效应(F=1.42,P＞0.05),两组间标准化活动水平变化趋势不服从第17次项曲线(F=5.24,P＜0.05)和第9次项曲线(F=4.26,P=0.05).两组标准化活动水平均逐渐增高,阿尔茨海默病组在18:00达到最高点,额颢叶痴呆组则在19:00达到最高点,Bonferroni法多重比较显示阿尔茨海默病组在5:00 ～7:00的标准化活动水平较额颞叶痴呆组高(分别为0.75±0.08比0.35±0.16,F =4.91;1.13±0.13比0.49±0.26,F=5.06;1.24±0.15比0.56±0.28,F=4.47;P＜0.05),而在16:00则较低(1.65±0.11比2.22±0.22,P＜0.05).圆形分布x2检验显示额颞叶痴呆组活动峰值时间较阿尔茨海默病组延迟(14:12±5:12比15:47±4:19,x2=87.31,P＜0.01).结论 徘徊行为的落日现象在阿尔茨海默病及额颞叶痴呆中均有出现,但两者徘徊行为时间趋势不尽相同.与额颞叶痴呆患者相比,阿尔茨海默病患者徘徊行为时相较长,且峰值时间较早.     

胰岛素样生长因子结合蛋白-3在肝脏组织中的表达及意义

目的研究胰岛素样生长因子结合蛋白-3(Insulin-like growth factor binding protein-3,IGF-BP-3)在慢性肝炎、肝硬化及肝癌中的意义.方法收集11例正常肝组织、12例慢性肝炎、16例肝硬化及21例肝癌组织标本及临床资料.采用标记链霉素卵白素生物素(SABC)法,用抗IGFBP-3单克隆抗体(Sigma,14527)行免疫组织化学染色.结果正常对照、慢性肝炎、肝硬化及肝癌肝组织中IGFBP-3的表达阳性率分别为100.00%(11/11),100.00%(12/12),87.50%(14/16)及42.86%(9/21).采用Ridit分析,其IGFBP-3表达强度的R±SR值分别为0.7462±0.0288,0.6589±0.0413,0.5344±0.0610,0.2330±0.0373,R±1.96SR分别为0.6898～0.8026,0.6149～0.7767,0.4148～0.6540,0.159～0.3061.肝癌组织中IGFBP-3的表达强度明显低于肝硬化、慢性肝炎及正常对照肝组织(P＜0.05);肝硬化肝组织明显低于正常肝组织(P＜0.05);而在肝硬化与慢性肝炎肝组织之间,以及慢性肝炎肝组织与正常肝组织之间无显著区别(P＞0.05).结论肝组织中IGFBP-3的表达强度可反映肝功能的损害程度.肝癌组织中IGFBP-3的表达强度显著降低.     

特发性正常颅压性脑积水(iNPH)患者认知障碍特征的临床分析

 目的   对特发性正常颅压性脑积水(idiopathic normal pressure hydrocephalus,iNPH)患者的认知障碍特征进行临床分析,为临床诊疗提供依据。方法  通过多个量表评价23例诊断为疑似iNPH患者的认知功能,对照组为15例性别年龄匹配、经磁共振明确无脑积水表现的病例。采用简易精神状态检查量表评价总体认知功能,Stroop色词测验评估执行功能,听觉词语学习测验评估学习和记忆功能,数字广度测验评估注意功能,改良Rankin量表和日常生活活动能力量表评价整体生活能力。结果   本研究中iNPH患者(iNPH组)的简易精神状态检查量表评分［21.00 (11.00~25.00)］较对照组［28.00(26.00～29.00)］显著下降(P＜0.01);Stroop色词测验中卡片A所耗秒数［59.60(33.60～97.70)］较对照组［32.00 (26.00~39.00)］显著延长(P=0.04),卡片A正确个数［50.00 (46.00～50.00)］较对照组(均为50个)显著下降(P=0.02),完成卡片B所耗秒数［106.00(59.20～227.60)］较对照组［46.00 (37.00~50.00)］显著延长(P＜0.01),完成卡片A及B总耗秒数［177.70(90.00～279.40)］较对照组［75.00 (72.00~89.00)］显著延长(P＜0.01),完成卡片C所耗平均秒数［206.60(99.50～237.10)］较对照组［88.00 (70.00~120.00)］显著延长(P=0.01);听觉词语学习测验中短延迟回忆平均个数,iNPH组(4.18±2.89)较对照组(6.29±2.14)显著下降(P=0.04),长延迟回忆个数［3.50(3.00～5.00)］较对照组［7.00 (6.00~9.00)］显著下降(P=0.01),线索回忆个数［1.50(0.00～4.00)］较对照组［5.50 (3.00~9.50)］显著下降(P=0.02),平均回忆总个数(即前5次回忆个数之和)［15.00(11.00～23.00)］较对照组［24.00 (20.00~37.00)］显著下降(P=0.04);数字广度测验中倒背得分(3.04±2.12)较对照组(4.15±0.99)显著下降(P=0.03);改良Rankin评分［3.00 (2.00~4.00)］较对照组(均为0分)显著增高(P＜0.01);ADL评分［85.00(70.00～95.00)］较对照组(均为100分)显著下降(P＜0.01)。结论  iNPH患者存在认知功能下降,表现为执行功能障碍、记忆损害、注意损害及日常生活能力下降。     

惊恐障碍患者人格特征、交感皮肤反应及血清白介素-2水平的研究

目的 探讨惊恐障碍(PD)患者的人格特征、交感皮肤反应及血清白介素-2(IL-2)水平.方法 对32例PD患者(PD组)和32名正常对照组(NC组),采用艾森克人格问卷(EPQ)评定其人格特征,采用汉密尔顿焦虑量表(HAMA)和90项症状清单(SCL-90)评定其焦虑程度及心理健康水平,应用肌电图/诱发电位仪记录其交感皮肤反应(SSR).采用放射免疫法测定血清IL-2水平.结果 (1)PD组EPQ评分的神经质和掩饰性显著高于对照组(P＜0.05).PD组HAMA评分、SCL-90评分显著高于对照组(P＜0.05).PD组的N分与SCL-90中的躯体化、抑郁、焦虑因子及HAMA评分存在Spearman正相关(P＜0.05).(2)PD组SSR波幅较NC组显著增高[左侧:(3.03±2.43)mV,(1.22±0.7)mV(P＜0.01);右侧:(2.33±1.41)mV,(1.26±0.71)mV(P＜0.01)].(3)PD组血清IL-2水平显著低于NC组[(2.18±0.87)ng/ml,(5.0±1.5)ng/ml(P＜0.01)].结论 PD患者存在高神经质、情绪不稳定的人格特征,并且影响其心理健康水平;PD患者交感神经活性增强;PD患者免疫功能失衡.     

具有痴呆倾向的老年轻度认知障碍患者神经心理学特点

目的 探讨具有痴呆倾向的老年轻度认知障碍(MCI)患者特征性的神经心理学变化.方法 以2008年6至10月某驻京部队干休所47例确诊MCI患者及21名认知功能正常者为研究对象,随访2年,应用蒙特利尔认知评估表(MoCA)中文版、简易精神状态量表(MMSE)和画钟表测验(CDT)评估认知状况.结果 第一年随访,MCI组视空间得分下降程度较对照组(0.6±0.7比0.1±0.6)显著,差异有统计学意义(P =0.008),两组均无进展为AD者.第二年随访,MCI组与对照组比较视空间(0.9±0.9比0.4±0.9)及注意(1.0±1.0比0.2±0.8)得分下降程度差异有统计学意义(P=0.021;0.001),MCI组中7例发生AD,对照组无发生AD者.7例发生AD者与40例末发生AD者基线认知评估得分差异无统计学意义;第一年随访时与未发生AD者比较,发生AD者MMSE(27.6 ±0.8比28.9±1.0)、MoCA(24.3±3.1比27.9±1.6)、视空间(3.9±0.7比4.5±0.6)、语言(1.86±0.38比2.65±0.53)及延迟回忆(2.1±1.5比3.9±1.0)得分显著下降,差异均有统计学意义(均P＜0.05);第二年随访时,除命名和抽象得分外,发生AD者其他项目得分均明显低于未发生AD者,差异均有统计学意义(均P＜0.05).结论 具有痴呆倾向的MCI患者视空间、执行功能,延迟回忆和语言功能的受损出现早,变化显著,对AD的发生具有预测意义.     

实时剪切波超声弹性成像技术评估帕金森病患者上肢肌张力的临床研究

目的研究帕金森病患者肱二头肌、肱桡肌杨氏模量值特征,探讨实时剪切波超声弹性成像技术评估帕金森病患者肌张力状况的应用价值。方法连续选取2013年5月至2013年10月在首都医科大学附属北京天坛医院神经内科帕金森病专科确诊的帕金森病患者46例,年龄（47.9±2.8）岁,健康志愿者31例,年龄（46.7±3.2）岁。使用法国Supersonnic公司的AixPlore型实时定量剪切波弹性成像超声诊断仪,L4-15线阵探头,获取帕金森病患者双侧、对照组右侧的肱二头肌及肱桡肌松弛状态下长轴杨氏模量值,探讨正常人及帕金森病患者、帕金森病患者症状明显侧与对侧肱二头肌、肱桡肌杨氏模量值差异。结果松弛状态下帕金森病患者症状明显侧、对侧及对照组肱二头肌长轴杨氏模量值分别为（59.94±20.91） kPa、（47.77±24.00） kPa和（24.44±5.09）kPa,帕金森病患者双侧肱二头肌杨氏模量值均高于健康对照组（P〈0.05）,帕金森病患者症状明显侧肱二头肌长轴杨氏模量值高于对侧（P〈0.05）;松弛状态下帕金森病患者症状明显侧、对侧及对照组肱桡肌长轴杨氏模量值分别为（32.18±17.19）kPa、（28.41±13.19）kPa和（21.71±7.45）kPa,帕金森病患者两侧肱桡肌杨氏模量值均高于健康对照者（P〈0.05）,但帕金森病患者两侧肱桡肌长轴杨氏模量值差异无统计学意义（P〉0.05）。结论实时定量剪切波弹性成像技术可检测帕金森病患者肱二头肌、肱桡肌杨氏模量值差异,为帕金森病患者肌张力状态评估提供一种新的检测方法。     

鼻咽癌放疗后吸入性肺炎早期纤维支气管镜治疗效果观察

回顾性分析2005年1月至2010年12月住院治疗的41例患者,均为鼻咽癌放疗后合并吸入性肺炎者,其中早期纤维支气管镜治疗组24例（A组）,单纯常规治疗组17例（B组）。分析早期纤维支气管镜治疗对鼻咽癌放疗后吸入性肺炎患者体温、血象、影像学肺部吸收和死亡率的影响。治疗前A组与B组的体温和血WBC处于同一水平[（38．7±0．7）℃与（38．5±0．7）℃,P=0．633;（15．8±4．2）×109／L与（16．2±3．4）×109／L,P=0．430],治疗3d后两组体温差异具有统计学意义[（37．3±0．9）℃与（38．4±1．4）℃,P=0．015];治疗5d后两组白细胞差异有统计学意义[（10．6±4．2）×109／L与（15．3±6．9）×109／L,P=0．045];A组肺部影像学改变较常规组吸收更快（z=-3．515,P=0．00）,两组死亡率没有统计学差异。