降钙素基因相关肽和P物质在原发性三叉神经痛发作过程中的作用

目的:测定原发性三叉神经痛(primary trigeminal neuralgia, PTN)病人血液和脑脊液中降钙素基因相关肽(calcitonin gene-related peptide, CGRP)和P物质(substance P, SP)的含量,探讨CGRP和SP在PTN发作过程中的作用。方法:诊断为PTN的住院病人共50例。术前记录疼痛视觉模拟评分(visual analogue scale, VAS),并抽取同侧颈外静脉血;行三叉神经节射频热凝术,术中穿刺如果有脑脊液,抽取0.5 ml;疼痛缓解后抽取颈外静脉血。结果:术前颈外静脉血CGRP、SP含量高于术后(P <0.01)。术中脑脊液CGRP、SP含量与术前颈外静脉内含量正相关(P<0.01)。结论:CGRP与SP可能参与了三叉神经痛疼痛发作过程。     

精神分裂症患者血清一氧化氮水平临床分析

目的 探讨不同病期精神分裂症患者血清一氧化氮水平的差异性.方法 将60例精神分裂症患者设为患者组,抽取30名身体健康的医务人员设为对照组.患者组于治疗前及治疗第4周、8周末晨起空腹采集肘静脉血标本;对照组于体检时晨起空腹采集肘静脉血标本.采用李恩明改良Griess硝酸还原法测定血清一氧化氮水平.结果 治疗前患者组血清一氧化氮水平显著高于对照组(P＜0.01);治疗4周末起,患者组血清一氧化氮水平均较治疗前有显著性下降(P＜0.01),与对照组比较差异无显著性(P＞0.05).结论 精神分裂症在发病期血清一氧化氮水平升高,病情好转后血清一氧化氮水平恢复到正常范围;一氧化氮在精神分裂症的发病中具有一定作用.     

缺血性脑卒中β—内啡肽值临床观察

β-内啡肽(β-EP)是近年发现的与脑缺血性损伤病理生理过程密切相关的神经肽。本文报道35例缺血性脑卒中患者血浆及脑脊液中β-EP含量测定,并初步探讨了其临床意义。 1 材料与方法 1.1 检测对象:病例组:均系近3年来随机选择的住院病人,年龄43～82岁,平均年龄54岁,其中脑梗塞29例,混合型中风6例,全部病例均经CT或磁共振明确诊断。所有对象取样前均未使用糖皮质激素。对照组:健康体检者30例,年龄27～60岁,平均46岁。 1.2 方法:在病人急性发病期间同时抽取肘静脉血、脑脊液。静脉血用EDTA—Na_2抗凝(每管内     

格林-巴利综合征患者白细胞介素6水平及临床意义的研究

目的　探讨白细胞介素 6 (IL - 6 )在格林—巴利综合征 (GBS)发病中的作用。方法　以生物学方法检测 2 6例GBS患者血清及脑脊液中IL - 6含量。结果　GBS患者血清及脑脊液中IL - 6含量分别为 73.15± 5 4 .32 ;9.2 4±7.37U/ml,而非炎症性神经病 (NIND)组脑脊液中IL - 6含量为 3.5 6± 2 .2 5 ,正常对照组 (NC)组血清IL - 6含量为 16 .33± 10 .39U/ml。GBS患者血清及脑脊液IL - 6水平均明显高于正常对照组 (P <0 .0 1) ;但GBS患者血清中IL - 6含量与脑脊液中IL - 6含量水平不呈线性相关 ;血清中IL - 6含量与血清免疫球蛋白含量无相关性 ,但血清免疫球蛋白水平明显高于正常对照组 (P <0 .0 1)。结论　B淋巴细胞在GBS免疫机制中可能处于激活状态。     

脑梗死患者血清和脑脊液S-100B蛋白含量的变化

目的：通过测定脑梗死患者急性期，恢复期血清和脑脊液S-100B蛋白含量动态变化，探讨其在脑梗死发病中的临床意义。方法：60例脑梗死住院患者（梗死组），将发病72h和7、21d的脑脊液及静脉血测定血清和脑脊液中S-100B蛋白含量，并分别与正常组比较。结果：梗死组患者发病72h和7d时血清和脑脊液S-100B蛋白显著高于21d患者和正常组（P〈0．01）；血清和脑脊液S-100B蛋白含量与梗死体积及神经功能缺损程度均呈正相关（P〈0．01）；脑脊液S-100B蛋白含量与年龄正相关，血清S-100B蛋白含量与年龄无关。结论：血清或脑脊液中的S-100B蛋白浓度可反映神经胶质细胞的损害程度。对判断病情程度。评估预后和调整治疗方案有重要意义。     

经卵圆孔三叉神经半月节射频热凝术治疗三叉神经痛的效果分析

目的 探讨经卵圆孔三叉神经半月节射频热凝术治疗三叉神经痛的临床效果,分析其并发症的诱发原因与防治措施.方法 选取2018年1月至2021年5月邯郸市眼科医院收治的300例三叉神经痛患者为研究对象,按照随机数字表法分为对照组和观察组,各150例.对照组患者采用常规药物治疗,观察组患者采用经卵圆孔三叉神经半月节射频热凝术治...     

灯盏花素对脑梗死患者超氧化物歧化酶及丙二醛含量的影响

目的：探讨灯盏花素注射液对脑梗死患者血清超氧化物歧化酶(SOD)及丙二醛(MDA)含量变化的影响。方法：32例脑梗死患者在综合治疗的基础上经静脉给予灯盏花素注射液治疗，治疗前及用药后1、3、5、7、10d取外周静脉血检测血清SOD及MDA的含量，并正常对照组进行对比分析。结果：脑梗死患者血清的SOD及MDA含量均明显高于正常对照组(P＜0．01)；应用灯盏花素注射液治疗后，患者血清SOD及MDA水平均有不同程度下降，至1周后与用药前比较有显著性差异(P＜0．01)。结论：灯盏花素对脑梗死超氧化物反应具有拮抗作用。     

蛛网膜下腔出血患者血液黏附分子及脑脊液中SOD MDA含量的动态变化研究

目的研究自发性蛛网膜下腔出血(SAH)患者血液黏附分子及脑脊液中SOD、MDA的动态变化规律。方法对30例SAH患者血清可溶性细胞间黏附分子(sICAM-1)、可溶性血管内皮间黏附分子(sVCAM-1)及脑脊液中SOD、MDA进行动态观察。结果SAH患者血清sICAM-1、sVCAM-1在发病后升高,以发病后5～7 d变化最明显；SOD在早期出现短暂升高后迅速下降,MDA则与之相反。结论SAH患者血液黏附分子及脑脊液中SOD、MDA含量与病情演变有关。     

血清中过氧化脂质、酶及微量元素含量变化在脑梗死发病中的作用

为探讨锌(Zn),铜(Cu),镁(Mg)及血清中过氧化脂质(LPO)及超氧化物歧化酶(SOD)含量变化在脑梗死发病中的作用。对30例脑梗死患者及30例其他神经科患者血清中LPO,SOD及微量元素含量进行测定,结果脑梗死组血清中LPO高于对照组,SOD,Zn,Cu,Mg含量低于对照组。血清中LPO,SOD及微量元素含量变化在脑梗死发病中起重要作用。     

DZY-C型三叉神经立体定向仪治疗三叉神经痛的特点

背景：经皮三叉神经半月穿刺损毁术是治疗原发性三叉神经痛的方法之一。因其穿刺技术操作上的难度，可导致误伤及一些严重的并发症.DZY—C型三叉神经立体定向仪治疗原发性三叉神经痛具有穿刺准确度高、并发症低等特点，可减少误伤周围血管、神经的机会。目的：评价应用DZY—C型三叉神经立体定向仪治疗三叉神经痛的疗效.设计：以患者为研究对象，前后对照研究。单位：一所市级中医院的脑外科和一所市级医院．对象：2001／2003佛山市中医院门诊或住院部就诊的原发性三叉神经痛患者90例，男39例，女51例；年龄21-90岁。干预：所有患者按要求在DZY—C型三叉神经立体定向仪的引导下，经皮穿刺三叉神经半月节，注射甘油。疗效根据视觉模拟评分法(visual analoguescale，VAS)在患者治疗前及治疗后30min对疼痛程度进行评估。主要观察指标：疗效评定结果。结果：应用DZY—C型三叉神经立体定向仪，对90例原发性三叉神经痛患者进行三叉神经半月节穿刺，均一次穿刺成功，注射甘油后，原三叉神经疼痛消除90例，优良率达100％。结论：DZY—C型三叉神经立体定向仪的结构设计合理，手术操作简易，调节灵活．组织损伤少．使用安全，可明显消除三叉神经痛。     

McGill疼痛问卷在三叉神经痛诊断和治疗中的应用

目的:通过采用McGill疼痛问卷(McGill pain questionnaire,MPQ)鉴别三叉神经痛,并观察射频热凝术的疗效,研究MPQ在面痛诊断上的重要性。方法:本研究共观察159例三叉神经痛患者,其中136例患有典型三叉神经痛(CTN),23例患有混合型三叉神经痛(MTN)。采用MPQ评估患者的疼痛,并观察其中124例术后患者疼痛的缓解情况。结果:CTN组的平均现有疼痛强度(PPI)值为4.20±0.34,MTN组的平均PPI值为3.50±0.57,明显低于CTN组(P0.001);与MTN患者相比,CTN患者在疼痛分级指数(PRI)-感觉项上报告了更高的强度(P0.001);两组间PRI-情感和PRI-评价项上有明显区别,CTN组的得分更高(P0.001);RFT术后CTN患者显示了高的立即疼痛缓解率,达到93.6%。MTN患者的结果没有CTN组的好,只有58.8%的患者疼痛明显缓解。结论:MPQ可以很好鉴别不同类型的三叉神经痛,鉴于射频热凝治疗两种三叉神经痛疗效的差异,使用MPQ在面痛诊断中有重要意义。     

阿片类药物在慢性非癌性疼痛中的应用

目的:回顾性分析卡马西平和加巴喷丁治疗原发性三叉神经痛、带状疱疹以及带状疱疹后遗神经痛的疗效、安全性和不良反应。方法:102位患者进入本研究,比较卡马西平或加巴喷丁治疗前后患者疼痛强度的改变和对睡眠影响的改善;依据药物分类,比较两种药物的副作用和不良反应。结果:卡马西平治疗原发性三叉神经痛起效较加巴喷丁快,二者长期疗效相当;加巴喷丁治疗带状疱疹和带状疱疹后神经痛的疗效优于卡马西平;疗效随治疗时间的延长而增加。卡马西平的副作用和不良反应事件发生率较加巴喷丁高。结论:抗癫痫药物卡马西平和加巴喷丁是治疗神经病理性疼痛的有效药物,可以改善患者的睡眠,但副作用和不良反应发生率高。     

Substance P,somatostatin and monoaminergic transmitters in the cerebrospinal fluid of patients with chronic idiopathic trigeminal neuralgia

The etiology of trigeminal neuralgia is unknown, but both peripheral and central causes have been suggested. To investigate the role of central neurochemical mechanisms we measured epinephrine, norepinephrine and their breakdown product, vanilly mandelic acid (VMA), in the cerebrospinal fluid (CSF) of 16 patients (53.3 +/- 8.3 years) suffering from trigeminal neuralgia. As markers for the dopaminergic system, we determined CSF levels of dopamine and its metabolite homovanillic acid (HVA). As a marker for the serotonergic system, we measured CSF levels of serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA). In addition, levels of the neuropeptides substance P and somatostatin were determined. The concentration of norepinephrine (P < 0.01), VMA (P < 0.05) and HVA (P < 0.05) were significantly decreased in patients with trigeminal neuralgia and correlated with the duration of the disease and depression scores. 5-HIAA was also significantly decreased (P < 0.05) compared to control patients. Whereas substance P was significantly elevated (P < 0.05), somatostatin was significantly decreased (P < 0.05). Various correlations between the classical neurotransmitters and the neuropeptides could be established. We hypothesize than the sum of complex neurochemical changes plays a role in the etiology of trigeminal neuralgia, which can be separated in local and more central proceedings. The increase in substance P, a major nociceptive neuromodulator, supports the concept of a local neurogenic inflammation, possibly located in the trigeminovascular system. Depending on the duration of the disease and depression, the loss of serotonergic, dopaminergic and noradrenergic innervation seems to reflect more central changes, possibly due to alterations in their antinociceptive descending pathways.     

核磁共振成像诊断三叉神经痛的价值分析与研究

目的：研究探讨MRI检查在三叉神经痛诊断中的价值。方法：100例拟行微血管减压术的原发性三叉神经痛患者,于术前行MRI检查,分别采集三维快速稳态自由梯度（three dimensional- fast imaging employing steady state acquisition,3D-FIESTA）、三维时间飞跃（three dimensional-time of flight,3D-TOF）序列图像,判断神经血管接触压迫情况。以手术诊断结果为参照,计算和比较3D-FIESTA、3D-TOF术前诊断三叉神经痛患者神经血管接触压迫的灵敏度、特异度、准确率,分析2种序列成像诊断结果与手术诊断结果之间的一致性,并计算和比较3D-FIESTA、3D-TOF对不同责任血管的显示率。结果：100例三叉神经痛患者中,有75例经手术诊断证实存在神经血管接触压迫患侧三叉神经脑池段及邻近脑干组织的情况。以手术诊断结果为参照,3D-FIESTA、3D-TOF诊断三叉神经痛患者神经血管接触压迫的灵敏度（97.33%比94.67%）、特异度（92.00%比96.00%）、准确率（96.00%比95.00%）比较,差异均无统计学意义（P>0.05）。一致性分析显示,3D-FIESTA、3D-TOF对三叉神经痛患者神经血管接触压迫的诊断结果与手术诊断结果之间的一致性均保持在良好水平（Kappa值均>0.7）。3D-FIESTA、3D-TOF对1级、2级、3级、4级、5级神经血管压迫程度的诊断符合率比较,差异均无统计学意义（P>0.05）。3D-FIESTA、3D-TOF对小脑上动脉、小脑前下动脉、椎动脉、基底动脉等责任血管的显示率均为100.00%,二者对2支以上动脉、动脉+静脉的显示率未达到100.00%,3D-FIESTA分别为94.74%、75.00%,3D-TOF分别为89.47%、50.00% ,但二者比较差异无统计学意义（P>0.05）。结论：术前行MRI检查可对原发性三叉神经痛患者的神经血管接触压迫情况予以清晰显示,尤其是采用3D-FIESTA、3D-TOF这2种序列成像 ,不仅可作为三叉神经痛的主要诊断手段,还可作为三叉神经痛手术定位的辅助手段。     

Autonomic nervous system and neuroendocrine changes in patients with idiopathic trigeminal neuralgia

To investigate sympathetic nervous system and neuroendocrine changes in idiopathic trigeminal neuralgia, we determined the plasma level of the catecholamines norepinephrine and epinephrine, as well as cortisol and ACTH in 16 patients (55.38.3 years) with trigeminal neuralgia at four different times during the day (7.00, 13.00, 17.00 and 23.00). Morning and evening values of plasma norepinephrine as well as the daily mean value (dmv) were significantly higher ( p <0.01) in patients with trigeminal neuralgia than in an age- and gender-matched control group. Moreover, morning, afternoon and dmv epinephrine values were also significantly elevated. The dmv norepinephrine levels correlated with the intensity of the attacks ( r =0.68, p <0.01), the frequency of the attacks ( r =0.75, p <0.01) and the duration of the disease ( r =0.78, p <0.01). In addition to elevated catecholamines, trigeminal neuralgia patients also demonstrated significantly increased morning, evening and daily mean values of plasma cortisol. Thus, patients with trigeminal pain have an increased sympathetic nervous system activity for an extended period of time without a direct link to pain attacks, which suggests that the sympathetic nervous system itself is at least co-activated in trigeminal neuralgia and perhaps plays a role in the induction and maintenance of trigeminal pain. The neuroendocrine changes are similar to cluster headache and point to a central dysregulation of the hypothalamic-pituitary-adrenal axis, possibly due to the cyclic phenomena in idiopathic trigeminal neuralgia.     

Increased CSF Levels of Apolipoproteins and Complement Factors in Trigeminal Neuralgia Patients–In Depth Proteomic Analysis Using Mass Spectrometry

The main cause of trigeminal neuralgia (TN) is compression of a blood vessel at the root entry zone of the trigeminal nerve. However, a neurovascular conflict does not seem to be the only etiology and other mechanisms are implicated in the development of the disease. We hypothesized that TN patients may have distinct protein expression in the CSF. In this study, lumbar CSF from TN patients (n = 17), scheduled to undergo microvascular decompression, and from controls (n = 20) was analyzed and compared with in depth mass spectrometry TMTbased quantitative proteomics. We identified 2552 unique proteins, of which 46 were significantly altered (26 increased, and 20 decreased, q-value < .05) in TN patients compared with controls. An over-representation analysis showed proteins involved in high-density lipoprotein, such as Apolipoprotein A4, Apolipoprotein M, and Apolipoprotein A1, and the extracellular region, including proteins involved in the complement cascade to be over-represented. We conclude that TN patients have distinct protein expression in the CSF compared to controls. The pathophysiological background of the protein alterations found in this study warrants further investigation in future studies.PerspectiveIn this article, cerebrospinal fluid from patients with trigeminal neuralgia was analyzed using in depth shotgun proteomics, revealing 46 differentially expressed proteins compared to controls. Among these, apolipoproteins and proteins involved in the complement system were elevated and significantly over-represented, implying an inflammatory component in the pathophysiology of the disease.     

原发性三叉神经痛灰质体积变化的磁共振形态学研究

目的应用基于体素的形态学分析方法检测原发性三叉神经痛患者是否存在灰质体积改变,探索中枢神经系统在其疼痛处理中的作用。材料与方法对19例右侧三叉神经痛患者和22例年龄性别匹配的正常对照进行磁共振三维T1结构像扫描(3D-T1BRAVO),应用基于体素形态学分析(voxel-based morphometry,VBM)检测三叉神经痛患者全脑灰质体积的变化,探索各变化的中枢神经系统脑区在疼痛处理中的作用,并分别分析其体积变化与疼痛程度及病程的相关性。结果与正常对照组相比,病例组左侧前扣带回灰质体积明显减少;右侧额上回、右侧岛叶、右侧壳核、双侧小脑前叶灰质体积明显增加,左侧前扣带回体积变化与疼痛病程呈负相关性。结论三叉神经痛患者存在中枢神经系统灰质体积变化,左侧前扣带回体积与疼痛病程呈负相关性,这些存在差异的中枢神经系统脑区在三叉神经痛患者疼痛的形成及慢性状态的维持中可能有重要作用,提示探索三叉神经痛的中枢处理机制有益于新的治疗方法的研发。     

射频热凝联合阿霉素治疗原发性三叉神经痛

目的:探讨射频热凝联合阿霉素治疗原发性三叉神经痛的安全性及临床疗效.方法150例三叉神经痛患者随机分成两组,RFT组(n=75):行单纯射频热凝术;RFT+A组(n=75):同RFT组方法行射频热凝后注射阿霉素3毫克.观察两种方法的疗效、复发率及副反应.结果:两种方法治疗三叉神经痛均获得良好的近期效果,RFT+A组副反应多于RFT组,RFT+A组远期复发率低于RFT组.结论:射频热凝联合阿霉素治疗原发性三叉神经痛远期效果优于单纯射频热凝术.阿霉素可暂时引起头痛、恶心、呕吐等不适.     

针刺联合药物治疗三叉神经痛显微血管减压术后面部麻木的疗效评价

目的:观察针刺联合药物治疗三叉神经痛显微血管减压术后面部麻木的疗效。方法:三叉神经痛显微血管减压术后面部麻木患者72例随机分为药物组和联合组,各36例;药物组给予营养神经、扩血管等综合药物治疗,联合组在药物组综合药物治疗的基础上给予针刺治疗。于治疗前及治疗1疗程后,采用巴罗神经学研究所三叉神经痛分级标准对面部麻木进行临床功能评分测定,同时进行SF-36(生活质量量表)评分。结果:联合组的治疗周期短于药物组(P<0.05);治疗前2组三叉神经功能评分及SF-36量表评分差异无统计学意义(P>0.05);治疗后,2组三叉神经功能评分均低于同组治疗前,且联合组低于药物组(均P<0.05),2组SF-36量表评分高于同组治疗前,且联合组高于药物组(均P<0.05)。结论:针刺结合药物治疗可有效促进三叉神经痛显微血管减压术后面部麻木患者功能恢复,改善患者的生活质量,缩短治疗周期。     

阿霉素改善三叉神经痛的疗效分析

Backgroud:Trifacial neuralgia is a refractory disease.Radio-frequency,operation or blocking with anhydrous alcohol in Western medicine get no satisfying effect. Objective:To investigate the effect of adriamycin on amelioration of trifacial neuralgia.