益智宁颤合剂治疗帕金森病的临床研究

目的：观察益智宁颤合剂治疗帕金森病（PD）的临床疗效。方法：将60例患者随机分成治疗组和对照组,每组30例,治疗组给予益智宁颤合剂口服,对照组给予安坦片口服,疗程均为3个月。观察2组临床疗效及治疗前后统一评分量表（UPDRS）评分、Hoehn-Yahr分级情况、不良反应。结果：治疗组的UPDRS评分、临床疗效明显优于对照组（P〈0.05）。结论：益智宁颤合剂可以明显改善PD患者症状,具有确切疗效。     

99Tcm-TRODAT-1 SPECT DAT显像与帕金森病UPDRS评分关系的研究

目的:探讨帕金森病(PD)患者双侧纹状体对99Tcm-TRODAT-1特异性摄取浓度与统一帕金森病评分量表(UPDRS)评分的关系,从影像学上对PD病情严重程度进行评价。方法:对51例PD患者以及15例正常对照组分别行99Tcm-TRODAT-1 SPECT多巴胺转运体(DAT)显像,利用感兴趣区技术计算双侧纹状体与小脑的特异性放射性比值(ST/CB)及两侧纹状体特异性放射性摄取比值的不对称指数(AIPD、AICON),同时对PD患者进行UPDRS评分和Hoehn-Yahr分级。结果:PD患者双侧ST/CB值与UPDRS日常生活能力、运动功能评分以及Hoehn-Yahr分级呈显著负相关,PD患者两侧纹状体特异性放射性摄取比值的不对称指数与PD病情呈负相关。结论:PD患者双侧纹状体对99Tcm-TRODAT-1特异性摄取浓度与UPDRS评分以及Hoehn-Yahr分级存在良好的相关性,能够监测PD的病情,反映PD病情的严重程度。     

影响帕金森病患者生活质量的因素

目的：调查帕金森病（PD）患者的认知功能、抑郁和影响生活质量的因素。方法：老年PD患者（PD组）与非PD患者（对照组）各50例,采用自填结合个人访谈法,选用老年抑郁量表（ODI）、简易精神状态量表（MMSE）、帕金森病统一评分量表（UPDRS）、Hoehn-Yahr分级及Schwab-England量表评定患者抑郁状态功能、认知功能及可能影响生活质量的因素。结果：①PD组患者的认知功能和生活质量均低于对照组,抑郁程度高于对照组（P〈0.05）。结论：ADL、认知功能及抑郁程度是影响PD患者生活质量的主要因素,在诊治过程中应重视改善这3方面的症状。     

帕金森病患者的营养状况与病情严重程度的临床研究

目的 初筛帕金森病(PD)患者的营养状况,进一步评估PD患者营养状况与病情严重程度的关系,为临床医生干预PD患者的营养状况提供依据。方法 选取2019年2月至2021年2月在该院就诊的210例PD患者作为PD组,另选取同期该院180例健康体检者作为对照组。采用实验室营养指标、微型营养评估精法(MNA-SF)、PD分级评分量表(H-Y)及统一帕金森病评定量表(UPDRS)第三部分量表调查PD患者的营养状况及其与病情严重程度的关系,并分析MNA-SF评分与UPDRS第三部分量表评分之间的相关性。结果 PD组清蛋白、血红蛋白水平及MNA-SF评分均低于对照组,差异均有统计学意义(P<0.05)。PD患者MNA-SF评分随着H-Y分级增高而降低。PD患者MNA-SF评分与UPDRS第三部分量表评分呈负相关(r=-0.54,P<0.05)。结论 PD患者营养不良发生率很高,且与病情严重程度相互影响,在临床工作中应重视PD患者的营养状况,对PD合并营养不良的患者应提供营养支持。     

普拉克索联合美多芭对帕金森病患者认知功能的影响

目的：分析帕金森病患者采取普拉克索联合美多芭治疗的疗效、安全性，并观察联合治疗方案对患者认知功能、运动功能的影响。方法：选取2021年6月至2022年6月就诊于泗洪分金亭医院的123例帕金森病患者为研究对象，按随机对照原则分为对照组与研究组。对照组61例给予美多芭治疗，研究组62例给予美多芭联合普拉克索治疗。治疗12周后评估疗效与安全性，并观察患者治疗前、治疗12周后Hoehn-Yahr分级、UPDRS评分、认知功能状态。结果：研究组治疗总有效率（90.32%）高于对照组（77.05%），Hoehn-Yahr分级优于对照组（P＜0.05）；治疗后，研究组UPDRSⅠ评分、UPDRSⅡ评分、UPDRSⅢ评分、UPDRSⅣ评分均低于对照组，简易智能精神状态检查量表（MMSE）评分、蒙特利尔认知评估量表（MoCA）评分均高于对照组（P＜0.05）；研究组不良反应发生率（8.06%）低于对照组（21.31%）（P＜0.05）。结论：帕金森病患者采取普拉克索联合美多芭治疗的疗效确切，在提高运动功能、认知功能、用药安全性上优势明显。     

帕金森病患者日常生活活动能力的主要影响因素

目的：探讨影响帕金森病（PD）患者日常生活活动能力的主要因素。方法：采用PD统一评分量表第2部分(UPDRSⅡ)对107例PD患者的ADL能力进行评估,并选用Hoehn-Yahr分级帕金森病统一评分量表-Ⅲ（UPDRS-Ⅲ）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）、简易精神状态量表（MMSE）、蒙特利尔认知评估（MOCA）、睡眠量表及Epworth嗜睡评分量表(ESS)等量表作为评估患者运动功能、焦虑、抑郁、认知、记忆、睡眠状况等的指标。同时结合年龄、性别、发病时间、目前左旋多巴用量等可能影响患者ADL能力的因素评估上述指标对PD患者ADL影响的程度。结果：逐步法多元线性回归分析提示：影响PD患者ADL能力的主要因素是UPDRS-Ⅲ、ESS、病程及受教育程度。结论：运动功能及心理因素是影响PD患者ADL能力的主要因素。因此,在治疗过程应联合药物治疗和康复治疗,以提高PD患者的ADL能力。     

帕金森病抑郁的临床特征、影响因素及治疗

目的探讨帕金森病(PD)合并抑郁患者的临床特征、影响因素及治疗,为临床治疗PD提供进一步依据。方法统计81例PD患者帕金森病抑郁(PDD)发病率,比较PDD组与PD非抑郁(PDND)组年龄、病程、统一PD评定量表(UPDRS)评分、性别、Hoehn-Yahr分期、临床分型的差异及汉密尔顿抑郁量表(HAMD)因子分差异。比较采用抗PD药物合并抗抑郁药与单纯使用抗PD药物治疗PDD 30天后UPDRS及HAMD评分的变化。结果81例PD患者中52例并发抑郁,其中轻度抑郁31例(59.6%),中重度抑郁21例(40.4%)。震颤为主型抑郁发生率44.4%,强直为主型抑郁发生率为69.8%。UPDRS分值越高、Hoehn-Yahr分期越高、女性、强直为主型更容易合并抑郁。PDD主要表现在焦虑/躯体化、认识障碍、阻滞、睡眠障碍及绝望感方面。抗PD药物合并抗抑郁药治疗能显著降低患者的UPDRS及HAMD评分。结论PD合并抑郁比较常见,以轻度抑郁为主,UPDRS分值越高、Hoehn-Yahr分期越高、女性、强直为主型更容易合并抑郁。治疗上使用抗PD药物联用抗抑郁药优于单纯抗PD药物。     

抗震止痉颗粒联合美多巴优化治疗帕金森病临床研究

目的:研究抗震止痉颗粒联合美多巴优化治疗肝肾不足型帕金森病(Parkinson disease,PD)患者的疗效及安全性.方法:将58例病例随机分为治疗组和对照组各29例.对照组继续原有西药治疗,治疗组加用抗震止痉颗粒,2组疗程均为12周;观察2组临床疗效及治疗前后帕金森病统一评分量表(UPDRS)评分、改良的Hoehn-Yahr(H-Y)分级情况,评价药物疗效及安全性.结果:2组均有不同疗效,治疗组的UPDRS评分、临床疗效明显优于对照组(P＜0.05);2组治疗前后H-Y分级比较无显著性差异(P＞0.05),可能与疗程较短有关.结论:中药抗震止痉颗粒作为美多巴的辅助用药,疗效明显而且不良反应少,能更好地控制帕金森病的各种运动性症状,降低UPDRS评分,优化帕金森病的治疗,达到延缓PD病程的目的.     

帕金森病合并主观认知功能减退的临床特点

目的:研究帕金森病(PD)患者主观认知功能减退(SCD)的临床特点及其相关因素。方法:将82例PD患者按是否有SCD主诉分为PD-SCD+组(n=42)和PD-SCD-组(n=40)。应用相关认知功能测试量表评定患者各认知域功能(包括注意力、执行功能、语言功能、记忆力功能、视空间功能等),研究PD患者SCD的特点及SCD与年龄、病程、Hoehn-Yahr分级、UPDRS评分的关系。结果:PD-SCD+组记忆力(即刻记忆及延迟记忆)、注意力(数字广度测验及逆向数字测验)、执行功能(连线测验)等认知域评分与PD-SCD-组相比,差异有统计学意义(t=5.578,P0.001;t=2.511,P0.05;t=2.801,P0.05)。双变量相关分析显示PD患者SCD与病情严重程度(H-Y分级)、病程、UPDRS(第1部分)评分评分呈负相关(r=-0.391,P=0.020;r=-0.383,P=0.025;r=-0.528,P=0.001),与年龄、UPDRS(第2、3部分)评分无明显相关(r=-0.132,P=0.451;r=0.487,P=0.156;r=-0.443,P=0.124)。结论:PD-SCD患者存在即刻记忆及延迟记忆异常,且SCD与病程、病情严重程度、URPDS评分第1部分有关。     

美多巴联合盐酸司来吉兰治疗帕金森病的临床疗效观察

目的探讨美多巴联合盐酸司来吉兰治疗帕金森病的疗效和安全性。方法将100例帕金森病患者随机分为对照组(50例)和治疗组(50例),对照组患者采用美多巴治疗,12周为1个疗程;治疗组患者采用美多巴联合盐酸司来吉兰治疗,6个月为1个观察周期。于用药前及用药后1、3、6个月采用PD统一评分量表(UPDRS)对两组患者进行疗效评定,并观察其不良反应。结果治疗组患者治疗3、6个月时与治疗前比较,其UPDRSⅠ~Ⅳ评分均下降(P0.05);治疗3、6个月时,治疗组UPDRSⅠ~Ⅳ评分均明显低于对照组(P0.05)。观察期内,两组患者未出现严重不良反应。结论美多巴联合盐酸司来吉兰可有效改善帕金森病症状,且耐受性好,不良反应少,值得临床推广使用。     

Lyme disease

PURPOSE: To review the presentation, treatment, and prevention of Lyme disease in primary care. DATA SOURCES: Selected articles from the scientific literature and the Centers for Disease Control. CONCLUSIONS: Lyme disease is a tick-borne, multisystem inflammatory disease with worldwide distribution caused by the spirochete Borrelia burgdorferi. Lyme disease is initially characterized by a spreading, annular erythema migrans skin rash and can disseminate to the musculoskeletal, neurologic, or cardiovascular system. Stages of the disease present with varying clinical manifestations. IMPLICATIONS FOR PRACTICE: Treatment of Lyme disease with appropriate antimicrobial therapy should be prompt in order to avoid debilitating outcomes. Awareness of the many presentations of Lyme disease in endemic areas may facilitate a timely diagnosis and appropriate treatment.     

Hodgkin's disease

The outlook for patients with Hodgkin's disease has improved dramatically over the past 20 years. The question is no longer whether cure is possible, but rather, how can cure be best achieved. With better understanding of the biology of Hodgkin's disease and with continued evolution of treatment approaches, the goal of curing all patients with Hodgkin's disease is clearly within reach. This article provides a summary of current concepts in the biology and management of Hodgkin's disease. Staging, treatment options, and complications of therapy are discussed.     

Legg-Calvé-Perthes disease

Legg-Calvé-Perthes disease is a disease occurring in otherwise healthy children. An understanding of the physiologic process of the disease and the purpose of various forms of treatment is essential for nurses caring for these children and their families. Nurses are in a position to assist the child and family to cope with the alterations in lifestyle that result from treatment of Perthes disease.     

Immunologic lung disease

The term "immunologic lung disease" comprises a broad spectrum of disease. I have covered a few entities in which recent studies have been particularly helpful in elucidating pathophysiology though not in uncovering the inciting cause. Common to all of these entities is the problem of finding appropriate methods of defining disease activity and response to treatment. As exemplified by the improved outlook for Goodpasture's syndrome with elucidation of its underlying immunopathology, it is likely that better understanding of the immunologic basis of sarcoid and interstitial disease may be helpful in planning more effective treatment strategies.     

Peptic ulcer disease

Peptic ulcer disease is a common gastrointestinal disease whose management and treatment has changed dramatically over the last 25 years. Treatment of peptic ulcer disease has evolved from dietary modifications and antacids to gastric acid suppression with H2-receptor antagonists and proton pump inhibitors to eradication of Helicobactor pylori infection. Treatment of patients infected with H pylori using antibiotics has changed the natural history of peptic ulcer disease. As a result of H pylori treatment and other unknown factors ulcer disease is declining and complications from ulcer disease have diminished significantly.     

Progress in Parkinson's disease

There has been lots of progress in Parkinson's disease. First of all, in Japan, a guideline for the treatment of Parkinson's disease was published. This guideline contains both EBM based systematic review of every drugs being used in the treatment of Parkinson's disease including those drugs for the management of side effects and other problems arising during the course of the treatment and an algorithm of the practical treatment of Parkinson's disease patients. This is an official publication of Japanese Neurological Society. In the diagnosis of Parkinson's disease, many specialists in Parkinson's disease have recognized the usefulness of MIBG SPECT of the cardiac sympathetic endings. MIBG uptake shows remarkable decrease in Lewy body positive Parkinson's disease patients from the early stage except for some of the stage I patients. In the basic aspect, studies on familial forms of Parkinson's disease have contributed a lot to the understanding of the pathogenesis of sporadic Parkinson's disease. Mutations of alpha-synuclein cause autosomal dominant Parkinson's disease. Recently, triplication of one of the alpha-synuclein genes was found as the third mutation of PARK1. Thus just overproduction of normal alpha-synuclein is toxic to nigral neurons. In this form and sporadic Parkinson's disease, oxidative damage plays an important role in nigral neurodegeneration. PARK2 is caused by mutations of the parkin gene. Parkin protein is an ubiquitin-protein ligase. In this form also, oxidative damage appears to be operating in neurodegeneration. Thus a common mechanism appears to be present in different forms of Parkinson's disease. Future investigation to find neuroprotective drugs should take this concept of common mechanism into their research strategies.     

Management of Lyme disease

It has been 30 years since Lyme disease was first described in a cohort of patients from Connecticut. An understanding of disease transmission, clinical manifestations and prevention strategies has been established. With the number of new cases increasing each year, it is important that clinicians are aware of the available treatment options. Most patients respond well to a course of treatment with a recommended antibiotic; however, for those patients who develop post-Lyme disease syndrome, the management is unclear. This review provides an overview of Lyme disease and the recommended treatment options available to physicians.     

Tick-borne disease

Tick-borne diseases in the United States include Rocky Mountain spotted fever, Lyme disease, ehrlichiosis, tularemia, babesiosis, Colorado tick fever, and relapsing fever. It is important for family physicians to consider these illnesses when patients present with influenza-like symptoms. A petechial rash initially affecting the palms and soles of the feet is associated with Rocky Mountain spotted fever, whereas erythema migrans (annular macule with central clearing) is associated with Lyme disease. Various other rashes or skin lesions accompanied by fever and influenza-like illness also may signal the presence of a tick-borne disease. Early, accurate diagnosis allows treatment that may help prevent significant morbidity and possible mortality. Because 24 to 48 hours of attachment to the host are required for infection to occur, early removal can help prevent disease. Treatment with doxycycline or tetracycline is indicated for Rocky Mountain spotted fever, Lyme disease, ehrlichiosis, and relapsing fever. In patients with clinical findings suggestive of tick-borne disease, treatment should not be delayed for laboratory confirmation. If no symptoms follow exposure to tick bites, empiric treatment is not indicated. The same tick may harbor different infectious pathogens and transmit several with one bite. Advising patients about prevention of tick bites, especially in the summer months, may help prevent exposure to dangerous vector-borne diseases.     

Lyme disease

Lyme disease is an infectious, immune-mediated, multisystem disease. Recent epidemiologic data confirms that in the United States, Lyme disease is spreading faster than any other infectious disease except AIDS. The bacteria that causes Lyme disease, Borrelia burgdorferi, is transmitted to humans by the bite of the deer tick, Ixodes dammini. If diagnosed and treated in its early stages, Lyme disease is less likely to result in later cardiac, neurologic, and arthritic complications. Arthritic complications account for 60% of all late manifestations. Nurses can play a major role in the prevention and early recognition of this disease. Early treatment with antibiotics can prevent subsequent complications.     

2015年肾脏病重要研究进展

在过去的2015年,有关肾脏病发病危险因素、原发性肾脏病和继发性肾脏病诊疗等方面有了长足的进步。本文就有关判断肾脏病发生、预后的生物学标志物、原发性肾脏病、继发性肾脏病及其并发症的部分相关诊疗进展进行了综述。