载脂蛋白E基因对轻、中型创伤性脑损伤急性期脑电活动的影响

目的 探讨载脂蛋白E基因(APOE)对轻、中型创伤性脑损伤后急性期脑电活动的影响.方法 收集112例轻、中型创伤性脑损伤患者的临床资料,采用聚合酶链反应限制性片段长度多态性法(PCR-RFLP)检测APOE基因型;在伤后1周内对全部患者进行两次脑电图检测,采用定性及定量的方法判断脑电活动的变化;对APOE分型结果、脑电图及临床资料等应用SPSS 11.5统计学软件分别进行x2检验、方差分析和Logistic回归分析.结果 112例患者的APOE分型分布符合遗传学Hardy-Weinberg定律;在22例APOEε4携带者中有12例(55%)脑电图加重,其比率明显高于非ε4携带者(18%,P＜0.01);通过定量指标的分析发现,经过4～5 d的正规治疗,携带APOEε4的患者脑电图慢波增多(P＜0.01),而携带APOEε2、APOEε3的患者脑电图慢波减少(P＜0.05),APOEε2携带者前后两次脑电图慢波减少的程度较APOEε3携带者更明显(P＜0.05).单因素和多因素Logistic回归分析均提示,APOEε4是脑电图加重的危险因素.结论 APOEε4等位基因是轻、中型脑损伤患者急性期脑电图加重的危险因素,而APOEε2有利于脑电活动的恢复.     

载脂蛋白E基因多态性与颅脑损伤的相关性

目的探讨在中国人群中载脂蛋白E(APOE)基因多态性与颅脑损伤病情的相关性。方法收集70例颅脑损伤患者的临床资料,每对象抽取静脉血2ml,提取基因组DNA,采用聚合酶链反应限制性片段长度多态性(PCR-RFLP)检测APOE基因型,分型结果与临床资料等分别采用SPSS11.5软件进行χ2检验和Logistic回归分析。结果在13例APOEε4等位基因携带者中有5例(38%)病情加重(较入院时脑内血肿体积增大,迟发性血肿等),明显高于非ε4等位基因携带者(12%,P<0.05);单因素和多因素logistic回归分析均提示,ε4是病情加重的危险因素。结论APOEε4等位基因是颅脑损伤患者病情加重的危险因素。     

载脂蛋白E基因多态性对创伤性脑损伤患者伤后早期脑氧饱和度的影响

目的探讨载脂蛋白E基因(APOE)对创伤性脑损伤(TBI)患者早期脑氧饱和度的影响。方法回顾性分析重庆医科大学附属第一医院TBI患者(TBI组)103例和正常人(对照组)50例的相关临床资料,采用聚合酶链式反应多重荧光定量法检测其APOE基因型。伤后1~3d对全部患者进行局部脑氧饱和度(rScO2)监测,在安静、清醒状态下对对照组进行rScO2监测,然后汇总数据进行统计学分析。结果TBI组APOEε4携带者rScO2(54.33±4.27)%显著低于非ε4携带者(58.38±5.24)%(P<0.05),而对照组APOEε4携带者rScO2(61.18±5.35)%与非ε4携带者的rScO2(62.52±6.06)%未见显著差异。单因素和多因素Logistic回归分析均提示,APOEε4(P=0.003,OR=7.455,95%CI=1.95~28.47)是TBI患者伤后rScO2下降的危险因素。结论APOEε4等位基因可能是TBI患者早期脑氧饱和度下降的危险因素。     

载脂蛋白E基因对轻、中型创伤性脑损伤急性期脑电活动的影响

Objective To investigate the influence of apolipoprotein E gene (APOE) polymorphism on the acute-phase brain electrical activity after mild/moderate traumatic brain injury. Methods The clinical data of 112 patients with mild/moderate traumatic brain injury were collected and the APOE genotypes were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The brain electrical activity in every patient was recorded twice by using electroencephalogram within one week after injury. Qualitative and quantitative methods were used to determine the variations of brain electrical activity. Chi-square test, variance analysis and logistic regression analyses via SPSS version 11.5 were performed among APOE genotypes, electroencephalogram data and clinical data. Results The distributions of APOE genetypes and alleles matched Haldy-Weinberg Law in 112 patients. Of 22 patients with APOEε4, 12 patients (55%) presented with deteriorated electroencephalogram, which was significantly higher than those (16 of 90 patients, 18%) without APOEε4 (P ＜ 0. 01). Comparison of the first and second electroencephalograms demonstrated that the slow waves were increased significantly in patients with APOEε4 ( P ＜ 0. 01 ) but decreased in patients with APOEε2 and APOEε3 (P ＜0.05). The reduction of slow waves in APOEε2 carriers was more obvious than APOEε3 carriers (P ＜0.05). Univariate and multivariate logistic regression analyses showed that APOEε4 was a risk factor to electroencephalogram aggravation after traumatic brain injury. Conclusion APOEε4 is a risk factor to electroencephalogram aggravation during acute stage after mild/moderate traumatic brain injury. However,APOEε2 seems to be beneficial for recovery of brain electrical activity.     

载脂蛋白E基因多态性对星形胶质细胞损伤早期胞内Ca2+浓度的影响

目的 探讨载脂蛋白E(apolipoprotein E,蛋白:apoE,基因:APOE)基因多态性与星形胶质细胞损伤后早期胞内Ca2+浓度的相关性.方法 (1)通过RT-PCR及定点突变技术扩增人源性APOE三种等位基因的CDS区,并构建pEGFP-N1-APOE重组质粒;(2)APOE基因敲除鼠星形胶质细胞的原代培养、鉴定;脂质体法将重组质粒转染入星形胶质细胞,并筛选稳定表达APOE信息的细胞株;(3)利用划痕致伤构建细胞损伤模型,于伤后12,24,48及72 h时相点,利用激光共聚焦显微镜(LCSM)技术检测各基因型细胞内Ca2+的荧光强度.结果 各型细胞相对于自身对照(致伤前),Ca2+荧光强度变化差异有统计学意义(P＜0.05).伤后12 h,三组细胞内Ca2+荧光强度较弱,组间差异无统计学意义(P＞0.05);伤后24,48及72 h,三组细胞Ca2+荧光强度进行性增加,且ε4组明显高于ε2和ε3组(P＜0.05).结论 损伤后早期,携带APOEε4等位基因的星形胶质细胞内Ca2+高于ε2和ε3型,提示ε4携带体可能通过伤后Ca2+通道的激活导致急性期伤情加重及不良预后.     

载脂蛋白E基因与阿尔茨海默病的遗传相关性研究

目的 :研究乌鲁木齐地区人群中载脂蛋白E(ApoE)基因型与阿尔茨海默病 (AD)的遗传相关性。方法 :采用PCR -RFLP方法检测ApoE各等位基因和基因型。结果 :5 1例散发性AD的ApoEε2、ε3和ε4等位基因频率分别为 7.8% (8)、71 .6 % (73)和2 0 .6 % (2 1 ) ,而 5 2例正常对照为 1 6 .4 % (1 7)、79.8% (83)和 3.9% (4 )。AD组ε4频率明显高于对照组 (χ2 =1 3.5 4 ,P <0 .0 1 )。结论 :ApoEε4是AD的易感基因和发病危险因素 ,其频率在不同人群中存在差异。临床上检测可疑AD患者的ε4等位基因具有一定的辅助诊断价值     

载脂蛋白E基因多态性在星形胶质细胞缺氧性损伤后早期凋亡中的作用

目的 探讨载脂蛋白E(apolipoprotein E,APOE)基因多态性在星形胶质细胞缺氧性损伤后早期凋亡中的作用.方法 原代培养APOE基因野生鼠、APOE转基因鼠(ε3、ε4)的星形胶质细胞,并纯化鉴定;利用缺氧法构建星形胶质细胞缺氧损伤模型,透射电镜观察细胞及线粒体形态变化,流式细胞仪检测细胞早期凋亡率及线粒体膜电位变化情况.结果 缺氧6h后,通过电镜观察到各组细胞足突肿胀,线粒体形态不规则、空泡化、嵴不规则,各组细胞之间形态变化无明显差异;APOEε4组细胞早期凋亡率、线粒体膜电位下降程度明显高于APOEε3组、APOE野生组(P＜0.05).结论 缺氧损伤后早期,与APOEε3组、APOE野生组比较,APOEε4组星形胶质细胞线粒体膜电位下降程度更大,这可能是导致更多的星形胶质细胞凋亡的原因之一.     

无菌性脑膜炎急性期继发癫痫的特点及危险因素

目的分析无菌性脑膜炎急性期继发癫痫发作的临床特点和危险因素。方法回顾性分析资料完整的急性无菌性脑炎患者138例，其中脑膜炎后癫痫患者21例，无癫痫发作者117例，系同期住院患者。病例和对照采用统一的调查表，用Microsoft Access2002建立数据库，共51个主项内容，部分主项有下属分项。总结癫痫发作的临床特点，对研究资料进行单因素分析和多因素非条件Logistic回归分析。结果全面发作14例（66．7％）。发病2周内出现抽搐者17例（81．0％）。经分析筛选出脑脊液蛋白含量升高、颅内压升高、脑电图低波幅3个因素为脑膜炎后继发癫痫的独立危险因素。结论无菌性脑膜炎后急性期癫痫以全面发作为主，多发生在发病2周内。脑脊液蛋白含量、颅内压升高和脑电图低波幅是癫痫发作的独立危险因素。     

急性颅脑损伤患者血浆D-二聚体和纤维结合蛋白变化的初步研究

业已发现 ,颅脑损伤后出现的凝血机能异常是加重脑损伤程度和影响患者预后的重要因素之一[1 ] 。笔者对颅脑外伤患者血浆Ｄ -二聚体 (ＤＤ)和纤维结合蛋白 (Ｆｎ)水平进行了动态检测 ,探讨凝血纤溶功能在脑损伤病程中的变化。一、临床资料与方法1.一般资料 :1999年 1月～ 2 0 0 0年 12月在我科住院的 90例急性颅脑损伤患者为病例组 ,男 5 6例 ,女 34例 ;年龄 15～ 6 0岁 ,平均 32 .6岁。患者均在伤后 2 4ｈ内入院 ,经头颅ＣＴ检查确诊 ,符合国内颅脑损伤诊断标准[2 ] 。根据患者入院时格拉斯哥昏迷评分 (ＧＣＳ) ,分为轻 (13～ 15分 )、中 (…     

基于DCE-MRI及临床病理特征的模型预测乳腺癌前哨淋巴结状态

目的:探讨基于DCE-MRI及临床病理特征建立的预测模型对乳腺癌前哨淋巴结(SLN)转移的预测价值,为临床个性化治疗提供依据。方法:回顾性分析我院2016年1月至2018年12月经手术病理证实为乳腺癌并符合入组标准的260例患者的临床、病理及MRI资料。根据SLN病理结果,将全部患者分为SLN转移阳性组(n=127)和SLN转移阴性组(n=133),比较两组患者的临床病理资料、MRI特征的差异。利用logistic回归分析确定与SLN转移相关的预测因子并构建预测模型,采用受试者工作特征(ROC)曲线评价预测模型的效能。结果:单因素分析结果显示,ER、PR、HER2、分子分型、多灶、增强形态与乳腺癌SLN转移相关(P<0.05)。多因素logistic回归分析结果显示PR、HER2、增强形态、ADC值(P<0.05)是乳腺癌SLN转移的独立危险因素,预测模型的曲线下面积为0.710(P<0.05),其预测乳腺癌前哨淋巴结转移的敏感度为77.2%,特异度为58.6%。结论:ER、PR、HER2、分子分型、多灶、增强形态与乳腺癌SLN转移相关,基于PR、HER2、增强形态、...     

颅脑损伤后癫痫发作的航空医学鉴定——附病例报告二例

目的 通过回顾性分析民航飞行员颅脑损伤病例及社区病例相关文献,探讨不同程度的颅脑损伤后不同时间段癫痫的发病率和颅脑损伤后癫痫发作的高危因素,以期指导民用航空人员颅脑损伤的医学鉴定.方法 获取并回顾相关颅脑损伤后癫痫发作的流行病学研究,获得社区颅脑损伤病例共9475例,其中重度605例,中度1955例,轻度6915例;民航飞行员重度颅脑损伤申请特许鉴定病例2例.分析并探讨颅脑损伤后癫痫发作的航空医学鉴定.结果 ①重度颅脑损伤后癫痫发病率高于中度,中度高于轻度.②颅脑损伤后随时间推移癫痫发作可能性逐步降低;轻度颅脑损伤1年后癫痫年发病率小于1%,中度颅脑损伤3年后癫痫年发病率小于1%,重度颅脑损伤8年后癫痫年发病率小于1%.③颅脑损伤后癫痫发作高危因素有:脑挫伤、硬膜下血肿、凹陷性骨折及意识丧失或损伤后遗忘大于24 h.④两名颅脑损伤飞行员经及时有效治疗后恢复良好,各项检查未见异常,密切随访期间未见癫痫发作.其中1名飞行员于伤后第4年特许合格,安全飞行2年(1800 h),未见癫痫发作;另1名于伤后第9年特许合格,安全飞行4年(1600 h),未见癫痫发作.结论 根据1%法则,颅脑损伤治愈后,若各项检查未见异常,轻度颅脑损伤1年后可评定为合格,中度3年后可评定为合格,重度8年后可考虑有或无限制的合格鉴定. Abstract： Objective To investigate the incidence of various grade of posttraumatic epilepsy in different time and risk factors by analyzing cerebral trauma cases of civil pilots and correlative literatures.The conclusion is expected to contribute to the aviation medical assessment for the civil pilot with posttraumatic epilepsy. Methods For analyzing epidemiology studies of posttraumatic epilepsy 9475 cases of civilians' posttraumatic epilepsy (include 605 severe, 1955 moderate and 6915 mild traumatic brain injury cases) were reviewed. Besides, 2 epilepsy cases of civil pilots with severe traumatic brain injury, who were specially applied for assessment, were also analyzed to investigate the application in aeromedical assessment. Results ①The severer traumatic brain injury the higher incidence of posttraumatic epilepsy. ②The possibility of posttraumatic epilepsy seizure was gradully diminished with time. The incidence of posttraumatic epilepsy could reduce to lower than 1% after 1, 3 or 8 years corresponding to the mild,moderate and severe traumatic brain injury. ③ The high risk factors of posttraumatic epilepsy included brain contusion, subdural hematoma, depressed fracture, loss of consciousness or post traumatic amnesia more than 24 h and early seizure. The close follow-up showed that 2 pilots well recovered by timely treatment and no more abnormities and seizure happened. One pilot was permitted for co-piloting at the 4th year of injury and had no epilepsy seizure in his safe flying for 2 years (1800 h). Another pilot returned to his qualified flight at the 9th year and had safely flied as pilot instructor for 4 years ( 1600 h) without seizure.Conclusions By applying 1% rule in aeromedical assessment, the mild traumatic brain injured pilot would be suggested to fit for flying by 1-year recovery and 3-year recovery for the moderate if no more abnormities were diagnosed. For the severe injured pilot, the flying qualification could be considered with or without limitation by 8-year recovery.     

改良大骨瓣开颅个体化外减压术治疗重型颅脑损伤伴急性硬膜下血肿

目的 分析改良大骨瓣开颅个体化减压术对重型颅脑损伤伴急性硬膜下血肿治疗效果和手术方法. 方法 回顾性分析2007年7月-2010年6月采用改良大骨瓣开颅个体化减压术治疗重型颅脑损伤伴急性硬膜下血肿患者81例(治疗组)与2004年7月-2007年6月采用标准外伤大骨瓣减压治疗同样的患者65例(对照组)的治疗效果. 结果 伤后6个月GOS评估法判定其疗效:治疗组良好(5分)21例,中残(4分)19例,重残(3分)24例,植物生存(2分)5例,死亡(1分)12例(P＜0.01),预后较好(良好/中残)占49%(P＜0.05),预后较差或差(重残/植物生存/死亡)占51%;对照组良好(5分)12例,中残(4分)9例,重残(3分)22例,植物生存(2分)3例,死亡(1分)19例,预后较好占32%,预后较差占68%.治疗组并发术后颅内血肿、硬膜下积液明显少于对照组(P＜0.05).结论 改良大骨瓣开颅个体化减压术治疗重型颅脑损伤伴急性硬膜下血肿有较好疗效,能有效降低大骨瓣减压术后并发症的发生.     

高压氧治疗对轻、中度脑外伤患者智能、情绪改善的研究

 目的 观察高压氧治疗改善轻、中度脑外伤患者智能、情绪情况。 方法 67例轻、 中度脑外伤患者随机分为高压氧组（34例）和对照组（33例）。两组均接受闭合性脑外伤基础治疗,高压氧组加用高压氧治 疗,压力为0.18～0.20 MPa,舱内氧浓度控制在23％以下,吸氧85 min/次,持续100 min,1次/d,10次为一疗程,共进行3 个疗程。两组治疗前后进行“中文版简易智能状态检查（MMSE）”、“抑郁自评量表（SDS）”及“焦虑自评量表（SAS）” 评估。 结果 两组治疗前MMSE各分项分、MMSE总分、SDS总分和SAS总分均无统计学差异,两组治疗后上述各项 评分均明显优于治疗前,且高压氧组治疗后SDS和SAS总分优于对照组（ P <0.05）。 结论 高压氧治疗改善 轻、中度脑外伤患者智能、情绪评分作用较为显著。     

SPET brain perfusion imaging in mild traumatic brain injury without loss of consciousness and normal computed tomography.

We present SPET brain perfusion findings in 32 patients who suffered mild traumatic brain injury without loss of consciousness and normal computed tomography. None of the patients had previous traumatic brain injury, CVA, HIV, psychiatric disorders or a history of alcohol or drug abuse. Their ages ranged from 11 to 61 years (mean = 42). The study was performed in 20 patients (62%) within 3 months of the date of injury and in 12 (38%) patients more than 3 months post-injury. Nineteen patients (60%) were involved in a motor vehicle accident, 10 patients (31%) sustained a fall and three patients (9%) received a blow to the head. The most common complaints were headaches in 26 patients (81%), memory deficits in 15 (47%), dizziness in 13 (41%) and sleep disorders in eight (25%). The studies were acquired approximately 2 h after an intravenous injection of 740 MBq (20.0 mCi) of 99Tcm-HMPAO. All images were acquired on a triple-headed gamma camera. The data were displayed on a 10-grade colour scale, with 2-pixel thickness (7.4 mm), and were reviewed blind to the patient's history of symptoms. The cerebellum was used as the reference site (100% maximum value). Any decrease in cerebral perfusion in the cortex or basal ganglia less than 70%, or less than 50% in the medial temporal lobe, compared to the cerebellar reference was considered abnormal. The results show that 13 (41%) had normal studies and 19 (59%) were abnormal (13 studies performed within 3 months of the date of injury and six studies performed more than 3 months post-injury). Analysis of the abnormal studies revealed that 17 showed 48 focal lesions and two showed diffuse supratentorial hypoperfusion (one from each of the early and delayed imaging groups). The 12 abnormal studies performed early had 37 focal lesions and averaged 3.1 lesions per patient, whereas there was a reduction to--an average of 2.2 lesions per patient in the five studies (total 11 lesions) performed more than 3 months post-injury. In the 17 abnormal studies with focal lesions, the following regions were involved in descending frequency: frontal lobes 58%, basal ganglia and thalami 47%, temporal lobes 26% and parietal lobes 16%. We conclude that: (1) SPET brain perfusion imaging is valuable and sensitive for the evaluation of cerebral perfusion changes following mild traumatic brain injury; (2) these changes can occur without loss of consciousness; (3) SPET brain perfusion imaging is more sensitive than computed tomography in detecting brain lesions; and (4) the changes may explain a neurological component of the patient's symptoms in the absence of morphological abnormalities using other imaging modalities.     

高压氧治疗改善轻、中度脑外伤患者睡眠质量的对照研究

目的观察高压氧（hyperbaric oxygen,HBO）治疗对轻、中度脑外伤患者睡眠质量的改善情况。方法连续选择住院治疗的轻、中度脑外伤67例,随机分为HBO组（34例）和对照组（33例）,两组均接受闭合性脑外伤基础治疗,HBO组另行HBO治疗,压力为0.22 MPa,舱内氧浓度在23%以下,吸氧85 min/次,1次/d,10次为1疗程,共进行3个疗程。两组治疗前后分别接受＂匹兹堡睡眠质量指数问卷（PSQI）＂评估。结果两组治疗前PSQI各成分评分及PSQI总分分布接近（P〉0.05）,治疗后多数PSQI成分评分及PSQI总分均明显优于治疗前,HBO组治疗后多数PSQI成分评分及PSQI总分优于对照组（P〈0.01或P〈0.05）。结论 HBO治疗可明确改善轻、中度脑外伤患者睡眠质量。     

颅脑外伤911例的脑电图临床分析

目的探讨颅脑外伤患者行脑电图(EEG)检查的临床意义。方法对911例颅脑外伤患者的临床资料及EEG检查进行分析。结果 EEG正常148例(16.2%),异常763例(83.8%),其中轻度异常465例(60.9%),中度异常193例(25.3%),重度异常105例(13.8%)。颅脑外伤的严重程度越高,EEG的异常率越高(P<0.05)。结论 EEG能比较客观的反映和评价颅脑外伤患者的脑皮质功能的实际情况,对诊断、病情程度和预后判断有着一定的临床意义。     

中、重型颅脑创伤并发创伤性脑梗死的多因素分析

目的 探讨颅脑创伤后动、静脉性脑梗死的相关风险因素,为防治颅脑创伤后脑梗死提供理论依据.方法 采用回顾性研究方法,调查154例行急性硬膜下和(或)脑内血肿清除加标准去骨瓣减压的中、重型颅脑创伤患者的临床资料,对性别、年龄、入院GCS评分、瞳孔变化、环池状态、中线移位、合并伤、围术期血压、大脑浅静脉损伤、血小板计数、血浆D-二聚体含量、脱水剂使用情况及围术期出入量13个相关指标进行单因素分析,对有意义的指标再行Logistic多因素回归分析.结果 单因素分析显示:瞳孔变化、GCS评分、年龄、合并伤、围术期血压、环池状态、中线移位等7个指标与动脉性脑梗死的发生相关(P＜0.05);大脑浅静脉损伤、血浆D-二聚体含量和合并伤等三个指标与静脉性脑梗死的发生相关(P＜0.05).Logistic多因素回归分析显示:瞳孔散大和围术期低血压可能为动脉性脑梗死的独立危险因素(P＜0.05);大脑浅静脉损伤可能为静脉性脑梗死的独立危险因素(P＜0.05).结论 瞳孔变化、GCS评分、年龄、合并伤、围术期血压、环池状态、中线移位是颅脑创伤继发动脉性脑梗死的危险因素,其中瞳孔散大和围术期低血压是独立危险因素;大脑浅静脉损伤、D-二聚体含量及合并伤是颅脑创伤继发静脉性脑梗死的危险因素,其中大脑浅静脉损伤是独立危险因素.