血管性痴呆和Alzheimer病的载脂蛋白E基因多态性研究

目的　探讨载脂蛋白 E(APOE)基因多态性与老年期痴呆 [血管性痴呆 (VD)、Alzheimer型痴呆(AD) ]的相关性。方法　采用聚合酶链反应限制长度片段多态性技术 (PCR- RFL P)检测 2 6例 VD(下称 VD组 ) ,32例 AD(下称 AD组 ) ,4 0例正常人 (下称对照组 ) APOE基因型和等位基因频率并进行对比分析。结果　三组均以 ε3/3为优势基因型。 VD组、AD组和对照组分别为 5 0 .0 0 %、5 6 .2 5 %、80 .0 0 % ,VD、AD两组较对照组有显著性差异 (P<0 .0 5 )。ε3/4基因型在 VD组、AD组分别为 7%、9% ,较对照组 (3% )也有显著性差异 (P<0 .0 5 )。ε4 /4基因型在各组中均在 5 %以下。 VD和 AD患者等位基因ε3降低、等位基因ε4增高 ,与对照组相比较差异有显著性 (P<0 .0 5 )。结论　基因型 ε3/4与 VD、AD具有相关性 ,等位基因 ε4可能是痴呆的遗传易感因素     

阿尔兹海默病与血管性痴呆患者脑电图及甲状腺功能分析

目的探讨阿尔兹海默病(AD)及血管性痴呆(VD)患者的脑电图(EEG)与甲状腺功能变化的关系。方法对AD患者组10例、VD组5例及认知功能正常的对照组20例进行脑电图、甲状腺功能和简明智力状况检查(MMSE)评分在各组间的比较。结果脑电图异常率AD组为70%,VD组100%,对照组25%,其中VD组与对照组比较差异有显著性意义(P<0.05)。脑电图改变越严重则MMSE评分越低。尽管有同等程度脑电图改变,但MMSE评分VD组显著高于AD组(P<0.05)。AD组和VD组甲状腺功能(TT3、FT3)比对照组显著降低(P<0.05)。结论脑电图、甲状腺功能测定及MMSE评分的结合有助于AD和VD的早期诊断与鉴别诊断。     

头颅磁共振及单光子发射断层扫描在老年期痴呆早期诊断中的价值

目的评价头颅磁共振（MRI）及单光子发射断层扫描（SPECT）对阿尔茨海默病（AD）及血管性痴呆（VD）早期诊断的应用价值,探讨局部脑萎缩程度及局部脑缺血程度与老年期痴呆严重程度的相关性。方法对36例AD患者、32例VD患者及年龄、性别相匹配的30名非痴呆老年人(NC)进行MRI脑局部萎缩定量检测,并同时应用SPECT对脑局部血流灌注情况进行半定量分析。结果头颅MRI显示,AD组较VD组及NC组海马萎缩程度明显,AD患者左侧海马高度为(9.27±3.43)mm,VD组为(11.62±5.72)mm,NC组为(12.13±2.97)mm（均为P＜0.01）。SPECT显示,AD组及VD组均有认知相关部位的血流灌注减低,AD患者左侧颞叶每像素计数与小脑每像素平均计数的比值(RAR)值为0.60±0.07,VD组为0.67±0.11,NC组为0.89±0.09,AD与VD组局部脑缺血情况明显较NC组严重（均为P＜0.01）。早期轻度AD患者简易智能状态量表（MMSE)评分22～26分,MRI左侧海马高度为(12.05±2.14)mm,与NC组差异无显著性(P＞0.05）,而SPECT显示有明显脑局部缺血,左侧海马的RAR值为0.61±0.07,低于NC组(P＜0.01）。MRI测量的脑局部萎缩程度（左侧海马高度）及SPECT检测的脑局部缺血程度（左侧颞叶）均与痴呆的严重程度（MMSE评分)呈正相关（r=0.96及0.98,均为P＜0.01）。结论MRI对AD有辅助诊断作用。对轻度的AD患者,MRI不如SPECT敏感。局部脑萎缩、局部脑缺血程度与痴呆的严重程度及病程相关。AD患者SPECT上均有缺血改变,提示AD的发生可能与局部脑血流灌注减低相关。     

阿尔茨海默病与血管性痴呆患者心理和行为症状的比较

目的比较阿尔茨海默病(AD)与血管性痴呆(VD)的心理和行为症状(BPSD)。方法收集AD和VD患者各30例,采用AD行为症状评定量表(BEHAVE-AD),Cohen-Mansfield激惹性问卷(CMAI)评定患者BPSD。结果 AD、VD二组的行为紊乱发生率均高,但无显著差异;AD组焦虑与恐惧发生率高于VD组,VD组焦虑与恐惧的严重程度重于AD组(均P<0.05)。VD组乱走、无目的游荡的发生率高于AD组(P<0.05),但严重程度相似;AD组试图出走的严重程度重于VD组(P<0.05),但发生率无差异。二组在偏执与妄想观念、幻觉、攻击行为、日夜节律紊乱、情感障碍的发生率与严重程度上无明显差异。结论 AD、VD患者均呈现出不同类型的BPSD,而其严重程度不尽相同。针对其BPSD的特点进行相关治疗,对痴呆BPSD的预后有重要的意义。     

阿尔茨海默病和血管性痴呆患者血脂代谢异常的研究

目的 探讨Alzheimer病(AD)和血管性痴呆(VD)患者与血脂代谢异常的关系. 方法 测定了70例AD、50例VD患者血清脂质代谢水平,并与50例非痴呆正常老年人进行比较. 结果 AD组和VD组血浆总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)明显高于对照组(P＜0.05);高密度脂蛋白胆固醇(HDL-C)显著低于对照组(P＜0.05),但AD、VD 2组间差异无统计学意义;VD组三酰甘油(TG)明显高于AD 组及对照组(P＜0.05);载脂蛋白A1和载脂蛋白B各组之间差异无统计学意义. 结论 患者血清TC、LDL-C的增高和HDL-C的下降可能和痴呆发病有关,调脂治疗可能有助于AD和VD的防治.     

阿尔茨海默氏病与血管性痴呆的智能障碍及MRI对比分析

将128例痴呆患者分别为阿尔茨海默氏病(AD)组56例和血管性痴呆(VD)组72例,两组均应用长谷川氏痴呆评定量表检查法、简易精神状态检查法(MUSE)、Kohs立方体组合测验(Kohs测验)检查法测查,并与加以比较研究.发现AD多慢性起病,VD多急性起病,呈阶梯性病程,常伴有高血压和卒中史;头颅MRI显示AD患者以广泛皮质萎缩且以双侧海马明显萎缩为主,VD患者多为局灶异常.VD组的长谷川氏、MMSE测验分数都显著高于AD组.提示MRI用于鉴别诊断AD和VD的方式值得在临床推广.     

老年期痴呆患者血浆同型半胱氨酸的临床观察

目的　了解老年期痴呆患者同型半胱氨酸 (Homocysteine,HCY)水平并探讨二者之间的关系。方法　老年性痴呆 (AD) 33例 ,血管性痴呆 (VD) 4 3例 ,健康老年人 2 8例 (对照组 )。对所有研究对象 ,空腹取血检测血浆 HCY,同时检测血叶酸和维生素 B1 2 。结果　老年期痴呆患者的HCY平均水平为 1 3.1 2± 4.64μmol/ L (AD)和 1 5.33± 5.0 6μmol/ L(VD) ,对照组 (1 2 .45± 3.0 5μmol/ L ) ,F值分别为 3.972 ,1 0 .82 1和 6.62 5(P<0 .0 5)。血清 HCY与叶酸及维生素 B1 2 水平呈负相关 ,相关系数分别为 0 .2 92和 0 .2 7(P<0 .0 5)。结论　老年期痴呆者有高水平的血清 HCY和低水平的血叶酸。     

血清、脑脊液Tau蛋白与β-淀粉样蛋白浓度在早期AD、VD患者的对照研究

目的研究早期老年性痴呆(AD)、血管性痴呆(VD)患者血清、脑脊液Tau蛋白与β-淀粉样蛋白浓度的变化,为早期诊断AD、VD及相互间的鉴别诊断提供依据。方法采用双抗体夹心酶联免疫吸附试验(ELISA)检测20例早期AD患者,20例早期VD患者及对照组正常人20例血清及脑脊液中的Tau蛋白和Aβ1-42的浓度。结果早期AD组患者脑脊液中的Aβ1-42浓度低于对照组(P<0.01)。而Tau蛋白浓度分别高于早期VD组(P<0.05)和对照组(P<0.01),早期AD组患者静脉血Aβ1-42浓度显著升高,分别高于早期VD组(P<0.01)和对照组(P<0.01)。结论联合检测血液、脑脊液Tau蛋白和Aβ1-42可提高早期AD与早期VD的诊断与鉴别诊断。     

血管性痴呆与帕金森氏病痴呆患者听觉事件相关电位的对比分析

目的探讨听觉事件相关电位(ERP)在帕金森氏病痴呆(PDD)和血管性痴呆(VD)中的差异以及意义。方法对23例VD患者,16例PDD患者及20位正常人检测ERP,进行对照分析。结果3组间ERP异常程度不同,VD组与PDD组P3潜伏期均较对照组显著延长(P<0.05),而VD组P3延长较PDD组更明显(P<0.05)。N2组间异常程度不同,VD组较PDD组N2潜伏期延长,波幅降低(P<0.05)。ERP的外源成份N1异常程度不同,VD组N1潜伏期延长,波幅降低,与正常对照组相比,差异显著(P<0.05),而PDD组N1潜伏期、波幅与正常对照组相比无显著差异。结论VD、PDD患者听觉ERP的外源、内源成份皆有差异。ERP检测对临床痴呆类型的鉴别,有一定的参考价值。     

精神病

20033027血管性痴呆患者SPECT脑血流灌注显像特点/冯亚青…//中风与神经疾病杂志.忍003,20 (l).召O一32 对45例而_管性痴呆(VD)、30例卒中非痴呆 (SWD)患者和30例正常对照者(NC)进行SPECT局部脑lfl!.流灌注撇像,半定量分析各脑区血流灌注情况。结果:VD组额廿十、顶口1、颖叶和基底节局部脑lflI流灌注较SwD组减少(尸<0.05),并以额叶、颖汗11沉流减少最显著(尸<0.01)。与NC组比较,SWD组额叶、顶叶、颖叶和基底节局部脑血流灌注均减少(尸<0.05)。额叶、额叶血.流灌注减少与痴呆严重程度呈正相关(r二0.755,尸<0.01)。应用SPECTrCR…     

经颅多普勒超声诊断大脑中动脉狭窄的价值

目的 探讨经颅多普勒超声(transcranial Doppler ultrasound,TCD)诊断大脑中动脉(middle cerebral artery,MCA)狭窄的价值.方法 对行数字减影血管造影(digital subtract angiography,DSA)和TCD检查的缺血性脑血管病患者的临床资料进行回顾性分析,以DSA为金标准,分析TCD诊断MCA狭窄的敏感性和特异性.对正常以及不同狭窄程度MCA的TCD血流速度进行比较,计算MCA不同狭窄程度时TCD血流速度的最佳截断值.结果 103例患者DSA证实存在MCA狭窄或闭塞,其中轻度狭窄12例,中度狭窄22例,重度狭窄40例,闭塞39例.与DSA相比,TCD检测中度以上MCA狭窄或闭塞的敏感性为78.8%,特异性为96%,准确度为93%,漏诊率为21.2%,误诊率为4%.轻度狭窄组与正常组之间血流速度无显著差异,中度狭窄组与正常组之间血流速度存在显著差异(P＜0.001),中度狭窄组与重度狭窄组之间血流速度无显著差异.判定中度狭窄的最佳收缩期峰值血流速度截断值为163.5 cm/s,平均血流速度的最佳截断值为108.5 cm/s.结论 TCD在诊断MCA狭窄或闭塞方面具有一定的优势,可作为DSA检查之前的一种安全而廉价的筛选手段.

Abstract：

Objective To explore the value of the diagnosis of middle cerebral artery (MCA) stenosis with transcranial Doppler ultrasound (TCD). Methods The clinical data in patients with ischemic cerebrovascular disease examined with digital subtract angiography (DSA)and TCD were analyzed retrospectively. DSA was used as a gold standard to analyze the sensitivity and specificity of the diagnosis of MCA stenosis with TCD. The normal and TCD blood flow velocity with different degrees of stenosis were compared. The best cut-off point of the TCD blood flow velocity of MCA at different degree of stenosis was calculated. Results DSA confirmed that 103 patients had MCA stenosis or occlusion, in which 12 were mild stenosis, 22 were moderate stenosis, 40 were severe stenosis, and 39 were occlusion. Compared to DSA, the sensitivity of TCD in detection of moderate and severe MCA stenosis or occlusion was 78. 8%, the specificity was 96. 0%, and the accuracy was 93. 0%, the missed diagnosis rate was 21. 2%, and the misdiagnosis rate was 4. 0%. As to the blood flow velocity, there was no significant difference between the mild stenosis and normal groups; while there was significant difference between the moderate stenosis and normal groups (P ＜0. 001). In addition, there was no significant difference in blood flow velocity between the moderate stenosis and severe stenosis groups. Determining the cut-off value of the best peak systolic velocity of the moderate stenosis was 163. 5 cm/s, while the best cut-off value of the mean velocity was 108. 5 cm/s. Conclusions TCD has certain advantages in the diagnosis of the MCA stenosis or occlusion, and it can be used as a safe and inexpensive screening means before DSA examination.     

氙-CT动态观察动脉瘤性蛛网膜下腔出血患者脑血流量变化的初步研究

目的探讨应用氙（Xe）-CT评价动脉瘤性蛛网膜下腔出血（SAH）患者的脑血流量变化以及与经颅多普勒超声（TCD）检测脑血流速度的关系。方法对7例在SAH后1～4d和7～14d的颅内动脉瘤患者进行2次Xe—CT检查。用自动皮质6分区模式和手工画法测量大脑中动脉（MCA）等血管分布区（每例患者双侧大脑半球10个感兴趣区，7例患者共70个）的脑血流量。在Xe—CT检查后1h内，采用TCD检测MCA血流速度，比较MCA供血区脑血流量与TCD检测的血流速度的相关性。结果Xe—CT检测7例患者SAH后1～4d双侧MCA供血区平均脑血流量为（48±12）ml·100g^-1·min^-1，7～14d为（43±15）ml·100g^-1·min^-1。TCD检测SAH后1～4d双侧MCA平均流速为（165±73）cm／s，7～14d为（151±70）cm／s。Xe—CT检测的MCA供血区局部脑血流量与TCD检测的MCA血流速度比较，SAH后1～4d的左侧MCA的脑血流量与血流速度呈显著正相关（r=0．869，P〈0．05），SAH后1～4d的右侧MCA和7～14d的双侧MCA的脑血流量和血流速度均呈负相关，但差异均无统计学意义（P〉0．05）。结论Xe—CT能获得脑血流量绝对值，可用于动脉瘤性SAH患者的脑血流量评价。TCD检测的MCA流速与Xe—CT测得的局部脑血流量可能无明显相关性，有待于扩大样本，继续深入研究。     

脑积水患者行经颅多普勒检测的意义

目的明确脑积水患者经颅多普勒（TCD）监测结果与颅内压的关系。方法选择我院32例行脑室腹腔分流术的脑积水患者（观察组），分别于术前1d和术后5d行大脑中动脉（MCA）的TCD监测；另选择27名门诊体检健康个体为对照组，行大脑中动脉TCD监测，并与观察组作对照。结果观察组患者行分流手术前TCD监测显示MCA收缩期血流速度（Vs）、舒张期血流速度（Vd）以及平均血流速度（Vm）较对照组明显下降（P〈0．05）；而搏动指数H和阻抗指数砌却明显高于对照组（P〈0．01）。观察组患者治疗前、后MCA的PI、RI、Vd、Vm间差异有显著性意义（P〈0．05）。结论经颅多普勒中RI和PI值可作为评价脑积水患者颅内高压的有效手段。     

高血压经颅多普勒脑血流动力学变化及与病程,年龄的关系

高血压经颅多普勒脑血流动力学变化及与病程、年龄的关系蒋崇福１吴妙英２（１．广州军区空军司令部门诊部，广州５１００７１２．衡阳医学院附属第一医院，衡阳４２１００１）ＡｇｅａｎｄＳｔａｇｅＲｅｌａｔｅｄＣｈａｎｇｅｓｉｎＴｒａｓｃｒａｎｉａｌＤｏｐｐｌｅ...     

西安地区中老年人的痴呆患病率调查

目的：了解西安载我中老年人痴呆的流行现状。方法：E要用多分层,多级,随机、整群抽样、以简易智能状态量表（MMSE）为筛查工具,对西安地区4850例5及以上中老年人进行了痴呆患病率调查。结果：符合美国精神疾病诊断和统计手册第4版（DSM－Ⅳ）和美国国立神经病学、语言交流障碍和卒中－老年性痴呆 关疾病学会（NINCDS－ADRDA）痴呆诊断标准者171例,痴呆患病率3．53％。其中Alzheimer痴呆（AD）100例,患病率2．06％,占58．48％,血管性痴呆（VD）54例,患病率1．11％,占31．58％,痴呆及VD患病率男女间差异无显著性P＞0．05）,而AD患病率女性明显高于男性（P＜0．01）。痴呆及AD、VD、患病率均随增龄而显著增高（P＜0．01）,年龄每增长5岁,患病率约增高1倍。文盲组痴呆及AD患病率高于小学和初中以上组（P＜0．01）。各职业之间痴呆及AD、VD患病率用年龄分层后差异均无显著性（P＞005）。城市和农村痴呆、AD、VD患病率差异亦无显著性（P＞0．05）。结论：我国痴呆患病率并不低,基本与欧美国家持平,高龄、女性、低文化水平,能是AD的危险因素。     

补肾健脑汤治疗血管性痴呆的临床研究

目的 探讨自拟补肾健脑汤对血管性痴呆（VD）病人的疗效及其对VD病人血液流变学、血脂及脑血流的影响。方法 将72例VD病人随机分为治疗组与对照组。两组治疗前后均计算长谷痴呆量表（HDS）和简易精神状态检查表（MMSE）积分，测定血液流变学及血脂各项指标，TCD检测VD病人脑血流的变化.结果 两组HDS和MMSE积分治疗后均较治疗前有明显提高（P〈0．01）；治疗组治疗后血液流变学及血脂各项指标均有明显改善（P〈0．05），而对照组仅低切变率全血黏度有明显的降低作用（P〈0．05）；治疗组对血流速度减慢的VD病人的平均血流速度均有增加趋势，其中对大脑中动脉的血流速度显著增加（P〈0．05）。结论 补肾健脑汤可以明显提高VD病人的智能水平，其作用机制可能是通过降低血液黏度，调节脂代谢紊乱，增加脑血流量，改善脑循环而买现的。     

Cognitive performance correlates with cerebrovascular impairments in multi-infarct dementia

Cerebral blood flow (CBF) was measured by the 133Xe inhalation method in patients with multi-infarct dementia (MID, N = 26), Alzheimer's dementia (AD, N = 19), and among age-matched, neurologically normal, healthy volunteers (N = 26). Cognitive performance was assessed in all subjects using the Cognitive Capacity Screening Examination (CCSE). Cerebral vasomotor responses were calculated from differences in values of mean hemispheric gray matter blood flow (Delta CBF) measured during inhalation of 100% oxygen (hyperoxia) compared with CBF measured while breathing room air. Significant correlations were found between CCSE performance and vasomotor responsiveness in patients with MID (P less than .01), but not in patients with AD or in neurologically normal volunteers. Loss of vasomotor responsiveness is an indicator of cerebrovascular disease with rigidity and/or loss of reactivity of cerebral vessels, which impairs cerebrovascular responses to situational demands and predisposes to cerebral ischemia. Loss of cerebral vasomotor responsiveness among MID patients, which is a biologic marker of cerebrovascular disease, provides confirmatory evidence of the vascular etiology of MID and assists in separating MID from AD patients.     

Effects of aging on cerebral blood flow in dementia

Regional cerebral blood flow values were measured utilizing the 133Xe inhalation method in patients with multi-infarct dementia (MID) (n = 22, age 67.4 +/- 9.8 years), in patients with senile dementia of Alzheimer type (SDAT) (n = 36, age 63.8 +/- 8.0) and in age-matched normal healthy volunteers (n = 50, age 67.5 +/- 9.3). Mean hemispheric gray matter flow values were significantly reduced in MID (P less than 0.01) and SDAT (P less than 0.01) patients compared with age-matched normal volunteers. In normal volunteers, mean flow values showed gradual declines with advancing age (r = -0.44, P less than 0.005). In MID patients there were significant decreases in flow values with advancing age (r = -0.43, P less than 0.05), but flow values were consistently lower than in age-matched normals. Reductions of flow were most evident in the distribution of both middle cerebral arteries. Unlike MID patients, patients with SDAT had diffusely reduced flow values over all age ranges without correlation with advancing age. Reductions of mean flow values in both dementia groups were significantly correlated with severity of dementia (P less than 0.05 for both groups). Cerebral blood flow reductions related to the aging process also contribute to decreased cerebral perfusion in patients with MID. This is not true in SDAT, where the disease process itself pre-empts cerebral blood flow reductions attributable to aging.     

Transcranial Doppler ultrasonography in siblings with sickle cell disease

Summary. The risk of stroke in sickle cell disease (SCD) may be influenced by either genetic or environmental factors. Elevated blood flow velocity in the large cerebral arteries, detected by transcranial Doppler (TCD) ultrasonography, predicts an increased stroke risk in children with SCD. We undertook this study to investigate the possibility of a familial predisposition to elevated cerebral blood flow velocity, a surrogate marker for stroke risk. We analysed the results of TCD studies performed on 63 children from 29 families that had more than one child with SCD. We assessed the association of elevated cerebral blood flow velocity with sibling TCD results as well as age and haemoglobin level, which are factors known to affect cerebral blood flow velocity. Positive or negative TCD results were highly correlated between family members ( r =  0·61). The presence of a sibling with a positive TCD result was significantly associated with an elevated cerebral blood flow velocity in other siblings with SCD (odds ratio = 41·9, 95% confidence interval 8·2–214·7, P  < 0·001). Furthermore, children who had a sibling with a positive TCD result had a significantly higher TCD velocity than children with SCD but without a sibling who were matched for age, sex, genotype and haemoglobin level. Our results are consistent with a familial predisposition to cerebral vasculopathy in SCD.     

原发性高血压患者经颅多谱勒脑动脉血流变化特征分析

目的 探讨原发性高血压患者脑动脉血流变化特征及其影响因素,为高血压防治提供依据。方法 对29名原发性高血压患者和16名健康人进行了经颅彩色多普勒脑血流成像技术（TCI）监测分析,观察大脑中动脉（MCA）的收缩期血流速度（Vs)平均血流速度（Vm)、舒张期血流速度（Vd)、搏动指数（PI）、阻力指数（RI）的变化特征,并与收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、脉压进行了直线相关分析。结果 与健康对照组相比,高血压组患者收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、脉压和体重指数（BMI）及PI、RI均明显升高（P＜0．01）;高血压组中DBP与Vs,Vm,Vd,PI,RI呈明显正相关（P＜0．05）,脉压与Vs,Vm,Vd及PI呈明显正相关（P＜0．05）。SBP、MBP均与脑血流指标相关不明显（P＞0．05）。结论 高血压患者脑动脉血流变化特征主要表现为PI和RI的显著升高,舒张压和脉压是影响脑血流变化的两个主要因子。TCI是一种简便的、有价值的检查方法。