重症帕金森病治疗进展:左旋多巴/卡比多巴肠凝胶

左旋多巴是帕金森病(PD)治疗的核心药物,晚期PD患者长期口服左旋多巴/卡比多巴(LC-oral)容易引起症状波动及异动症,症状波动与药物浓度波动有关。持续的多巴胺能释放被认为是改善PD症状的关键。通过经皮内镜胃造口术十二指肠置管利用CADD Duodopa泵将左旋多巴/卡比多巴肠凝胶(LCIG)持续定向泵入小肠上段或上段空肠,不受胃排空的影响,血药浓度波动小,可显著改善晚期PD患者     

卡比多巴-左旋多巴控释片治疗帕金森病合并睡眠障碍患者的疗效观察

目的探讨卡比多巴-左旋多巴控释片治疗帕金森病合并睡眠障碍患者的疗效。方法应用卡比多巴-左旋多巴控释片治疗46例帕金森病合并睡眠障碍患者,分别于治疗前后连续2次全夜PSG监测,取第2晚PSG结果进行比较,对比治疗前后全PSG监测参数、PQSI评分及ESS评分,评定UPDRS-Ⅲ评分及H&Y分期评分的改变。结果治疗后ESS评分、UPDRS-Ⅲ评分明显下降(P﹤0.05);而PQSI评分、H&Y分期评分、卧床时间、总睡眠期变化、总睡眠时间、睡眠潜伏期、睡眠效率、微觉醒指数、睡眠中觉醒次数、入睡后觉醒时间、S1(min)、S2(min)、S3+S4(min)、REM(min)、S1(%)、S2(%)、S3+S4(%)、REM(%)均差异无统计学意义(P﹥0.05)。结论卡比多巴-左旋多巴控释片既可改善帕金森病运动症状又能改善患者日间嗜睡状态,同时具有改善帕金森病患者夜间睡眠质量的趋势。     

胺碘酮与伊贝沙坦对特发性阵发性心房颤动患者P波离散度的影响

目的观察胺碘酮和伊贝沙坦对特发性阵发性心房颤动患者心电图P波离散度(Pd,ms)和最大P波时限(Pmax,ms)的影响。方法90例特发性阵发性心房颤动患者随机分成胺碘酮加伊贝沙坦组31例,伊贝沙坦组29例和胺碘酮组30例,健康对照组30例,观察药物治疗2个月前后心电图Pd和Pmax的变化。结果特发性阵发性心房颤动患者Pd和Pamx明显延长;胺碘酮加伊贝沙坦治疗能明显改善Pd和Pmax;伊贝沙坦治疗对Pd和Pmax有改善倾向,但差异无显著性(P>0.05);胺碘酮能改善Pd和Pmax,但对Pd和Pamx的改善少于胺碘酮加伊贝沙坦组。结论胺碘酮加伊贝沙坦能显著缩小特发性阵发性心房颤动患者的P波离散度及P波最大时限。     

牙周正畸联合治疗牙周病的疗效评价

目的评估牙周正畸联合治疗牙周病的临床疗效。方法选取轻、中度牙周病患者45例,在牙周基础治疗后结合正畸联合治疗,观察患者治疗前及治疗后不同时间点牙周袋探诊深度(PD)、牙冠长度、牙根长度及不同区域牙槽骨密度的变化。结果与治疗前比较,牙周基础治疗及正畸治疗后患者牙周袋PD明显减小,牙冠长度明显增加,牙周正畸治疗效果更为显著(P0.05或P0.01);牙根长度治疗前后未见明显变化(P0.05)。与治疗前比较,牙周基础治疗后患者牙槽嵴顶及根尖区骨密度明显增加(P0.05),而牙周正畸治疗后明显减少(P0.05或P0.01),且显著低于牙周基础治疗后(P0.01)。结论牙周正畸联合治疗牙周病可有效改善牙周状况,增加牙冠长度,减少牙槽骨密度,且对牙根长度无明显影响。     

室性心律失常合并抑郁症状的临床分析与治疗

目的　分析抗抑郁治疗对室性心律失常合并抑郁症患者的临床效果。方法　 6 3例心律失常伴抑郁症患者 ,随机分为观察组 (n =32 )和对照组 (n =31)。入组患者均给予常规抗心律失常治疗 ;观察组在抗心律失常的基础上给予心理治疗并口服百忧解 2 0mg/d ,共 12周。比较两组治疗前及 6、12周抑郁自评量表分值及心律失常情况。结果　①治疗前两组之间比较抑郁程度无显著差异 ;治疗 6周 (P =0 0 12 )及 12周(P <0 0 0 1)后 ,观察组抑郁程度显著优于对照组 ;与治疗前比较 ,对照组治疗后 6周无显著差异 ,治疗 12周有差异 (P =0 0 3) ,观察组治疗后 6周 (P <0 0 0 1)及 12周 (P <0 0 0 1)抑郁情况均显著改善 ;治疗 12周后与 6周后比较 ,对照组无差异 ,观察组抑郁情况进一步改善 (P <0 0 0 1)。②两组间心律失常发生情况对比 ,抗抑郁治疗 6周和 12周观察组均显著优于对照组 (P <0 0 0 1)。③观察组 6个月后随访结果显示心律失常的发生明显少于对照组 (P <0 0 0 1)。结论　抗抑郁治疗可明显提高室性心律失常伴抑郁患者的抗心律失常效果 ,减少复发率     

多巴胺受体激动剂治疗帕金森病

帕金森病(Parkinson's disease,PD)是由于中脑黑质-纹状体系统中缺少多巴胺(dopamine,DA)所致的慢性进展性疾病.多数在发病后2～3年内尚能工作,往往在病情影响到工作或生活时才就诊.对PD尽早诊断和及时治疗的积极意义,主要在于能够延长患者的可工作时间和提高生存质量.在应用左旋多巴替代疗法取得可喜的效果后,DA受体激动剂治疗PD才得到迅速发展.当前对PD的所有治疗都只能改善或缓解其症状,而不能根除;至于延缓其病情发展的神经元保护疗法所应用的药物效果,在学术界尚未达成共识.     

侵袭性牙周炎患者牙周基础治疗的临床效果评价

目的:探讨对侵袭性牙周炎患者实施牙周基础治疗后获得的临床效果。方法:选择我院2013年06月~201 5年06月收治的侵袭性牙周炎患者151例作为本次对比实验观察对象;观察组79例以及对照组72例侵袭性牙周炎患者的分组依据为不同的侵袭性牙周炎治疗方法;对照组:常规治疗;观察组:常规治疗+牙周基础治疗;通过对比PD(牙周探诊深度)、AL(附着水平)以及BOP(探诊出血指数)等以突出牙周基础治疗的临床应用价值。结果:在PD指标、AL指标以及BOP指标几方面,同治疗前进行比较,两组侵袭性牙周炎患者治疗后表现出显著改善(P0.05);同对照组侵袭性牙周炎患者进行比较,观察组患者表现出显著改善(P0.05)。结论:对于侵袭性牙周炎患者,临床选择牙周基础治疗的方法,可以将患者的PD指标、AL指标以及BOP指标等显著改善,最终显著提高侵袭性牙周炎患者的生活质量。     

大豆磷脂对小鼠学习记忆及脑组织脂类成分的影响

目的　大豆磷脂对小鼠学习记忆、脑组织蛋白质和脂类成分的影响。方法　小鼠用不同剂量的大豆磷脂灌胃 ,分别为低剂量组 (2 5g kg)、中剂量组 (5 0g kg)、高剂量组 (10 0g kg) ,同时设立对照组 (去离子水 ) ,连续灌胃 30天 ,进行小鼠学习记忆测定后处死 ,取全脑 ,测定小鼠脑组织中蛋白质含量、磷脂和脂肪酸的成分及含量。结果　 (1)与对照组比较 ,高、中剂量组小鼠学习记忆能力显著增强 (P <0 0 5 ) ;低剂量组小鼠记忆力显著改善 (P <0 0 5 )。 (2 )各剂量组脑重占体重的比例及脑组织中蛋白质含量均显著上升 (P <0 0 5 )。 (3)高剂量组C1 8:2 含量、C1 8:3含量、PUFA占总脂肪酸的比例显著提高 (P <0 0 5 ) ;中剂量组C1 8:3含量有显著差异 (P <0 0 5 )。 (4 )高剂量组PS、PE、PC、PL含量显著增加 (P <0 0 5 ) ,SM PC的比值则显著下降 (P <0 0 5 ) ;中剂量组PS、PC、PL含量显著增加 (P <0 0 5 )。结论　提示大豆磷脂可明显提高小鼠脑组织中蛋白质、PUFA和PL的含量 ,显著改善小鼠学习记忆能力 ,且与大豆磷脂存在剂量对应关系。     

脑蛋白水解物治疗帕金森病50例效果评估

目的观察脑蛋白水解物治疗帕金森病(PD)的效果。方法 100例PD患者随机分为对照组与治疗组各50例,两组均给予抗胆碱能药物、左旋多巴等药物治疗,治疗组加用脑蛋白水解物120 mg/d。观察两组治疗前后帕金森病Hoehn-Yahr分期、Schwab和英格兰日常生活活动量表及帕金森病综合评分量表(UPDRS)积分改善情况。结果治疗组有效率较对照组明显提高(p<0.01),治疗后的UPDRS积分较治疗前明显下降(p<0.05)。结论脑蛋白水解物治疗PD患者疗效显著。     

总结司来吉兰与左旋多巴联用治疗帕金森病运动障碍的疗效以及安全性

目的:研究司来吉兰与左旋多巴联用治疗帕金森病运动障碍的疗效以及安全性。方法:60例帕金森病运动障碍患者,以抽签法分组,对比组及观察组各30例。对比组给予左旋多巴治疗,观察组联合司来吉兰治疗。观察两组治疗效果。结果:治疗后4周及8周后,观察组患者UPDRS评分比治疗前显著降低且低于对比组(P0.05)。观察组用药不良反应发生率为13.33%,对比组为10.00%,组间无显著差异(P0.05)。结论:司来吉兰与左旋多巴联合用于帕金森病运动障碍的治疗中,效果好,安全性高。     

慢性失眠障碍患者多导睡眠图与事件相关电位P300的相关性研究

目的探讨慢性失眠障碍(CID)患者多导睡眠图(PSG)与事件相关电位P300特征及其相关性。方法选取2016年6月至2018年6月在我中心收治的CID患者33例为研究组,并选取30例健康成年人为对照组。两组均行PSG和事件相关电位P300检查,分析研究组患者PSG及事件相关电位P300之间的相关性。结果 PSG检查显示,与对照组比较,研究组的总睡眠时间(TST)、 N2睡眠时间较短,睡眠效率(SE)较低,睡眠潜伏期(SL)、 REM睡眠潜伏期(REML)、觉醒时间(AT)较长,觉醒次数(ATs)增加,N1睡眠时间和比例增高(P <0.01或P <0.05);P300检查显示,与对照组相比,研究组的P3潜伏期(PL)延长、波幅(Amp)降低(P <0.01)。研究组P3 PL与AT、 N1比例呈正相关(r=0.819、 0.431, P <0.01或P <0.05),与TST、 SE、 N2睡眠时间、 REM睡眠时间及比例呈负相关(r=-0.657、-0.753、-0.513、-0.589、-0.480, P <0.01);P3 Amp与TST、 SE、 REM睡眠时间及比例呈正相关(r=0.534、 0.491、 0.803、 0.677, P <0.01),与AT呈负相关(r=-0.492, P <0.01)。结论 CID患者睡眠结构紊乱与认知功能受损相关,且二者相互影响。     

左乙拉西坦对良性癫痫伴中央-颞区棘波患儿的疗效观察及智力影响

目的 分析左乙拉西坦对良性癫痫伴中央-颞区棘波患儿的疗效观察及智力影响,为临床治疗提供科学依据。方法 选取保定市儿童医院2016年8月—2018年7月收治的60例伴中央-颞区棘波良性癫痫患儿作为研究对象,按照信封法随机分为对照组(30例)与观察组(30例),对照组采用卡马西平治疗,观察组采用左乙拉西坦治疗。比较两组的临床疗效、P300潜伏期、智力水平、视听觉刺激的注意能力以及不良反应发生率。结果 治疗后,观察组伴中央-颞区棘波良性癫痫患儿的临床总有效率高于对照组,差异有统计学意义(96.67% vs.73.33%,P＜0.05);观察组患儿治疗6个月后的P300潜伏期短于对照组,差异有统计学意义(t=3.527,P＜0.05);观察组患儿治疗后的语言智商、操作智商、总智商、视觉刺激、听觉刺激的反应控制商数、注意商数均显著高于对照组,差异有统计学意义(t=9.186、2.347、3.143、2.113、4.171、2.052、3.592,P＜0.05);两组间不良反应发生率比较,差异无统计学意义(P＞0.05)。结论 左乙拉西坦治疗能够有效控制伴中央-颞区棘波良性癫痫患儿的癫痫发作情况,对于P300潜伏期以及智力水平存在积极影响。     

癫痫患者服用托吡酯前后P300的变化

目的用托吡酯治疗癫痫患者，并用P300来检测其认知功能的变化。方法收集笔者所在医院神经内科门诊2004～2007年癫痫大发作患者共31例，其中男18例，女13例；年龄在25～40岁，用药前均作EEG、IQ及P300检查，服药半年或一年后再作P300检测。结果服用托吡酯半年组，P300潜伏期和反应时间较服药前明显缩短，P300波幅无显著性改变。服用托吡酯一年组，P300潜伏期和反应时间较服药前明显缩短，但因样本较少差异未达到显著性水平，P300波幅无明显改变。结论服用托吡酯半年或一年后，临床症状得到控制。P300潜伏期反应时间有明显变化，提示托吡酯治疗对癫痫患者的认知功能有一定的正影响。     

Auditory event-related potential (P300) in relation to peripheral nerve conduction in workers exposed to lead, zinc, and copper: effects of lead on cognitive function and central nervous system.

By measuring auditory event-related potential (P300 and N100) and peripheral nerve conduction velocities, the subclinical effects of lead, zinc, and copper on the central and peripheral nervous system were examined in 22 male gun metal foundry workers exposed to these metals. Their blood lead (BPb) concentrations ranged from 12 to 59 micrograms/dl (median 30). Control subjects were 14 healthy workers, employed at the same factory, who had never been occupationally exposed to these metals. In the gun metal foundry workers, the latencies of P300 and N100 were significantly prolonged; the latency of P300 was significantly correlated with BPb concentrations and other indicators of lead absorption. Similarly, the maximal motor and sensory conduction velocities in the radial and median nerves were significantly slowed, and were significantly correlated with indicators of lead absorption. The data suggest that lead exposure at low levels affects cognitive and central auditory nervous system function together with peripheral nerve conduction.     

非痴呆帕金森病患者轻度认知障碍与发病年龄和疾病阶段的关系

目的探讨非痴呆帕金森病患者轻度认知障碍与发病年龄和疾病阶段的关系。方法对84例非痴呆帕金森病患者按照患者发病年龄及疾病阶段分期,早期PD患者38例(早期PD组),晚期PD患者46例(晚期PD组),其中年轻早期PD患者23例(年轻早期PD组),老年早期患者15例(老年早期PD组),年轻晚期PD患者26例(年轻晚期PD组),老年晚期PD患者20例(老年晚期PD组)。选取同期门诊健康体检无神经系统阳性体征40例体检者作为对照组,进行神经心理学简易智能状态检查量表(MMSE)、蒙特利尔认知评价量表(MoCA)、Fuld物体记忆评价(FOM)、语言流畅性测验(RVR)、积木试验(BD)、数字广度测验(DS)及P300测试。结果 MMSE、MoCA、RVR、BD、DS、FOM对照疾病的阶段进展呈现下降趋势,P300PL呈现上升趋势,早期PD组、晚期PD组与对照组之间差异有统计学意义(P﹤0.05),年轻晚期PD组与年轻对照组之间差异有统计学意义(P﹤0.05),老年早期PD组、老年晚期PD组与老年对照组之间差异有统计学意义(P﹤0.05)。结论非痴呆帕金森病随着年龄的增加认知障碍状态有所下降,并且疾病晚期患者认知障碍状态比较疾病早期患者有所下降。     

Acute effects of alcohol on cognitive function and central nervous system assessed by auditory event-related potentials.

To clarify which sites of the central nervous system are influenced by acute administration of alcohol at an early stage, auditory event-related potentials (ERP) using a target-selection paradigm were measured in 13 healthy volunteers. In the recorded waveforms of ERPs, the N100, P165, N200 and P300 latencies for the target tone and the N100 and P200 latencies for the non-target tone were determined in each subject before and 1- and 2-hr after ingestion of 200 ml of alcohol (containing 25% ethanol) or of 200 ml of water, for a total of six times on two different days. The P300 latency was significantly prolonged at 1- and 2-hr after alcohol ingestion; and, the N200 latency was significantly prolonged at 2-hr after alcohol ingestion. The 2-hr alteration in the P300 latency after alcohol ingestion was positively correlated with the ethanol dose per body weight. These data suggest that ethanol, in proportion to its dose, affects cognitive function estimated by the P300 latency earlier than other lower central nervous system functions. Evaluating subclinical effects on central nervous function, using the ERPs, of environmental neurotoxins such as organic solvents, researchers should pay particular attention not only to the degree of the drinking habit but also to the interval between the measurement and alcohol intake.     

P300 in heavy social drinkers: The effect of lorazepam

The P300 component of the event-related potential (ERP) and reaction time (RT) were recorded during a simulated driving task using an oddball paradigm. ERPs and RTs were recorded from heavy social drinkers (n = 11) and low social drinkers (n = 11). A pharmacological challenge (lorazepam-ATIVAN) was administered to both groups in a double-blind procedure. In both groups, P300 amplitude was reduced and RT was increased by the presence of lorazepam; however, heavy social drinkers had longer latency P300 than low social drinkers regardless of the drug condition. The P300 amplitude results are consistent with reduced information processing being induced by lorazepam, or with reduced effectiveness of the eliciting stimuli. On the other hand, the P300 latency results suggest that P300 latency may reflect deficits in information processing induced by alcohol abuse or may have preceded the alcohol abuse. The P300 latency results are consistent with heavy social drinkers occupying an early point on the hypothesized continuum of alcohol-related brain damage.     

度洛西汀与氟西汀对首发抑郁症患者P300电位干预效果的比较

目的 比较度洛西汀与氟西汀对首发抑郁症患者疗效及认知功能的影响.方法 首发抑郁症患者74例随机分为度洛西汀组与氟西汀组,对两组在治疗前、治疗12周后进行P300及汉密尔顿抑郁量表的评定.与研究组性别、年龄匹配的正常人作对照,比较P300的变化.结果 与对照组相比,度洛西汀组与氟西汀组P300的P2、N2、P3潜伏期及反应时间明显延长,而P300的P2、N2、P3波幅降低,具有统计学差异;治疗后,度洛西汀组与氟西汀组P300的P2、N2、P3潜伏期及反应时间较治疗前减少且波幅升高,具有统计学差异;度洛西汀组与氟西汀组,P300指标的组间比较,无统计学差异.12周末,疗效比较无差异.治疗前后的P300潜伏期、波幅及反应时间均与其治疗前后HAMD评分无显著性相关性.结论 度洛西汀与氟西汀均能有效治疗首发抑郁患者,且具有改善其认知功能作用.     

丙戊酸钠对癫痫患者认知功能影响的meta分析

目的以事件相关电位P300或智商作为观察指标,运用meta分析的方法综合评价丙戊酸钠对癫痫患者认知功能的影响。方法按照Cochrane系统评价方法,计算机文献检索收集所有关于丙戊酸钠对癫痫患者认知功能影响的研究文献,采用Cochrane协作网提供的软件RevMan 4.2对符合要求的研究结果进行meta分析。结果共有相关文献7篇纳入分析（丙戊酸钠起始剂量10 mg/（kg·d）,维持剂量小于30 mg/（kg·d）。meta分析结果表明,癫痫患者使用丙戊酸钠治疗后P300潜伏期显著缩短（WMD=0.61,95%CI为0.31,0.90,假设检验z=3.98,P〈0.01）,P300波幅差异有统计学意义（P〈0.05）,总智商、语言智商差别无统计学意义（P〉0.05）、操作智商得分显著下降（P〈0.001）。结论目前有限的证据证明丙戊酸钠对癫痫患者的认知功能有改善作用,对语言智商和全面智商影响不明显,对操作智商具有不良影响。今后还需要更多高质量、多中心、大样本的随机对照试验加强证据力度,并将P300与韦氏智力量表结合用于癫痫患者认知功能评估,使其结果更客观、全面。     

Effect of mental fatigue induced by repeated continuous calculation tasks on event-related brain potential (P300)]

It is well known that the amplitude and latency of P300 in event-related brain potentials (ERPs) evoked by performing the oddball paradigm reflect the extent of individuals' selective attention. The purpose of this study was to examine whether P300 is a reliable measure for evaluating mental fatigue. In addition to the measurement of auditory ERPs derived from Fz, Cz and Pz, the concentrations of lactic acid, cortisol in plasma and the reaction time of the oddball paradigm, which are believed to reflect fatigue, were measured. In an attempt to cause mental fatigue, 12 healthy college students (8 males, 4 females; 19.5 +/- 0.5 yr; mean +/- S.D.) were forced to perform a continuous addition task using the Uchida-Kreperin test paper for about 2 h. Before the task, the latencies of P300 in Fz, Cz and Pz were 295.6 +/- 8.7 msec, 298.8 +/- 8.5 msec and 297.5 +/- 7.2 msec (mean +/- S.D.), respectively, and after the task they were 312.6 +/- 11.2 msec, 314.6 +/- 10.1 msec and 315.8 +/- 8.7 msec, respectively. A significant difference in the latency before and after the task was detected (p<0.01). In all subjects, the latency of P300 was prolonged in all recording positions, Fz, Cz and Pz. In a control experiment where the continuous addition task was not loaded, a significant change of the latency was not detected. The amplitude of P300 didn't change significantly in all recording positions after the task. In the control experiment, the amplitude of P300 did not change significantly. On the other hand, the changes in the concentrations of lactic acid and cortisol and the reaction time were not induced by the continuous addition task. The prolongation of the latency of P300 would originate from a decline in brain function. In this study, a prolongation of the latency of P300 after the task was detected in all subjects. It is well known that the value of P300 changes with modification of the recording condition, therefore a recording of P300 under the same conditions is required for qualitative evaluation.