儿童青少年抑郁症伴自杀倾向患者的风险因素及其炎症因子的水平

目的 探究儿童青少年抑郁症伴自杀倾向患者炎症因子的变化及风险因素。方法 回顾性分析本院2021年1月～2022年9月收治的150例青少年抑郁症患者的临床资料,依据贝克自杀意念量表（BSI-CV）评分分为A、B组,其中A组为伴随自杀意念,B组为不伴随自杀意念,另选取80例体检正常的青少年作为健康对照组。对比不同组别患者血清炎性因子水平,分析影响青少年抑郁症患者存在自杀倾向的危险因素。结果 （1）A组白细胞介素-6、CC趋化因子配体2、肿瘤坏死因子α、白细胞介素-1β(IL-1β)水平均高于B组与健康对照组（P<0.05）;(2)抑郁症病程、精神病家族史、近期与父母关系、IL-1β水平与BSI-CV评分均为影响抑郁症患者存在自杀倾向的独立危险因素（P<0.05）。结论 儿童青少年抑郁症伴自杀倾向患者表现为血清炎症因子的上升,这类患者出现自杀倾向与多种危险因素有关,需引起重视。     

抑郁症患者治疗前后血清TNF-α、IL-6和IL-18水平变化

目的探讨抑郁症患者治疗前后血清肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)和白细胞介素18(IL-18)水平变化,进一步确认其在抑郁症发生过程中的作用。方法纳入符合《国际疾病分类(第10版)》(ICD-10)诊断标准的48例住院抑郁症患者,招募64例健康对照组。采集对照组和患者组治疗前后静脉血,采用ELISA试验检测其血清TNF-α、IL-6和IL-18水平。收集抑郁症患者既往住院次数、住院时长、病程、发病年龄、用药剂量等临床资料。采用汉密尔顿抑郁量表17项版(HAMD-17)评定患者治疗前后抑郁程度。结果治疗前,患者组血清TNF-α和IL-6水平均高于对照组[(3.40±1.46)pg/mL vs.(2.02±1.39)pg/mL,(2.54±0.69)pg/mL vs.(0.49±0.30)pg/mL,P均0.05];血清IL-18水平低于对照组[(23.01±4.55)pg/mL vs.(35.31±5.20)pg/mL,P0.05]。患者治疗前后血清TNF-α、IL-6和IL-18水平比较差异均无统计学意义(P均0.05)。患者治疗前后TNF-α、IL-6和IL-18水平的变化值与既往住院次数、住院天数、病程、发病年龄、抗抑郁药剂量、HAMD-17评分均无线性相关(P均0.05)。结论抑郁症患者的症状改善与血清TNF-α、IL-6和IL-18水平变化之间可能并不存在相关性。     

海风藤对β淀粉样蛋白寡聚体激活小胶质细胞的影响

目的 研究海风藤提取物对β淀粉样蛋白(Aβ)寡聚体诱导小胶质细胞激活的影响.方法 模拟体内生理条件诱导Aβ单体形成Aβ寡聚体,原代培养新生大鼠小胶质细胞,分别用Aβ25-35寡聚体、Aβ25-35寡聚体+海风藤提取物、Aβ25-35寡聚体+DMSO干预小胶质细胞,并设空白对照组,48 h后测上清液中白细胞介素1β(IL-1β)和白细胞介素6(IL-6)水平,并比较各组间炎性因子差异.结果 Aβ寡聚体组上清液中IL-1β、IL-6水平明显高于空白对照组[IL-1β:(67.06±1.79)pg/mL vs.(36.30±1.40)pg/mL;IL-6:(181.14±4.46) pg/mLvs.(110.90±4.62)pg/mL,均P＜0.05];Aβ寡聚体组上清液中IL-1β、IL-6水平明显高于Aβ寡聚体+海风藤提取物组[IL-1β:(63.24±2.00) pg/mL,IL-6:(170.34±3.47) pg/mL,P＜0.05];Aβ寡聚体组上清液中IL-1β、IL-6水平和Aβ寡聚体+DMSO组[IL-1β:(68.26±1.38) pg/mL,IL-6:(184,7±6.06) pg/mL]比较无统计学差异.结论 Aβ寡聚体能激活小胶质细胞;海风藤提取物能明显抑制Aβ寡聚体诱导小胶质细胞的激活.     

难治性抑郁症停药清洗合并MECT一周及后续治疗反应

目的探讨对难治性抑郁症患者,停药清洗1周并同期合并无抽搐电休克治疗(MECT)的效果,并评价1周后续用先前抗抑郁药的治疗反应。方法将符合《中国精神障碍分类与诊断手册(第3版)》(CCMD-3)抑郁症诊断标准的40例难治性抑郁症患者,予1周的清洗,清洗期停用除苯二氮艹卓类药物以外的所有精神科药物,同期合并MECT治疗,清洗期结束后继续使用原抗抑郁药物,共观察6周。在MECT治疗前及治疗后第1、2、4、6周末分别采用汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)评定疗效,用副反应量表(TESS)评定不良反应。结果①6周末痊愈14例,显效17例,进步7例,无效2例。有效率77.5%。②治疗第1周末(清洗期合并MECT后)HAMD-17、HAMA评分较治疗前差异有统计学意义(P均0.01)。治疗第4周末(即重新开始续用原抗抑郁药后第3周)和第6周末HAMD-17、HAMA评分与第1周末比较差异均有统计学意义(P0.05或0.01)。结论停药清洗1周合并MECT对难治性抑郁症效果良好,经过清洗合并MECT后可提高原抗抑郁药物的疗效。     

焦虑症患者血清IL-1β、IL-6、IL-10水平分析

目的研究白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、白细胞介素10(IL-10)在焦虑症患者血清变化及意义。方法选取2017年11月～2018年11月我院收治的42例慢性焦虑症患者和42例抑郁症患者分别作为焦虑组和抑郁组,选择同期42例健康体检者作为健康组。患者均采用选择性5-羟色胺再摄取抑制剂连续治疗8周。比较治疗前后两组患者和对照组的血清IL-1β、IL-6、IL-10水平。结果焦虑组患者IL-6水平显著低于健康组和抑郁组(P0.05);抑郁组患者IL-6水平与健康组比较差异无统计学意义(P0.05)。焦虑组和抑郁组患者IL-10水平均显著高于健康组(P0.05);焦虑组患者IL-10水平与抑郁组比较差异无统计学意义(P0.05)。治疗后两组患者的IL-1β、IL-6、IL-10水平均有显著改善(P0.05),两组患者IL-1β、IL-6、IL-10水平无明显差异(P0.05)。结论焦虑症和抑郁症与健康者可能具有不同免疫机制,可通过血清IL-10和IL-6来鉴别。     

无抽搐电休克治疗对抑郁症患者血清C反应蛋白的影响

目的:探讨无抽搐电休克治疗(MECT)过程中抑郁症患者血清C反应蛋白(CRP)水平的动态变化及其与疗效的关系方法:30例抑郁症患者纳入本研究,分别在MECT前和MECT后第1次、第3次和第5次和最后1次结束后次日清晨空腹抽血检测血清CRP水平。采用汉密尔顿抑郁量表(HAMD)评估MECT的疗效。结果:MECT第1次后CRP水平即出现降低,随着MECT次数的增加CRP水平持续降低并伴随着抑郁症状的改善。抑郁症状缓解者在MECT结束时CRP水平显著降低,女性患者基线CRP水平显著预测MECT的疗效(P0.05)。结论:MECT前后CRP的变化与疗效相关,女性抑郁症患者基线CRP水平能够预测MECT治疗效果,提示MECT可能通过降低炎症因子起作用。     

精神科医生对伴有自杀意念和自杀未遂抑郁症患者的诊疗现况调查

目的 基于精神科医生视角，调查我国伴有自杀意念和自杀未遂的抑郁症患者的疾病特征、治疗现状以及目前临床诊疗中未被满足的需求。方法 本研究为横断面研究。采用便利抽样法，于2020年12月至2021年1月选取在我国24个省/直辖市的三甲综合医院或精神专科医院精神科工作的医生为研究对象。基于文献回顾和临床实践设计电子调查问卷，由专家顾问委员会审核完成问卷设计，采用该问卷收集医生的基本信息、接诊抑郁症患者的构成、接诊的伴自杀意念和自杀未遂抑郁症患者的临床特征、对伴自杀意念和自杀未遂患者的临床诊疗现况、医生与患者的临床需求和期望。本研究发放问卷317份，回收有效问卷209份，有效问卷回收率为65.9%。结果 分别有29.2%(61/209)和10.0%(21/209)的医生认为其接诊的抑郁症患者中，>50%有自杀意念和自杀未遂；而认为住院抑郁症患者>50%有自杀意念和自杀未遂的医生分别占58.4%(122/209)和16.3%(34/209)。46.9%(98/209)的医生认为有自杀意念的抑郁症患者会发展出现自杀未遂的比例在10%～30%。医生认为自杀未遂常见的风险因素包括既往自杀史...     

改良电痉挛治疗对精神分裂症患者血清细胞因子及C-反应蛋白水平的影响

目的探讨改良电痉挛治疗(MECT)对精神分裂症患者血清细胞因子及C-反应蛋白水平的影响。方法选取符合《国际疾病分类(第10版)》(ICD-10)中精神分裂症诊断标准的58名精神分裂症患者为MECT组进行MECT治疗,41名未行MECT的患者为药物组,另选取健康人82名为对照组,三组间性别、年龄均相匹配。观察治疗前后血清白介素-1(Interleukin-1,IL-1)、白介素-4(Interleukin-4,IL-4)、白介素-6(Interleukin-6,IL-6)、白介素-10(Interleukin-10,IL-10)和C-反应蛋白(C-reactive protein,CRP)水平变化,采用PANSS量表测评精神症状。结果 1MECT治疗4次后男性血清CRP浓度高于女性,差异有统计学意义(P<0.05);2MECT组治疗4次后、6次后血清CRP浓度高于健康对照组,药物组治疗2周后血清CRP浓度高于健康对照组,差异均有统计学意义(P<0.05);3MECT治疗前后血清IL-1、IL-4、IL-6、IL-10浓度差异无统计学意义(P>0.05),MECT治疗4次后血清CRP浓度高于其他治疗时间点(P<0.05);4MECT组有效率为63.8%,药物组为24.4%,差异有统计学意义(P<0.01)。结论 MECT可能不引起细胞因子的显著变化,但会引起C-反应蛋白的应激性增高,且男性较女性更为敏感。     

颅内外动脉狭窄支架成形术后血清IL-1β、IL-1Ra的变化及与再狭窄的关系

目的 分析血清白细胞介素-1β(IL-1β)、白细胞介素-1受体拮抗剂(IL-1Ra)、IL-1Ra/IL-1β比值在颅内外血管狭窄支架成形术后血清中的变化以及与再狭窄的关系,同时探讨IL-1β与IL-1Ra水平之间的相关性.方法 选择自2008年4月至2009年3月31例在四川省人民医院神经内科接受颅内外支架成形术的颅内外动脉狭窄患者,就术前、术后1 h、1 d、3 d、5 d以及造影复查(术后6～12个月)时血清IL-1β、IL-1Ra和IL-1Ra/IL-1β比值以及血管再狭窄情况进行分析.结果 本组31例患者在31根血管上放置31枚支架,随访6～12个月,6例出现了再狭窄(19.35%),超过50%的再狭窄为3例,余3例在10%～30%之间.2组患者术前IL-1β、IL-Ra、IL-1Ra/IL-1β比值差异均无统计学意义(P>0.05),IL-1β与IL-Ra呈正相关(r=0.444,0.881;P均<0.05);术后1 h、1 d、3 d、5 d 2组患者IL-1β、IL-Ra水平均明显高于术前,差异有统计学意义(P<0.05);术后6～12个月复查时2组IL-1β、IL-Ra水平无明显差别(P>0.05),但再狭窄患者IL-1Ra/IL-1β比值明显低于未再狭窄患者,差异有统计学意义(P<0.05);IL-1β与IL-R呈正相关(r=0.531,0.953;P均<0.05).结论 血清IL-1β、IL-1Ra与支架术后的炎性过程有关,两者的免疫失调状态可能与再狭窄有关.IL-1Ra/IL-1β比值的变化可做为再狭窄监测的指标.     

Th17/Treg细胞及相关细胞因子在复发缓解型多发性硬化中的作用及机制

目的探讨辅助性T细胞(Th17)、调节性T细胞(Treg)和相关细胞因子在复发缓解型多发性硬化(RRMS)患者发病机制中的作用与机制。方法收集急性期RRMS患者(RRMS组)31例,以神经系统非炎性疾病29例为对照组。RRMS患者入院后给予静脉滴注甲泼尼龙1000 mg/d冲击治疗,后续每3 d剂量减半。对RRMS组患者治疗前和甲泼尼龙治疗2周后(治疗后)分别进行残疾状况拓展性量表(EDSS)评分;采用流式细胞术(FCM)检测RRMS组患者治疗前后及对照组患者外周血Th17(CD4~+IL-17~+)细胞和Treg(CD4~+FOXP3~+)细胞百分率;采用酶联免疫吸附试验(ELISA)检测RRMS组患者治疗前后及对照组患者外周血血浆中白细胞介素(IL)-17A、IL-23、IL-6、IL-10、IL-35和转化生长因子-β(TGF-β)水平;采用Spearman相关分析对RRMS组患者治疗前外周血Th17细胞数量与IL-17A、IL-23、IL-35、IL-6、IL-10及TGF-β水平进行相关性分析。结果 (1)RRMS组治疗前EDSS评分高于治疗后[分别(6.31±1.54)分vs.(4.02±0.68)分,t=0.75,P0.05];(2)FCM分析结果显示,与对照组[(3.12±1.27)%]比较,RRMS组患者治疗前Th17细胞百分率[(15.24±2.54)%]明显升高(P0.05),而对照组Treg细胞百分率[(35.04±4.21)%]明显高于RRMS组治疗前[(11.12±3.13)%,P0.05];与对照组(0.10±0.02)相比,RRMS组治疗前Th17/Treg(1.51±0.62)也明显升高(P0.01);与RRMS组治疗前[(11.12±3.13)%]比较,甲泼尼龙治疗后Treg细胞比例[(23.14±2.86)%]明显升高(P0.01);与RRMS组治疗前Th17细胞百分率[(15.24±2.54)%]相比,甲泼尼龙治疗后Th17细胞百分率[(4.24±1.14)%]明显降低(t=0.88,P0.05);与RRMS组治疗前(1.51±0.62)相比,甲泼尼龙治疗后Th17/Treg比值(0.19±0.07)降低(t=0.95,P0.01);(3)ELISA法检测结果显示,RRMS组治疗前IL-17A[分别(17.26±1.21)pg/mL vs.(3.23±0.81)pg/mL,t=0.72,P0.05]、IL-23[(分别(64.38±7.51)pg/mL vs.(21.14±1.82)pg/mL,t=0.75,P0.05]、IL-6[分别(70.14±8.17)pg/mL vs.(7.28±0.75)pg/mL,t=0.95,P0.01]和IL-10水平[分别(21.12±2.74)pg/mL vs(2.39±0.34)pg/mL,t=0.91,P0.01]均明显高于对照组,而IL-35[分别(0.31±0.06)pg/mL vs.(1.55±0.16)pg/mL,t=-0.89,P0.01]和TGF-β水平[分别(5.13±0.34)pg vs.(18.25±0.74)pg/mL,t=-0.83,P0.05]显著低于对照组;与RRMS组治疗前比较,治疗后IL-17A[分别(17.26±1.21)pg/mL vs.(4.23±0.90)pg/mL,t=0.82,P0.05]、IL-23[分别(64.38±7.51)pg/mL vs.(29.73±2.51)pg/mL,t=0.77,P0.05]和IL-6[分别(70.14±8.17)vs.(15.23±1.86),t=0.89,P0.01]水平明显降低,IL-35(分别(0.31±0.06)pg vs.(1.41±0.18)pg,t=-0.88,P0.01)和TGF-β水平[分别(5.13±0.34)pg vs.(16.91±0.59)pg,t=-0.72,P0.05]明显升高;(4)RRMS组患者Th17细胞与IL-17A(r=0.89,P0.01)、IL-23(r=0.71,P0.05)和IL-6(r=0.83,P0.05)水平呈正相关,与IL-35和TGF-β水平呈负相关[分别r=-0.82,P0.01;r=-0.74,P0.05]。结论 RRMS的发生可能与Th17细胞上调,Treg细胞下调,Th17/Treg表达失衡,相关细胞因子IL-17A、 IL-23、IL-6水平升高,IL-35和TGF-β水平降低有着密切关系。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -