急性脑梗死患者C反应蛋白、ApoA1、Fib检测的临床意义

目的 探讨急性脑梗死(ACI)患者血清C反应蛋白(CRP)、载脂蛋白A(ApoA1)、纤维蛋白原(Fib)检测的临床意义.方法 测定136例ACI患者、67例正常对照组血清CRP、ApoAl、Fib的水平,观察比较不同类型ACI患者的血清CRP、ApoAI、Fib含量差异,对发病后48h后病情发展变化进行评定,将(ACI)患者分为进展型与完全型脑梗死两组.根据NIHSS评分将临床神经功能损害程度分为:轻型、中型、重型.结果 CRP水平:进展组高于完全组和对照组(P＜0.05),NIHSS重型组明显高于中型、轻型组(P＜0.05);ApoAl水平:进展组明显低于完伞组和对照组,重型组明显低于中型、轻型组(P＜0.05).Fib水平:进展组和完全组均明显高于对照组,NIHSS重型组明显高于中型、轻型组(P＜0.05)CRP与ApoAl,Fib均有相关性,相关系数分别是(r=-0.557,r=0.643)P＜0.05.结论 CRP、ApoAl、Fib一定程度上是预测ACI患者病情及发展方向的生化指标.     

急性脑梗死患者血清脂蛋白(a)、超敏C反应蛋白水平的改变及其临床意义

目的 探讨急性脑梗死(ACI)患者血清脂蛋白(a)[Lp(a)]和超敏C反应蛋白(hs-CRP)水平的改变及其临床意义.方法 采用免疫比浊法和免疫散射比浊法检测101例ACI患者、40名正常对照者(NC组)的血清Lp(a)和hs-CRP水平.对ACI患者进行美国国立卫生研究院卒中量表(NISSH)评分；比较不同NIHSS评分患者的血清Lp(a)和hs-CRP水平.对ACI患者的血清Lp(a)与hs-CRP水平相关性进行分析.结果 ACI组血清Lp(a)和hs-CRP水平均明显高于NC组(均P＜0.05).ACI组NIHSS评分＜5分、5～15分和＞15分3个亚组之间血清Lp(a)、hs-CRP水平的差异有统计学意义(均P＜0.05)；NIHSS评分越高的亚组,其血清Lp(a)、hs-CRP水平越高.血清Lp(a)与hs-CRP水平之间呈正相关(r=0.457,P＜0.05).结论 ACI患者的血清LP(a)和hs-CRP水平明显增高.并且Lp(a)和hs-CRP在ACI发病中可能有相互协同作用.     

急性脑梗死患者血清尿酸、超敏C反应蛋白的改变及其临床意义

目的探讨急性脑梗死(ACI)患者血清尿酸(UA)和超敏C反应蛋白(hs-CRP)水平的改变及其临床意义。方法采用尿酸酶比色法和免疫散射比浊法检测101例ACI患者(ACI组)及40例正常对照者(正常对照组)的血清UA和hs-CRP水平。采用NIHSS评分评价ACI组患者的神经功能缺损程度。根据NIHSS评分,将患者分为轻度缺损亚组(≤5分)、中度缺损亚组(5~15分)及重度缺损亚组(15分)。结果ACI组血UA及hs-CRP水平显著高于正常对照组(均P0.01)。与轻度缺损亚组比较,中度缺损亚组及重度缺损亚组的UA及hs-CRP水平均显著升高(均P0.05)。重度缺损亚组UA及hs-CRP水平均显著高于中度缺损亚组(均P0.05)。结论 ACI患者血清尿酸和超敏C反应蛋白水平显著增高,与ACI严重程度有关。     

急性脑梗死患者血浆纤维蛋白原和C反应蛋白水平的改变及其与病情和预后的关系

目的 探讨急性脑梗死(ACI)患者血浆纤维蛋白原(Fib)和C反应蛋白(CRP)水平的改变及其与病情和预后的关系.方法 检测86例脑梗死患者(CI组)、27例腔隙性脑梗死患者(LCI组)和48名健康人(正常对照组)的血浆Fib及CRP含量.在CI患者入院当天和4周时进行临床神经功能缺损程度评分(NDS)评定.结果 CI组和LCI组血浆Fib、CRP水平和异常率明显高于正常对照组(均P＜0.01);NDS重型患者血浆Fib、CRP含量明显高于中型、轻型患者(均P＜0.01);中型患者血浆CRP含量显著高于轻型患者(P＜0.01).血浆Fib和CRP含量异常组患者住院4周时显著进步和进步的比率明显低于正常对照组(均P＜0.01),而无变化和死亡的比率明显高于正常对照组(均P＜0.01).结论 ACI患者血浆Fjb和CRP水平均明显升高,病情重的患者升高更明显;血浆Fib、CRP含量升高的患者预后较差.     

血清同型半胱氨酸、纤维蛋白原、胱抑素C水平与急性脑梗死患者NIHSS评分的相关性分析

目的 探讨入院时血清同型半胱氨酸（homocysteine，Hcy）、纤维蛋白原（fibrinogen，FIB）和胱抑素C （cystatin-C，Cys-C）水平与急性脑梗死患者NIHSS评分的关系。 方法 回顾性纳入2014年1月-2018年11月于任丘康济新图医院神经内科住院的急性脑梗死患者，依 据入院时NIHSS评分分为轻型组（NIHSS评分＜7分）、中型组（7分≤NIHSS评分＜15分）、重型组（NIHSS 评分≥15分）。比较三组间血清Hcy、FI B、Cys-C水平差异，进一步用Spearman相关分析评估血清Hcy、 FI B、Cys-C水平与NIHSS评分的关系。 结果 共纳入4468例患者，中位年龄65.00（65.00～72.00）岁，男性2765例（61.88%）。轻型组3943 例（88.25%），中型组441例（9.87%），重型组84例（1.88%）。三组间血清Hcy（P＜0.001）、FI B（P ＜0.001）、Cys-C（P =0.035）水平比较，整体差异有统计学意义；进一步两两比较发现，轻型组血清 Hcy、FI B和Cys-C水平均低于中型组和重型组。Spearman相关分析发现，血清Hcy（r =0.770，P＜0.001）、 FI B（r =0.440，P =0.003）、Cys-C（r =0.580，P＜0.001）水平与急性脑梗死患者NIHSS评分呈正相关。 结论 急性脑梗死患者血清Hcy、FI B、Cys-C水平与NIHSS评分呈正相关。     

血清脂蛋白相关磷脂酶a2、hs-CRP和血小板活化 因子在后循环供血区梗死患者中的水平变化

目的 探讨血清脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,LP-PLA2)、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)和血小板活化因子(platelet activating factor,PAF)在后循环供血区梗死患者中的水平变化。方法 选取2014年1月-2017年1月本院神经内科住院部162例后循环供血区梗死患者作为病例组,同期选取健康体检中心160例体检健康者作为对照组,参照NIHSS标准将病例组分为轻度亚组(<4分,n=59),中度亚组(4～15分,n=53)与重度亚组(>15分,n=50),依据预后状况分为预后良好亚组(NIHSS评分差值>4分,n=77)与预后不良亚组(差值≤4分,n=85),采用ELISA测定血清LP-PLA2、PAF水平,采用免疫速率散射比浊法测定血清hs-CRP水平。结果 病例组血清LP-PLA2、hs-CRP、PAF水平明显高于对照组(P<0.05); 重度亚组血清LP-PLA2、hs-CRP、PAF水平明显高于轻中度亚组,中度亚组上述指标明显高于轻度亚组; 预后不良亚组血清LP-PLA2、hs-CRP、PAF水平明显高于预后良好亚组(P<0.05); 经Pearson相关分析显示,病例组血清LP-PLA2、hs-CRP、PAF与NIHSS评分呈正相关(r=0.412,0.503,0.498,P<0.05)。结论 后循环供血区梗死患者血清LP-PLA2、hs-CRP和PAF水平可能参与疾病发生发展与预后转归过程。     

延边地区朝鲜族急性脑梗死患者hs-CRP,Hcy,D-二聚体水平的研究

目的 检测延边地区朝鲜族急性脑梗死患者hs-CRP、Hcy、D-D的水平,探讨其在脑梗死诊治中的临床意义.方法 选择2009年1月～2010年12月在延边大学附属医院神经内科住院的首次发病的ACI患者200例,将其分为入院时神经功能缺损评分(NIHSS)评分≥7分者为A组,神经功能缺损评分(NIHSS)评分＜7分者为B组.于入院后第2天清晨空腹采取静脉血,检测血清hs-CRP水平、血清Hcy水平、血浆D-D水平.同时将在医院体检科进行体检的100名健康汉族列为对照组,检测三者血清水平.结果 ACI患者的hs-CRP、Hcy、D-D水平均高于对照组,A组高于B组,3组间比较及组内比较,差异均有统计学意义(P＜0.05).A组患者hs-CRP、Hcy、D-D阳性率均显著高于B组,差异均有统计学意义(P＜0.05).结论 Hs-CRP、Hcy、D-D水平升高是延边地区朝鲜族急性脑梗死患者发病的危险因素.     

动态检测血清S100B蛋白与同型半胱氨酸对急性脑梗死的诊断价值

目的探讨动态检测血清S100B蛋白和Hcy水平对急性脑梗死(ACI)的诊断价值。方法选取72例ACI患者按病情分为轻、中、重型损伤3组各24例,于患者发病后首日及第3、6、14天采样进行血清S100B和Hcy检测,并对患者进行NIHSS评分,同期选择正常人24例测定血清S100B和Hcy,4组结果进行比较并分析S100B和Hcy与病情、NIHSS之间的相关性。结果除发病第14天轻型组血清S100B、Hcy水平与对照组无明显差异外,其他时间点测定结果均为S100B、Hcy水平重型组中型组轻型组对照组(P均0.05);血清Hcy、S100B与患者病情严重程度、同期NIHSS评分均呈正相关。结论血清Hcy、S100B联合检测是诊断ACI早期、特异、准确的检查方法,值得临床推广。     

通脑活络针刺法与常规疗法治疗急性脑梗死的疗效比较

目的 比较通脑活络针刺法与常规疗法治疗急性脑梗死(ACI)的疗效及通脑活络针刺法治疗ACI的最佳治疗时间窗.方法 采用多中心、随机、对照的研究方法,将145例ACI患者(针刺治疗组)按病程分为＜6 h、6～48 h、＞48 h亚组,在常规治疗的基础上,给予通脑活络针刺法治疗,每天1次,连续14 d.治疗前后进行美国国立卫生研究院卒中量表(NIHSS)评分和Barthel指数(BI)评定;治疗后90 d评定疗效;并与125例常规治疗的ACI患者(常规治疗组)进行比较.结果 治疗后,针刺治疗组各亚组的总有效率(96.4%、90.9%、80.4%)显著高于常规治疗组各亚组(86.7%、75.0%、58.3%)(均P＜0.01);针刺治疗组中,＜6 h亚组的总有效率明显高于6～48 h亚组和＞48 h亚组(P＜0.05～0.01).针刺治疗组各亚组NIHSS评分明显低于、BI明显高于常规治疗组各亚组(均P＜0.01);针刺治疗组中,＜6 h亚组明显优于6～48 h亚组和＞48 h亚组(P＜0.05～0.01).结论 通脑活络针刺法治疗ACI的疗效显著,并且在发病6 h内开始治疗为最佳.     

血清ox-LDL、Lp-PLA2水平与缺血性脑卒中患者动脉粥样硬化及神经功能缺损的相关性研究

目的 探讨缺血性脑卒中患者血清中氧化低密度脂蛋白(ox-LDL)和脂蛋白相关磷脂酶A2(Lp-PLA2)水平与颈动脉粥样硬化及神经功能缺损的相关性。方法 选取2015年7月～2016年7月本院神经内科收治的急性脑梗死患者135例(ACI组)和同期本院体检中心健康人群150例(对照组),均对所有入选者血清中的ox-LDL、Lp-PLA2水平进行检测,比较ACI组和对照组的血清ox-LDL、Lp-PLA2及其他血脂指标水平; 行颈动脉超声检查,对无斑块组、稳定斑块组和不稳定斑块组患者的ox-LDL、Lp-PLA2水平进行比较; 按美国国立卫生研究院卒中量表(NIHSS)评分,对轻型、中型、重型患者的ox-LDL、Lp-PLA2水平进行比较。结果 ACI组的血清ox-LDL、Lp-PLA2水平均高于对照组(P<0.01); 稳定斑块组、不稳定斑块组血清ox-LDL、Lp-PLA2水平显著高于无斑块组(P<0.05); 不稳定斑块组血清ox-LDL、Lp-PLA2 水平显著高于稳定斑块组(P<0.05); NIHSS评分中型组、重型组血清ox-LDL、Lp-PLA2水平均显著高于轻型组(P<0.05),重型组血清ox-LDL、Lp-PLA2水平显著高于中型组(P<0.05)。结论 缺血性脑卒中患者血清ox-LDL、Lp-PLA2水平较正常者显著上升,其在一定程度上反映患者颈动脉粥样硬化的程度及神经功能缺损的程度,ox-LDL、Lp-PLA2 可作为急性缺血性脑血管病的血清标记物,在评估急性缺血性脑血管病的病情及预后方面有一定的临床意义。     

Satisfaction with quality of life varies with temperament types of patients with schizophrenia

We sought to explore the relationships of three temperament factors with domain-specific subjective quality of life (QOL) of patients with schizophrenia. Ninety patients with schizophrenia were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire, the Tridimensional Personality Questionnaire, the Positive and Negative Syndromes Scale, the Distress Scale for Adverse Symptoms, the Insight and Treatment Attitudes Questionnaire, the Insight Self-Report Scale, and standardized questionnaires for self-reported emotional distress and stress process-related variables. Predictors of domain-specific QOL were identified using multiple regression techniques. Temperament factors explain 6% to 16% of variability in QOL domain scores among patients with schizophrenia after controlling for the remaining variables (emotional distress, social support, self-esteem, avoidance coping, age, side effects, and depression). We found that higher levels of novelty seeking are associated with better general QOL, physical health, and more positive subjective feelings, whereas higher levels of reward dependence are related to better satisfaction from social relationships. Higher levels of harm avoidance are associated with poorer satisfaction with general activities, and medication. Thus, temperament factors, as assessed by the Tridimensional Personality Questionnaire, substantially influence satisfaction with life quality in schizophrenia. Novelty seeking, reward dependence, and harm avoidance are associated with different domains of QOL.     

Treatment of patients with tardive dystonia with olanzapine

Tardive dystonia represents a complication of long-term use of neuroleptics and its treatment is often unsatisfactory. Atypical neuroleptics appear to improve tardive dystonia, and cases of tardive dystonia successfully managed with clozapine have been reported. The aim of this open-label video-blinded study was to evaluate the antidystonic efficacy of olanzapine, a new atypical neuroleptic with a low risk of agranulocytosis, in a group of four patients (one man and three women) with tardive cervical dystonia. They developed severe dystonia after several years of neuroleptic treatment. Extensive laboratory evaluations, as well as neurophysiologic and neuroradiologic investigations, were negative. Olanzapine was started at a dose of 5 mg/d and increased up to 7.5 mg/d. All patients were evaluated at baseline and after 2, 4, 8, and 12 weeks of treatment, using the Toronto Western Spasmodic Torticollis Rating Scale, and videotaped. At the end of the trial, the videotapes were reviewed and scored by a blind observer. A self-rating visual analog scale completed the disability evaluation.A moderate to marked improvement in dystonia was observed in all patients, and significant differences were observed in Toronto Western Spasmodic Torticollis Rating Scale scores and videotape ratings after 8 and 12 weeks of treatment compared with the basal values (p < 0.05). The average percentage of improvement in Toronto Western Spasmodic Torticollis Rating Scale score and visual analog scale was 26.4% and 42.6%, respectively. No serious side effects were reported at the maximum dosage reached (7.5 mg/d). This study warrants a larger controlled study to conclusively demonstrate the efficacy of olanzapine in tardive dystonia.     

Compliance with health regimens of adolescents with epilepsy

The purpose of this paper was to describe the compliance of adolescents with epilepsy and some factors connected to it. Altogether 300 individuals with epilepsy aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Seventy-seven per cent (n= 232) of the selected adolescents with epilepsy returned a questionnaire sent to them relating to compliance. The data were analysed using the SPSS software. Twenty-two per cent of the adolescents with epilepsy felt that they complied fully with their suggested health regimens, while 44% placed themselves in the category of "satisfactory compliance", and the remaining 34% reported poor compliance. Compliance with their recommended life-style was poorest, while the highest degree of compliance was recorded for medication. Background variables, such as the duration of the disease, exercise, smoking, alcohol-intake and the number of seizures, were statistically significantly related to compliance (P< 0.001). Good motivation, a strong sense of normality, experience of results, subjective outcome, energy and will-power, support from parents, physicians and nurses, and a positive attitude towards to the disease and its treatment, no threat to social and emotional well-being and no fears of complications and no fear of seizures explained good compliance (P< 0.001).     

血管内栓塞治疗未破裂脑动静脉畸形并发癫痫患者的预后分析

目的分析血管内栓塞治疗未破裂脑动静脉畸形(CAVM)并发癫痫患者的预后情况。方法选择2013年3月至2017年6月收治的符合诊断标准的CAVM并发癫痫发作患者49例为研究对象,分析血管内栓塞治疗后患者的临床症状、生活质量(QOLIE-31)改善情况。结果患者经血管内栓塞治疗后,QOLIE-31各项指标(除了药物影响)评分均明显提高,高于治疗前(P0.05);Spetzler-Martin分级与Engel分级的I~II级例数多于治疗前(P0.05),同时Spetzler-Martin分级I~II级生活质量评分(76.04±18.33)分明显高于III~V级的(65.65±16.76)分(P0.05);Engel分级I~II级的生活质量评分(75.25±17.78)分明显高于III~V级的(66.23±13.22)分(P0.05);血管内栓塞比例80%的生活质量总评分(78.37±18.87)分明显高于栓塞比例80%的(64.16±16.92)分(P0.05);术后患者的头疼症状中重度例数明显低于治疗前(P0.01);患者的NIHSS评分和MRS评分均明显低于治疗前,头疼症状的生活质量评分高于治疗前(均P0.05)。结论血管内栓塞能明显改善未破裂脑动静脉畸形并发癫痫患者的头疼症状、癫痫发作情况、神经功能缺损,提高血管内栓塞比例能够提高患者生活质量。