C-反应蛋白和皮质醇预测恶性脑梗死的价值

目的研究联合检测血清C-反应蛋白(CRP)和皮质醇预测恶性脑梗死(MCI)的临床价值。方法检测73例大脑中动脉供血区大面积脑梗死患者血清CRP和皮质醇水平,依据临床症状和脑CT检查将患者分为MCI组和非MCI组,应用受试者工作特征曲线(ROC)进行评价。结果MCI组患者血清CRP和皮质醇分别为(17.90±4.30)mg/L和(1059.95±226.67)nmol/L,非MCI组患者血清CRP和皮质醇分别为(12.87±4.31)mg/L和(858.48±300.55)nmol/L,MCI组患者血清CRP和皮质醇高于非MCI组,差异有显著性(P0.01)。CRP诊断MCI的灵敏度和特异度分别为87.1%和85.7%。皮质醇诊断的灵敏度和特异度分别为71.0%和64.3%。平行诊断试验:灵敏度为96.26%,特异度为55.11%。系列诊断试验:灵敏度为61.845,特异度为94.895。结论脑梗死患者血清CRP和皮质醇为预测MCI的敏感指标;联合检测血清CRP和皮质醇有助于提高诊断的敏感性(平行诊断试验)和特异性(系列诊断试验)。     

肌炎特异性自身抗体在多发性肌炎/皮肌炎及其他神经肌肉疾病的表达

目的 探讨肌炎特异性自身抗体(MSAs)在多发性肌炎/皮肌炎(PM/DM)及其他神经肌肉疾病的敏感度和特异度.方法 采用免疫斑点分析法测定63例PM/DM(PM/DM组)及60例神经肌肉疾病(非肌炎)患者(对照组)的血清抗Jo-1抗体和抗SRP抗体水平,分析其对PM/DM诊断的敏感度和特异度.结果 PM/DM组抗Jo-1和抗SRP抗体阳性率分别为17%和5%,对照组均为阴性.两种抗体诊断PM/DM特异度均为100%(95%CI:94%～100%),总敏感度为22%(95%CI:13%～34%).结论 抗Jo-1和抗SRP自身抗体对PM和DM特异度高.     

抗Hu抗体阳性副肿瘤性边缘叶脑炎1例报告及文献复习

正神经系统副肿瘤综合征(paraneoplastic neurologic syndromes,PNS)是指肿瘤在中枢神经系统和周围神经、肌肉系统出现的远隔效应,是一组针对神经系统某些靶抗原的自身免疫性疾病,如累及大脑边缘叶系统即表现为副肿瘤性边缘叶脑炎~([1])。在一些PNS患者血清和(或)脑脊液中可发现肿瘤神经抗体,特异性抗神经元抗体有抗Hu、抗Yo、抗CV2、抗Ri、抗Ma2等抗体,现将我院收治的1例抗Hu抗体阳性的副肿瘤性边缘叶脑炎患者病例报道如下,并结合相关文献进行     

重症肌无力患者血清学标志物检测及临床意义

目的探讨血清抗乙酰胆碱受体(ACh R)抗体、抗连接素(Titin)抗体和抗Ryanodine受体(Ry R)抗体对重症肌无力的诊断价值。方法采用酶联免疫吸附试验分别检测182例重症肌无力患者(MG组)、105例其他神经系统疾病患者(OND组)和62例正常对照者(对照组)血清抗ACh R抗体、抗Titin抗体和抗Ry R抗体水平。结果重症肌无力患者血清抗ACh R抗体、抗Titin抗体和抗Ry R抗体阳性率分别为68.13%(124/182)、64.29%(117/182)和67.03%(122/182),高于OND组(均P=0.000)和对照组(均P=0.000);3种血清学标志物同时阳性,诊断重症肌无力的灵敏度为41.21%,特异度达99.40%。其中,早发型与晚发型重症肌无力亚组血清抗ACh R抗体、抗Titin抗体和抗Ry R抗体阳性率差异无统计学意义(均P0.05);伴胸腺瘤的重症肌无力亚组仅血清抗ACh R抗体阳性率高于不伴胸腺瘤的重症肌无力亚组(P=0.004),而抗Titin抗体和抗Ry R抗体阳性率差异无统计学意义(均P0.05);不同改良Osserman分型亚组中仅全身型重症肌无力(Ⅱa和Ⅱb型)血清抗ACh R抗体阳性率高于眼肌型重症肌无力(Ⅰ型;P=0.005,0.012),而抗Titin抗体和抗Ry R抗体阳性率差异无统计学意义(均P0.05)。结论血清抗ACh R抗体、抗Titin抗体和抗Ry R抗体均有助于诊断重症肌无力,对于3种生物学标志物同时呈阳性的患者,应高度怀疑重症肌无力,其中,眼肌型重症肌无力患者血清抗ACh R抗体水平较高,有可能进展为全身型重症肌无力,应积极治疗。     

抗Hu抗体检测在神经系统副肿瘤综合征诊断中的临床意义

目的 探讨抗Hu抗体检测在神经系统副肿瘤综合征诊断中的临床意义.方法 采用间接免疫荧光方法和蛋白免疫印迹法对送检至北京协和医院神经病理实验室的1500余例患者的血清和脑脊液进行抗Hu抗体检测,回顾性分析抗Hu抗体阳性患者的临床资料及诊断.神经系统副肿瘤综合征的诊断标准参照Graus等的诊断标准.结果 共有27例患者抗体阳性,其中血清抗Hu抗体阳性25例,脑脊液抗Hu抗体阳性8例.临床主要表现为感觉神经元神经病、亚急性小脑变性、Lambert-Eaton综合征和抗利尿激素分泌不当综合征引起的脑病等,其中20例(74.1%)患有肿瘤,包括肺癌17例,胃癌2例,不明性质腹部肿瘤1例.7例患者未发现恶性肿瘤,包括多发性肌炎和系统性红斑狼疮(SLE)合并神经肌肉病各1例.根据Graus等神经系统副肿瘤综合征的诊断标准,27例中22例可确诊神经系统副肿瘤综合征或相关的肿瘤,抗Hu抗体的阳性预测值为81.5%.结论 抗Hu抗体阳性对神经系统副肿瘤综合征的诊断具有一定意义;其相关肿瘤以肺癌,特别是小细胞肺癌最常见.其他自身免疫性疾病偶可见抗Hu抗体阳性,需要全面检查和密切随访以排除恶性肿瘤的可能.     

关于中国抗γ-氨基丁酸B受体脑炎患者叠加多种自身抗体的临床分析

目的探讨中国抗γ-氨基丁酸B(GABA-B)受体脑炎患者合并多种抗神经元抗体及系统性自身抗体的临床意义。方法分析本院2015年1月-2019年1月诊断的抗GABA-B受体脑炎患者情况,并系统性检索同时期已发表的关于我国抗GABA-B受体脑炎患者临床研究文献,对其合并抗神经元抗体及系统性自身抗体情况及临床意义进行荟萃分析。结果 4年期间,本院共确诊4例抗GABA-B受体脑炎患者;对全国所有已发表的关于抗GABA-B受体脑炎患者的荟萃分析,共纳入确诊92例,中位年龄数为57岁(18～79岁),男性68例(73.9%),女性24例(26.1%);共29例(31.5%)患者检测到一种或多种叠加抗体,其中神经元抗体以抗Hu抗体最常见,11例(37.93%),其次为抗NMDAR抗体5例(17.24%),抗Ma2、Yo、CV2、CASPR2抗体各1例,系统性自身抗体以甲状腺相关抗体最为常见,占7例(24.14%)。叠加抗体组患者合并肿瘤占16例(55.2%),高于无叠加抗体组33.3%(P=0.04),其中以抗Hu抗体组合并肿瘤占比最高8/11例(72.7%)。所有入组患者随访时间为0.5～33个月,中位时间8个月,共死亡23例(25.56%),抗神经元抗体组病死率7/18,高于系统性自身抗体组2/11(P=0.036)。结论中国抗GABA-B受体脑炎患者合并其他自身抗体较常见,其中叠加抗神经元抗体提示合并恶性肿瘤可能性大,预后较差,病死率高;而合并的系统性自身抗体未发现与病情及预后的相关性。     

重症肌无力患者血清titin抗体和乙酰胆碱受体抗体与疾病临床特征的关系

目的探讨重症肌无力(MG)患者血清titin抗体及乙酰胆碱受体(AChR)抗体与疾病临床特征的关系。方法采用酶联免疫吸附试验对90例MG患者和30例对照组成员进行titin抗体和AChR抗体的检测并进行比较。结果 MG患者AChR抗体、Titin抗体阳性率(76.7%,54.5%)明显高于对照组(10%,6.7%)(χ2=41.667,P=0.000;χ2=21.017,P=0.000)。titin抗体与AChR抗体检测MG的灵敏度分别为54.5%和76.7%,两种抗体并联试验灵敏度为89.4%。titin抗体在伴胸腺病变及晚发型MG患者中有较高阳性率,分别为80.0%和72.5%,明显高于非胸腺瘤组(47.1%,χ2=6.771,P=0.009)和早发型MG患者(40%,χ2=9.46,P=0.002)。全身型MG患者titin抗体与AChR抗体阳性率(69.2%,90.4%)显著高于眼肌型MG(34.2%,χ2=10.856,P=0.001;57.9%,χ2=12.956,P≤0.000)。甲亢组与非甲亢组MG患者titin抗体(33.3%,56.8%)与AChR抗体阳性率(55.6%,79%)差异性均无统计学意义(χ2=1.797,P=0.19;χ2=2.491,P=0.063)。结论 MG患者病情越重,titin抗体与AChR抗体阳性率越高。Titin抗体及AChR抗体能作为诊断MG的指标,联合检测能提高MG诊断的灵敏。然而MG患者血清titin抗体与AChR抗体并无一致性关系。     

血清抗核抗体在视神经脊髓炎谱系疾病和多发性硬化中的分布

目的 研究血清抗核抗体(ANAs)在视神经脊髓炎谱系疾病(NMOSDs)和多发性硬化(MS)中的分布.方法 收集2009-01-2011-03间在作者医院神经内科门诊和住院诊治并行血清ANAs筛查的NMOSDs患者74例,包括视神经脊髓炎(NMO)53例、复发长节段横贯性脊髓炎(rLETM)20例和复发性视神经炎(RON)1例,以及MS患者49例,统计其血清ANAs阳性率并进行分析.结果 NMOSDs患者血清ANAs阳性率为45.9%(34/74),其中ANA(本文中特指用间接免疫荧光法检测的抗核抗体)、抗dsDNA、抗着丝粒抗体(ACA)、抗SSA抗体、抗SSB抗体阳性率分别为36.5%(27/74)、5.4%(4/74)、1.4%(1/74)、27.0%(20/74)、9.5%(7/74),MS组仅1例ANAs阳性,阳性率为2.0%(1/49),两组间差异有统计学意义(P<0.01).血清ANAs诊断NMOSDs的灵敏度为45.9%,特异度达98.0%;NMO和rLETM患者血清ANAs阳性率分别为47.2%和40.0%,两者无统计学差异(P=0.635).结论 NMO和rLETM患者血清ANAs阳性率高于MS组,支持NMO和rLETM同属于NMOSDs的观点.ANAs有可能是NMOSDs和MS两组疾病的鉴别指标之一.     

抗髓鞘碱性蛋白抗体及抗髓鞘少突胶质细胞糖蛋白抗体在中枢神经系统炎性脱髓鞘疾病诊断中的价值

目的探讨抗髓鞘碱性蛋白抗体(抗MBP抗体)及抗髓鞘少突胶质细胞糖蛋白抗体(抗MOG抗体)在中枢神经系统炎性脱髓鞘疾病中的表达率,并研究两种抗体对该病的临床诊断价值。方法选取我院于2012-03—2013-09收治的中枢神经系统炎性脱髓鞘疾病患者90例为实验组(MS组30例,AM组30例,NMO组30例);同时选取45例非中枢神经系统炎性疾病患者为对照组。应用ELISA方法对各组患者血清和脑脊液中抗MBP抗体、抗MOG抗体进行检测,并对比分析各组及各亚组之间表达水平差异。结果实验组在血清及CSF中的抗MOG抗体和抗MBP抗体水平均明显高于对照组(P0.05)。而各组的血清抗体阳性率与CSF差异无统计学意义(P0.05)。MS组与AM组血清及CSF中抗MOG抗体阳性率均显著低于NMO组(P0.05)。MS组血清中抗MBP抗体阳性率明显高于AM组(χ2=4.356,P0.05),其余各亚组及CSF中的抗MBP抗体水平均无显著差异(P0.05)。而MS组血清中的抗MBP抗体阳性率显著高于CSF组(χ2=5.963,P0.05)。结论中枢神经系统炎性脱髓鞘疾病患者中抗MBP抗体、抗MOG抗体高表达,对疾病诊断具有临床意义;同时血清中的抗MOG抗体和抗MBP抗体含量差异可辅助疾病各亚型的鉴别诊断。     

水通道蛋白4抗体检测的方法学比较及其临床意义

目的 比较经典分析法和水通道蛋白4(AQP4)抗体分析法对AQP4抗体检测率的异同,并探讨该抗体对区分中国视神经脊髓炎(NMO)和多发性硬化(MS)患者的诊断准确度.方法 选择44例NMO和46例MS患者的血清,采用经典分析法检测血清中的NMO-IgG(AQP4),AQP4抗体分析法检测血清中AQP4抗体.结果 90份血清中,两种方法检测结果均为阳性的36份,两种方法检测结果均为阴性的45份,经典分析法阳性但AQP4抗体分析法阴性血清4份,AQP4抗体分析法阳性但经典分析法阴性血清5份,2种方法的阳性率、阴性率差异无统计学意义(P=1.000).2种方法一致性检验Kappa=0.798,P=0.000.经典分析法检测NMO患者NMO-IgG的灵敏度为77.3%,阳性预测值85.0%,特异度87.0%,阴性预测值87.0%,诊断正确率为82.2%,Youden指数74.3%.AQP4抗体分析法检测NMO患者AQP4抗体的灵敏度为88.6%,阳性预测值95.1%,特异度95.7%,阴性预测值89.8%,诊断正确率为92.2%,Youden指数84.3%.结论 两种AQP4抗体检测方法对区分MS与NMO都具有高灵敏度与特异度,但是抗AQP4抗体分析法对NMO诊断具有更高的诊断准确性,值得推广.     

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.     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.