腹腔注射A型肉毒毒素对大鼠肠道肥大细胞的影响

目的探讨腹腔注射A型肉毒毒素(BTA)对大鼠肠黏膜肥大细胞数量的影响。方法8周龄Wistar雄性大鼠40只随机分为A、B、C、D组,每组10只,A、B、C组分别腹腔注射含BTA4u、2u、1u的生理盐水2ml,D组为对照组,腹腔注射生理盐水2ml。4周后取大鼠回肠末段、回盲部、直肠标本行改良甲苯胺蓝染色测定肥大细胞数目。结果A、B组大鼠回肠末段、回盲部及直肠肥大细胞数量(个)[分别为(5.16±2.74)、(4.50±3.19);(3.83±1.78)、(3.33±2.50)和(7.00±2.53)、(7.50±3.29)]均明显少于D组[(11.16±4.48)、(8.50±3.04)、(13.66±4.83),各组P<0.05],而C组各部位计数与D组相比差异无统计学意义。结论腹腔注射A型肉毒毒素能够减少大鼠肠道肥大细胞数量。     

丙烯酰胺抑制大鼠肌注A型肉毒毒素后的神经芽生

目的观察丙烯酰胺是否能抑制肉毒毒素肌注后的神经芽生,以延长其治疗肌肉过强活动疾病的疗效。方法SD大鼠随机分为肉正常对照组、丙烯酰胺组、肉毒毒素组和毒毒素+丙烯酰胺组。每只大鼠右肢腓肠肌分别肌肉注射A型肉毒毒素5U或生理盐水1次(0.2mL),肌注后d3,6,9,12,15,18及21分别ip3%丙烯酰胺或生理盐水,每次0.1mL。肌肉注射肉毒毒素后1,2,3,4,6,8,10及12周的8个时间点评定大鼠右后肢肌力,观察单纤维肌电图和形态学计数神经纤维。结果肉毒毒素组右后肢肌力下降,单纤维肌电图纤维密度测定和病理形态神经纤维计数结果均显示A型肉毒毒素肌肉注射后神经芽生现象;单纤维肌电图动作电位平均连续差结果提示出现神经肌肉接头传导异常,12周可基本恢复正常。加用丙烯酰胺可延缓芽生高峰的时间和抑制芽生程度,并延缓神经肌肉接头功能的恢复。结论应用丙烯酰胺可抑制A型肉毒毒素局部注射后神经芽生,延迟肌力恢复。     

肉毒毒素A治疗肛裂有效

肉毒毒素A(botulinum toxinA)在治疗慢性肛裂是其非美容的用途。在两家印度医院用两个公司的肉毒毒素A产品(Botoxt和Dysport)直接注射进肛门括约肌内治疗100名肛裂患者的结果。     

生物反馈治疗小儿排便失禁20例

目的　探讨生物反馈治疗小儿肛门直肠畸形肛门成型术后排便失禁的方法和疗效。方法　应用高分辨多通道胃肠功能测定仪及肛门直肠测压分析软件 ,对 2 0例肛门成型术后排便失禁的患儿 ,用生物反馈疗法训练 ,加强肛门周围的肌肉力量 ,训练直肠对各种感觉的识别 ,调节直肠受到刺激时 ,肛门内括约肌和外括约肌的协调运动。结果　 2 0例排便失禁的患儿经生物反馈治疗后 ,肛门直肠测压表明 ,最大收缩时间延长 ,收缩向量容积提高 ,感觉阈值降低 ,肌电振幅增高。临床评分提高 (2 .8±1.0 )分。结论　生物反馈治疗是排便失禁儿童疗效可靠且无创伤的后续治疗     

A型肉毒毒素对肌肉痉挛患者功能康复中的应用价值

目的:探讨A型肉毒毒素对肌肉痉挛患者功能康复中的应用效果.方法:选择2015年1月~2016年1月我院收治的80例肌肉痉挛患者为研究对象,均为运动神经元受损后肢体肌肉痉挛、应用BTX-A(A型肉毒毒素)治疗的患者,观察治疗后的肌张力变化情况、运动功能及日常生活能力改善情况.结果:治疗后的Ashworth评分(1.1±0.2)分明显低于治疗前,Fugl Meyer评分(61.5±6.9)分、ADL评分(60.5±5.8)分明显高于治疗前,治疗前后相比差异具有统计学意义(P<0.01);小腿三头肌、肱二头肌、屈指肌处不同剂量组在A型肉毒毒素治疗后Ashworth评分均明显下降,但同一位置内不同剂量组(A、B组)的Ashworth评分下降幅度并无明显差异(P>0.05).结论:A型肉毒毒素对肌肉痉挛患者功能康复的应用效果显著,能改善肌张力及运动功能,提高患者日常生活能力,值得推广.     

A型肉毒毒素减轻面部整形切口瘢痕的临床观察

目的 观察A型肉毒毒素在减轻面部整形美容切口瘢痕中应用的临床疗效。方法 选取中国人民解放军空军军医大学第一附属医院2017年5—8月的面部整形手术病人32例,在手术结束关闭切口时将A型肉毒毒素随机注射到任意一半切口下为观察侧,另一半切口注射等量生理盐水为对照侧,比较病人两半切口愈合的瘢痕宽度、视觉模拟量表评分、温哥华瘢痕评分及病人满意度。结果 在瘢痕宽度［(0.31±0.12)mm比(0.45±0.17) mm,t＝2.252,P＝0.028］、视觉模拟量表评分［(6.10±3.82)分比(4.75±2.55)分,t＝2.834,P＝0.006］、温哥华瘢痕评分［(3.46±3.12)分比(6.62±3.47)分,t＝2.933,P＝0.005］及病人满意度［(9.21±1.32)分比(7.37±2.01)分,t＝2.120,P＝0.038］方面,注射A型肉毒毒素的切口侧优于对照侧,差异有统计学意义(P＜0.05)。结论 A型肉毒毒素可减轻面部整形美容术后切口瘢痕,产生更美观的术后外观,值得临床推广。     

肛门括约肌肌电图在帕金森病和多系统萎缩诊断中的研究

目的探讨肛门括约肌肌电图在帕金森病及多系统萎缩鉴别诊断上的价值。方法收集2008年1月至2011年10月我院神经内科收治的临床诊断帕金森病(Parkinson’s disease,PD)、多系统萎缩(Multiple system atrophy,MSA)、正常对照组等患者共61例(其中PD:符合全国锥体外系疾病研讨会2006年制定的PD诊断标准;MSA:按照2008年Gilman诊断标准)。将所有病人分为3组:PD组、MSA组、正常对照组;所有病人行相关病史采集、体格检查和相应辅助检查(如头颅MRI等),并对每个入组病人进行肛门括约肌肌电图(ASEMG)检查。结果PD、MSA及对照组之间分析:PD患者在ASEMG检查上也可表现出MUP平均时限轻度延长,但很少出现卫星电位,MSA患者在ASEMG检查上突出表现出MUP平均时限延长,出现较多卫星电位。平均时限和卫星电位出现率对于鉴别PD、MSA是ASEMG的重要参数。结论(1)平均时限和卫星电位出现率对于鉴别PD、MSA是ASEMG的重要参数;(2)自发电位、多相波比例增高及平均波幅增高,不能作为MSA、PD患者骶髓onuf核受损在ASEMG上的典型表现。     

局部注射A型肉毒杆菌毒素治疗面肌痉挛的效果

目的观察肉毒毒素局部注射治疗面肌痉挛的临床疗效、作用时间及不良反应。方法采用A型肉毒毒素对56例面肌抽搐患者进行多点肌肉注射,观察治疗前后效果、作用维持时间和并发症。结果治疗面肌痉挛56例(96例次),完全缓解34例(61．71％),明显缓解21例(37．5％),无效1例(1．7％);总有效率98．2％。注射后起效时间4h至8d,平均(2．4±1．6)d,药物作用时间2-8个月,平均(4±1．3)个月。未见过敏反应,不良反应轻微、可逆。结论A型肉毒毒素局部肌肉注射是一种简捷、有效、安全的治疗面肌痉挛的方法。     

分析P-VEP的P100波及F-ERG的b波对白内障术后视功能的评估作用

目的评价术前综合视觉电生理检测在预测白内障术后视功能评估中的作用。方法回顾笔者所在医院2011年3月～2012年3月白内障患者146例,术前视力>0.02,双眼手术患者选用术前视力较好眼,术前用TEC-350视觉电生理检查系统检测图形视诱发电位和闪光视网膜电流图,记录P100波及b波的振幅及潜伏期。术后3d查矫正视力,根据术后矫正视力将患者分为3组,A组视力<0.2,36例,B组视力0.2～0.5,64例,C组视力>0.5,46例,分别计算3组术前P100波及b波的振幅及峰时平均值,并比较3组之间的差异。结果 A组P100波振幅平均值(3.7±0.5)uV,潜伏期平均值(112.3±20.1)ms,b波振幅平均值(21.9±3.5)uV,潜伏期平均值(56.6±18.4)ms;B组P100波振幅平均值(9.5±4.6)uV,潜伏期平均值(100.5±22.2)ms,b波振幅平均值(42.4±12.6)uV,潜伏期平均值(56.2±15.4)ms;C组P100波振幅平均值(10.9±1.2)uV,潜伏期平均值(98.5±17.4)ms,b波振幅平均值(45.6±19.4)uV,潜伏期平均值(55.2±10.4)ms;3组之间有统计学差异,A组与B组﹑A组与C组之间P100的振幅及潜伏期﹑b波的振幅差异有统计学意义,b波的潜伏期差异无统计学意义,B组与C组之间P100波及b波振幅及潜伏期差异均无统计学意义。结论分析P-VEP的P100波及F-ERG的b波振幅及潜伏期,对白内障术后视功能评估有一定的指导作用。     

A型肉毒毒素注射联合悬吊训练治疗痉挛型脑性瘫痪尖足的短期疗效观察

目的研究 A型肉毒毒素( BTX-A)注射联合悬吊训练治疗痉挛型脑性瘫痪尖足的短期疗效。方法收集 2021年 1— 12月就诊于安徽省儿童医院康复科痉挛型脑性瘫痪尖足病例共 63例,按随机数字表法分成对照组 30例,观察组 33例,对照组给予常规康复治疗联合悬吊训练,观察组在对照组基础上联合 A型肉毒毒素注射,分别在治疗前、治疗 4周后对两组病儿进行改良 Tardieu量表( MTS)评估、改良 Ashworth量表( MAS)评估、粗大运动功能测试量表( GMFM-88)评估。结果治疗 4周后,两组病儿的 MTS得分、 MAS得分、 GMFM-88 D区和 E区得分均较治疗前改善,且观察组 MTS得分［伸膝位 R1(-7.88±1.40)分、 R2(16.36±1.19)分、 R2-R1(24.24±2.56)分;屈膝位 R1(10.18±1.30)分、 R2(22.58±1.62)分、 R2-R1(12.39±0.75)分］、 MAS得分［( 1.82±0.85)分］、 GMFM-88区得分［( 33.42±5.20)分］、 E区得分［( 50.88±5.32)分］的改善程度优于对照组［MTS伸膝位 R1(-10.60±1.13)分、 R2(12.23±1.33)分、 R2-R1(22.83±0.53)分;屈膝位 R1(5.03±0.72)分、 R2(18.40±1.16)分、 R2-R1(13.37±0.85)分; MAS(2.37±1.03)分; GMFM-88D区( 30.40±4.67)分, E区( 43.83±4.33)分,均 P<0.05］。结论 A型肉毒毒素注射联合悬吊训练治疗短期内能提高痉挛型脑性瘫痪尖足的临床疗效。     

Lack of effficacy of botulinum toxin in chronic anal fissure

BACKGROUND AND AIM: Hypertonicity of internal anal sphincter plays a major role in the persistence of chronic anal fissure. Botulinum toxin could induce internal anal sphincter relaxation without the adverse effects of surgery (long-term faecal incontinence) or topical nitrates (anal burning, headaches, hypotension). METHODS: We conducted a placebo-controlled, randomised, double-blind study to assess the efficacy of a single injection of botulinum toxin in the internal anal sphincter of patients with chronic anal fissure in six ambulatory care clinics. Eligibility criteria included a mean value of post-defecation anal pain >or= 30 mm on a 100 mm visual analogue scale over the week preceding inclusion. Main endpoint was the proportion of patients with symptomatic improvement during the fourth week after inclusion (post-defecation anal pain below 10 mm). RESULTS: Forty-four patients (22 in each group) were included. At inclusion, there was no significant difference between groups on age, sex ratio, pain duration, post-defecation anal pain, analgesic consumption and stool frequency. Ten (45%) and 11 (50%) patients reported symptomatic improvement on the main endpoint (P=0.76) in placebo and botulinum toxin groups, respectively. Ten patients (five in each group) had healed fissure at week 4 and ten patients (five in each group) required surgical treatment between weeks 4 and 12. Similarly, there was no significant difference between groups on other variables between weeks 4 and 12. CONCLUSIONS: The efficacy of a single injection of botulinum toxin in the internal anal sphincter does not differ from that of a placebo in patients with chronic anal fissure.     

康复训练结合药物治疗儿童脑瘫的疗效观察

目的：探讨A型肉毒毒素辅助治疗儿童脑瘫的临床价值。方法：将86例双下肢痉挛脑瘫患儿随机分为两组：对照组43例,采用Vojta训练治疗;实验组43例,采用Vojta训练与肌肉注射A型肉毒毒素治疗。观察比较两组患儿的痉挛状况、运动功能及日常生活活动能力。结果：实验组治疗后的综合痉挛评分明显低于对照组（P〈0．05）,实验组治疗后的粗大运动功能D区、E区分值均明显高于对照组（P〈0．05）,实验组治疗后的日常生活活动能力评分明显高于对照组（P〈0．05）。结论：A型肉毒毒素能有效缓解脑瘫患儿的肢体肌肉痉挛,促进运动功能恢复。     

Botulinum neurotoxin to treat chronic anal fissure: results of a randomized "Botox vs. Dysport" controlled trial

BACKGROUND: Botulinum neurotoxin induces healing in patients with idiopathic fissure. The optimal dosage is not well established. AIM: To compare the efficacy and tolerability of two different formulations of type A botulinum neurotoxin, and to provide more evidence with regard to the choice of dosage regimens. METHODS: Symptomatic adults with chronic anal fissure were enrolled in a randomized study. The outcome of each group was evaluated clinically, and by comparing the pressure of the anal sphincters before and after treatment. RESULTS: Fifty patients received injections of 50 units of Botox formulation (group I), and 50 patients received injections of 150 units of Dysport toxin (group II). One month after injection, 11 patients in group I and eight in group II had mild incontinence of flatus. At the 2-month evaluation point, 46 patients in group I and 47 patients in group II had a healing scar. In group I patients, the mean resting anal pressure was 41.8% lower, and the maximum voluntary squeeze pressure was 20.2% lower, than the baseline value. In group II patients, the resting anal pressure and maximum voluntary squeeze pressure were 60.0 +/- 12.0 mmHg and 71.0 +/- 30.0 mmHg, respectively. There were no relapses during an average of about 21 months of follow-up. CONCLUSIONS: Botulinum neurotoxin may be considered an effective treatment in patients with chronic anal fissure. The efficacy and tolerability of the two different formulations of botulinum neurotoxin were indistinguishable.     

不同位置注射A型肉毒毒素对除皱后额部皮肤油脂分泌及皮肤质地的影响

目的研究不同位置注射A型肉毒毒素对除皱后额部皮肤油脂分泌及皮肤质地的影响。方法 60例额部皱纹患者,按照随机数字表法分为对照组和试验组,各30例。对照组给予A型肉毒毒素肌肉下注射治疗,试验组给予A型肉毒毒素真皮下注射治疗。比较两组患者治疗前后额部注射区域(A、B区域)皮肤油脂分泌水平、额部皮肤弹性参数R2、R5、R7弹性变化及注射前后图像。结果治疗前,两组患者A、B区域皮肤油脂分泌水平比较差异无统计学意义(P>0.05);治疗后4周,两组患者A、B区域皮肤油脂分泌水平均低于治疗前,且试验组患者A区域皮肤油脂分泌水平(95.45±10.34)μg/cm²、B区域皮肤油脂分泌水平(97.26±11.46)μg/cm²均低于对照组的(107.56±12.12)、(107.35±9.16)μg/cm²,差异有统计学意义(P<0.05)。治疗前,两组患者皮肤弹性R2、R5、R7参数水平比较差异无统计学意义(P>0.05);治疗后4周,两组患者皮肤弹性R2、R5、R7参数水平均较治疗前升高,且试验组高于对照组,差异有统计学意义(P<0.05)。与注射前图像对比,注射后患者额部皱纹明显改善。结论不同位置注射A型肉毒毒素可有效去除患者额部皱纹,减少皮肤油脂分泌,改善皮肤质地,且真皮下注射效果更佳。     

A型肉毒毒素治疗紧张型头痛合并面肌痉挛的疗效观察

目的观察紧张型头痛合并面肌痉挛患者选择A型肉毒毒素治疗的临床效果。方法 52例紧张型头痛合并面肌痉挛患者,采用随机单盲法分为对照组和观察组,每组26例。对照组患者采用常规治疗,观察组患者采用A型肉毒毒素治疗。比较两组患者治疗效果、不良反应发生情况及疼痛评分。结果观察组患者的治疗总有效率100.00%明显高于对照组的80.77%,差异有统计学意义(P<0.05)。观察组不良反应发生率11.54%(3/26)和对照组的7.69%(2/26)比较差异无统计学意义(χ²=0.221, P=0.638>0.05)。治疗后,观察组患者的疼痛评分(4.1±0.6)分低于对照组的(4.9±0.9)分,差异具有统计学意义(t=3.771, P=0.000<0.05)。结论 A型肉毒毒素治疗紧张型头痛合并面肌痉挛的效果显著,安全度高,能减轻疼痛感受程度,应在临床治疗中引起关注。     

Clinical trial: effects of botulinum toxin on levator ani syndrome – a double-blind, placebo-controlled study

Background  Levator ani syndrome is characterized by anorectal discomfort/pain, treatment of which is unsatisfactory. We hypothesized that Botulinum toxin relieves spasm and improves symptoms.
Aim  To perform a randomized, placebo-controlled, crossover study to examine the efficacy and safety of botulinum toxin in patients with levator ani syndrome.
Methods  Twelve patients with levator ani syndrome (≥1 year) received anal intra sphincteric injections of 100 units of botulinum toxin A and placebo at 90-day intervals using EMG guidance. Daily frequency, severity, duration and intensity of pain (VAS) were recorded. Anorectal manometry, balloon expulsion and pudendal nerve latency tests were performed to examine the physiological changes and adverse effects.
Results  Seven patients (male/female = 4/3) completed the study and three had incomplete data, but all 10 underwent in an ITT analysis; two others dropped out. After administration of botulinum toxin, the mean frequency, intensity and duration of pain were unchanged ( P  = 0.31) compared with baseline. The 90-day mean VAS pain score was 6.79 ± 0.27 vs. baseline score of 7.08 ± 0.29 ( P  = 0.25). Anal sphincter pressures, rectal sensory thresholds, pudendal nerve latency and balloon expulsion times were unchanged after drug or placebo administration.
Conclusions  Injection of botulinum toxin into anal sphincter is safe, but it does not improve anorectal pain in levator ani syndrome.     

电刺激定位引导埋线治疗脑瘫患儿小腿三头肌痉挛的疗效观察

目的观察电刺激定位引导埋线治疗脑瘫患儿小腿三头肌痉挛的疗效。方法将18例脑瘫患儿随机分为电刺激定位引导埋线组（埋线组）和电刺激定位引导A型肉毒毒素（BTX．A）注射组（肉毒素组）,观察治疗1月后患儿的踝背屈曲度、综合痉挛量表CSS评分、改良Ashworth法评分。结果肉毒素和埋线治疗1月后患儿踝背屈曲度、综合痉挛量表CSS评分、改良Ashworth法评分均有明显改善（P〈0．05）,埋线组对患儿踝背屈曲度的改善弱于肉毒素组（P〈0．05）,但综合痉挛量表CSS评分、改良Ashworth法评分与肉毒素组比较差异无统计意义（P〉0．05）。结论电刺激定位引导埋线治疗脑瘫患儿小腿三头肌痉挛有较好的临床疗效。     

Botulinum toxin injected in the gastric wall reduces body weight and food intake in rats

BACKGROUND: Botulinum toxin is a powerful, long-acting inhibitor of muscular contractions in both voluntary and smooth muscle. It acts by blocking the release of the neurotransmitter acetylcholine. In the stomach, propulsive contractions of the antrum are necessary for the gastric contents to pass into the duodenum. AIMS: To investigate whether intramuscular injections of botulinum toxin type A into the gastric antrum of rats would cause a reduction in food intake and hence body weight, by inhibition of gastric emptying. MATERIALS AND METHODS: This was a prospective, randomized, 3-way parallel group study in rats. The first group was anaesthetized, laparotomized and given 20 U of botulinum toxin type A by intramuscular injection into the gastric antrum (botulinum toxin type A group, n=14). The second group was anaesthetized, laparotomized and injected with saline (sham group, n=14) and the third group did not have any intervention (control group, n=5). Food intake was measured daily for 7 weeks and body weight was measured daily for 10 weeks. RESULTS: There was a significant difference in loss of body weight between the two treated groups (14.0 +/- 8.2% botulinum toxin type A group, 4.4 +/- 2.7% sham group; P < 0.001). Further, the time to reach the weight nadir was significantly longer in the botulinum toxin type A group (8.7 +/- 3.9 days) compared with the sham group (5.3 +/- 3.8 days; P < 0.04). There were no significant differences between the sham and control groups for any of the body weight parameters. The minimum dietary intake was significantly lower in the botulinum toxin type A group than in the sham group (37.8 +/- 21.8% of the basal value in the botulinum toxin type A group, vs. 65.5 +/- 32.0 in the sham group, P < 0.05). In addition, the time to reach the nadir was significantly prolonged (8.2 +/- 3.5 days, botulinum toxin type A group vs. 4.9 +/- 1.7 days, sham group, P < 0.001). CONCLUSIONS: The parallel reduction of body weight and food intake in botulinum toxin type A treated animals is consistent with a long lasting inhibition of the antral pump. This is probably due to slowed gastric emptying leading to early satiety. Patients with morbid obesity might benefit from endoscopic injections of botulinum toxin type A into the stomach wall.     

A型肉毒素与曲安奈德上睑结膜下注射在甲状腺相关眼病上睑退缩治疗中的对照研究

目的比较A型肉毒素与曲安奈德上睑结膜下注射治疗甲状腺相关眼病上睑退缩的疗效。方法以沈阳市第四人民医院2019年3月至2020年9月稳定期甲状腺相关眼病伴上睑退缩单眼发病病例共60例为研究对象,采用计算机随机数法进行分组:对照组30例,给予曲安奈德20 mg上睑结膜下注射1次;试验组30例,给予A型肉毒素3 U上睑结膜下注射1次。对注射后1周以及1、3、6个月各临床指标(上眼睑退缩值、上眼睑下移值、CAS评分、眼球突出度、眼压、矫正视力)变化及并发症进行比较。结果给药后1周,两组上眼睑退缩值及上眼睑下移值优于治疗后1个月时(P<0.05),试验组优于对照组;治疗后3个月时,两组比较差异无统计学意义(P>0.05);治疗后6个月两组比较差异有统计学意义(P<0.05),对照组优于试验组。对照组给药1周以及1、3、6个月后眼睑退缩值均下降,与治疗前比较差异均有统计学意义(P<0.05);试验组给药1周以及1、3个月后上眼睑退缩值均下降,与治疗前比较差异均有统计学意义(P<0.05),给药6个月后的上眼睑退缩值与治疗前比较差异无统计学意义(P>0.05);C...     

Alternative use of botulinum toxin in urology

Botulinum toxin A is used in the treatment of lower urinary tract symptoms due to detrusor sphincter dysynergia and detrusor hyper-reflexia (neurogenic detrusor deficiency). The toxin acts by producing paralysis of muscle tissue and has been shown to be safe and effective in the treatment of conditions caused by increased muscle tonicity and spasticity. Here the literature is reviewed chronologically, the established and emerging indications for the urological use of botulinum toxin evaluated and future applications are also considered.