血红素加氧酶-1基因多态性与脑梗死的相关性

目的探讨血红素加氧酶-1(HO-1)基因启动子基因多态性与ACI患者遗传易感性的关系及碳氧血红蛋白(COHb)在ACI患者中含量的变化。方法采用聚合酶链反应(PCR)和改良双波长分光光度法分析57例急性ACI患者及55例健康对照者血清中HO-1基因启动子(GT)n重复序列不同基因型频率分布特征及碳氧血红蛋白(COHb)含量与ACI的关系。结果ACI组中的Ⅰ类基因型组(携带S等位基因)显著低于2类基因型组(不携带S等位基因)(43.86%比65.45%,P<0.05),提示Ⅰ类基因型与脑梗死的危险性降低相关。ACI组血浆的COHb水平较对照组COHb水平明显升高(t=16.92,P<0.01),提示脑梗死患者血浆COHb含量较高,差异有统计学意义。结论HO-1基因启动子(GT)n重复序列遗传多态性与脑梗死的遗传易感性有关。ACI患者血浆中CO-Hb含量较正常时升高。     

血红素加氧酶-1基因多态性,神经元特异性烯醇化酶与脑梗死关系的研究

目的 探讨血红素加氧酶-1基因启动子区域GT重复序列[HO-1(GT)n]遗传多态性,神经元特异性烯醇化酶(NSE)与脑梗死的遗传易感性的关系.方法 采用巢式PCR法检测HO-1(GT)n,酶联免疫吸附法(ELISA)检测血清NSE,分析55例急性脑梗死(ACI组)患者和56例对照者的外周血样本.结果 ACI组短GT重复序列分布43.64%明显低于对照组64.29%,差别有统计学意义.在急性脑梗死患者治疗前后均显示短GT重复序列组NSE水平低于长GT重复序列组NSE水平.结论 HO-1基因启动子短重复序列脑梗死患者血清NSE水平较低,HO-1短GT重复序列遗传多态性可能与脑梗死的遗传易感性有关.

Abstract：

Objective To investigate the interrelation between genetic polymorphism of Heme oxygenase-1 genic repeated sequence in promoter region( HO-1 (GT) n) and serum levels of neuron-specific enolase(NSE) in hereditary susceptibility of cerebral infarction. Methods The information and peripheral blood sample came from 55 acute cerebral infarction (ACI group)and 56 healthy people as control group were collected. HO-1 (GT)n was detected by PCR,and NSE was detected by ELISA. Results The number of HO-1 genotype with S allele was significantly different between the ACI group (43.64%) and control group(65.45% ). The level of serum NSE before treatment in ACI-group was significantly different with that of after treatment ACI-group and control group ( P < 0.05 ). Conclusion The ACI patients whose HO-1 genotype with S allele have lower level of serum NSE than the ACI patients whose HO-1 genotype without S allele, and neuron was less damaged. The less repetitive sequence exhibits a reduced risk for ACI.     

急性脑梗死患者血清可溶性CD40L与C-反应蛋白含量的改变及其意义

目的 探讨急性脑梗死(ACI)患者血清可溶性CD40L(sCD40L)和C-反应蛋白(CRP)含量的改变及其意义.方法 采用双抗体夹心酶联免疫法及比浊法检测40例ACI患者及30人正常对照者的血清sCD40L和CRP含量,比较不同病情、不同梗死面积ACI患者的血清sCD40L和CRP含量变化,对二者之间的关系进行相关性分析.结果 ACI组血清sCD40L[(3.57±0.86) ng/ml]、CRP[(17.53±7.61) mg/L]的含量明显高于正常对照组(均P<0.01),ACI病情重度组、大面积梗死组血清sCD40L、CRP的含量明显高于病情中度、轻度组和小面积、腔隙性脑梗死组,病情中度组、小面积梗死组又明显高于病情轻度组、腔隙性脑梗死组(均P<0.05).血清sCD40L与CRP含量呈正相关(r=0.817,P<0.01).结论 ACI患者血清sCD40L、CRP含量升高,并与病情严重程度和梗死面积有关.提示其可作为判断ACI病情的血清生物学指标.     

急性脑梗死患者蛋白S基因多态性和血浆蛋白S水平与其家族史关系的研究

目的探讨急性脑梗死(ACI)患者蛋白S基因(PROS1)多态性和血浆总蛋白S(tPS)和游离蛋白S(fPS)水平与其家族史的关系。方法对93例ACI患者,其中散发(NFCI)组83例,有家族史(FCI)组10例,采用聚合酶链式反应-限制性片段长度多态性分析法(PCR-RLFP)检测PROS1A2148G多态性;采用酶联免疫吸附双抗体夹心法(ELISA)测定血浆tPS和fPS水平;并与正常对照组进行比较。结果ACI组PROS1A2148G的AA、AG和GG型频率分别为18.3%、48.4%和33.3%,与正常对照组(22.0%、48.0%和30.0%)差异无统计学意义(均P>0.05)。FCI组A2148GGG基因型频率(50%)高于正常对照组(30%),但差异无统计学意义(P>0.05)。ACI组GG基因型患者血浆tPS水平和fPS水平[(13.67±1.49)、(6.07±0.61)μg/ml]显著低于AA型和AG型[(15.73±1.24)、(6.72±0.55)和(15.15±1.48)、(6.63±0.66)μg/ml](均P<0.01),且FCI组血浆fPS水平[(6.12±0.69)μg/ml]显著低于NFCI组[(6.48±0.75)μg/ml](P<0.05)。结论PROS1A2148GGG基因型导致FCI患者血浆fPS水平降低,其基因型可能与ACI家族史有关。     

急性脑梗死患者血清白介素-18和组织因子水平变化及其与凝血功能的关系

目的 探讨急性脑梗死(ACI)患者血清白介素(IL)-18和组织因子(TF)水平的变化及其与凝血功能关系.方法 79例ACI患者(ACI组)于入院次日、25名健康体检者(正常对照组)于体检当日早晨,分别检测血清IL-18、TF水平和凝血功能.结果 ACI组患者的血清IL-18、TF水平[(282.22±127.45)pg/ml,(2.10±1.23)ns/ml]明显高于正常对照组[(131.13±37.17)pg/ml,0.67±0.34)ng/ml](P<0.01～0.001):ACI组患者凝血功能指标中的部分凝血活酶时间及纤维蛋白原(Fib)水平显著高于正常对照组(均P<0.05);ACI组患者血清TF水平与凝血酶原时间及Fib水平呈正相关(r=0.376,r=0.473,P<0.05～0.01).结论 血清IL-18与TF水平异常增高是参与动脉粥样硬化相关性血栓形成的重要原因之一,抗凝及降纤治疗通过抑制TF水平逆转该病理过程.     

急性脑梗死患者血清血栓素B2、6-酮-前列环素F1α水平与颈动脉粥样硬化的关系

目的 探讨急性脑梗死(ACI)患者血清血栓素B2(TXB2)、6-酮-前列环素F1α (6-K-PGF1α)与动脉粥样硬化(CAS)斑块及其硬化程度的关系.方法对入选的ACI患者进行血清TXB2、6-K-PGF1α的监测,并行颈动脉超声,测量颈动脉内中膜厚度(IMT)并观察有无斑块之间的相关性分析.结果 急性脑梗死合并颈动脉粥样硬化的患者血清TXB2水平明显高于无颈动脉硬化患者,6-K-PGF1α水平显著低于无颈动脉硬化患者(均P<0.01).有CAS斑块的患者血清TXB2水平显著高于颈动脉内中膜正常与增厚患者,6-K-PGF1α水平显著低于颈动脉内中膜正常与增厚患者,差异有统计学意义 (均P<0.05).结论 血清TXB2、6-K-PGF1α水平与急性脑梗死 (ACI)患者颈动脉粥样硬化的发生有一定相关性,CAS程度愈重,相关性愈大.     

急性脑梗死患者血清脂蛋白相关磷脂酶A2水平的改变及其与病情的关系

目的 研究急性脑梗死(ACI)患者血清脂蛋白相关磷脂酶A2(LP-PLA2)水平的改变及其与病情的关系.方法 91例ACI患者按照美国国立卫生研究院卒中量表(NIHSS)评分分为轻型ACI组(NIHSS评分＜4分)、中型ACI组(4～15分)、重型ACI组(＞15分).应用酶联免疫吸附法测定ACI患者及31名正常对照者的血清LP-PLA2水平.ACI患者NIHSS评分与血清LP-PLA2水平的关系用Spearman相关分析.结果 ACI组的血清LP-PLA2水平显著高于正常对照组(P＜0.01);重型ACI亚组血清LP-PLA2水平又显著高于中型ACI亚组和轻型ACI亚组(均P＜0.01).经Spearman相关分析,ACI患者的NIHSS评分与血清LP-PLA2水平呈正相关(r=0.485,P＜0.001).结论 ACI患者的血清LP-PLA2水平显著升高,病情越重者升高越明显.     

急性脑梗死诱发SIRS及MODS时患者血清SOD含量变化研究

目的 探讨急性脑梗死(ACI)诱发全身炎症反应综合征(SIRS)及多器官功能障碍综合征(MODS)的发生率,以及血清中超氧化物岐化酶(SOD)含量变化在ACI诱发SIRS及MODS中的作用机制及临床意义. 方法 选取自2006年1月至2008年6月菏泽市立医院神经内科住院及门诊就诊的68例ACI患者.分为3组,其中急性单纯性脑梗死36例(SACI组),ACI诱发SIRS患者(SIRS组)32例,ACI诱发MODS患者(MODS组)24例,采用黄嘌呤氧化酶法测定血清SOD含量,另设28例到本院查体的健康人为正常对照组(NC组). 结果 (1)本组SACI诱发SIRS的发生率为88.9%,诱发MODS的发生率为66.7%;ACI诱发SIRS时MODS的发生率为75.0%.ACI诱发MODS时100%发生SIRS.(2)各组之间SOD含量比较差异有统计学意义(P<0.05),且血清SOD含量水平依次为MODS组相似文献   

微创血肿清除术对脑出血患者血清NSE水平的影响

目的 探讨微创血肿清除术对脑出血患者血清神经元特异性烯醇化酶(NSE)水平的影响.方法 住院脑出血患者80例,随机分为微创手术组38例和保守治疗组42例.在入院当时及2,4,7,14d各留取血液标本1次,测定血清中神经元特异性烯醇化酶(NSE)的水平.在入院时和7、14、21d进行欧洲卒中量表(ESS)和日常生活能力(ADL)评分.结果 脑出血患者入院时血清NSE含量即有升高,微创组与保守组NSE水平均在2d达到高峰,4、7、14d时微创组NSE水平低于保守组(P<0.05),微创组神经功能缺损和生活能力神经功能缺损和生活能力评分明显高于保守组(P<0.05).结论 微创穿刺血肿清除术能降低ICH患者血清NSE水平,减轻神经损伤,促进神经功能恢复.     

急性脑梗死患者血浆溶血磷脂酸、总磷脂和低密度脂蛋白水平的改变及其与颈动脉粥样硬化的关系

目的 研究急性脑梗死(ACI)患者溶血磷脂酸(LPA)、总磷脂(AP)、低密度脂蛋白(LDL)水平的改变及其与颈动脉粥样硬化的关系.方法 应用多普勒超声仪检测67例ACI患者和30名正常对照者的颈动脉,用有机溶剂抽提法测定血浆LPA、AP含量,用酶直接法测定血浆LDL含量.结果 ACI组血浆LPA、AP和LDL水平显著高于正常对照组(均P<0.01);ACI颈动脉软斑块组、混合斑块组血浆LPA水平显著高于硬斑块组(均P<0.01),各斑块组血浆AP、LDL水平差异无统计学意义.结论 ACI患者血浆LPA、AP、LDL水平增高,ACI合并颈动脉不稳定斑块患者的血浆LPA水平显著高于稳定性斑块患者.提示血浆LPA的水平可以反映颈动脉粥样硬化斑块的稳定性.     

The neuroendocrinology of stress and the pathophysiology and therapy of depression and anxiety

Clinical and preclinical studies have gathered substantial evidence that stress response alterations play a major role in the development of major depression, panic disorder, and post-traumatic stress disorder. The stress response, the hypothalamic pituitary adrenocortical (HPA) system and its modulation by corticotropin-releasing hormones (CRH),corticosteroids,and their receptors, and the roles of natriuretic peptides and neuroactive steroids are described. We review the role of the HPA system in major depression, panic disorder, and post-traumatic stress disorder and its possible relevance for treatment. Impaired glucocorticoid receptor function in major depression is associated with an excessive release of neurohormones such as CRH, to which a number of signs and symptoms characteristic of depression can be ascribed. In panic disorder, a role of central CRH in panic attacks has been suggested. Atrial natriuretic peptide (ANP) is causally involved in sodium lactate-induced panic attacks. Furthermore, preclinical and clinical data on its anxiolytic activity suggest that nonpeptidergic ANP receptor ligands may be potentially useful in the treatment of anxiety disorders. Post-traumatic stress disorder is characterized by a peripheral hyporesponsive HPA system and elevated CRH concentrations in the CSF. This dissociation is probably related to an increased risk of this disorder. We further review recent data that describe an important role of GABA(A)-receptor modulatory,3 alpha-reduced neuroactive steroids in major depression, anxiety, and its treatment. Antidepressants are effective in both depression and anxiety disorders and have major effects on the HPA system,especially on glucocorticoid and mineralocorticoid receptors. Normalization of HPA system abnormalities is a strong predictor of the clinical course, at least in major depression and panic disorder. Currently,CRH-R1 or glucocorticoid receptor antagonists and ANP receptor agonists are being studied and may provide future treatment options more closely related to the pathophysiology of these disorders.     

Polymorphisms of DRD4 and DRD3 and risk of avoidant and obsessive personality traits and disorders

We investigated whether polymorphisms of the dopamine D4 receptor (DRD4) and polymorphisms of the dopamine D3 receptor (DRD3) were associated with personality disorder symptomatology rather than with personality traits such as novelty seeking. DNA was obtained from 145 depressed patients in a clinical trial. These patients were assessed for the presence of personality disorder symptoms and disorders. The 2-repeat allele of the DRD4 exon III polymorphism was associated with increased rates of avoidant and obsessive personality disorder symptomatology. The T,T genotype of the DRD4 -521 C>T polymorphism was also associated with increased rates of avoidant and obsessive personality disorder symptomatology. The Gly9,Gly9 genotype of the DRD3 Ser9Gly polymorphism was associated with increased rates of obsessive personality disorder symptomatology. None of these three polymorphisms were associated with novelty seeking or other temperament traits on the Temperament and Character Inventory. Our results suggest that genetic polymorphisms of DRD4 and DRD3 may well be associated with personality traits, and that conflicting findings to date may arise from the problem of phenotype definition.     

沙盘游戏疗法在地中海贫血患儿心理干预中的应用

本文目的是对沙盘游戏疗法在地中海贫血患儿心理干预中的应用进行综述,以期为地中海贫血患儿的心理康复提供参考。地中海贫血是以珠蛋白生成障碍为主要特征的遗传性疾病,由于长期输血治疗,患儿存在较多的心理和行为问题。沙盘游戏疗法作为一种有效、实用的儿童心理治疗方法,对提高地中海贫血患儿的康复效果、改善生存质量有重要的临床意义。     

癫痫共病抑郁的机制及临床诊疗

本文目的是探讨癫痫共病抑郁的可能机制及临床诊疗。癫痫是一种常见的、慢性的、致残性的神经疾病,癫痫患者生活质量下降,存在明显的负性情绪,常伴发各种精神疾病。癫痫与抑郁具有共同的神经生物学基础,可能存在共同的发病机制。本文从癫痫共病抑郁的发病机制、临床诊断及治疗方面予以总结归纳。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Seclusion and restraint and prediction of violence

The authors studied the use of seclusion and restraint on an inpatient unit in a state psychiatric hospital. Of 69 randomly selected inpatients, 51% experienced seclusion or restraint at least once. More psychotic than nonpsychotic patients required seclusion or restraint. However, neither psychosis/nonpsychosis nor voluntary/involuntary admission status predicted the likelihood of violent threats or actions. Patients experiencing seclusion and restraint showed a nonsignificant trend toward longer mean length of stay in the hospital. The frequency of patient behavior leading to seclusion or restraint appeared to be directly related to the stimulation caused by the presence of many staff members and other patients.     

Comparison of trigeminal and spinal modulation of pain and nociception

Modulation of pain and nociception by noxious counterstimulation, also called "diffuse noxious inhibitory controls" or DNIC-like effect, is often used in studies of pain disorders. It can be elicited in the trigeminal and spinal innervation areas, but no study has previously compared effects in both innervation areas. Therefore, we performed a study comparing DNIC-like effects on the nociceptive flexion reflex (NFR) and the nociceptive blink reflex as well as the respective pain sensations. In 50 healthy volunteers, the blink reflex elicited with a concentric electrode and the NFR were recorded before and after immersion of the contralateral hand in cold water. Responses were recorded as the subjective pain sensation and the reflex size. The cold water immersion of the contralateral hand elicited a reduction of both subjective pain sensation and reflex amplitude following the stimulation of both reflexes. However, there were no strong correlations between the individual reductions of both subjective pain sensation and reflex amplitude for both reflexes, and neither when results of the two reflexes were compared with each other. The dissociation between DNIC-like effects on pain and on nociception, which had been found previously already for the NFR, implies that both effects need to be studied separately.