脑膜炎患者脑脊液中肿瘤坏死因子α、乳酸脱氢酶及其同工酶检测的临床意义

目的 探讨脑膜炎患者脑脊液(CSF)中肿瘤坏死因子α(TNF-α)、乳酸脱氢酶(LDH)及其同工酶检测的临床意义.方法 收集53例化脓性脑膜炎患者(化脑组)、58例病毒性脑膜炎患者(病脑组)、49例结核性脑膜炎患者(结脑组)、60例非神经系统感染性疾病患者(对照组)的CSF样本,采用酶联免疫吸附法(ELISA)测定TNF-α水平,采用酶测速率法测定LDH的活性,采用琼脂糖凝胶电泳法测定LDH同工酶含量,并进行比较.结果 3组脑膜炎患者CSF TNF-α含量明显高于对照组[(25.64±20.08)pg/L],其中化脑组[(462.24±368.13)pg/L]明显高于病脑组[(73.47±68.74)pg/L]及结脑组[(62.97+40.58)pg/L](均P＜0.01),病脑组与结脑组间差异无统计学意义.化脑组CSF LDH水平[(201.37±148.06)U/L]显著高于其他各组(均P＜0.01),结脑组[(170.32±86.45)U/L]明显高于病脑组[(79.54±43.71)U/L](P＜0.01);但病脑组[(79.54±43.71)U/L]与对照组[(64.56±49.68)U/L]间差异无统计学意义.化脑组LDH4[(22.83±2.08)U/L]、LDH5[(35.26±2.18)U/L]明显高于其他各组,LDH1[(7.84±1.15)U/L]、LDH2[(13.01±1.46)U/L]明显低于其他各组(均P＜0.01);结脑组LDH3[(29.48±3.24)U/L]较对照组[(16.13±3.95)U/L]明显升高(P＜0.01);而病脑组同工酶谱与对照组比较差异无统计学意义.结论 CSF中TNF-α、LDH及LDH同工酶水平检测有助于不同类型脑膜炎的鉴别诊断.     

可溶性DLL1检测在结核性脑膜炎早期诊断中的价值探讨

目的 探讨脑脊液(CSF)及血清中可溶性Delta-Like-Ligand 1 (DLL1)的检测对结核性脑膜炎(结脑)早期诊断的临床意义. 方法 选取郑州大学第一附属医院神经内科自2008年12月至2011年3月收治的CNS感染性疾病患者110例,其中结脑患者50例、病毒性脑(膜)炎(病脑)患者30例、化脓性脑膜炎(化脑)20例、隐球菌脑膜炎(隐脑)10例,另正常对照组30例.ELISA法测定各组受试者入院后CSF、血清中可溶性DLL1的含量,动态观察结脑组患者治疗后不同时间CSF中DLL1的含量并分析DLL1含量与CSF蛋白、细胞数的相关性. 结果 与病脑组、化脑组、隐脑组、正常对照组比较,结脑组患者CSF、血清中DLL1的含量增高,差异有统计学意义(P＜0.05),而病脑组、化脑组、隐脑组与正常对照组之间相比差异无统计学意义(P＞0.05).治疗好转的14例结脑患者CSF中DLL1含量在第2、4、6周逐渐降低,而治疗加重的4例患者CSF中可溶性DLL1含量第1、2(4)、6周逐渐升高,差异均有统计学意义(P＜0.05).结脑患者CSF中DLL1的含量与CSF蛋白、细胞数均无明显相关关系. 结论 CNS感染时结脑患者的CSF和血清中可溶性DLL1的含量显著增高,对于结脑的早期鉴别诊断具有重要参考意义.     

血清尿酸水平与中枢神经系统感染的相关性研究

目的 探讨血清尿酸(serum uric acid,SUA)与中枢神经系统感染(central nervous system infections,CNSI)发病机制的关系,为CNS1的病情评估及临床治疗开辟新途径.方法 收集CNSI患者357例,包括病毒性(脑膜)脑炎(病脑)97例、脑囊虫病65例、结核性(脑膜)脑炎(结脑)74例、隐球菌性(脑膜)脑炎(隐脑)75例以及细菌性(脑膜)脑炎(化脑)46例,以132例多发性硬化( multiple sclerosis,MS)患者及89名健康体检者( healthy controls,HC)作为对照.各CNSI组给予临床常规药物治疗:病脑患者予盐酸伐昔洛韦等抗病毒,脑囊虫病患者予阿苯达唑驱虫,结脑患者给予异烟肼、利福平、乙胺丁醇、吡嗪酰胺、莫西沙星5联抗结核,隐脑患者予两性霉素B、5氟胞嘧啶、氟康唑等抗真菌,化脑患者给予头孢曲松钠等抗细菌治疗.检测各组对象治疗前及治疗后病情稳定时的静脉血SUA水平并进行比较.结果 CNSI患者中病脑、脑囊虫病、化脑、结脑和隐脑组SUA水平[分别为(264.94±120.67)、(264.86士96.97)、(170.22士102.02)、(200.04士129.81)、(179.59士106.77) μmol/L]均显著低于HC组[(312.06土92.76)μmol/L](均P＜0.01).病脑组和脑囊虫病组SUA水平与MS组[(244.48±111.86) μmol/L]无统计学差异(均P＞0.05),而化脑、结脑和隐脑组SUA水平均低于MS组(均P＜0.01),也低于病脑组(均P=0.000)和脑囊虫病组(均P＜0.01).治疗后CNSI各组患者SUA水平(病脑、脑囊虫病、结脑、隐脑和化脑组分别为(290.92士111.80)、(278.59士80.86)、(458.89±189.32)、(232.41土138.11)、(195.73士103.69)μmol/L]较治疗前[(242.86士105.12)、(249.07±90.59)、(240.17士169.74)、(181.06±101.89)、(153.11士120.55)μmol/L]均明显升高.结论 CNSI患者SUA水平降低.     

脑脊液中免疫球蛋白及腺苷脱氨酶测定对三种脑膜炎的诊断价值

目的 对不同病因的脑膜炎患者的脑脊液(CSF)中的免疫球蛋白(Ig)各组及腺苷脱氨酶(ADA)含量进行分析。方法 选取3组脑膜炎患者的CSF标本32份，对其中的Ig成分及ADA的含量进行测定。结果 结脑患者的CSF中ADA含量显著升高，IgG显著增高(P＜0．01)；化脑患者CSF中IgG显著增高(P＜0．01)，ADA无显著性变化；病脑患者CSF中Ig、ADA均没有显著性变化。结论 对脑膜炎患者CSF中Ig各组分及ADA含量的联合测定对病因的鉴别诊断具有很高的应用价值。     

病毒性脑炎及化脓性脑膜炎患儿血清血管内皮细胞钙黏蛋白降钙素原的变化及意义

目的探讨血管内皮细胞钙黏蛋白(VE-cadherin)、血清降钙素原(PCT)在病毒性脑炎、化脓性脑膜炎患儿中的临床诊断价值。方法选择病毒性脑炎患儿62例(病脑组),化脓性脑膜炎患儿40例(化脑组)作为研究对象,无热惊厥非感染患儿40例作为对照组。采用酶联免疫吸附法(ELISA法)测定血清VE-cadherin、PCT浓度。结果 3组血清VE-cadherin、PCT水平比较,差异有统计学意义(P0.01)。化脑组血清VE-cadherin水平高于对照组、病脑组(P0.01),病脑组高于对照组(P0.01)。化脑组血清PCT水平高于对照组和病脑组(P0.01),而病脑组PCT水平较对照组差异无统计学意义(P0.01)。病脑组VE-cadherin异常升高率高于PCT,差异有统计学意义(P0.01);化脑组血清VE-cadherin异常升高率为82.5%,PCT异常升高率为100%,两者比较差异有统计学意义(P0.05)。2组间比较,化脑组血清VE-cadherin异常升高率差异无统计学意义(P0.05);血清PCT异常升高率高于病脑组(P0.05)。病脑组血清VE-cadherin与CSF清蛋白呈正相关(P0.05),血清PCT水平与血WBC、CRP、CSF指标均无相关性(P0.05),血清VE-cadherin与PCT水平无相关性(P0.05);化脑组血清VE-cadherin、PCT浓度与血WBC、CRP、CSF清蛋白、CSFWBC均呈正相关(P0.05),血清VE-cadherin和PCT水平呈正相关(P0.05)。结论检测血清VE-cadherin、PCT浓度对病毒性脑炎、化脓性脑膜炎的诊断和鉴别诊断具有重要的临床意义。     

中枢神经系统感染患者脑脊液乳酸和神经元特异性烯醇化酶浓度的临床价值

目的通过观察中枢神经系统感染患者脑脊液乳酸(LA)和神经元特异性烯醇化酶(NSE)浓度,以鉴别病毒性脑膜炎(病脑)、化脓性脑膜炎(化脑)、结核性脑膜炎(结脑)。方法选取住院的中枢神经系统感染患者85例,其中化脑组25例、结脑组26例、病脑组34例。30例外科手术患者为对照组。用酶显色法测定脑脊液LA浓度;用ELISA法测定脑脊液NSE浓度。结果化脑组和结脑组患者脑脊液乳酸浓度明显高于病脑组和对照组(分别为P0.01和P0.05),其浓度依次为化脑组结脑组病脑组对照组,但化脑组与结脑组及病脑组与对照组脑脊液LA浓度比较差异无统计学意义(P0.05);病脑组、结脑组患者脑脊液NSE浓度均明显高于化脑组和对照组(P0.01),其浓度依次为病脑组结脑组化脑组对照组,但病脑组与结脑组及化脑组与对照组脑脊液NSE水平比较差异无统计学意义(P0.05)。结论脑脊液LA和NSE浓度检测有助于病脑、化脑和结脑间的临床鉴别诊断。     

老年卒中后抑郁患者血清细胞因子的研究

目的 探讨老年卒中后抑郁患者(PSD)血清细胞因子白细胞介素-1β(II-1β)、白细胞介素-6(IL-6)以及肿瘤坏死因子(TNF-α)的水平.方法 采用酶联免疫吸附法检测PSD组(36例)及卒中后无抑郁患者(对照组;32例)的血清IL-1β、IL-6及TNF-α水平,并以汉密尔顿抑郁量表(HAMD)评分将PSD组分为轻度组(8～16分;9例)、中度组(17～23分;17例)及重度组(≥24分;10例),比较各组血清IL-1β、IL-6及TNF-α水平的差异.结果 (1)PSD组血清IL-1β[(35.2±4.2)ng/L]、IL-6[(11.3±4.3)ng/L]及TNF-α[(32.4±6.9)ng/L]水平,均高于对照组[分别为(18.1±3.3)ng/L、(6.1±1.9)ng/L及(21.6±4.8)ng/L;P＜0.01];(2)卒中后重度抑郁组血清IL-1β[(41.8±3.2)ng/L]、IL-6[(17.5±5.7)ng/L]及,TNF-α[(38.8±5.8)ng/L]水平,均高于轻度抑郁组[分别为(29.1±2.3)ng/L、(6.6 ±1.7)ng/L及(25.9 ±3.3)ng/L;P＜0.05]、中度抑郁组[分别为(34.6±2.6)ng/L、(10.2 ±3.5)ng/L及(32.1±3.6)ng/L;P＜0.05],中度抑郁组亦高于轻度抑郁组(P＜0.05);(3)血清IL-1β(r=0.637)、IL-6(r=0.698)、TNF-α(r=0.722)水平均与抑郁的严重程度显著相关(P＜0.01).结论 IL-1β、IL-6及TNF-α可能在卒中后抑郁的发生发展中起重要作用.     

脑脊液MMP-9 IGF-Ⅱ水平检测在颅内感染鉴别诊断中的意义

目的探讨血清和脑脊液中基质金属蛋白酶9(MMP-9)、胰岛素样生长因子-2(IGF-Ⅱ)在化脓性脑膜脑炎和病毒性脑炎鉴别诊断中的应用价值。方法选取入院24h内92例明确诊断中枢神经系统感染患者,其中化脓性脑膜脑炎(化脑组)18例,病毒性脑炎(病脑组)74例和20例非中枢神经系统感染者(对照组)的脑脊液,应用酶联免疫吸附(ELISA)法测定血清及脑脊液(CSF)中MMP-9及IGF-Ⅱ浓度。结果血清及CSF中MMP-9含量比较:化脓性脑膜脑炎和病毒性脑炎组均较对照组显著升高(P0.05),化脓性脑膜脑炎组明显高于病毒性脑炎组(P0.05)。血清及CSF中IGF2Ⅱ含量比较,化脓性脑膜脑炎组CSF中IGF2Ⅱ含量高于病毒性脑炎组及对照组(P0.01),血清IGF2Ⅱ含量化脓性脑膜脑炎组低于病毒性脑炎组及对照组(P0.01),病毒性脑炎组与对照组比较差异无显著性。结论联合测定血清及脑脊液MMP-9及IGF-Ⅱ含量的变化,有助于颅内感染早期鉴别诊断。     

儿童脑膜炎脑脊液中前列腺素的变化

本文对24例脑膜炎患儿包括结核性脑膜炎(结脑)、化脓性脑膜炎(化脑)、病毒性脑膜炎(病脑)和9例非中枢神经系统感染儿童脑脊液(CSF)中前列腺素(PG_s)包括PGF_(2α)PGF_2、6—酮—PGF_(1α)含量进行了测定。结果表明,脑膜炎患儿CSF中PG_s三项指标皆较对照组显著升高,其中以结脑组最高,PGF_(2α)在三项指标中升高尤为明显,表明PG_s在脑膜炎炎症反应及组织损伤过程中生成增多并释放至CSF中。     

病毒性脑炎及化脓性脑膜炎患儿脑脊液1-磷酸鞘氨醇水平的变化

目的探讨病毒性脑炎及化脓性脑膜炎患儿脑脊液(CSF)1-磷酸鞘氨醇(S1P)的变化。方法选取病毒性脑炎患儿30例,化脓性脑膜炎患儿30例以及非颅内感染患儿(对照组)20例,采用酶联免疫吸附试验定量测定CSF中S1P水平。结果化脑组CSF中S1P水平高于病脑组及对照组[(0.217±0.017)nmol/L vs(0.191±0.010)nmol/L、(0.172±0.015)nmol/L,P0.05];病脑组CSF中S1P的水平高于对照组[(0.191±0.010)nmol/L vs(0.172±0.015)nmol/L,P0.05]。结论 S1P参与儿童颅内感染发病过程,在不同病原导致的颅内感染中作用程度可能不同。     

Mental illness in England,in Scotland and in Scots living in England

Summary Beginning from the observation that Scots living in England have much higher rates of mental hospital admission than do the English, several hypotheses are proposed to account for this. Much of the excess in rates of mental illness is accounted for by those diagnosed as having alcohol-related disorders and behaviour and personality problems. The results of an examination of offical statistics in the two countries enabled some explanations to be offered. It was found that rates of admissions to mental hospitals are higher in Scotland than in England but not as high as those found among Scots migrants who have a much higher rate of readmission to hospitals than either of the other groups. In fact, if first admissions only are considered the rates of admission in Scotland are not only higher than rates for English natives but also higher than for Scottish migrants. It seems that Scots living in England are somewhat less likely to become mental patients than Scots in Scotland but that once they do achieve this status they are very much more likely to be readmitted on subsequent occasions. It was concluded that there might be two fairly distinct groups of migrants from Scotland to England who have different backgrounds, different reasons for migrating and different psychological characteristics. On the one hand there are stable, economically motivated migrants who move south for definite employment related reasons and who show few psychological symptoms. While on the other hand there is a group of migrants who perhaps have psychological problems and who move more in hope than expectation without definite prospects and who account for the high rates of mental hospital admission found in Scottish migrants.     

Prostacyclin release in the coronary circulation during sustained stimulation in in vitro and in in vivo experimental systems

Prostacyclin release from rat isolated perfused hearts and from dog coronary circulation was studied by measuring immunoreactive 6-keto-PGF1 alpha (6-keto-PGF1a) in heart perfusate and in plasma obtained from the great cardiac vein respectively. Continuous infusion of arachidonic acid at constant concentration in isolated perfused hearts induced an increased prostacyclin release. This release showed a rapid peak within 10 min and a subsequent decrease. Low-flow ischemia induced an increased perfusate concentration of 6-keto-PGF1a but, considering the decreased flow, prostacyclin release was actually reduced. During the whole period of ischemia (60 min) prostacyclin release was constant. In open-chest anesthetized dogs 6-keto-PGF1a concentration in the great cardiac vein was increased after ligation of the left anterior descending coronary artery. A prolonged period of coronary occlusion (4.5 hours) resulted in a progressive rise of prostacyclin release. 6-keto-PGF1a determinations in the femoral vein and in the aorta did not show relevant variations during the observation period.     

癫痫与抑郁关系的研究进展

抑郁是癫痫患者中常见的精神障碍,严重地影响了患者的生活质量。传统的观点认为癫痫患者因为存在着诸多社会学问题易出现抑郁倾向,癫痫和抑郁是单向的联系,但大量的研究已经证明癫痫和抑郁之间存在双向的联系,一种异常状态的存在可能易转化为另一种异常状态的发展。癫痫和抑郁存在着共同的发病机制。本文主要就癫痫和抑郁的双向联系以及抗抑郁药物在癫痫患者中的应用进行阐述。     

神经介入：回眸2022

<正>2022年,国际上公布了多项大型神经介入领域的随机对照试验（randomized controlled trial,RCT）结果,在血管内治疗（endovascular treatment,EVT）急性大血管闭塞（large vessel occlusion,LVO）适应证的扩展、药物治疗、管理,症状性颅内动脉粥样硬化性狭窄（symptomatic intracranial atherosclerotic stenosis,sICAS）治疗,无症状性颈动脉狭窄治疗,     

Neuroimaging in epilepsy in tropics

Epilepsy is a major public health problem in many tropical countries. Also, some of the tropical diseases are major contributors to the higher prevalence of epilepsy in these countries. The etiologic factors responsible for epilepsy in these countries are quite different from those in the developed world. This article discusses the etiologic factors and neuroimaging of epilepsy in light of the conditions in these tropical countries.