5-羟色胺2A受体基因多态性与抑郁症的关联研究

目的探讨5-羟色胺2A（5-HT2A）受体基因T102C和A-1438G多态性与抑郁症的关系。方法采用聚合酶链式反应（PCR）和限制性片断长度多态性（RFLP）技术检测123例抑郁症患者和122名健康对照的T102C和A-1438G基因多态性分布,病例-对照关联分析法分析两组间基因型频率和等位基因频率的差异。结果5-HT2A基因T102C多态性等位基因频率和A-1438G等位基因频率在患者组和对照组间的分布均有显著性差异（P〈0．05）,患者组C102等位基因频率（30．1％）明显低于对照组（41．0％）,在分层分析中,男性患者组中频率（26．2％）明显低于男性对照组（50．0oA）;患者组A-1438等位基因型频率（69．1％）明显高于对照组（56．6％）,A-1438等位基因在女性患者组中频率（69．1％）明显高于女性对照组（55．2％）。患者组中TT／AA（T102T／A-1438A）基因型组合频率（43．9％）明显高于对照组（20．5％）。结论5-HT2A基因T102C和A-1438G多态性可能与抑郁症的发病有关,其中C102等位基因可能是男性罹患抑郁症的保护因子,A-1438等位基因可能是抑郁症特别是女性抑郁症患病的危险因子,T102T和A—1438A基因型同时出现可能是抑郁症发病的重要危险因素。     

儿茶酚邻甲基转移酶基因多态性与焦虑症的关联研究

目的探讨焦虑症与儿茶酚邻甲基转移酶基因多态性的相关性。方法运用聚合酶链反应技术检测88例焦虑症患者和87例健康对照儿茶酚邻甲基转移酶基因多态性,并加以对照分析。结果患者组高活性H型（G）和低活性L型（A）等位基因频率分别为81％、19％,对照组分别为67％和33％,两组间的差异均有显著性（P〈0．05）;患者组G／G、G／A、A／A基因型分布频率分别为61％、39％、0,对照组分别为40％、53％和7％,除G／A基因型在两组间差异无显著性（P〉0．05）外,G／G和A／A基因型在两组间差异均有显著性（P〈0．05）;焦虑症亚型间各基因型、等位基因频率比较的差异均无显著性（P〉0．05）。结论COMT的G等位基因、G／G基因型可能是焦虑症的危险因素之一,A等位基因、A／A基因型可能是焦虑症的保护基因之一;焦虑症两种亚型间COMT多态性无显著性差异。     

可诱导协同刺激分子、CD28、CD24基因多态性与多发性硬化的相关性

目的探讨可诱导协同刺激分子（ICOS）、CD28、CD24基因多态性与多发性硬化（multiple sclerosis，MS）遗传易患性的相关性。方法以来自中国汉族人群的83例确诊MS患者和110例非自身免疫性疾病的患者及健康志愿者为研究对象，利用聚合酶链．限制性长度多态性分析（PCR-RFLP）技术检测3个基因扩增产物酶切多态性。结果ICOS-2394位点TT基因型频率MS组明显高于对照组（分别为33．7％和10．9％，P〈0．01），携带T等位基因可增加MS患病危险性（OR=3．482，P〈0．01）；ICOS-2119位点携带C-等位基因MS组明显低于对照组（分别为4．8％和15．5％，P〈0．05）。CD28-372位点基因型等位基因频率分布MS组与对照组差异无统计学意义。CD24 E2＋226位点T等位基因频率MS组较对照组增多（分别为44．6％和33．2％，P〈0．05）。单倍体型关联分析显示CD24 E2＋226T等位基因分别与ICOS-2394T及ICOS-2119C联合可明显增加MS患病危险性，CD28基因多态与ICOS基因多态构成的单体型在MS和对照组中差异无统计学意义。结论中国汉族人群ICOS-2394C／T、ICOS-2119C／T及CD24E2＋226C／T多态性与Ms发病相关，两基因可能均是MS的易患基因或与易患基因相连锁。CD28-372位点多态性与MS患病无直接相关。     

5-羟色胺1Dβ受体基因861G／C多态性与强迫症关联的病例对照研究

目的：探讨5-羟色胺lDr3受体（5-HTRlDβ）基因861G／C多态性与强迫症的关联性。方法：对239例强迫症（强迫症组）患者和337名健康对照（对照组）通过聚合酶链式反应与限制性片段长度多态性基因分型技术对5-HTRlDB基因单核苷酸多态性位点861G／C进行基因分型。结果：861G／C位点基因型频率分布两组问比较差异有统计学意义（X2=7．59,df=2,P=0．023）,而等位基因频率分布差异无统计学意义;杂合子GC基因型与纯合子（GG＋CC）基因型（X。=4．59,P=0．03,OR=1．44,95％CI：1．03～2．01）或CC基因型与GG＋GC基因型（X2=6．85,P=0．009,OR：0．58,95％C1=0．38～0．87）两组间比较差异有统计学意义,而GG基因型与GC＋CC基因型差异无统计学意义。两组女性之间比较,基因型（）f。=11．98,df=2,P：0．0025）与等位基L天J频率（X。=4．90,af=1,P=0．03,OR=1．51,95％C1=1．05～2．17）分布差异有统计学意义,而两组男性之间比较,基因型与等位基因频率分布差异无统计学意义。,强迫症晚发（〉16岁）组与对照组基因型频率分布差异有统计学意义（×。=6．45,妙=2,P=0．04）,而等位基因频率分布差异无统计学意义;强迫症早发（≤16岁）组、强迫症临床3个亚组基因型与等位基因频率分布上与对照组之间差异均无统计学意义。结论：5-HTR1Dβ861G／C多态性可能与强迫症和晚发型强迫症仔在关联;G等位基因可能是女性强迫症的风险因子。     

多药耐药基因1C3435T多态性在癫(癎)患者中的分布

目的了解多药耐药基因1（MDR1）C3435T多态性在癫痫患者分布特点，探讨其与患者耐药的相关性。方法用常规酚-氯仿法提取72例癫痫药物治疗耐药患者和62例癫痫药物治疗有效患者的外周血DNA，应用PCR-RFLP方法检测其MDR1基因外显子26（exor26）C3435T的多态性。结果患者的MDR13435位点存在3种基因型，野生型CC、杂合突变型CT和纯合突变型TT在134例癫痫患者中分布频率分别为24．63％、53．73％和21．64％。TT基因型在耐药患者组和药物有效组中分别为18．1％和25．8％，CT基因型分别为48．6％和59．7％，差异均无统计学意义（P：0．277和P=0．200）。CC基因型在耐药患者组中的频率为33．3％，在药物有效组为14．5％，两者比较差异有统计学意义（P=0．012）。等位基因C和T在癫痫人群中分布频率为51．5％和48．5％，其中C等位基因在耐药组的频率（57．6％）明显高于药物有效组（44．4％）；相反，T等位基因在药物有效组的频率（55．6％）分布要高于耐药组（42．3％，P=0．03）。结论MDR1基因多态性分布中，CC基因型、C等位基因可能与癫痫耐药有关。癫疴治疗有效可能与TT基因型、T等位基因有相关趋势。     

载脂蛋白E基因多态性与血管性痴呆的关系

目的 探讨载脂蛋白E（ApoE)基因多态性与血管性痴呆（VD）的关系。方法 采用PCR－RFLP方法对VD组47例，脑梗死组（CI）46例，正常对照组60人进行ApoE基因型测定。结果 VD组，CI组与正常对照组ApoE基因型频率分布，以3／3型所占比率最高。VD组4／3占第2位（27．7％），与正常对照组（18．33％）比较有显著差异（P＜0．05）。各组ApoE等位基因频率比较，VD组ApoEε4高于对照组（P＜0．05）。C1组与正常对照组之间ApoE基因型频率及等位基因频率比较无显著差异。结论 ApoEε4等位基因可能是VD发生的遗传危险因素这一。本研究不支持ApoEε4等位基因可以增加发生CI的危险性。     

脂联素基因多态性在抗精神病药对糖脂代谢影响中的意义

目的了解精神分裂症患者的脂联素基因外显子2T45G多态性,并探讨其与应用非典型抗精神病药治疗相关的肥胖以及糖代谢的关系。方法入组患者组125例为应用非典型抗精神病药的精神分裂症患者,正常对照组59例。提取两组基因组DNA,采用聚合酶链式反应-限制片段长度多态性技术,检测脂联素（Adi）基因外显子2T45G多态性和等位基因分布频率。采用免疫酶吸附（ELISA）法分别测定两组血脂,空腹血糖、胰岛素水平计算胰岛素抵抗指数（HOMA-IR）,测量身高、体质量,计算体质量指数（BMI）,并将两组对照比较。结果使用抗精神病药的患者与正常对照组之间脂联素基因型分布及等位基因频率均差异无显著性（χ^2=0．723,0．257;P=0．697,0．613）。携带TG／GG基因型患者的BMI显著高于携带TT型患者（23．53±2．77vs22．37±3．11,P〈0．05）,且携带TG／GG型患者低密度脂蛋白（LDL—C）水平显著高于携带,TT型患者（2．67±0．85vs2．28±1．15,P〈0．05）。携带TT和TG／GG型基因的患者之间的胰岛素抵抗及血脂其他各项差异均无显著性（P〉0．05）;多元线性回归分析示Adi基因外显子2T45G多态性与HOMA—IR并不相关。结论Adi基因外显子2T45G多态性与非典型抗精神病药物治疗相关的脂代谢异常相关,但不是影响血糖代谢障碍的基因危险因子。     

Cav1.1基因26内含子67位点A/G多态性与甲状腺功能亢进性周期性瘫痪的相关性研究

目的探讨钙通道α1亚基（Cav1．1）基因26内含子-67A／G多态性与男性甲状腺功能亢进（简称甲亢）性周期性瘫痪（TPP）的相关性。方法采用多聚酶链反应-单链构象多态性（PCR-SSCP）方法检测46例男性TPP患者（TPP组）、68例男性甲亢患者（GD组）和72名男性健康对照者（CON组）Cav1．1基因26内含子-67A／G多态性。分析比较此多态位点基因型和等位基因在不同人群中分布的差异。结果（1）TPP组、GD组及CON组AG＋GG基因型频率分别为47．83％、14．71％、29．17％，G等位基因频率分别为44．57％、13．24％、27．78％。（2）TPP组AG＋GG基因型频率明显高于GD组和CON组（OR=5．32，P〈0．01；OR=2．23，P=0．04），TPP组G等位基因频率明显高于GD组和CON组（OR=5．27，P〈0．01；OR=2．09，P=0．008）。结论Cav1．1基因26内含子-67位点A／G多态性与男性TPP有相关性。     

儿童孤独症与儿茶酚氧位甲基转移酶基因多态性的关联研究

目的探讨儿童孤独症与儿茶酚氧位甲基转移酶（COMT）基因多态性的关系。方法应用聚合酶链反应和限制性片段长度多态性技术，检测67例孤独症患儿（孤独症组）及其父母（父母组）的COMT基因多态性，采用传递不平衡检验（TDT）方法分析儿童孤独症核心家系COMT基因与孤独症的关系。结果（1）孤独症组COMT基因A／A基因型频率（4．5％）高于父母组（0例），A／G基因型频率（26．9％）低于父母组（38．5％），C／G基因型频率（68．7％）也高于父母组（61．5％），差异有统计学意义（X^2=6．593，P〈0．05）。（2）TDT检验未发现孤独症与COMT基因相连锁（P〉0．05）。结论孤独症患儿组与父母组的COMT基因多态性的差异存在统计学意义，未发现COMT基因与孤独症的发病存在传递不平衡，COMT基因可能是孤独症的易感基因。     

青年缺血性卒中的TOAST病因分型及相关基因研究

目的：探讨青年缺血性卒中的TOAST病因分型，各分型与血浆纤维蛋白原（Fg）、总同型半胱氨酸（tHcy）浓度及相关基因Fgβ-148C／T、MTHFR 677C／T多态性的关系。方法：98例中国北方汉族青年急性缺血性卒中按照TOAST标准进行病因分型，检测血浆Fg和tHcy浓度；应用聚合酶链式反应-限制性片段长度多态性对患者和60例相匹配的青年对照者进行Fgβ-148C／T、MTHFR 677C／T多态性分析。结果：本组TOAST病因分型心源性脑栓塞（CE）13．27％，大动脉粥样硬化性卒中（LAA）23．47％，小动脉闭塞性卒中（SAO）28．57％，其他原因引发的卒中（OC）19．39％，原因不明性缺血性卒中（UND）15．31％。TOAST各型青年缺血性卒中血浆Vg、tHcy浓度均明显高于对照组（P〈0．05）。其中，LAA型血浆Fg、tHcy浓度最高，但与其他各型无显著差异（P〉0．05）。缺血性卒中组Fgβ-148和MTHFR 677 T等位基因频率和各基因型与对照组无显著差异（P〉0．05）。LAA型Fgβ-148T等位基因频率和CT＋TT型比例显著高于对照组（P〈0．05），其余各型无显著差异（P〉0．05）。与吸烟、饮酒进行联合分析，缺血性卒中组Fgβ-148或MTHFR 677基因T携带者同时吸烟或饮酒所占比例均高于对照组，但仅Fgβ-148CT／TT同时吸烟及MTHFR 677 CT／TT同时饮酒比例显著高于对照组（P〈0．05）。结论：青年缺血性卒中病因复杂，血浆Fg和tHcy浓度增高是青年缺血性卒中的独立危险因素。Fgβ-148T等位基因可能是大动脉粥样硬化性卒中的遗传易感因素。Fgβ-148与MTHFR 677T等位基因分别与吸烟、饮酒协同作用影响青年缺血性卒中的发病。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.