社区精神分裂症患者代谢综合征影响因素

背景 精神分裂症患者是罹患代谢综合征的高风险人群。既往关于代谢综合征影响因素的研究主要集中于住院精神分裂症患者,对社区精神分裂症患者的研究较少。目的 探索广州市社区精神分裂症患者不同代谢综合征风险层级的影响因素,为社区精神分裂症患者代谢综合征干预提供参考。方法 于2021年11月,选取广州市精神卫生信息系统在册在管且完成2020年度健康体检的精神分裂症患者3 339例。从信息系统导出患者健康体检资料,采用《中国2型糖尿病防治指南（2020年版）》评估患者是否罹患代谢综合征。根据《精神分裂症患者代谢综合征管理的中国专家共识》,将患者分为高风险组（n=423）、临界组（n=1 524）和代谢综合征组（n=1 392）。采用多元Logistic回归分析社区精神分裂症患者罹患代谢综合征的危险因素。结果 社区精神分裂症患者代谢综合征患病率为41.69%。单因素分析显示,三组在性别（χ²=44.610）、年龄（χ²=55.992）、婚姻状况（χ²=30.755）、病程（χ²=25.913）和体质量指数（χ²=829.265）方面差异均有统计学意义（P均<0.01）。Kruskal-Wallis H检验显示,三组患者腰围（H=920.331）、收缩压（H=436.673）、舒张压（H=393.337）、空腹血糖（H=807.304）、甘油三酯（H=1 134.125）、高密度脂蛋白胆固醇（H=593.615）水平差异均有统计学意义（P均<0.01）。Logistic回归分析显示,年龄≥50岁（OR=1.761,95% CI：1.087~2.853）、超重（OR=2.418,95% CI：1.862~3.140）和肥胖（OR=57.903,95% CI：14.340~233.802）是社区精神分裂症患者成为代谢综合征临界人群的危险因素（P<0.05或0.01）;女性（OR=1.295,95% CI：1.034~1.622）、年龄40~49岁（OR=2.597,95% CI：1.582~4.263）、年龄≥50岁（OR=4.392,95% CI：2.609~7.395）、超重（OR=7.844,95% CI：6.018~10.223）和肥胖（OR=426.785,95% CI：105.724~1 722.839）是社区精神分裂症患者成为代谢综合征人群的危险因素（P<0.05或0.01）。结论 社区精神分裂症患者代谢综合征患病率较高,女性、年长、超重和肥胖是精神分裂症患者罹患代谢综合征的高风险因素。     

老年急性缺血性脑卒中患者颈动脉斑块检出率及其与脑卒中复发的相关性

目的 应用多普勒彩色超声诊断仪评估老年急性缺血性脑卒中（AIS）患者颈动脉斑块检出情况,总结斑块发生的高危因素,并分析其与AIS复发的相关性。方法 以2020年1月至2020年6月于常州市第一人民医院神经内科和老年医学科住院的首次发生AIS,并且72 h内入院的老年患者236例为研究对象。依据颈动脉超声检查结果分为颈动脉斑块组（199例）和无颈动脉斑块组（37例）。收集并分析2组患者的临床资料及随访1.5年后脑卒中复发情况。结果 老年AIS患者颈动脉斑块检出率为84.3%。60~69岁、70~79岁及≥80岁患者颈动脉斑块检出率分别为74.7%、86.9%、96.0%,随着年龄增长颈动脉斑块检出率逐渐增加。颈动脉斑块组女性、高血压史和糖尿病史的比例明显高于无斑块组（均P<0.05）。颈动脉斑块组与无颈动脉斑块组脑卒中复发事件发生率比较,差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,年龄（OR=1.070,95%CI：1.02~1.122,P=0.005）、糖尿病史（OR=2.262,95%CI：1.055~4.850,P=0.036）、颈动脉斑块（OR=8.128,95%CI：1.077~61.348,P=0.042）是AIS复发的独立影响因素。结论 老年AIS患者颈动脉斑块检出率高。年龄、性别、高血压史、糖尿病史是颈动脉粥样硬化的危险因素。年龄、糖尿病史、颈动脉斑块与脑卒中复发事件发生相关。     

网络认知行为治疗对癌症患者心理痛苦、抑郁、焦虑和生活质量影响的Meta分析

背景 网络认知行为治疗（ICBT）越来越多地应用于缓解癌症患者的焦虑抑郁情绪,但目前尚无ICBT对癌症患者焦虑、抑郁、心理痛苦以及生活质量影响的荟萃分析。目的 运用系统评价的方法,探讨ICBT对缓解癌症患者心理痛苦、抑郁、焦虑症状以及提高生活质量的效果。方法 于2022年3月28日,以PubMed、PsycINFO、Embase、Cochrane Library、Web of Science、中国知网、维普、万方、中国生物医学文献数据库为数据源,系统收集关于癌症患者心理痛苦、抑郁、焦虑、生活质量、且以ICBT为治疗手段的随机对照试验（RCT）。评价纳入文献的偏倚风险后,采用Stata 17.0进行Meta分析。结果 共纳入12项RCT,包括1 686例患者。Meta分析结果显示,与对照组接受的干预措施相比,ICBT有助于缓解癌症患者的心理痛苦（SMD=-0.547,95% CI：-1.090~-0.145,P<0.01）,但对抑郁（SMD=-0.652,95% CI：-1.734~0.002,P=0.051）、焦虑（SMD=-1.045,95% CI：-3.656~0.101,P=0.088）以及生活质量（SMD=0.234,95% CI：-0.064~0.449,P=0.112）的改善效果不明显。ICBT组脱落率高于对照组（OR=1.795,95% CI：1.358~2.374,P<0.01）。结论 ICBT对癌症患者的心理痛苦有一定的缓解作用,但对抑郁和焦虑症状以及生活质量的改善不明显。     

张家口市气象因素变化与急性脑卒中疾病的相关性研究

目的 探讨张家口市气象因素变化与急性脑卒中疾病的相关性。方法 收集2018年2月至2020年6月在该院神经内科住院的1 426例患者资料进行回顾性分析。收集患者人口学特征、生活方式、入院时季节及入院时气候信息。根据患者入住医院病因是否为脑卒中将其分为2组,已确诊患有脑卒中疾病者为脑卒中组,其他疾病患者为非脑卒中组。比较2组患者上述各因素,并采用多因素Logistic回归分析判断各因素对脑卒中发病的综合作用。结果 调查的1 426例患者中共有327例(22.92%)为脑卒中患者,多因素Logistic回归分析结果显示,患者年龄增长(OR=1.474,95%CI=1.073~2.025)、有吸烟史(OR=1.493,95%CI=1.033~2.159 )、有饮酒史(OR=1.530,95%CI=1.094~2.139)、秋季(OR=1.418,95%CI=1.006~1.998)、冬季(OR=1.464,95%CI=1.035~2.071)、月平均气温下降(OR=1.486,95%CI=1.016~2.173)、月平均气压升高(OR=1.442,95%CI=1.009~2.060)为脑卒中发病的危险因素(P<0.05)。结论 张家口市脑卒中患者在秋、冬季节高发,月平均气温下降及月平均气压升高为张家口市脑卒中患者发病的危险因素,另外年龄、吸烟史、饮酒史也与脑卒中的发生密切相关。     

抗精神病药物对精神分裂症患者血尿酸水平影响的Meta分析

目的 探讨抗精神病药物对精神分裂症患者血尿酸水平的影响,明确抗精神病药物抗氧化性,为精神分裂症的治疗提供循证参考。方法 采用主题词+自由词的方式,计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据库、维普数据库、中国生物医学文献数据库,纳入抗精神病药物对精神分裂症患者血尿酸水平影响的对照研究。采用RevMan 5.4进行Meta分析。结果 纳入中英文文献共15篇,包括9种抗精神病药、1 434例精神分裂症患者。Meta分析结果显示,奥氮平（MD=14.01,95% CI：2.39~21.62,P<0.05）和氯丙嗪（MD=51.36,95% CI：42.15~60.57,P<0.05）可升高精神分裂症患者血尿酸水平,利培酮、阿立哌唑、氯氮平、氟哌啶醇、喹硫平和齐拉西酮对精神分裂症患者血尿酸水平的影响均无统计学意义（P均>0.05）。结论 不同种类的抗精神病药对精神分裂症患者血尿酸水平的影响不同,其中奥氮平和氯丙嗪可升高精神分裂症患者血尿酸水平,尚未发现其他抗精神病药物对患者血尿酸水平的影响。     

糖尿病/高血糖对脑出血预后的影响：动物实验meta分析

目的 通过提取动物实验相关数据,分析糖尿病／高血糖对脑出血预后的影响。方法 系统检索中国知网、万方、PubMed、Web of Science、Cochrane Library和Embase数据库,检索时间截止2021年11月1日。收集关于高血糖／糖尿病与脑出血的动物实验研究。严格按照纳入、排除标准进行筛选,采用随机效应模型或固定效应模型估计合并率及95%可信区间。采用SYRCLE动物实验偏倚风险评估工具进行质量评价。将最终纳入的研究通过Review Manager 5.3软件进行meta分析,以研究糖尿病／高血糖对脑出血预后的影响。结果 共纳入7篇动物实验,meta分析结果显示,在脑出血动物模型中,糖尿病／高血糖组血肿体积大于对照组(SMD=1.2, 95%CI=0.13～2.27, P<0.05)。进一步进行亚组分析,两组的前3 d血肿体积未见明显差异(SMD=0.68, 95%CI=-0.38～1.74, P>0.05);两组的第7天血肿体积存在差异性,糖尿病／高血糖组血肿体积大于对照组(SMD=3.26, 95%CI=0.21～6.31, P<0.05)。糖尿病／高血糖组血肿周围水肿(PHE)大于对照组(MD=1.57, 95%CI=0.71～2.44, P<0.05)。糖尿病／高血糖组神经功能评分大于对照组(SMD=1.06, 95%CI=0.50～1.62, P<0.05)。结论 在动物实验中,糖尿病／高血糖可增加脑出血的血肿体积、PHE,从而影响脑出血预后。 [国际神经病学神经外科学杂志, 2022, 49(3): 59-65.]     

大学生分裂型人格与创造性的关系：认知灵活性的中介作用

目的 探讨大学生分裂型人格与创造性的关系以及认知灵活性在其中的作用机制。方法 采用分裂型人格问卷（SPQ）、认知灵活性问卷（CFI）和威廉姆斯创造性倾向量表（WCAT）对471名大学生进行问卷调查。使用Spearman相关分析变量间的相关关系，使用Bootstrap方法分析认知灵活性的中介作用。结果 大学生SPQ总评分、阳性分裂维度、瓦解维度和CFI评分与WCAT评分均呈正相关（r=0.241~0.313，P均<0.01），SPQ总评分、阳性分裂维度、瓦解维度与CFI评分均呈正相关（r=0.111~0.128，P均<0.05）；认知灵活性在阳性分裂维度与创造性之间起部分中介作用［间接效应=0.052（95% CI：0.016~0.112，P<0.01），占总效应的11.93%］；认知灵活性在瓦解维度与创造性之间起部分中介作用［间接效应=0.075（95% CI：0.020~0.161，P<0.01），占总效应的11.50%］。结论 分裂型人格不仅直接影响大学生的创造性，还通过认知灵活性的中介作用间接影响大学生的创造性。     

经蝶垂体瘤手术后脑脊液漏多因素回归方程搭建及预测价值研究

目的 研究经蝶垂体瘤手术后脑脊液漏多因素回归方程搭建及预测价值。方法 分析2018年5月—2020年9月郴州市第一人民医院56例经蝶窦手术的垂体腺瘤患者资料,其中运用改良带蒂鼻中隔黏膜瓣32例,未用24例。筛查经蝶垂体瘤手术后脑脊液鼻漏的相关因素。结果 经蝶垂体瘤手术后脑脊液鼻漏与年龄大于65岁、肿瘤直径大于2 cm、术中鞍膈破裂、手术时间超过120 min都呈正相关（均P<0.05）,与用改良带蒂鼻中隔黏膜瓣呈负相关（P<0.05）。影响经蝶垂体瘤手术后脑脊液鼻漏的因素有再次手术（95％CI:1.205～859.886, P=0.038)、肿瘤直径大于2 cm(95％CI:1.371～375.766, P=0.029)、术中鞍膈破裂（95％CI:5.351～14461.621,P=0.005)、用改良带蒂鼻中隔黏膜瓣（95％CI:0.001～0.371, P=0.009)。模型预测值绘制ROC曲线及分析,得到AUC=0.971（95%CI：0.935~1.000）,敏感度为1,特异性为0.882。结论 再次手术、肿瘤直径大于2 cm、术中鞍膈破裂、未用改良带蒂鼻中隔黏膜瓣是经蝶垂体瘤手术后脑脊液漏的危险因素,而应用改良带蒂鼻中隔黏膜瓣能减少这种不良并发症的发生。     

产前抑郁风险预测简易模型的构建与验证

背景 近年来,孕妇心理问题已成为我国重要的公共卫生问题,抑郁是孕期最常见心理问题,目前研究多集中在产前抑郁的治疗方面,缺少产前抑郁风险预测模型的构建。目的 建立产前抑郁风险预测简易模型,为预防孕妇抑郁提供参考。方法 于2021年5月-2022年2月,连续选取在南充市三所医院就诊的803名孕妇为研究对象。采用自制问卷收集孕妇的社会人口学信息、产科与医学信息、心理信息,采用抑郁自评量表（SDS）评定其抑郁症状。按照8∶2有放回地、随机将研究对象分为模型组（n=635）和检验组（n=168）,采用二元Logistic回归分析孕妇抑郁的危险因素,构建预测模型,采用ROC曲线对预测模型的价值进行验证。结果 ①产前无伴侣陪伴（β=-0.692,OR=0.501,95% CI：0.289~0.868）、末次月经期情绪低落（β=-1.510,OR=0.221,95% CI：0.074~0.656）、末次月经期情绪紧张（β=-1.082,OR=0.339,95% CI：0.135~0.853）、婆媳关系不满意（β=-1.228,OR=0.293,95% CI：0.141~0.609）以及婆媳关系一般（β=-0.831,OR=0.436,95% CI：0.260~0.730）是孕妇产前抑郁的危险因素（P<0.05或0.01）。②模型组ROC曲线下面积（AUC）为0.698,95% CI：0.646~0.749,约登指数最大为0.357,灵敏度为0.606,特异度为0.751;检验组AUC=0.672,95% CI：0.576~0.767,约登指数最大值为0.263,灵敏度为0.556,特异度为0.707。结论 本研究构建的产前抑郁风险预测简易模型具有较好的判别效度。     

淀粉样脑血管病相关脑出血患者血肿增大的影响因素

目的 分析淀粉样脑血管病（CAA）相关脑出血患者住院期间血肿增大的影响因素。方法 分析2016年7月—2023年7月江南大学附属医院收治于神经外科、神经内科、急诊科符合CAA纳入标准的患者242例，将其分为血肿增大组48例和血肿无增大组194例，对影响血肿增大的因素进行Logistic分析。结果 Logistic分析显示高龄（OR：1.064，95%CI：1.018-1.113，P=0.006）、高收缩压（OR：1.063，95%CI：1.015-1.113，P=0.009）、使用三七类药物（OR：5.078，95%CI：2.191-11.766，P＜0.001）、高血钙水平（OR：0.033，95%CI：0.005-0.202，P=0.033）是CAA相关脑出血患者住院期间血肿增大的影响因素。结论 CAA相关脑出血患者血肿增大的影响因素中高龄、高收缩压、使用三七类药物为危险因素，高血钙水平为保护因素。     

Evidence for an alternative mechanism of human platelet secretion involving peripheralization of secretory granules and formation of membrane-associated multivesicular structures

Stimulated platelets release the content of their granules to the environment by a process known as platelet secretion. The precise mechanism of platelet secretion is poorly understood. The most widely-held theory suggests that, during platelet activation, secretory granules centralize and their content is released into the surface-connected canalicular system. Using fixation techniques directed at preserving membrane structures, morphological evidence is provided that human platelet activation is associated with secretory granules migrating to the periphery of platelets, where they undergo transition to participate in the formation of membrane-associated multivesicular structures. These multivesicular structures then undergo dissolution resulting in granule content secretion to the environment. The formation of the membrane-associated multivesicular structures occurs in platelets in which some of the secretory granules have also become centralized. This suggests that during the activation of human platelets, membrane-associated multivesicular structure release may occur concurrently with other mechanisms of secretory granule content release. The present observations are consistent, however, with the hypothesis that during human platelet activation the formation of membrane-associated multivesicular structures by platelet secretory granules contributes importantly to the mechanism of platelet secretion.     

Theoretical requirements for the density separation of platelets with comparison of continuous and discontinuous gradients

In continuous density gradients platelets will approach their equilibrium position with exponential deceleration. The time taken to reach an acceptable approximation to equilibrium will depend upon platelet radius, density and medium viscosity. If centrifugation is stopped before equilibrium has been achieved then platelet “subpopulations” produced will not be density dependent. Discontinuous gradients take longer to reach equilibrium. Separation of platelets by density must conform to theoretical physical criteria.     

抗栓前后血小板参数对非心源性脑梗死预后预测价值研究

目的探讨抗栓前及抗栓7 d后血小板计数(PC)、平均血小板体积(MPV)、血小板分布宽度(PDW)及MVP/PC比值和PDW/PC比值在急性非心源性脑梗死(NCCI)中是否具有预测预后的价值。方法纳入2018年12月-2019年7月入住常德市第一人民医院神经内科142例NCCI患者,均在入院第1天抗栓前行PC、MPV、PDW检测。抗栓后第7天,有94例患者完善了PC、MPV、PDW复查。采用改良Rankin量表(MRS)评估患者6个月时神经功能恢复状态,并将其分为预后良好组(MRS≤2分)及预后不良组(MRS>2分),比较上述血小板参数在两组之间的差异。结果不良预后组抗栓前的PC低于预后良好组(P <0.05),而抗栓前MPV/PC、抗栓后MPV、MPV/PC、PDW、PDW/PC高于预后良好组(P <0.05)。多因素Logistics回归分析发现抗栓治疗7 d后的MPV为NCCI不良预后的危险因素(O^R=7.669, 95%CI=1.527~38.528)。ROC曲线提示抗栓后MPV具有预测价值,最佳临界值是10.13fl,曲线下面积(AUC)0.787(P <0.05),灵敏度83.33%,特异度69.50%。结论抗栓治疗7 d后的MPV值为NCCI预后不良的危险因素,对其有预测价值。     

缺血性脑血管病常用药物对血小板聚集功能的影响

应用比浊法测定了川芎嗪，刺五加，维脑路通，潘生丁，阿斯匹林对２０例脑梗塞病人和１２例健康人的血小板聚集功能的影响。结果显示：不论是正常人还是脑硬塞病人，这些药物在体外都能抑制血小板聚集。其中川芎嗪对血小板聚集抑制作用最强，维脑路通作用最弱。     

ADP‐induced platelet aggregation in acute ischemic stroke patients on aspirin therapy

Background and purpose: Aspirin is an important therapeutic regimen to prevent the recurrent ischemic events or death after acute ischemic stroke. In this study, we evaluated the relationship between the extent of adenosine diphosphate (ADP) ‐induced platelet aggregation and outcome in acute ischemic stroke patients on aspirin therapy. Methods: We selected 107 acute ischemic stroke patients who had been prescribed aspirin and evaluated platelet function test by using optic platelet aggregometer test after 5 days of taking it and investigated the prognosis 90 days after ischemic events. Kaplan–Meyer curve was used for survival analysis. Results: After stratification of the subjected patients by tertiles of ADP‐induced platelet aggregation, the events rates were 7.4%, 9.3% and 30.8% (P = 0.023). In multiple logistic regression analysis, old age over 70 years (OR, 13.7; 95% CI, 2.14–88.07; P = 0.001) and the increased ADP‐induced platelet aggregation had independent significance to the risk of primary end‐points after acute ischemic stroke (OR, 1.1; 95% CI 1.01 to 1.20; P = 0.026). Conclusions: This study showed that the increased ADP‐induced platelet aggregation under using aspirin is associated with poor outcome after acute ischemic stroke.     

Effect of dietary linoleic acid on platelet function in the rat

The effect of different concentrations of dietary linoleic acid (from 0 to 6 %) in the form of corn oil, at the expense of hydrogenated coconut oil (HCO) (saturated fat) on platelet functions, was studied in male rats fed purified diets. Increased amounts of linoleic acid were associated with decreased susceptibility of platelets to thrombin-induced aggregation and prolongation of the platelet-rich plasma clotting time. Platelet functions of rats fed HCO (38 %) were also compared to those of rats fed diets lower (24–28%) in HCO, but high in either linoleic acid, oleic acid or glucose. Solely the group fed high amounts of linoleic acid presented a lower platelet aggregation than the group fed 38 % HCO. An increase in 18:1, 20:3ω9 and in the ratio 20:4/18:2 seems to be, in both studies, in the platelet phospholipid fatty acids, the change the most closely associated with the platelet enhanced activities. In rat, dietary linoleic acid is apparently responsible for a specific protective effect on platelet functions which cannot be observed by merely decreasing the level of saturated fat.     

Efflux of granule constituents from platelets exposed to different mechanical forces

The efflux of 14C-norepinephrine, 3H-serotonin and β-thromboglobulin from platelets was compared with the extent of lysis in two different systems of incubation, in which Ca²⁺ and conventional platelet activating agents were omitted. In the first system platelets were incubated in buffer at 37°C and gently shaken. Cell lysis was low and efflux of 14C-norepinephrine was 71–97% of total initial uptake after 24 hours. In the other system rotating plastic tubes at 20°C were used which exposed the platelets to higher mechanical stress. Cell lysis and aggregation was already high after 10–30 minutes, but the efflux of 14C-norepinephrine and 3H-serotonin was lower and not parallel to cell lysis. The release of 14C-norepinephrine was higher than that of 3H-serotonin in both systems. There was a considerable release of β-thromboglobulin from platelets remaining in plasma despite of a constant pH. These findings indicate that platelet lysis is independent of the release of platelet granule constituents.     

The relationship between the age and density of circulating 51-Cr labelled platelets in the sub-human primate

Change in the density of circulating platelets in monkeys was studied by using a method that removed greater than 90% of the platelet population from whole blood. These were labelled with 51-Cr and reinjected, having been protected by prostacyclin while in vitro. Platelets were separated into density subpopulations the following day by continuous linear gradients of polyvinyl pyrrolidone coated silica (Percoll) under conditions that approximated well to equilibrium centrifugation. The 51-Cr labelled platelets were then found to be distributed equally throughout all density subpopulations. When the same procedure was repeated at 5 days after re-injection an average of 5% of the density range increase in platelet density had occurred in the reinjected platelets compared to the circulating population (p less than 0.001). Lighter platelets may have a slightly shorter survival time than dense ones. Monkey platelet volume is log normally distributed.     

Influence of blood dilution on the findings of platelet aggregates in native venous blood fixed by edta-formalin

Healthy subjects and an heterogeneous group of patients were investigated by the Wu and Hoak test performed with low and high dilution of blood in the test mixtures (1:1 and 1:25 respectively). In normal subjects no significant difference was observed between the results obtained by the two procedures. Abnormal platelet aggregate ratio (P.A.R.) observed in patients with the 1:1 diluted test appeared to be normalized in almost all cases when using the 1:25 diluted test. Abnormal P.A.R. values observed in both procedures were not significantly associated with vascular thrombotic disorders. These results suggest that platelet aggregates as detected by the Wu and Hoak test may be formed in vitro through an interaction of formalin with undiluted non-specific plasma factors.     

The effect of myelin basic protein on the endogenous phosphorylation of platelets

Bovine myelin basic protein (BP) induced a shape change and endogenous phosphorylation of a 45,000 (45K) molecular weight protein of intact human platelets. This effect occurred rapidly over an effective concentration range of 5–100 uM BP. BP peptides encompassing residues 1–42, 43–88, and 89–169 from the BP molecule of 169 residues, neither induced phosphorylation of platelets nor blocked the effect of intact BP. Subfractionation of disrupted platelets demonstrated the phosphorylated 45K protein in the 100,000 xg supernate. When isolated platelet membranes were used. no BP induced phosphorylation of a 45K protein could be detected. The amino acid composition of the purified, phosphorylated 45K protein differed from those of other known platelet proteins. BP itself was also phosphorylated by an endogenous platelet protein kinase(s) present both in the 100,000 xg supernatant and in the isolated membrane fraction of platelets. These results indicate that the normal or pathological release of BP from myelin may lead to phosphorylation of an internal protein of platelets and possibly other tissue elements with resultant metabolic and functional changes.