脑白质疏松与认知功能障碍关联分析

目的探讨认知功能障碍与脑白质疏松的关系。方法选取2010年8月-2012年8月在柳州医学高等专科学校第一附属医院就诊的80例脑白质疏松患者为研究对象,根据脑白质疏松的CT或MRT表现将患者分为对照组和观察组,每组各40例。采用老年认知功能障碍筛查工具(MMSE,即Mini-Mental State Examination)进行评分,根据Aharon-Ptretz标准对脑白质疏松程度进行分级,观察比较两组患者认知功能障碍以及MMSE评分情况,分析脑白质疏松程度与认知功能障碍的关系。结果观察组无认知障碍10例,轻度认知障碍16例,中度认知障碍10例,重度认知障碍4例,认知障碍发生率为75.0%,MMSE评分为(21.52±7.58);对照组无认知障碍31例,轻度认知障碍4例,中度认知障碍3例,重度认知障碍2例,认知障碍发生率为22.5%,MMSE评分为(26.45±5.33)分。对照组MMSE评分显著高于观察组,认知障碍发生率明显低于观察组,两组之间具有显著差异(P<0.05)。结论脑白质疏松是导致认知功能障碍的因素之一,脑白质疏松可能引起不同程度的认知功能障碍。     

老年糖尿病合并急性心肌梗死患者抑郁焦虑状况研究

目的 探讨老年糖尿病合并心肌梗死患者的焦虑、抑郁状态及其并发症发生情况.方法 将232例60岁以上老年急性心肌梗死患者分为糖尿病合并心肌梗死组(128例,DM-AMI组)和非糖尿病合并心肌梗死组(104例,NDM-AMI组),采用问卷调查的方法对患者抑郁、焦虑状态进行评价,并记录患者并发心律失常、心力衰竭、心源性休克的情况,以及死亡患者例数.结果 DM-AMI组焦虑、抑郁评分分别为(62±12)分和(60±12)分,明显高于NDM-AMI组的(52±10)分和(52±10)分,差异有统计学意义(t值分别为6.97和5.68,P＜0.001);DM-AMI组焦虑程度:轻度28例、中度25例、重度13例;抑郁程度:轻度20例、中度16例、重度10例.NDM-AMI组焦虑程度轻度25例、中度10例、重度3例;抑郁程度:轻度16例、中度5例、重度2例.两组患者焦虑和抑郁的程度间差异有统计学意义(u值分别为5.67和4.25,P=0.04).同时合并抑郁或焦虑的心肌梗死患者的心律失常、心力衰竭和心源性休克的发生率明显高于无抑郁或焦虑患者(χ2值分别为4.89,11.98,4.24;P=0.03,0.00,0.04).结论 老年糖尿病合并急性心肌梗死患者更易出现焦虑抑郁、情绪,急性心肌梗死患者并发症的发生与抑郁、焦虑状态相关.     

脑出血患者认知功能障碍与脑白质疏松症相关性分析

目的:探讨脑出血患者认知障碍与脑白质疏松的关系。方法:对48例基底区脑出血患者采用MMSE联合Moca进行认知功能测评,分为无认知障碍组、轻度、中度、重度认知组障碍各10、14、12、12例,进行MRI检查行脑白质疏松程度的分级和评分,分析脑出血后认知障碍程度与脑白质疏松程度的相关性。结果:脑出血后认知障碍各组间MMSE评分与LA评分比较有显著性差异(P<0.05),Spearman相关性分析,相关系数r=-0.906(P<0.05),随着认知功能障碍程度增加(MMSE评分减低),而LA评分增加,呈负相关;脑出血无认知障碍与合并认知障碍组脑白质疏松的并发病分别为40.0%(4/10),94.37%(36/38),两组相比有显著性差异(P<0.05)。结论:对于脑白质疏松的患者在发生脑出血时,要重视其发展为认知障碍的高危性,需积极治疗原发病,改善脑代谢治疗,防治认知障碍的发生与进展。     

脑卒中抑郁与神经功能缺损的相关性研究

目的探讨脑卒中抑郁与神经功能缺损的相关性。方法选择2013年6月至2014年12月武汉市普仁医院收治的急性脑卒中患者120例为研究对象,根据抑郁自评量表(SDS)进行初步诊断,再通过汉密尔顿抑郁量表(HAMD)进行测评,比较入院后第2日、第1周、第2周、第3周HAMD和斯堪的纳维亚神经功能缺损评分量表(SSS)情况。结果 120例患者中脑卒中患者中抑郁49例,发病率为40.8%,轻度抑郁患者12例(10.0%),中度抑郁患者21例(17.5%),重度抑郁患者16例(13.3%);治疗后1、2、3周轻度抑郁、中度抑郁与重度抑郁患者的HAMD评分均呈上升趋势(P<0.05);单纯脑卒中组、轻度抑郁组治疗后1、2、3周SSS评分均呈上升趋势,中度抑郁组与重度抑郁组SSS评分呈下降趋势(P<0.05)。中度抑郁组与重度抑郁组患者的HAMD评分与SSS评分呈正相关(r=5.102,P<0.05)。结论急性脑卒中患者存在较高的抑郁发病率,抑郁状态加深与神经系统的缺损相关,尽早进行抑郁管理可以改善患者神经功能缺损情况。     

脑卒中后抑郁患者370例的临床分析

目的 观察370例患者缺血性脑卒中后1个月内脑卒中后抑郁(PSD)的患病率、相关因素及症状特点.方法 采用病例登记连续观察的研究方法,对370例急性脑卒中后1个月内意识清楚、无智力障碍、能正常交流并完成检查的患者进行观察.以中国精神障碍诊断和分类标准第3版(CCMD-3)的抑郁诊断标准诊断PSD,采用汉密尔顿抑郁量表(HAMD,17项版本)评估抑郁症状的严重程度.将研究对象分为非PSD组(HAMD评分≤6分)和PSD组(HAMD评分＞7分),再将PSD组进一步分为轻度抑郁症状亚组(HAMD评分＞7分且≤16分)和中-重度抑郁症状亚组(HAMD评分≥17分).结果 缺血性脑卒中后1个月内PSD的患病率为17.0%,PSD组的既往脑卒中史的构成比为31.7%,显著高于非PSD组的19.5%(P＜0.05).轻度抑郁症状患者占88.9%,PSD的临床症状以阻滞、焦虑/躯体化障碍、睡眠障碍多见.轻度抑郁症状亚组中阻滞因子评分最高,而中-重度抑郁症状亚组中焦虑/躯体化因子评分最高.中-重度抑郁症状亚组的焦虑/躯体化、体重变化、阻滞、睡眠障碍因子评分均显著高于轻度抑郁症状亚组(P值均＜0.05).结论 PSD以轻度抑郁症状为主,且躯体化症状及睡眠障碍多见.     

不同程度脑白质疏松轻度认知障碍患者的MoCA评估分析

目的 通过蒙特利尔认知评估(MoCA)量表初步分析脑白质疏松(LA)轻度认知障碍特点.方法 选择78例LA轻度认知障碍患者,进行MoCA量表测评,初步分析LA轻度认知障碍特点,比较LA不同分级患者认知功能障碍损伤程度.结果 78例患者MoCA总分平均(21.8±2.9)分.视空间与执行功能平均(3.4±1.1)分,83.3%的患者受损;命名平均(2.8±0.6)分,17.9%的患者受损;注意与计算力平均(5.3±1.0)分,46.2%的患者受损;语言平均(1.6±0.8)分,88.5%的患者受损;抽象思维平均(0.9±0.7)分,76.9%的患者受损;延迟记忆平均(1.8±1.3)分,98.7%的患者受损;定向力平均(5.9±0.4)分,9.0%的患者受损.MoCA总分、命名、注意与计算力评分LA 3级低于LA 1级(P<0.05),语言评分LA 3级低于LA 1级和LA 2级(P<0.05),其余各亚项评分组间比较差异无统计学意义.结论 LA轻度认知障碍患者表现多个认知领域的损害,其中延迟记忆受损最常见,其次为语言、视空间与执行功能、抽象思维、注意与计算力.LA不同分级与认知功能损害程度存在相关性.     

急性脑梗死患者CT评分变化与血清NSE、乳酸、CRP的相关性

目的 探究急性脑梗死(ACI)患者CT评分变化与血清神经元特异性烯醇化醇(NSE)、乳酸(LA)、C-反应蛋白(CRP)的相关性，并分析各指标与病情和预后的关系。方法 回顾性分析2019年2月至2021年3月渭南市中心医院神经内科收治的143例急性脑梗死患者的临床资料，根据美国国立卫生院卒中量表(NIHSS)将患者分为轻度组38例、中度组47例、重度组58例，比较不同严重程度ACI患者CT评分及血清NSE、LA、CRP水平，并分析患者CT评分与血清NSE、乳酸、CRP的相关性；临床接受治疗3个月后根据改良Rankin量表(MRS)评分将上述患者分为良好转归组89例和不良转归组54例，分析CT评分及NSE、LACRP水平对ACI患者预后的预测效能。结果 重度组患者CT评分为(3.25±0.87)分，低于轻度组、中度组患者的(7.42±1.47)分、(6.86±1.23)分，差异具有统计学意义(P<0.05)；重度组患者的NSE、LA和CRP值分别为(21.82±3.87)μg/L、(6.89±1.57) mmol/L、(16.82±2.64) mg/L，明显高于轻度组、中度组的(1...     

慢性阻塞性肺疾病患者抑郁状态与血液检验相关性的研究

目的:观察慢性阻塞性肺疾病患者抑郁评分与超敏C反应蛋白(hs-CRP)、N末端B型利钠肽原(NT-ProB-NP)、D二聚体(D-dimer)的相关性.方法:50例慢性阻塞性肺疾病合并抑郁患者作为研究1组,50例慢性阻塞性肺疾病患者作为研究2组组,30例同期健康体检者作为对照组,3组均空腹抽血,hs-CRP采用免疫比浊法测定,NT-ProB-NP、D-dimer均采用电化学发光免疫法定量测定,研究1组应用抑郁自评量表(SDS)评分,比较3组hs-CRP、NT-ProB-NP、D-dimer表达水平,观察研究1、2组HAMD评分与超敏C反应蛋白、NT-ProBNP、D二聚体的关系.结果:3组血清hs-CRP、NT-ProBNP、D-dimer表达水平差异有统计学意义(P＜0.05),研究1、2组水平均明显高于对照组(P＜0.05),研究1组和研究2组比较差异无统计学意义(P＞0.05).研究1组抑郁自评量表测试(SDS)评分:其中轻度17例(56～62分),中度15例(63～72分),重度18例(＞72分),轻度抑郁、中度抑郁、重度抑郁患者血清hs-CRP、NT-ProBNP、D-D表达水平逐渐升高,但差异无统计学意义(P＞0.05).结论:慢性阻塞性肺疾病患者hs-CRP、NT-ProBNP、D-dimer表达水平明显高于健康人群,但合并抑郁的慢阻肺患者随抑郁程度的加重水平逐渐升高,但与慢阻肺患者无显著性差异.     

基于颅内MRI检查分析抑郁程度与老年脑白质病变部位的关系

目的 分析颅内MRI检查分析抑郁程度与老年脑白质病变部位的关系.方法 选取医院2017年4月至2021年4月收治的老年脑白质病变患者150例作为研究对象,按照HAMD评分结果将其分成轻度组、中度组、重度组,例数分别为50例、48例、52例,均接受MRI检查.比较三组患者脑白质病灶部位、病变程度、脑白质病变体积及相关性....     

HAMD与SDS区分抑郁症严重程度的准确性研究

目的 研究自评抑郁量表(SDS)与汉密尔顿抑郁量表(HAMD)对区分抑郁症不同严重程度的准确性.方法 选取2017年9月至2019年9月该院收治的162例抑郁症患者为研究对象,均根据国际疾病分类标准第10版(ICD-10)评估患者抑郁症严重程度,并以此结果为金标准,将其分为轻度抑郁组(46例)、中度抑郁组(62例)、重度抑郁组(54例).比较3组SDS及H AMD评分,分析SDS、H AMD评分区分抑郁症严重程度与ICD-10评估结果的一致性.结果 SDS、HAMD评分随患者抑郁程度加重而明显增加(P<0.05).SDS评分诊断轻、中、重度抑郁的灵敏度分别为0.696、0.597、0.519,特异度分别为0.681、0.830、0.898,准确率分别为0.685、0.741、0.772,阳性预测值分别为0.464、0.685、0.718,阴性预测值分别为0.849、0.769、0.789,与ICD-10评估结果一致性检验的Kappa值分别为0.327、0.438、0.448.HAMD评分诊断轻、中、重度抑郁的灵敏度分别为0.848、0.855、0.667,特异度分别为0.862、0.880、0.944,准确率分别为0.858、0.870、0.852,阳性预测值分别为0.709、0.815、0.857,阴性预测值分别为0.935、0.907、0.850,与ICD-10评估结果一致性检验的Kappa值分别为0.670、0.728、0.647.结论 HAMD较SDS对区分抑郁症严重程度的准确性更高.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.