缺血性脑血管病患者载脂蛋白B基因多态性与血脂关系探讨

应用聚合酶链反应（ＰＣＲ），检测了１０６例正常汉族人及５５例缺血性脑血管病（ＩＣＶＤ）病人的ａｐｏＢ基因ｘｂａⅠ酶切位点限制性片段长度多态性（ＲＦＬＰｓ）及其与血脂的关系。结果表明ＩＣＶＤ组ｘｂａⅠ酶切位点上Ｘ＋的等位基因频率明显高于正常对照组（Ｐ＜０．００５）；ＩＣＶＤ组中具Ｘ＋Ｘ－基因型者的血浆ＨＤＬ－Ｃ较Ｘ－Ｘ－基因型者明显降低（Ｐ＜０．０５），而ＬＰ（ａ）和ＴＣ明显增高（Ｐ＜０．０５～０．００５）。提示ａｐｏＢ基因多态分析结合血浆脂蛋白测定更能有效地检测ＩＣＶＤ易患人群。     

动脉粥样硬化性血栓性脑梗塞患者血浆氧化修饰低密度脂蛋白含量的研究

目的探讨氧化修饰低密度脂蛋白（ＯＸ－ＬＤＬ）与动脉粥样硬化性血栓性脑梗塞（ＡＴＣＩ）发生、发展的关系。方法应用酶联免疫吸附试验（ＥＬＩＳＡ）双抗夹心法检测了８３例ＡＴＣＩ患者血浆ＯＸ－ＬＤＬ含量变化。结果（１）ＡＴＣＩ组血浆ＯＸ－ＬＤＬ水平显著高于正常对照组（Ｐ＜０．０１）;血浆ＯＸ－ＬＤＬ水平变化与病程有关,但与梗塞部位无关。（２）ＡＴＣＩ患者血浆ＯＸ－ＬＤＬ水平与血糖、血胆固醇呈正相关。结论ＯＸ－ＬＤＬ可能参与了ＡＴＣＩ的发生和发展过程。     

载脂蛋白E与脑动脉硬化症

本文观察７８例脑动脉硬化症患者与对照组４４例，对其血清载脂蛋白Ｅ（ＡＰＯＥ）和高密度脂蛋白（ＨＤＬ－Ｃ）、低密度脂蛋白（ＬＤＬ－Ｃ）、胆固醇（ＴＣ）、甘油三脂（ＴＧ）、载脂蛋白ＡＩ（ＡＰＯＡＩ）、载脂蛋白Ｂ（１００）（ＡＰＯＢ（１００））进行含量测定，并将ＡＰＯＥ与ＨＤＬ－Ｃ、ＬＤＬ－Ｃ、ＴＣ、ＴＧ、ＡＰＯＡＩ、ＡＰＯＢ（１００）逐一进行相关比较，结果发现：脑动脉硬化症病人（ＣＡＳ）血清ＡＰＯＥ、ＬＤＬ－Ｃ、ＴＣ、ＴＧ、ＡＰＯＢ（１００）明显高于正常对照组（Ｐ＜０．０１），ＨＤＬ－Ｃ显著低于正常对照组（Ｐ＜０．０１），ＡＰＯＡＩ无明显变化（Ｐ＞０．０５），且ＡＰＯＥ与ＨＤＬ－Ｃ呈负相关；与ＬＤＬ－Ｃ、ＴＣ、ＴＧ、ＡＰＯＢ（１００）呈正相关；与ＡＰＯＡＩ无直线相关关系。提示ＡＰＯＥ可做为诊断脑动脉硬化症的重要指标。     

脑血管病分类亚型与血脂关系的研究

目的：阐明血脂与脑血管病分类亚型的关系。方法：检测了２０８例脑血管病患者血清血脂７项指标含量。并与对照组５０例结果进行比较。ＴＧ、ＴＣ及ＨＤＬ－Ｃ采用酶法测定，ＡＰＯＡ－１、ＡＰＯＢ１００及ＬＰ（ａ）用免疫多点定标法测定，ＬＤＬ－Ｃ由ＴＧ、ＨＤＬ－Ｃ结果按公式计算。结果：脑梗塞（ＣＩ）患者ＴＧ、ＴＣ、ＬＤＬ－Ｃ、ＡＰＯ１００及ＬＰ（ａ）含量显著高于对照组，其ＴＧ、ＡＰＯＢ１００、含量也显著高于脑出血组，且ＬＰ（ａ）与ＡＰＯＢ１００，ＨＤＬ－Ｃ相关，复发ＣＩ亚组ＴＣ、ＬＤＬ－Ｃ、ＡＰＯＢ１００含量，首发及老年ＣＩ亚组ＴＧ、ＴＣ、ＡＰＯＢ１００含量显著高于对照组。结论：血清ＴＧ、ＴＣ、ＬＤＬ－Ｃ、ＡＰＯＢ１００及ＬＰ（ａ）水平升高是ＣＩ的危险因素，其中ＴＣ、ＬＤＬ－Ｃ、ＡＰＯＢ１００对复发ＣＩ危险性大，而首发及老年ＣＩ可能主要与ＴＧ、ＴＣ、ＡＰＯＢ１００有关     

动脉粥样硬化性血栓性脑梗塞患者血浆氧化修饰低密度蛋白 …

目的 探讨氧化修饰低密度脂蛋白（ＯＸ－ＬＤＬ）与动脉粥样硬化性血栓性脑梗塞（ＡＴＣＩ）发生,发展的关系。方法 应用酶联免疫吸附试验（ＥＬＩＳＡ）双抗夹心法检测了８３例ＡＴＣＩ患者血浆ＯＸ－ＬＤＬ含量变化。结果 （１）ＡＴＣＩ组血浆ＯＸ－ＬＤＬ水平显著高于正常对照组（Ｐ〈０．０１）;血浆ＯＸ－ＬＤＬ水平变化与病程有关,但与梗塞部位无关。（２）ＡＴＣＩ患者血浆ＯＸ－ＬＤＬ水平与血糖、血胆固醇呈正相关。     

血管性痴呆和脑梗塞患者载脂蛋白E基因多态性的分析比较

目的探讨ＡＰＯＥ多态性与血管性痴呆（ＶＤ）和脑梗塞（ＣＩ）的关系。方法应用ＰＣＲ－ＲＦＬＰ技术分析２０例ＶＤ、２４例ＣＩ及２４例健康老年人的ＡＰＯＥ基因型。结果ＶＤ和ＣＩ患者ε３频率均降低（Ｐ＜０．０５），ε４频率均升高（Ｐ＜０．０５），而两组患者间各等位基因频率差异均无统计学意义（Ｐ＞０．０５）；且ε４与血清ＡＰＯＥ、ＡＰＯＢ、ＴＣ、ＬＤＬ－Ｃ正相关，与ＡＰＯＡ、ＨＤＬ－Ｃ负相关。结论ＡＰＯＥ多态性与ＶＤ和ＣＩ的发病机制有关，其在这两种疾病中的作用可能相似。     

AC─PC线与OM线的相关性研究

分析了９０例Ｘ线脑室遗留头颅侧位片，对ＡＣ─ＰＣ线、ＩＣ线与ＯＭ线之间的夹角分别进行了测量。ＡＣ─ＰＣ线与ＯＭ线的夹角为６～１３°（平均９．９２５±１．２４°）；ＩＣ线与ＯＭ线的夹角为６～１３°（平均９．８２５±０．９１°）．经统计学处理，两者间无明显差异（Ｐ＞０．０５）．证实了在扫描线与ＯＭ线呈向前开放的１０°夹用时，扫描线正好与ＡＣ─ＰＣ线平行。同时也证明了ＩＣ线在立体定向功能神经外科中实用价值。     

脑出血与8项血脂指标的关系探讨

测定了１２５例脑出血病人的血总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白（ＨＤＬ）、低密度脂蛋白（ＬＤＬ）、载脂蛋白Ａ－１、Ｂ－１００（ＡｐｏＡ－１、ＡｐｏＢ－１００）、脂蛋白（ａ）［ＬＰ（ａ）］和氧化修饰低密度脂蛋白（ｏｘＬＤＬ）浓度。结果显示：与对照组比较，ＡｐｏＢ－１００、ｏｘＬＤＬ显著增高，ＨＤＬ、ＡｐｏＡ－１显著降低（Ｐ＜０．０１），ＬＤＬ明显降低（Ｐ＜０．０５），ＴＣ、ＴＧ、ＬＰ（ａ）无明显变化（Ｐ＞０．０５）。提示：血ＬＤＬ、ＡｐｏＢ－１００、ｏｘＬＤＬ浓度增高和ＨＤＬ、ＡｐｏＡ－１浓度降低与脑出血有一定的相关关系，可作为脑出血的危险因素。     

氧化修饰低密度脂蛋白刺激血管内皮细胞表达VCAM-1的实验研究

目的：探讨氧化修饰低密度脂蛋白（ＯＸ－ＬＤＬ）对血管内皮细胞表达血管细胞粘附分子－１（ＶＣＡＭ—１）的影响,以阐明其在动脉粥样硬化发生中的作用。方法：在血管内皮细胞的培养基中分别加入２５μｇ／ｍｌ的低密度脂蛋白（ＬＤＬ）和ＯＸ－ＬＤＬ,３7℃下温育 ２４小时,应用定量免疫细胞化学分析技术检测内皮细胞 ＶＣＡＭ－１蛋白的表达。结果：与对照组和ＬＤＬ组比较,ＯＸ－ＬＤＬ组内皮细胞ＶＣＡＭ－１蛋白的表达显著增加。结抡：ＯＸ－ＬＤＬ能够明显刺激内皮细胞ＶＣＡＭ－１的表达。     

脑梗死与脑出血患者血脂及脂蛋白含量的对比研究

目的：为了研究血脂与因管疾病的关系。方法：对２００例脑血管病患者血总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白（ＨＤＬ）、低密度脂蛋白（ＬＤＬ）、载脂蛋白－Ａ１（ＡＰＯ－Ａ１）、载脂蛋白（ＡＰＯ－Ｂ）水平进行了检测,并与１００例年龄、性别,匹配的非脑血管对照组患者进行了对比分析。结果：脑梗死组血ＴＣ、ＴＧ、ＬＤＬ、ＡＰＯ－Ｂ含量显著高于脑出血组及非脑血管病对照组,ＡＰＯ－Ａ和ＨＤＬ脑梗死组显著     

苍白球腹后部切开术治疗帕金森病靶点定位规律探讨

目的 研究苍白球腹后部切开术(PVP)治疗帕金森病(PD)的靶点定位方法及其规律。方法 45例原发PD患者接受手术．采用MRI进行靶点解剖定位，术中用电生理方法对靶点做必要的调整，同时在MRI操作台上准确测量ACPC线的长度(L)、三脑室的宽度(W)、头颅的长度和宽度。结果 本组患者UPDRS评分改善率大于35％，手术效果满意；依据术中电生理方法调整靶点20例．调整范围1～3mm；靶点横坐标(X)与L和W之间存在线性依从关系即：X=10．09 0．30L 0．48W．决定系数R^2=0．7258．结论 PVP术中应用电生理方法调整靶点是非常重要的，实现了靶点的功能定位；X坐标值随L和W的增加而增大，且W对X的贡献大于L，靶点Z坐标与L和W之间无相关性，靶点坐标与颅长、颅宽无相关性。     

建立数学模型预测苍白球腹后内侧部毁损术靶点坐标

目的 建立数学模型,预测靶点与AC-PC线之间的垂直距离(靶点X坐标值),并对预测准确性进行前瞻性研究。方法根据病人入院时的先后顺序将本研究分为两个阶段,通过第一阶段的资料建立数学模型。利用第二阶段的资料进一步分析预测可靠性。结果通过三脑室宽度(W)和AC-PC线长度(L)建立靶点坐标(X)的数学模型即：X^=10．09 0．30L 0．48W。利用该数学模型对后期病例进行预测分析,研究结果显示预测值和实际值之间具有较高的相关性。结论该数学模型在理论上能较准确地对预测靶点X坐标,可能具有一定的临床参考价值。     

苍白球腹后内侧部毁损治疗帕金森病靶点定位研究

目的　探讨MRI定位微电极引导的苍白球腹后内侧部毁损术治疗帕金森病靶点定位方法及其规律。方法　 39例原发PD病人施行PVP术 ,UPDRS评分改善率大于 35 %。采用MRI进行靶点解剖定位 ,同时在MRI操作台上测量有关参数。术中用电生理方法对靶点做必要的调整。结果　MRI具有较高的分辨率 ,对靶点定位具有直接、准确等优点 ,Gpi靶点坐标在不同的个体有很大差异 ;靶点坐标X与三脑室宽度 (W )和AC -PC线长度 (L)之间存在线性依从关系 ,即 :^X =10 .0 9 0 .30L 0 .4 8W。 结论　PVP术治疗帕金森病效果满意 :通过MRI扫描 ,实现了Gpi靶点解剖定位个体化 ,提高了定位精度 ;应用电生理学方法调整靶点是必要的 ,并实现了靶点的功能定位 ;靶点X坐标值与三脑室宽度和AC -PC线长度有相关性     

Targeting the subthalamic nucleus for deep brain stimulation: technical approach and fusion of pre- and postoperative MR images to define accuracy of lead placement

OBJECTIVES: To define the role of magnetic resonance imaging (MRI) and intraoperative electrophysiological recording in targeting the subthalamic nucleus (STN) in Parkinson's disease and to determine accuracy of electrode placement. PATIENTS AND METHODS: We implanted 54 electrodes into the STN in 27 patients. Target planning was done by coordinate guidelines and visualising the STN on MRI and defined in relation to the mid-point of the AC-PC line. Intraoperative microelectrode recording was used. We adjusted electrode positions for placement in the centre of the STN electrical activity and verified this on postoperative MRI in 16 cases, which were fused to the preoperative images to measure actual error in electrode placement in the three axes. RESULTS: Based on coordinate calculation and MRI localisation, the mean of the target was 11.5 mm lateral, 2.5 mm posterior and 4.1 mm inferior to the mid-point of the AC-PC line. Fifty good electrophysiological recordings of the STN (average length 4.65 mm) were achieved and target point adjusted in 90% of lead placements. The mean of the final target after electrophysiological correction was 11.7 mm lateral, 2.1 mm posterior, and 3.8 mm inferior to the mid-point. The distance from the centre of the electrode artefact to the final target used after electrophysiological recording on the fused images was 0.48 mm, 0.69 mm, and 2.9 mm in the x, y, and z axes, respectively. No postoperative MRI related complication was observed. CONCLUSION: Both direct visualisation of the STN on MRI and intraoperative electrophysiological recording are important in defining the best target. Individual variations exist in the location of the STN target. Fewer tracks were required to define STN activity on the side operated first. Our current stereotactic method of electrode placement is relatively accurate.     

丘脑底核电刺激治疗苍白球毁损术后的帕金森病(12例报告)

目的探讨帕金森病(Parkinson's disease,PD)苍白球腹后部毁损术(posteroventral pallidotomy,PVP)后再行丘脑底核(subthalamic nucleus,STN)脑深部电刺激术(deep brain stimulation,DBS)的可行性、术中电生理学特点和治疗结果。方法应用MR和微电极记录技术进行靶点定位,对12例单侧PVP术后症状再次加重的PD患者实施STN-DBS手术,其中4例行毁损灶对侧的STN-DBS,8例行双侧STN-DBS。结果STN-DBS对本组12例PD患者症状有不同程度的改善,双侧STN-DBS的效果尤为明显,术后3个月的UPDRS运动及ADL评分较术前明显减少(P<0．05或0．01),美多巴的用量明显减少(P<0．01),无明显术后并发症。术中电生理记录显示毁损灶同侧的细胞放电明显低于正常情况。结论曾行单侧PVP的PD患者如面临二次手术,可以选择DBS手术,以双侧STN的DBS效果最好,可减少药物用量。     

磁共振结合微电极记录技术定位治疗帕金森病

目的：探讨磁共振扫描（ＭＲＩ）定位结合微电极记录技术在帕金森病（ＰＤ）立体定向手术治疗中的作用。方法：ＭＲＩ定位结合微电极记录技术,定向毁损法治疗ＰＤ２７０例,分析术中靶点更换,手术治疗效果和并发症发生情况。总结应用体会。结果：ＭＲＩ定位结合应用微电极记录技术,ＰＤ的立体定向外科手术治疗疗效优良,并发症少,无永久性并发症：脑内出血发生率为１．８６％,结论：ＭＲＩ定位结合微电极记录技术提高了ＰＤ的手     

Efficacy and safety of simultaneous bilateral pallidotomy in advanced Parkinson's disease

BACKGROUND: Although unilateral pallidotomy is generally considered a safe and effective neurosurgical treatment for advanced Parkinson's disease (PD), controversies concerning efficacy and adverse effects of bilateral posteroventral pallidotomy (PVP) exist and need to be resolved. METHODS: We studied 8 patients with advanced PD who underwent simultaneous bilateral PVP. The patients were assessed preoperatively, immediately after surgery, and 6 and 12 months later. RESULTS: Dyskinesia was almost entirely abolished immediately after surgery, as well as being significantly lower 1 year later (p < 0.05). The 'off' medication score of the Unified Parkinson's Disease Rating Scale motor part (UPDRS III) was significantly improved after surgery (p < 0.05) but increased gradually after 6 months. The off medication score of activities of daily living tended to improve immediately after surgery, but it returned to preoperative levels at 12 months. There were no major complications of surgery. CONCLUSIONS: Simultaneous bilateral PVP may be a safe and highly effective method of reducing levodopa-induced dyskinesia. Our results suggest that simultaneous bilateral PVP may be a reasonable therapeutic option for advanced PD with severe levodopa-induced dyskinesia.     

Anatomical alterations of the subthalamic nucleus in relation to age: a postmortem study.

The subthalamic nucleus (STN) is currently the preferred target for chronic electrical high-frequency stimulation in Parkinson's disease. Anatomical determination of the exact position of the STN in the individual patient, using magnetic resonance imaging, remains cumbersome, whereas calculation of the target using a stereotactic atlas bypasses patient interindividual variations in the exact delineation of the STN. The aim of this study was to demonstrate variations in shape and position of the STN during life. In this anatomopathological study, a method was applied to localize the STN in reference to the anterior commissure-posterior commissure line (AC-PC line) in 12 postmortem brains of patients who died of non-neurological diseases. Their age varied from 29 to 84 years. Centers and borders of the STN were macroscopically measured in three spatial orthogonal planes in relation to the AC-PC line, and verified by light microscopy. The AC-PC distance remains almost constant during life (24.4 mm; SD 3.58). With increasing age, the center of the STN tends to move 3.9 mm cranially, 2.6 mm laterally, and 0.2 mm anteriorly. This last result also differs from the position mentioned in the stereotactic brain atlases. The form of the STN also changes. During life, the STN becomes wider in the mediolateral direction and smaller in the superior-inferior and anterior-posterior direction. The shape and spatial position of the STN also change during life. These changes should be taken into account during target determination in deep brain stimulation procedures in Parkinson's disease.     

听眦线与前后联合间线关系的核磁共振研究

目的探讨听眦线（OML）作为脑立体定向手术颅内靶点定位体表扫描基线的可行性。方法采用1．5T高清MRI图像测量105例接受立体定向手术的患者前后联合连线（AC-PC）与OML、大脑长轴、丘脑长轴的夹角,分析OML与AC-PC、大脑长轴、丘脑长轴的关系及其他体表参考线基线与AC-PC的关系。结果AC-PC与OML成向下（10．17±1．46）°夹角,大脑长轴与OML成向下（9．77±1．57）°夹角,丘脑长轴与OML成向下（9．84±1．64）°夹角,大脑长轴、丘脑长轴与AC-PC基本平行。结论OML为较理想的功能神经外科定位用体表参考线,具有标志明确、操作简单的优点。