路易体痴呆1例

1 病例介绍 患者,女,83岁,小学校长,以＂记忆力、日常生活能力下降,手抖2年,走路不稳10余天＂为主诉于2010年3月5日入院.患者两年前无明显诱因出现记忆力下降,不认识亲人和朋友,刚说过的事也记不住,不会穿衣服,不会花钱,并时而出现双手不自主震颤,握物不稳,偶伴有幻觉等.     

阿尔茨海默病和路易体痴呆的临床和1H-MRS分析

目的对轻、中度阿尔茨海默病和路易体痴呆患者进行临床表现和1H-MRS研究,以期对疾病的早期诊断、鉴别诊断和治疗有所帮助。方法对10例阿尔茨海默病患者、6例路易体痴呆患者和8例对照者进行神经科检查、简易精神状态检查量表(MMSE)评分、半定量临床认知功能波动性评分(SCFCRS)和统一帕金森等级量表(UPDRS)评分。同时进行双侧海马的1H-MRS检查,测量NAA/Cr、Cho/Cr值。结果路易体痴呆较阿尔茨海默病患者表现出更明显的波动性认知功能障碍、反复出现的视幻觉和帕金森综合症样运动障碍。痴呆组较对照组有明显的双侧海马NAA/Cr值降低。阿尔茨海默病组较对照组有明显的双侧海马NAA/Cr值降低,路易体痴呆组较对照组左侧海马NAA/Cr值降低差异均有统计学意义。阿尔茨海默病组较路易体痴呆组左侧海马的NAA/Cr值降低、双侧海马的Cho/Cr值降低,但差异无统计学意义。结论患者海马NAA/Cr值降低能为阿尔茨海默病和路易体痴呆的早期诊断提供有价值的信息,有效指导临床治疗。对两组痴呆间1H-MRS的差异开展进一步的研究将有助于临床早期的鉴别诊断。     

35例路易体痴呆临床特点分析

目的了解中国路易体痴呆（DLB）的临床特点,提高临床诊治水平。方法电子检索中国生物医学文献数据库和中国知识仓库医学专题全文数据库1980～2012年收录的DLB病例报告,并分析其临床特点。结果共纳入18个研究35例患者,其中男26例,女9例。平均起病年龄（67.2±9.8）岁。以记忆力减退起病者占58.8%,以帕金森综合征起病者占11.8%,以视幻觉起病者占8.8%,以强迫症为首发症状占2.9%,以3种核心症状中的两种同时起病者占17.6%。随着病程的进展,68.6%的患者有波动性认知功能障碍,97.1%的患者有视幻觉,100%的患者有帕金森综合征,81.8%的患者对神经镇静药高度敏感,22.9%的患者有睡眠行为障碍,40.0%的患者有反复跌倒,17.1%的患者有短暂意识丧失,85.7%的患者有精神症状。26例患者行简易精神状态量表（MMSE）检查,评分均≤24分。影像学检查中,29.4%行头颅CT或MRI检查的患者显示海马和颞叶中部结构相对保留。3例患者行SPECT/PET检查,1例提示枕叶葡萄糖代谢减低。脑电图检查患者中63.2%表现为基本节律慢化,波率调节差,额、颞叶区明显。结论 DLB患者多在老年期发病,波动性认知功能障碍、视幻觉和帕金森综合征为3大核心症状,可合并存在。神经心理学、影像学及脑电图检查有一定诊断及鉴别诊断的价值。     

胆囊结石合并肝损害的临床特征(附48例报告)

目的探讨胆囊结石合并肝损害机制、临床特征及处理。方法对48例胆囊结石合并肝损害患者进行抗感染、护肝及胆囊切手术治疗，观察其肝功能变化。结果胆囊结石合并肝才员害患者经过上述治疗，大部分肝功能恢复良好。结论胆囊结石合并感染及胆源胰腺炎是合并肝损害主要机制，及时抗感染、护肝，早期手术对防治肝脏病变有重要意义。     

亚急性硬化性全脑炎的临床与病理分析（附8例报告）

目的探讨对亚急性硬化性全脑炎（SSPE）的早期临床征象和病理过程。方法分析8例SSPE的首发症状等临床征象,脑脊液丙种球蛋白含量,血清及脑脊液麻疹抗体滴度,脑电图和头部MRI资料;并给活检脑组织以电子显微镜扫描及麻疹病毒分离。结果患者分别以智能障碍（6例）或双眼视觉障碍（2例）为首发症状,并均于病程2月后陆续出现SSPE的典型临床经过;其血及脑脊液的麻疹抗体滴度高,脑脊液丙种球蛋白含量高;脑电图基础节律慢而不规则,伴周期性双侧对称性高波伏棘慢波;头部MRI示弥漫性脑萎缩、灰白质界线模糊及广泛分布的异常信号;电子显微镜扫描显示弥漫性亚急性或慢性脑炎,脑细胞核内嗜酸性包涵体并分离出麻疹病毒。结论SSPE多以亚急性智能障碍或双眼视觉障碍为首发症状,并可在病程2个月后出现SSPE的典型临床经过。     

骨包囊虫病影像病理及临床分析(附9例报告)

目的 探讨骨包囊虫病的影像学、病理学特征表现.方法 回顾性分析本院9例骨包囊虫病影像病理临床资料.结果 9例均为感染细粒棘球蚴病者,无感染泡状棘球蚴病者.结论 骨包虫病的影像学表现与常见的肿瘤及瘤样病损有非常明显的区别.骨包虫病的病理学感染细粒棘球蚴病者远多于感染泡状棘球蚴病者.     

帕金森病痴呆患者的神经心理学和18 F-FDG PET脑代谢显像分析

目的：研究帕金森病痴呆患者的神经心理学特点及18 F-脱氧葡萄糖（ FDG） PET脑代谢显像的影像学特征。方法①对10例正常对照组,10例帕金森病患者,10例帕金森病痴呆患者,运用蒙特利尔认知评估量表（MoCA）进行检查。②静脉注射18F-FDG后行脑断层显像,获得10例正常对照组,10例PD患者,10例PDD患者PET图像。结果①PDD组的MoCA总成绩低于正常对照组,其中 MoCA子项目中的视空间功能、执行功能、注意力、语言（复述和流畅性）、抽象思维成绩显著低于正常对照组。②18 F-FDG PET脑代谢显像,PDD组的大脑半球各叶、尾状核、豆状核、丘脑的脑代谢显像不对称性重度减低。结论 PDD表现为多认知域受损,而以视空间功能、执行能力、注意力、言语（复述及流畅性）、抽象思维障碍较为严重。18 F-FDG PET脑代谢显像对PDD的诊断可能有一定的帮助。     

幽门螺杆菌感染对疣状胃炎发生和发展的影响(附78例报告)

目的探讨幽门螺杆菌（Hp）感染及根除对疣状胃炎的影响。方法将疣状胃炎患者Hp感染率与同期浅表性胃炎患者Hp感染率相比较；60例疣状胃炎合并Hp感染者随机分为A组（抗Hp治疗组）和B组（非抗Hp治疗组）各30例，A组患者接受常规三联治疗2周。B组仅接受替普瑞酮治疗1月。在治疗结束后1个月分别接受胃镜检查和Hp检测。结果疣状胃炎组Hp感染率显著高于浅表性胃炎组，差异有统计学意义（P〈0．01）。A组中27例HP得到根除，HP根除者疣状胃炎治愈率达74％，有效率88．9％。未接受抗Hp治疗的B组30例，疣状胃炎治愈0例，有效率26．7％。结论Hp感染和疣状胃炎的发生密切相关，根除Hp后，大部分疣状胃炎可得到恢复。     

非痴呆帕金森病患者轻度认知障碍与发病年龄和疾病阶段的关系

目的探讨非痴呆帕金森病患者轻度认知障碍与发病年龄和疾病阶段的关系。方法对84例非痴呆帕金森病患者按照患者发病年龄及疾病阶段分期,早期PD患者38例(早期PD组),晚期PD患者46例(晚期PD组),其中年轻早期PD患者23例(年轻早期PD组),老年早期患者15例(老年早期PD组),年轻晚期PD患者26例(年轻晚期PD组),老年晚期PD患者20例(老年晚期PD组)。选取同期门诊健康体检无神经系统阳性体征40例体检者作为对照组,进行神经心理学简易智能状态检查量表(MMSE)、蒙特利尔认知评价量表(MoCA)、Fuld物体记忆评价(FOM)、语言流畅性测验(RVR)、积木试验(BD)、数字广度测验(DS)及P300测试。结果 MMSE、MoCA、RVR、BD、DS、FOM对照疾病的阶段进展呈现下降趋势,P300PL呈现上升趋势,早期PD组、晚期PD组与对照组之间差异有统计学意义(P﹤0.05),年轻晚期PD组与年轻对照组之间差异有统计学意义(P﹤0.05),老年早期PD组、老年晚期PD组与老年对照组之间差异有统计学意义(P﹤0.05)。结论非痴呆帕金森病随着年龄的增加认知障碍状态有所下降,并且疾病晚期患者认知障碍状态比较疾病早期患者有所下降。     

心力衰竭与氧自由基相关分析(附53例报告)

近年来 ,氧自由基 (ＯＦＲ)对冠心病、高血压病等的影响日益引起人们关注 ,对其他心血管疾病的影响亦有报道。氧自由基包括超氧阴离子 (Ｏ2 - )、羟自由基(·ＯＨ)、过氧化氢 (Ｈ2 Ｏ2 )等 ,可能参与了心力衰竭的形成和发展过程[1] ,且心衰时抗氧化酶系统活力降低使ＯＦＲ在体内积蓄 ,造成机体细胞的损伤。本文测定53例各种心脏病心力衰竭患者血中超氧化歧化酶(ＳＯＤ)及丙二醛 (ＭＤＡ)的变化 ,以探讨ＯＦＲ在各种心脏病心衰发病过程中的作用。1　对象与方法1·1　对象　正常对照组 (ＮＣ组 ) :31例健康体检者 ,男 18例 ,女 13例 ,年龄 ( 5…     

Differentiating between lewy body dementia and Alzheimer's disease: a retrospective brain bank study

Recent research has shown that while Lewy body dementia. (LBD) may be the second most common form of dementia, it is difficult to confirm the disease before autopsy. Patients with LBD share many clinical signs and symptoms with patients diagnosed with Alzheimer's disease (AD), making it difficult to differentiate between the two diseases in patients who are still living. Still, our purpose in this study was to determine any clinical features which may differentiate between autopsy-confirmed cases of AD and cases of LBD. We compared 13 patients with autopsy-confirmed AD with 12 patients who had autopsy-confirmed LBD. Phone calls were made to family members of the deceased to help clarify and add any other information not documented in the patient's files. Significant differences were found in three areas, and trends approaching statistical significance were found in two other areas. Visual hallucinations were more prominent in the patients with LBD than in the patients with AD (10/12 LBD vs. 4/13 AD, P < 0.05). A nonspecific tremor was also found more often in the LB patients than in the Alzheimer's patients (8/12 LBD vs. 3/13 AD, P < 0.05). Finally, the LB patients were more prone to wandering, especially earlier in the disease course than were the patients with AD (10/12 LBD vs. 6/13 AD, P < 0.5). There was also a trend within the LB patients for higher use of anxiolytics (9/12 LBD vs. 6/13 AD, P = 0.14) as well as antidepressants (7/12 LBD vs. 4/13 AD, P = 0.16). Our data confirmed our hypothesis that LBD from a clinical perspective is indeed similar to AD. However, the higher incidence of visual hallucinations, tremor and wandering as well as the trend toward the use of anxiolytics and antidepressants among LB patients was noted. This gives hope that a clinical differentiation between these two diseases and more specific treatments may be possible in the future.     

妊娠合并心脏病296例临床分析

目的:探讨妊娠合并器质性心脏病患者母儿预后的影响因素。方法:对我院1995年1月～2005年12月间296例妊娠合并器质性心脏病患者的有关临床资料进行回顾分析。结果:妊娠合并器质性心脏病的发病率为2.31%。孕前已行心脏手术纠正者心功能I～II级占95.50%。心脏病的种类对产妇及新生儿预后无显著影响。心功能Ⅲ～Ⅳ级者,其早产儿、新生儿低体重和围产儿死亡等发生率明显增加。孕前未行外科手术者,其妊娠合并症明显高于已行手术者,早产儿及胎儿生长受限发生率亦明显高于后者。结论:妊娠合并先天性心脏病最常见,风湿性和先天性心脏病是导致孕产妇严重心功能不良的主要病因,母亲心功能状态直接影响围产儿质量。孕前积极治疗或行心脏手术能明显改善心功能,使妊娠有良好结局。剖宫产是终止妊娠的最佳方式。     

A retrospective study of Creutzfeldt-Jakob disease in Italy (1972–1986)

In a retrospective study of Creutzfeldt-Jakob disease (CJD) in Italy from 1972 to 1986, we found 79 cases which fulfilled the diagnostic criteria for CJD. The annual mortality rate was 0.09 cases per million inhabitants. In this series the female to male ratio was 2.59, a value significantly higher than that found in Italian population (1.05). The mean age at death was 62.1 ± 9.4 years and the mean duration of the disease was 5.3 ± 3.0 months. No familial cases of CJD were found in our series. Mental deterioration was present in all of our cases, myoclonus in 85% and the other clinical signs were present at a lower rate. Periodic EEG activity was found in 92% of the cases. Two patients had had neurological or ophthalmic surgery and 17% of our cases had undergone general surgery within 5 years prior to the clinical onset of CJD.     

帕金森病患者医院感染临床分析

目的 分析帕金森病患者的医院感染情况,探讨其相关因素,以采取有效的控制措施.方法 对2008年1月1日-2010年12月31日神经内科出院的165例帕金森病患者的医院感染情况进行回顾性调查分析.结果 医院感染17例25例次,感染率为10.30％,例次感染率为15.15％;多发生在住院2周内;呼吸道感染最多,占55.43％,其次为泌尿道,占24.00％;共分离出33株病原菌,居首位的为肺炎克雷伯菌,占42.42％;年龄、病程、侵入性操作、抗菌药物预防性应用、住院天数、血浆白蛋白与医院感染的发生相关.结论 帕金森病患者的医院感染发生率高,应重视医院感染的相关因素,采取预防治疗措施,减少医院感染发生率,促进患者康复.     

Physical inactivity is associated with Parkinson's disease mild cognitive impairment and dementia

Parkinson's disease (PD) is a neurodegenerative disorder marked by both motor symptoms and cognitive impairment. Individuals with PD are generally less physically active relative to healthy older adults. This study examined if physical activity predicted future PD mild cognitive impairment (PD-MCI) and PD dementia (PDD).Participants were part of the Parkinson's Progression Markers Initiative (PPMI), a longitudinal cohort study of individuals newly diagnosed with PD. 307 participants were followed for up to three years. Individuals were classified as cognitively normal (CN), PD mild cognitive impairment (PD-MCI), or PD dementia (PDD) at each year. A self-report measure of physical activity was completed annually. Ordinal multilevel models were computed to examine the longitudinal relationship between physical activity and cognitive status. Less self-reported engagement in physical activities predicted worse cognitive status. Specifically, we found evidence of a significant within-person effect. Individuals with PD who became less active were at greater risk of developing PD-MCI or PDD. This effect was driven by longitudinal decreases in leisure/recreational physical activities. Findings support the hypothesis that longitudinal changes in physical activity are associated with clinically meaningful diagnostic outcomes of cognitive status. Since individuals with PD are prone to sedentary behaviors, future studies are needed to determine the clinical utility of interventions promoting routine physical activity.     

精神疾病患者的体内25-(OH)维生素D的不足与缺乏

目的:了解精神疾病患者体内25-(OH)维生素D不足与缺乏的患病率,为合理的维生素D治疗提供依据。方法:用化学发光免疫法定量测定精神分裂症、血管性痴呆和脑器质性疾病伴精神障碍三类人群及健康体检者血清中的25-(OH)维生素D的含量,比较其均值。结果:与对照组相比,三组病人血清中25-(OH)维生素D的含量均低,但精神分裂组和血管性痴呆组偏低程度有显著性差异。结论:维生素D在精神疾病人群中含量较正常人低,提示给予合适的维生素D治疗,可能能促进病情的好转。     

中国痴呆症疾病负担研究及未来预测分析

目的 分析1990—2019年我国痴呆症疾病负担变化趋势和现状,并对未来25年疾病负担进行预测,以期为痴呆症疾病的科学防控和延缓发生发展提供科学依据。方法 应用年龄-时期-队列模型(age-period-cohort,APC)分析年龄、时期和队列因素对痴呆症发病和死亡风险影响;应用Nordpred模型对未来25年疾病负担进行预测。结果 我国痴呆症整体疾病负担自1990年以来呈现上升趋势,女性高于男性。年龄-时期-队列模型分析显示,痴呆症发病率呈现低龄化趋势,在70～74岁组后明显上升。死亡风险在75～79岁组后明显上升。发病风险随时期变化单调上升,2015—2019年发病风险最高,死亡风险随时期变化近似“S”型,2005—2010年死亡风险最高。越晚出生的队列发病风险较高,死亡风险较低。Nordpred模型预测显示,在未来25年内,ASIR值将继续增加,ASMR值平稳下降,但每年新增发病和死亡人数将持续增加。结论 1990年以来我国痴呆症疾病负担居高不下,未来发病和死亡人数将持续上升,女性人群和老年人群疾病负担重,低龄人群发病风险急剧上升。     

The PREMAP Study: Prevalence and risk factors of dementia and clinically diagnosed Alzheimer's disease in Provence, France

The PREMAP Study investigated the prevalence and risk factors of dementia and Alzheimer's Disease (AD) in a random sample of 1062 residents 70 year old or more, living in south-eastern France (private homes and institutions). All persons living in institutions for the elderly (n = 258) and community dwellers (n = 804) scoring less than 24 points on the MMSE (18.4%) were invited to undergo a medical evaluation at home by a qualified neurologist using the CERAD battery. We found 177 cases of dementia (9.2%), including 82 cases of AD (5.5%). Prevalence of AD increased significantly with age and was higher among women (OR: 4.24) and persons with no formal educational level (OR: 2.47). While a MMS score less than 24 was more frequent among persons with a foreign native language (OR: 3.05), the OR of AD was not significantly associated with native language. The proportion of AD among persons suffering from senile dementia was 45% among elderly living in institutions and 69% among those living in the community. Prevalence rates in south-eastern France are similar to the average rates for Europe. This study underlines the need to investigate the relationships between native language, MMSE and AD on the one hand, and the link between a low MMSE score and institutionalisation of patients suffering from AD on the other.