慢性肾衰竭以神经精神症状发病23例误诊分析

目的：了解慢性肾衰竭（CRF ）以神经精神症状发病的临床特点，误诊原因。方法对我院2002‐12—2012‐12收治的126例CRF中23例以神经精神症状发病患者的临床资料回顾性分析。结果本组23例首诊时全部误诊，误诊率占同期收治CRF的18.3％，分别被误诊为癫痫9例，高血压6例，吉兰‐巴雷综合征和末梢神经炎、精神病各2例，眩晕症、急性脑梗死各1例，入院后完善相关医技检查（尿常规、肾功能、肾脏B超或彩超）确诊为CRF。结论 CRF的起病缓慢，早期症状多样且无特异性，易被误诊或漏诊。临床医生应提高认识，详细询问病史，及时选做尿常规、肾功能、肾脏B超或彩超，以及早期诊断。     

烧伤患者并发神经精神表现100例临床分析

目的探讨烧伤患者伴发神经精神表现引起的原因,以便及时确定原因和疾病,给予正确的治疗。方法收集我院烧伤伴发神经精神表现100例患者的临床资料,包括,现病史、既往病史、体征、化验检查、影像学检查并认真进行分析,必要时多学科会诊,最后确定诊断。结果 100例烧伤合并神经精神表现的最后诊断:呼吸系统疾病占首位:重症肺炎20例,AECOPD并发肺性脑病16例,肺梗死3例,共39例;心脑血管病次之:心力衰竭5例,休克3例,脑梗死25例,共33例;其他低渗性脑病等28例。结论烧伤患者伴发神经精神表现时必须认真了解病史,尤其既往病史,认真检查,认真观察病情变化,作必要的辅助检查,认真进行分析,有时多学科会诊亦很重要,只有如此,才能及时诊断和治疗,达到好的愈后。     

以原发性高血压贫血为首发症状的非典型慢性肾衰竭临床分析

目的探讨以原发性高血压贫血为首发症状的非典型慢性肾衰竭的临床特征，其预后和病情的进展，与其他系统疾病误诊的病种分析。方法对我院2006—06—2011-12收治的192例慢性肾衰竭患者，均根据病史、症状与主要体征，结合临床检验结果综合判断。结果192例慢性肾衰竭患者，有26例误诊。结论慢性肾衰竭是临床常见病、多发病，此病进展缓慢、表现复杂，易误诊，临床上大夫应先仔细问诊，结合血尿常规、肾功能、电解质及肾脏B超等检查综合判断，以避免误诊。     

慢性酒精中毒性精神障碍患者脑电图分析

目的：探讨慢性酒精中毒的脑电力产改变。方法：对９６例慢性酒精中毒性精神障碍患者进行脑电图检查并加做各种活化诱发试验。结果：显示异常率为６４．５％，明显高于正常人群的１０％，差异非常显著（Ｐ〈０．０１）。脑电图主要异常可分为失筝型和慢波型及阗样放电。结论：提示慢性酒精中毒对脑功能的影响及其及组织的损害是弥温性的，可能与脑组织的变性、萎缩等有关。     

慢性肾衰竭患者同型半胱氨酸与脑卒中的关系

目的　研究慢性肾衰竭 (CRF)患者同型半胱氨酸 (Hcy)水平与脑卒中的关系。方法　采用荧光偏振免疫法 (FDIA )测定 97例 CRF患者 (其中 30例并发脑卒中 )和 35例健康对照组血浆总 Hcy水平 ,并对结果进行统计学处理、分析。结果　 CRF患者血浆总 Hcy水平明显高于健康对照组 ,有显著性差异 (P<0 .0 0 1) ,其中并发脑卒中组血浆总 Hcy水平明显高于未并发脑卒中组 ,有显著性差异 (P<0 .0 5 ) ;CRF患者血浆 Hcy水平分别与叶酸、维生素 B1 2 呈负相关。结论　慢性肾衰竭患者普遍存在高同型半胱氨酸血症 ,并可能参与了脑卒中的发生过程 ,临床应监测 CRF患者的血浆总 Hcy水平 ,并对高 Hcy血症者给予相应的治疗 ,以防止 CRF患者并发脑卒中     

慢性肾衰竭患者抗生素应用与神经精神症状表现

目的研究慢性肾衰竭病人抗生素应用与神经精神症状的表现。方法 2011年11月~2015年11月一共有61例慢性肾衰竭并发感染病人到我院治疗,根据使用抗生素的不同将其分成了头孢组(34例)以及非头孢组(27例),比较两组病人神经精神症状的发生率以及治疗前后的简明精神病量表(BPRS)评分,并探究不同抗生素使用后病人的神经精神症状情况。结果头孢组以及非头孢组神经精神症状的总发生率分别为38.24%以及18.52%,头孢组神经精神症状的发生率显著的高于非头孢组(P0.05);抗生素使用后两组的BPRS评分明显的升高,并且头孢组的显著高于非头孢组,比较差异均具有显著性(P0.05);使用头孢拉定、头孢吡肟以及头孢哌酮三种头孢类抗生素后神经精神症状的发生率比较没有显著的差异(P0.05)。结论慢性肾衰竭感染病人在使用头孢类抗生素会大大提高精神神经症状的发生率,因此,在治疗中应结合患者情况,对抗生素的使用进行实时的调整,减少神经精神症状的发生。     

慢性酒精中毒性精神障碍159例临床分析

我院于１９６４～１９９８年期间共收住慢性酒精中毒性精神障碍１５９例,报告如下：１　一般情况在此３４年间共收治首次住院的精神疾病患者１１２７６例,其中慢性酒精中毒性精神障碍者１５９例,占１４１％。各时间段的发病率呈上升趋势,如表１。其中男１５８例,女１例。年龄２１～６９岁,平均４２３±３８岁。已婚１３４例,未婚１２例,离婚１２例,丧偶１例。文盲２１例,小学３６例,初中６６例,高中３４例,大学２例。工人８０例,农民４２例,干部作者单位：２６６０３３　青岛第七人民医院２８例,其他９例。饮酒时间２…     

慢性酒精中毒的临床特点

对嗜酒患者的临床特征和影响因素进行分析。1　对象与方法对象为 1998年 2月～ 2 0 0 1年 10月在我院住院的患者 ,符合ＣＣＭＤ 3酒精所致精神障碍的诊断标准。共 10 8例 ,均为男性 ,发病年龄 2 8～ 6 5岁 ,平均 (42 4± 10 1)岁。 10 8例的饮酒史为 5～ 2 4年 ,平均 (11 6± 7 5 )年。饮酒量 (以白酒 5 0度计算 ) 15 0～ 6 5 0ｍｌ/ｄ ,平均 (332± 12 9)ｍｌ/ｄ。其中 92例伴有吸烟。有精神疾病家族史 15例 ,酗酒家族史 4 2例。采用回顾性研究方法 ,对临床资料进行分析。2　结果10 8例精神症状有幻视 38例 ,幻听 4 4例 ,幻视加幻听 2 5…     

神经精神性狼疮精神症状分析

目的 分析神经精神性狼疮(NPLE)的精神症状特征,以加强精冲科、神经科临床医生对系统性红斑狼疮所致精神症状的理解和认识.方法 对本院2003年4月至2005年11月间收治的104例系统性红斑狼疮(SLE)患者的补体、免疫球蛋白、抗核抗体、抗核糖体P蛋白、抗核糖核酸蛋白抗体、抗脑神经抗体、脑脊液变化及抗双链DNA等实验室指标及出现的精神症状进行回顾性分析.结果 59.62%(62/104)的SLE伴神经精神症状,其中30.77%(32/104)合并有精神症状,表现为类精神分裂症症状者12例;类情感性精神障碍者25例;类神经症症状者17例.精神症状出现时间在发现患SLE后2 d到5年不等,SLE或NPLE中有无精神症状亚组间抗脑神经抗体阳性率差异均有统计学意义(P<0.05),伴有精神症状组较高.结论 在SLE中精神障碍的发生率较高,但症状没有特征性,出现时间变异大,可能与神经免疫损伤机制密切相关,尤其是与抗脑神经抗体相关.     

213例慢性酒精中毒性精神障碍临床资料分析

目的 了解慢性酒精中毒性精神障碍的精神神经症状及躯体损害。方法 对１９９１年９月至１９９６年９月住院２１３例慢性酒精中毒性精神障碍患者临床资料进行回顾性分析。结果 主要精神症状出现率分别为：各种妄想６１．３０％，幻觉５６．８０％，伤人损物４６．４８％，智能障碍３４．２７％。主要神经系统症状出现率分别为：四肢震颤５３．５２％，舌震颤１９．２５％，周围神经炎１７．８４％，共济失调１５．０２％，癫痫样发     

Bilateral ballism in a patient with diabetes mellitus and chronic renal failure

Acute movement disorder associated with bilateral basal ganglia lesions is an increasingly recognized syndrome in patients with end-stage renal disease, especially in the setting of diabetes mellitus. The exact mechanism of the basal ganglia lesions is unclear. We report a patient with end-stage diabetic nephropathy admitted to our clinic with acute onset bilateral ballistic movements.     

Heart rate variability and cardiac arrhythmias in patients with chronic renal failure

Heart rate variability was measured from 24-h electrocardiograms in 61 patients with end stage chronic renal failure. The method used counts the number of times successive RR intervals differ by more than 50 ms over the 24-h period, and is a reliable indicator of cardiac parasympathetic activity. Also analysed were the frequency and type of ectopic beats and other arrhythmias. Twentyone subjects (34%) had varying numbers of ventricular ectopic beats, and twelve (20%) had frequent supraventricular ectopics. Total 24-h count values were abnormal in 30 (76%) of the 41 subjects whose tapes were technically suitable for this analysis. There were no sex differences, but those patients maintained on haemodialysis had significantly lower counts than those on continuous ambulatory peritoneal dialysis. We conclude that about three-quarters of patients with chronic renal failure have abnormal cardiac parasympathetic activity. This may increase susceptibility to cardiac arrhythmias and sudden death and contribute to the high mortality of patients with chronic renal failure.     

Sympathetic skin response in patients with chronic renal failure

Sympathetic skin response (SSR) was measured in 20 normal healthy subjects and in 22 patients with chronic renal failure on regular hemodialysis, and its correlation with abnormalities of sensorimotor nerve conduction study and clinical autonomic symptoms was investigated. Nerve conduction studies (NCS) were abnormal in 17 of 22 patients (77.3%), and SSR was absent in 14 of 22 patients (63.6%). Patients were divided into three groups based on their SSR response: patients with normal SSR (n:8, 36.4%), patients with absent SSR in the foot only (n:9, 40.9%), and patients with absent SSR in both hand and foot (n : 5, 22.7%). Good correlation between abnormalities of NCS and absent SSR was observed. No correlation was noted between patient age, sex, duration of hemodialysis, duration of renal failure history, and absent SSR. However, statistically significant correlation was found between mean amplitude of the foot SSRs and sensorimotor nerve conduction velocities, and weekly frequency of hemodialysis.     

Clinico-radiological spectrum in enterovirus 71 infection involving the central nervous system in children

Enterovirus 71 infection causes hand, foot and mouth disease in children, and can produce diverse neurologic complications. Epidemics occurring in Korea between 2009 and 2012 resulted in the death of some patients. The present study aimed to clarify the correlation between clinical features and MRI findings in patients presenting with acute neurologic manifestations related to enterovirus 71 infection. Based on their clinical features, the patients were classified into four clinical groups: (1) brainstem encephalitis (n = 17), characterized by myoclonus, tremor, ataxia, and autonomic dysregulation such as pulmonary hemorrhage; (2) aseptic meningitis (n = 2); (3) encephalitis (n = 2), characterized by decreased consciousness, seizure, and fever without myoclonus, tremor, ataxia, and autonomic dysregulation; and (4) acute flaccid paralysis (n = 1). Thirteen of the 17 patients with brainstem encephalitis showed characteristic lesions in the dorsal brainstem and bilateral cerebellar dentate nuclei on brain MRI, whereas three had no abnormality. One of the two patients with meningitis had a small lesion in the left dorsal pons. Two patients with encephalitis had no apparent MRI abnormality. One patient with acute flaccid paralysis of the right leg had contrast-enhancement of the bilateral ventral nerve roots at the lumbar spine level on MRI. Five of 13 patients with lesions in the bilateral dentate nuclei of the cerebellum exhibited no cerebellar symptoms, while two with no cerebellar lesions developed ataxia. Although most patients presenting with neurologic manifestations of enterovirus 71 infection had characteristic clinical features together with typical MRI findings, the clinical features were not necessarily consistent with MRI findings.     

Abnormal Neurological Exam Findings in Individuals with Mild Traumatic Brain Injury (mTBI) Versus Psychiatric and Healthy Controls

In those with a history of mild traumatic brain injury (mTBI), cognitive and emotional disturbances are often misattributed to that preexisting injury. However, causal determinations of current symptoms cannot be conclusively determined because symptoms are often nonspecific to etiology and offer virtually no differential diagnostic value in postacute or chronic phases. This population-based study examined whether the presence of abnormalities during neurological examination would distinguish between mTBI (in the chronic phase), healthy controls, and selected psychiatric conditions. Retrospective analysis of data from 4462 community-dwelling Army veterans was conducted. Diagnostically unique groups were compared on examination of cranial nerve function and other neurological signs. Results demonstrated that individuals with mTBI were no more likely than those with a major depressive disorder, generalized anxiety disorder, posttraumatic stress disorder, or somatoform disorder to show any abnormality. Thus, like self-reported cognitive and emotional symptoms, the presence of cranial nerve or other neurological abnormalities offers no differential diagnostic value. Clinical implications and study limitations are presented.     

Plasma thrombospondin in patients with chronic renal failure, liver disease and splenectomy

Thrombospondin (TSP), is a major constituent of human blood platelet alpha-granules. Stimulation of platelets causes the release of TSP in parallel with other alpha-granule constituents such as beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4) but the thrombospondin plasma in vivo half life is significantly greater than beta-TG and PF4. The aim of this study was to assay TSP levels in plasma of patients with chronic renal failure (CRF), liver disease (LD) and following splenectomy. The TSP values were then compared to the patients plasma levels of two traditional markers of platelet activation, beta-TG and PF4, and to fibronectin (FN) and von Willebrand factor (VIII:vWF). Plasma TSP levels (67.6 +/- 16.9 ng/ml) assayed in 14 CRF patients were significantly higher (p less than 0.05) than those measured in 28 donors (55.5 +/- 11.7 ng/ml). No correlation was observed, in CRF patients, between the TSP level and PF4 (2.5 +/- 1.5 ng/ml), beta-TG (131.1 +/- 21 ng/ml), FVIII:vWF (252 +/- 85%), or FN (102 +/- 33%) plasma levels. The TSP plasma level in CRF patients was significantly correlated (p less than 0.02) with that of fibrinopeptide A (4.1 +/- 1.9 ng/ml). Although the beta-TG (23.5 +/- 6.9 ng/ml) and PF4 (2.9 +/- 2 ng/ml) plasma levels in six LD patients were normal, the TSP levels (82.5 +/- 39.1 ng/ml) were significantly increased (p less than 0.01). Thrombospondin plasma levels (77.1 +/- 20.1 ng/ml) in 14 patients having undergone splenectomy were significantly increased (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Alteration of serum semicarbazide-sensitive amine oxidase activity in chronic renal failure

Summary Despite recent intensive investigations, physiological and pathological role of semicarbazide-sensitive amine oxidase (SSAO) is far from clear. In this study, serum SSAO activity was determined, radiochemically, in various groups of uremic patients: haemodialysed (HD), peritoneally dialysed (PD) and those receiving conservative treatment but still not dialysed (ND), as well as in controls. Reduced enzyme activity was found in HD uremic patients before and after dialysis treatment, compared to controls (5260 ± 862 and 6011 ± 958 pmol/h/ml vs. 8601 ± 283 pmol/h/ml, p < 0.01 and p < 0.05, respectively). The activity was slightly lower in PD, and normal in ND patients. In HD patients SSAO activity was also determined by an assay based on the formation of hydrogen peroxide, and was found to be elevated compared to controls (2384 ± 323 pmol/h/ml vs. 1437 ± 72 pmol/h/ml, p < 0.05). The elevated serum SSAO activity measured through the detection of the enzyme-generated hydrogen peroxide in HD patients might indicate its contribution to the accelerated atherosclerotic disease observed in uremia.     

脑卒中患者急性肾功能衰竭与高渗透压血症相关性的研究

目的研究脑卒中并发急性肾功能衰竭(急性肾衰)与高渗透压血症的相关性及有关因素。方法总结59例脑卒中并发急性肾衰患者(急性肾衰组)和76例肾功能正常的脑卒中患者(对照组)的临床资料。将两组患者的血浆渗透压与血清肌酐值进行相关分析。用Logistic回归分析确定脑卒中并发急性肾衰的有关因素。结果平均血浆渗透压急性肾衰组[(320.98±30.63)mOsm/L]明显高于对照组[(295.49±17.7)mOsm/L](P<0.001)。平均血清肌酐急性肾衰组[(298.15±94.72)μmol/L]明显高于对照组[(93.47±33.34)μmol/L](P<0.001)。两组患者的血浆渗透压与肌酐均呈正相关(r=0.452,P<0.001)。多因素分析显示,高渗透压血症(OR=4.40,95%C I=1.91~10.14)、全身炎症反应综合征(SIRS)3~4级(OR=4.58,95%C I=2.01~10.43)、静滴甘露醇(OR=8.88,95%C I=1.74~45.27)与脑卒中患者急性肾衰有关联。结论血浆渗透压升高与脑卒中并发急性肾衰有密切关系。高渗透压血症、SIRS 3~4级和静滴甘露醇是脑卒中并发急性肾衰的联合因素或独立因素。     

Prostacyclin production by whole blood from children: impairment in the hemolytic uremic syndrome and excessive formation in chronic renal failure

The capacity of leukocytes to produce prostacyclin (PGI2) from endogenous and from platelet-derived endoperoxides was tested in whole blood. During the acute phase of the hemolytic uremic syndrome (H.U.S.), the PGI2-production was lower than the controls, whereas the blood from children with chronic renal failure produced higher amounts. Production of PGI2 by blood from children 3/12 to 6 years after the acute phase of H.U.S. was normal, as was the case with blood from their parents. Furthermore, in two H.U.S.-patients studied serially, the decreased PGI2-production capacity normalized 2 1/2 months after the acute phase.