卒中后抑郁患者的交感神经皮肤反应与事件相关电位对照研究

目的探讨交感神经皮肤反应(SSR)与事件相关电位(ERP)对卒中后抑郁患者的诊断价值。方法对55例卒中后抑郁患者和52例正常健康者分别进行了SSR和ERP测定,并将结果加以比较。结果卒中后抑郁组中SSR和ERP测定中的P300成分异常率分别为87.3%(48/55)和83.6%(46/55),两者异常吻合率为76.4%(42/55)。卒中后抑郁组SSR测定结果中,SSR潜伏期和波幅值较对照组延长和降低,其差异具有显著性(P<0.01),ERP测定中N2、P3波潜伏期和P3波幅较对照组分别延长和降低,存在显著性差异(P<0.01)。其中N2、P3波潜伏期与SSR测定中潜伏期以及波幅与波幅之间呈正相关(r=0.29~0.36,P<0.01),而两者潜伏期与波幅之间呈负相关(r=-0.32~-0.33,P<0.01)。结论交感神经皮肤反应和事件相关电位测定可作为卒中后抑郁患者的诊断指标应用于临床。     

慢性紧张型头痛患者的抑郁和交感神经皮肤反应相关性的研究

目的探讨慢性紧张型头痛(CTTH)患者抑郁和交感神经皮肤反应(SSR)相关性。方法选取神经内科就诊、符合入组的CTTH患者54例,对照组为同期健康体检者40例,两组均行汉密顿抑郁量表(HAMD)和SSR检测。结果 CTTH患者轻度抑郁(HAMD8¹7分)26例,占48.15%;中、重度抑郁(HAMD>17分)10例,占18.52%。与对照组比较,轻度和中、重度抑郁患者SSR潜伏期均延长(p<0.01),而波幅均降低(p<0.01);无抑郁的CTTH患者SSR潜伏期亦显著长于对照组(p<0.05),而波幅显著低于对照组(p<0.05);中、重度抑郁患者较轻度抑郁患者SSR潜伏期延长(p<0.01),波幅降低(p<0.01)。结论 CTTH患者抑郁发生率高,CTTH患者存在皮肤交感神经兴奋性减低,伴发抑郁重者变化更为明显,SSR检测为CTTH的诊断和治疗可提供一定的参考价值。     

卒中后抑郁

卒中后抑郁 (PSD)早在 2 0世纪 40年代国外就有学者报道过 ,但当时仅将它归咎于卒中后躯体功能障碍产生的心理反应。近 10多年的研究证明 PSD与卒中有着直接关系 ,抗抑郁治疗不但能提高卒中患者的生活质量 ,而且有助于卒中后神经功能的康复。1　患病率PSD的患病率在 30 %左右 [1 ,2 ] ,Eastwood等 [3 ] 调查一组卒中患者的 PSD患病率高达 5 0 % ,国内张庆臣等 [4]报告PSD患病率为 5 5 %。有文献报告老年期静止性脑梗死 (SCI)病人中 PSD的发生率则更高 ,老年期 SCI发生率约 30 %左右 ,而老年期严重抑郁或躁狂病人 SCI的发生率可…     

卒中后抑郁与卒中部位的相关研究

目的 探讨卒中后抑郁（post-stroke depression PSI））与卒中病灶部位的关系。方法通过CT或MRI进行卒中病灶定位,采用Hamilton抑郁量表对200例卒中患者在发病2周和3月进行调查评分。结果急性期和恢复期大脑半球左侧、右侧、双侧卒中PSD发生率无统计学差异。2周时大脑半球前部与后部卒中病灶两PSD发生率无统计学差异（x^2=1．9546,P〉0．1）。3月时大脑半球前部与后部卒中痛灶两PSD发生率有统计学差异（x^2=6．04,P〈0．05）。结论PSD的发生无半球偏利性。急性期大脑半球前部卒中病灶与PSD无明显相关性。恢复期走脑半球前部卒中病灶与PSD存在相关性。     

脑梗死患者交感神经皮肤反应分析

交感神经皮肤反应（sympathetic skin response,SSR）是由内源或外源性刺激所诱发的皮肤 瞬时电位变化,属于脑和脊髓参与的交感催汗运动。本文主要概述近年来SSR在脑梗死患者中应用 价值,阐述其对脑梗死患者自主神经功能紊乱的临床诊断作用,与脑梗死患者运动功能的相关性, 以及SSR在推断交感神经可能的中枢传导通路中的价值。     

皮电生物反馈治疗卒中后抑郁的对照研究

目的 通过对卒中后抑郁（post-stroke depression,PSD）患者随机分组进行皮电生物反馈（galvanic skin response,GSR）及假反馈训练,比较训练前后抑郁症状及生理指标的变化,探讨GSR生物反馈对 PSD患者的疗效。 方法 24例卒PSD患者随机分为GSR反馈组（11例）和对照组（13例）,均给予常规康复治疗和药物治 疗,反馈组在此基础上接受GSR生物反馈治疗,每次40 mi n,每周3次,共4周,对照组仅使用电脑开展 放松治疗而没有反馈信号。在治疗前后采用汉密尔顿抑郁量表（Hamilton depression scale,HAMD）进行 评估,并在安静状态下进行各生理指标的采集,比较训练前后抑郁症状及生理指标的变化。 结果 GSR组经训练后,HAMD量表焦虑躯体化症状（P =0.034）、认知症状（P =0.019）及抑郁总分 （P =0.011）与对照组比较有显著改善。GSR组经训练后,生理指标皮电明显减小（[ 0.94±2.38）μV vs （0.59±0.33）μV,P =0.023]。 结论 GSR生物反馈能改善卒中后抑郁患者的抑郁症状及生理指标。     

抑郁症患者的交感神经皮肤反应探讨

目的探讨交感神经皮肤反应(SSR)对抑郁症患者的临床价值。方法对45例抑郁症患者治疗前后和43例正常健康者分别进行SSR测定和汉密尔顿抑郁量表(HAMD)评定,并加以比较。结果抑郁症组治疗前SSR测定的异常率为84.4%(38/45),而治疗后异常率为13.3%(6/45)。治疗前SSR测定波潜伏期及波幅值较治疗后及对照组分别延长和降低,差异有统计学意义(P<0.01);治疗后抑郁症组HAMD评定分值较治疗前降低,差异有统计学意义(P<0.01)。相关分析结果表明,抑郁症患者SSR波潜伏期与HAMD分值呈显著正相关(P<0.01),其波幅与HAMD分值呈显著负相关(P<0.01)。结论交感神经皮肤反应测定可作为判定抑郁症患者自主神经功能的参考指标应用于临床。     

T2DM患者交感神经皮肤反应特征分析

目的探讨2型糖尿病(T2DM)患者的交感神经皮肤反应(SSR)改变特征.方法测定88例T2DM患者的上、下肢体的SSR改变特征;并分析与病程、糖基化血红蛋白(以下简称HbA1C)的关系.选正常人50例作为对照组.结果 T2DM患者的上、下肢SSR的异常率分别为68.5%、58.5%,明显高于正常对照组(P《0.05) ,进一步发现,病程越长,HbAIC水平越高,SSR异常率越高.结论 T2DM患者存在着广泛的植物神经神经病变,SSR技术有助于诊断.     

卒中后抑郁与脑卒中患者载脂蛋白E水平对照研究

目的:探讨卒中后抑郁(PSD)患者载脂蛋白E(ApoE)水平特点,为PSD的诊断提供新的客观依据。方法:采用实时荧光定量PCR技术和酶联免疫吸附法(ELISA)检测PSD患者及卒中后非抑郁患者ApoE水平。结果:PSD组ApoE基因mRNA表达量低于卒中组,差异具有统计学意义(P<0.01);PSD组血清ApoE水平高于卒中组,差异具有统计学意义(P<0.05)。结论:PSD患者外周血ApoE基因mRNA表达和血清ApoE水平与卒中非抑郁患者不同。     

Sympathetic skin response in patients with reflex sympathetic dystrophy

The sympathetic skin response (SSR) originates from synchronized activation of the sweat glands as a response to a volley discharge in efferent sympathetic nerve fibres. The aim of the study was to verify the diagnostic value of SSR in patients with reflex sympathetic dystrophy (RSD). SSR was recorded in 20 normal subjects and in 24 patients with predominantly chronic RSD. In normal subjects inter- and intra-individually different mono-, bi- and triphasic potentials could be recorded without difference of the waveform from side to side. SSR abnormalities were found in 15 patients and correlated with the severity of the disease. In patients with slight dystrophies, SSR was predominantly normal. In intermediate dystrophies, mainly differences of the SSR waveform between sides could be recorded, indicating unilateral sudomotor dysfunction. In severe dystrophies abnormalities of SSR amplitude or latency were found, indicating more serious disturbance of sudomotor activity, possibly due to a lesion of sympathetic fibres. The SSR provides useful information on sudomotor dysfunction in patients with RSD. However, as there is no consensus in the literature for the clinical criteria to diagnose RSD, it is not yet possible to determine the final diagnostic value of SSR for the diagnoses of RSD.     

偏头痛患者交感神经皮肤反应的研究

目的:探讨交感神经系统在偏头痛伤害性信息传递中的作用。方法:应用神经电生理测定了56例偏头痛患者和30例健康人交感神经皮肤反应。结果:偏头痛患者发作期、间歇期交感神经皮肤反应的潜伏期均明显长于正常对照组,而波幅显著低于对照组;偏头痛发作期的潜伏期显著长于间歇期,波幅显著低于间歇期。结论:偏头痛患者存在交感神经功能低下。     

Hyperhidrosis and sympathetic skin response in chronic alcoholic patients

Palmoplantar hyperhidrosis is frequently observed in patients with a clinical history of chronic abnormal alcoholic intake. It can be related to peripheral or central mechanisms such as abnormal spontaneous activity in peripheral damaged fibres; receptor hypersensitivity; compensatory incremented activity in segmentary anhidrosis; or impairment of central sweat control. With the aim of quantifying this phenomenon and of identifying its possible origin, sympathetic skin response (SSR) analysis was performed in 20 chronic alcoholic patients with clinical diffuse acral hyperhidrosis, compared with 30 normal subjects and 2 patients affected by primary palmoplantar hyperhidrosis (PPH). SSRs were recorded by disc electrodes place on the hands and feet, simultaneously. At the hand level two recording sites were selected: palm-dorsum proximally and ventral-dorsal tip of the third finger distally. Attention was paid to the number of SSR after a single endogenous or exogenous stimulus. The alcoholic patients were divided into two groups, with and without mild polyneuropathy. Both patient groups showed synchronous SSR at recording sites, with the same pattern and the normal delay between upper and lower arms. In the control group one response was generally related to a single stimulus; if more responses were elicited an evident adaptation was shown; in the two groups of patients an increase of the waves was observed in all the recording sites without any adaptation. The SSR profile described in alcoholic patients was observed also in PPH. The pattern of SSR waves in alcoholic patients seems to suggest a possible central origin of this type of hyperhidrosis.     

Brain-derived neurotrophic factor and post-stroke depression

Brain-derived neurotrophic factor (BDNF) is well known to play a critical role in cognition. Its role in mood disorders, including post stroke depression (PSD), is also recognized with more evidence surfacing. In patients with PSD, their serum BNDF level is lower than in those without depression. Furthermore, antidepressants could enhance BDNF expression in the brain, resulting in an alleviation of depression symptoms. Such therapeutic effect can be abolished in animals with the BDNF gene deleted. In PSD patients, the presence of stroke may contribute to the development of depression, including affecting the expression of BDNF. However, the mechanisms of BDNF in the development of PSD remain largely unknown. Lower BDNF levels may have existed in some patients before stroke onset, making them vulnerable to develop depressive symptoms. Meanwhile, the hypoxic environment induced by stroke could possibly downregulate BDNF expression in the brain. Current antidepressant treatments are not specific for PSD and there is a lack of treatments to address the linkage between stroke and PSD. This review summarizes the current knowledge of BDNF in PSD. By regulating BDNF expression, a synergistic effect may be achieved when such treatments are applied together with existing antidepressants.     

Patterns of sympathetic skin response in palmar hyperhidrosis

Sympathetic skin responses (SSRs) were studied in 44 patients with palmar hyperhidrosis. The mean age was 19±4 years and the mean age of onset 9.1±3.6 years. Palmar SSRs were evoked by median nerve stimulation and by magnetic stimulation of the neck. Four types of SSR were identified: normal response, small-amplitude response, multiphasic response and absent response. Four palmar conditions were also identified: warm-wet in 26 patients, warm-dry in seven, cold-wet in seven, and cold-dry in four. Normal SSRs were present in about 25% of patients and absent SSRs in another 25%. The other two types of SSR were evently distributed among patients, except those with cold-dry palms, who only had absent responses. There was no apparent difference between centrally and peripherally activated SSRs. It is concluded that skin temperature and moisture of the palms play an important role in producing different types of SSR in palmar hyperhidrosis.     

The significance of intact sympathetic skin responses in carpal tunnel syndrome

The current study aimed to investigate the impact of carpal tunnel syndrome (CTS) on sympathetic skin response (SSR) recorded from the median and ulnar territory. Thirty patients were studied and idiopathic CTS was documented in a total of 46 hands. These were classified, according to electrophysiological criteria, into two groups; a group of 31 hands with severe CTS and a group of 15 hands with mild/moderate CTS, and were compared with a group of 30 hands of age-matched controls. SSR was recorded simultaneously from the median and ulnar side of the palm following electrical stimulation at the wrist, in a mid-point between median and ulnar nerve. Latency, amplitude, habituation and the median-to-ulnar ratio were estimated. In all controls clear recordings of SSR were obtained. In the patient groups, absence of SSR was never observed either in mild/moderate or in the severe CTS hands. The mean SSR latency and amplitude values recorded from both the median and ulnar nerves did not significantly differ between mild/moderate or severe CTS hands and controls. Likewise, the median-to-ulnar ratio and habituation of SSR latencies and amplitudes did not significantly differ between groups. SSR does not seem to be a sensitive method for evidence of autonomic involvement in CTS, even in patients manifesting sudomotor or other autonomic symptoms. In the present setting, SSR appeared to be independent of somatic afferent function and the corresponding sensory action potentials.     

The influence of skin temperature on latency and amplitude of the sympathetic skin response in normal subjects

The influence of skin temperature on latency and amplitude of the sympathetic skin response (SSR) was studied in 10 normal subjects. SSRs were elicited in all four limbs of each subject by electrical stimulation after cooling of the right arm and after cooling of the right hand only. At low skin temperature, the latency was prolonged and the amplitude decreased. Latency and amplitude were linearly correlated with skin temperature of the right arm. There were no changes in the left arm and the legs, which basically excludes involvement of central pathways in these response parameters. With regard to the skin temperature of the arm, a temperature correction factor of 0.088 s/°C was calculated for latency. With regard to the skin temperature of the hand, latency prolongation was significantly greater after cooling of the whole arm. This suggests that not only the neuroglandular junction, but also the postganglionic sympathetic C fibers were responsible for latency modifications. In contrast, amplitude was reduced similarly after cooling of the whole arm and the hand only, suggesting that mainly the neuroglandular junction is responsible for amplitude modifications. We conclude that skin temperature is a mandatory measurement in the study of the SSR. © 1998 John Wiley & Sons, Inc. Muscle Nerve, 21: 34–39, 1998.