高同型半胱氨酸血症致脑梗死病例特点研究

目的探讨高同型半胱氨酸血症脑梗死患者病例特点,为进一步对脑梗死的综合干预提供依据。方法对90例脑梗死患者根据血浆同型半胱氨酸水平分为高同型半胱氨酸血症脑梗死组(Hhcy脑梗死组)60例及同型半胱氨酸正常脑梗死组(nHcy脑梗死组)30例,将其临床特点、血脂水平、血浆纤维蛋白原水平及影像学特点进行回顾性分析。结果 Hhcy脑梗死组患者中男性、吸烟及饮酒者均多于nhcy脑梗死组,血浆Hcy及低密度脂蛋白(LDL-C)水平高于nhcy脑梗死组,并且均有统计学差异(P<0.05)。相关性分析显示Hcy水平与性别相关(r=0.257,P=0.015)。Hhcy脑梗死组病情进展患者比例、复发性脑梗死患者比例、病灶多发者比例均高于nhcy脑梗死组(P<0.05);两组神经功能缺损程度、梗死面积无差别。结论高同型半胱氨酸血症脑梗死发病以男性多见,临床上病情容易进展,脑血管事件再发风险高,影像学上以多发梗死病灶多见。血浆同型半胱氨酸增高对于神经功能缺损程度、脑梗死面积无明显影响。     

高同型半胱氨酸血症对大鼠脑血管的影响及干预

目的 探讨高同型半胱氨酸血症(hyperhomocysteinemia,Hhcy)对大鼠脑血管结构的影响及B族维生素十顶后的结果.方法 30只SD大鼠随机分为对照组、Hhey组、于预组,每组10只.分别给予普通饲料,高蛋氨酸饲料,高蛋氨酸饲料加B族维生素干预.采用高效液相法测定不同时期大鼠血浆总同型半胱氨酸(total homocysteine,tHcy)水平,采用电镜观察各组大鼠脑部血管结构的变化.结果 ①高蛋氨酸饮食使Hhcy组大鼠血浆tHey水平(22.85±4.92 μmol/L)高于埘照组(11.66±3.74 μmol/L)(P＜0.01),B族维生素干预8周后,干预组血浆tHey水平(10.28±5.05 μmol/L)下降,与对照组(13.27±3.63 μmol/L)无统计学筹异(P＞0.05);②通过电镜观察Hhcy组大鼠大脑中动脉及腑皮质微血管结构均可见损伤.B族维生素干预后大鼠脑血管结构损伤较Hhcy组减轻.结论 Hhcy对大鼠脑血管结构造成损伤,联合应用多种B族维生素可以降低血浆tHey水平,并减轻Hhcy对大鼠脑血管结构造成的损伤.     

高同型半胱氨酸血症对中青年脑梗死临床意义的研究

目的探讨高同型半胱氨酸血症(hyperhomocysteinemia,Hhcy)与中青年脑梗死的关系,以及蛋氨酸负荷试验(methionine loading test,MLT)对于发现隐匿性Hhcy的作用。方法选取2000—2003年发病2 d内住院的中青年脑梗死患者85例,正常对照组44例。利用高效液相色谱法测定并比较空腹及口服蛋氨酸后血浆总同型半胱氨酸(toal homocysteine,tHcy)水平,并结合血脂、血糖等生化指标进行分析。结果(1)病例组空腹及蛋氨酸负荷后血浆tHcy水平分别为(22.49±9.80)及(48.07±11.20)μmol/L,显著高于对照组(13.08±2.33)及(37.23±3.48)μmol/L(P<0.01)。(2)病例组空腹血浆tHcy(Fhhcy)水平高于正常者35例(占41.18%),仅负荷后血浆(Phhcy)水平高于正常者23例(占27.06%),两者合计病例组Hhcy者占68.24%,显著高于对照组(Fhhcy、Phhcy各2例,占9.09%)(P<0.01)。(3)单因素分析结果显示,Fhhcy、Phhcy水平与性别具有显著相关性(分别r=0.488与r=0.343,均P<0.01),而与吸烟、饮酒等其他危险因素及神经功能缺损评分等无相关性。结论Hhcy是中青年脑梗死的一个独立危险因素,而MLT是发现隐匿性Hhcy的必要手段。     

B族维生素干预对高同型半胱氨酸血症脑梗死患者二级预防的作用

目的 评价联合应用B族维生素对高同型半胱氨酸血症( hyperhomocysteinemia,Hhcy)脑梗死症状与非症状复发的二级预防作用.方法 采取前瞻、开放、平行对照研究方法,将1000例Hhcy脑梗死患者分为B族维生素干预组500例(每日口服叶酸2.5 mg、维生素B12 500 μg、维生素B6 25 mg)和对照组500例,随访2年观察B族维生素联合应用对脑梗死症状性复发与影像学再发的二级预防作用,记录试验期间血浆总同型半胱氨酸( total homocysteine,tHcy)水平.结果 B族维生素干预可显著降低患者血浆tHcy水平,干预3个月后干预组tHcy较基线下降14.7％,随访2年时下降19.2％,与对照组比较差异有统计学意义(F=94.39,P＜0.05).症状性脑梗死复发率干预组13.6％ (68/500)、对照组14.0％( 70/500,RR=0.99,95％ CI0.68～1.42)；无症状性影像学脑梗死复发率干预组与对照组均为4.8％ (24/500,RR=1.11,95％ CI0.62 ～2.02);总计脑梗死复发干预组18.4％ (92/500)、对照组18.8％(94/500,RR =0.96,95％ CI0.73～1.26),组间差异均无统计学意义.结论 本研究结果未能证实B族维生素干预Hhcy对脑梗死症状性与非症状性复发二级预防有益.     

Hcy水平与脑梗死患者颈动脉内膜中层厚度的相关性研究

目的探讨血浆总同型半胱氨酸(tHcy)与脑梗死患者颈动脉内膜中层厚度(carotid intima-media thickness,CIMT)的关系。方法选取2010-09—2015-03我院急性脑梗死患者300例,其中非Hhcy组(tHcy≤10μmol/L)、H1组(10μmol/LtHcy≤15μmol/L)和H2组(tHcy水平15μmol/L)各100例,测量3组患者CIMT,测量3组患者的一系列临床指标,包括空腹血糖(FBS)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDLC)、维生素B_(12)(Vit B_(12))、叶酸(FA)和糖化血红蛋白(HbA1c)等并进行对比。结果 3组患者CIMT值差异有统计学意义(P0.001),H2组CIMT值较非Hhcy组和H1组均高(P0.05)。3组tHcy、FA和VitB_(12)水平差异有统计学意义(P0.001),H1组和H2组tHcy水平较非Hhcy组高,FA和VitB_(12)水平较非Hhcy组低,H2组tHcy水平较H1组高,FA和VitB_(12)水平较H1组低,差异均有统计学意义(P0.05)。以CIMT值为因变量对各项因素进行多重线性逐步回归分析发现,年龄、吸烟史、糖尿病史、LDL-C和tHcy是CIMT的影响因素。结论伴Hhcy的脑梗死患者CIMT值上升,FA和VitB_(12)水平降低,尤其当tHcy15μmol/L时,CIMT明显升高,CIMT值与年龄、吸烟史、糖尿病史、LDL-C和tHcy有关。     

中青年缺血性脑血管病与血浆高同型半胱氨酸血症的相关性研究

目的探究血浆高同型半胱氨酸血症对中青年缺血性脑血管病的影响。方法本研究选取2012年1月至2016年3月于我院进行诊治的短暂性脑缺血发作患者45例,脑梗死患者45例,同期选取我院健康体检的志愿者50例为对照组,比较三组患者血浆高同型半胱氨酸水平,并进行相关性分析。结果三组患者同型半胱氨酸水平比较,差异明显(F=30.152,P0.05),短暂性脑缺血发作组同型半胱氨酸水平低于脑梗死组(t=8.153,P0.05),高于对照组(t=6.294,P0.05);脑梗死组高同型半胱氨酸血症发生率(86.67%)明显高于短暂性脑缺血发作组(68.89%),短暂性脑缺血组发作高于对照组(12%),短暂性脑缺血发作组与脑梗死组高血压、高血糖、高血脂发生率无明显差异(P0.05),均高于对照组(P0.05);将高同型半胱氨酸血症、高血糖、高血压、高血脂等指标纳入Logistic多因素回归模型中,高同型半胱氨酸血症与缺血性脑血管病存在相关性(P0.05)。结论血浆高同型半胱氨酸血症是中青年缺血性脑血管病的危险因素,与缺血性脑血管病存在相关性,血浆高同型半胱氨酸血症患者应警惕缺血性脑血管病的发生。     

牛磺酸对高同型半胱氨酸血症脑梗死患者的治疗作用

目的探讨牛磺酸对伴有高同型半胱氨酸(Hhcy)血症的脑梗死患者的治疗作用。方法100例Hhcy脑梗死患者随机分为牛磺酸治疗组和叶酸 维生素治疗组,给予相应的药物治疗8周。治疗前后分别测定血同型半胱氨酸(Hcy)、叶酸、维生素B12水平;采用美国国立卫生院神经功能缺损评分量表(NIHSS)及日常生活活动能力指数(BI)进行评分。结果治疗后两组血浆Hcy水平较治疗前显著下降(均P<0.01),但两组间差异无统计学意义;治疗后两组NIHSS及BI评分较治疗前显著改善(均P<0.01),但两组间差异无统计学意义。结论牛磺酸治疗对Hhcy脑梗死患者的疗效与叶酸、维生素B12相同。     

高同型半胱氨酸血症对缺血性脑卒中患者再发及死亡预后影响的随访研究

目的 前瞻性观察高同型半胱氨酸血症(hyperhomocysteinemia, Hhcy)对缺血性脑卒中(ischemic stroke, IS)患者再发及死亡事件发生的影响,为进一步综合干预IS提供依据.方法 检测245例随访5年的急性脑梗死和短暂性脑缺血发作(transient ischemic attack, TIA)患者的空腹血浆同型半胱氨酸(homocysteine, Hcy)水平,根据Hcy水平再划分为Hhcy组和非Hhcy组,追踪观察两组患者IS再发及死亡事件的发生情况.另选取52名健康体检者作对照.结果 Hhcy组与非Hhcy组患者5年脑梗死再发率分别为41.05%和20.00%(P<0.01);TIA发生率分别为11.58%和4.67%(P<0.05);IS(包括脑梗死及TIA)事件再发率分别为52.63%和24.67%(P<0.01);多次再发患者比例分别为13.68%和5.33%(P<0.05);死亡事件发生率分别为12.63%和3.33%(P<0.01);Logistic回归分析显示Hcy升高是再发IS的独立危险因素(OR为1.171;95%CI:1.118～1.227;P<0.01).结论 Hhcy与IS再发、死亡密切相关.     

同型半胱氨酸在帕金森病患者血浆中的变化及临床意义

目的对比研究同型半胱氨酸(homocystein,Hcy)在帕金森病(Parkinson’s disease,PD)和脑梗死患者血浆中的变化,探讨其临床意义。方法检测PD、脑梗死患者及对照组血浆Hcy水平,检测PD、脑梗死患者及对照组血浆叶酸和维生素B_(12)水平。对PD患者血浆Hcy水平与叶酸及维生素B_(12)水平进行相关性分析,对血浆Hcy水平与PD严重程度、病程、临床类型、情绪、认知功能及是否服用美多芭进行相关性分析。结果 (1)PD组、脑梗死组及对照组血浆Hcy水平分别为20±11μmol/L、16±7μmol/L及11±2μmol/L,PD组和脑梗死组血浆Hcy水平均高于对照组,差异有统计学意义(P0.05或0.01),PD组血浆Hcy水平明显高于脑梗死组(P0.01);(2)PD组血浆叶酸和维生素B_(12)水平分别为6±5μg/L和514±345ng/L。PD组血浆叶酸和Hcy水平呈明显负相关(r=-0.453,P0.01);血浆维生素B_(12)和Hcy水平无明显相关性(r=-0.268,P0.05)。(3)按照Hoehn-Yahr分期对PD严重程度进行分组,轻、中、重度PD组血浆Hcy水平分别为16±8μmol/L、21±9μmol/L和35±3μmol/L,三组之间差异有统计学意义(P0.05);(4)血浆Hcy水平与病程、临床类型、情绪、认知功能及是否服用美多芭无关。结论 PD组和脑梗死组血浆Hcy水平明显增高,PD组Hcy水平与疾病严重程度密切相关,PD组血浆叶酸和Hcy水平呈明显负相关。     

青年脑梗死患者血浆脂联素及同型半胱氨酸的水平

目的研究青年脑梗死患者的血清脂联素(ADPN)和血浆同型半胱氨酸(HCY)水平。方法选取30例体检健康者(对照组)及30例青年脑梗死患者(病例组),应用放射免疫技术检测其空腹血清脂联素和血浆同型半胱氨酸水平并进行比较。结果青年脑梗死患者血清脂联素水平较对照组明显降低(P0.01),血浆同型半胱氨酸水平较对照组明显增高(P0.01)。结论血清脂联素、血浆同型半胱氨酸水平可能与青年脑梗死的发生有关,低脂联素血症及高同型半胱氨酸血症可能是青年脑梗死的危险因素。     

Assessment of closed head injury in trauma-related spinal cord injury

The complete medical records of 122 patients who sustained traumatic spinal cord injuries were reviewed to determine the frequency and results of emergency room assessments for loss of consciousness (LOC) and post-traumatic amnesia (PTA). Eighty-eight percent of the patients were assessed for LOC and 19% were assessed for PTA. Fifty patients (41% of the total population) admitted to LOC, PTA or both. Fourteen of these 50 patients underwent subsequent radiographic examinations of the skull, all of which were negative. Because of the association of intracranial complications and long-term cognitive sequelae with even brief LOC or PTA, early recognition of craniocerebral trauma is an important component of the acute management of spinal cord injured patients.     

弥漫性轴索损伤在重型脑损伤中的意义

在15例闭合性脑损伤尸检中,病理诊断弥漫性轴索损伤(DAI)5例。根据病理研究结果和文献报道,分析了530例急性脑外伤病人脑CT表现,发现DAI61例。其CT表现为大脑皮髓质交界处、基底节内囊区域、胼胝体、脑干或小脑有一个或多个直径≤2cm的出血灶,脑室内出血及急性弥漫性脑肿胀。本文把DAI分为高颅压型和非高颅压型,后者又分的脑干损伤型和局灶性损伤型。这种分型对指导治疗和判断预后均有重要意义。DAI预后较差,是目前脑外伤病人死亡率高的重要原因之一。     

Neural injury of uncinate fasciculus in patients with diffuse axonal injury

The recent development of diffusion tensor imaging (DTI) allows visualization and estimation of the uncinate fasciculus (UF). We investigated injuries of the UF in patients with diffuse axonal injury (DAI) who showed no specific lesions except for DAI lesions on conventional brain MRI. Twenty-one chronic patients with DAI, and 21 age- and sex-matched normal control subjects were recruited for this study. Diffusion tensor images were acquired using a sensitivity-encoding head coil at 1.5 T and the UF was reconstructed using DTI-Studio software. Fractional anisotropy (FA), apparent diffusion coefficient (ADC) value, and fiber number of the UF were measured. In the DAI group, the FA values and fiber numbers were significantly decreased compared to those of the control group (P< 0.05). The FA value and fiber number decreased 8.4% and 26.5% in the DAI group compared to those of the control group. By contrast, the ADC value did not show any difference between the DAI and control groups (P> 0.05). Changes in the DTI parameters of the DAI group appeared to indicate neural injury of the UF. We believe that DTI can be a useful evaluation tool for detecting hidden neural injuries of UF in patients with DAI.     

Assessing connectivity related injury burden in diffuse traumatic brain injury

Many of the clinical and behavioral manifestations of traumatic brain injury (TBI) are thought to arise from disruption to the structural network of the brain due to diffuse axonal injury (DAI). However, a principled way of summarizing diffuse connectivity alterations to quantify injury burden is lacking. In this study, we developed a connectome injury score, Disruption Index of the Structural Connectome (DISC), which summarizes the cumulative effects of TBI‐induced connectivity abnormalities across the entire brain. Forty patients with moderate‐to‐severe TBI examined at 3 months postinjury and 35 uninjured healthy controls underwent magnetic resonance imaging with diffusion tensor imaging, and completed behavioral assessment including global clinical outcome measures and neuropsychological tests. TBI patients were selected to maximize the likelihood of DAI in the absence of large focal brain lesions. We found that hub‐like regions, with high betweenness centrality, were most likely to be impaired as a result of diffuse TBI. Clustering of participants revealed a subgroup of TBI patients with similar connectivity abnormality profiles who exhibited relatively poor cognitive performance. Among TBI patients, DISC was significantly correlated with post‐traumatic amnesia, verbal learning, executive function, and processing speed. Our experiments jointly demonstrated that assessing structural connectivity alterations may be useful in development of patient‐oriented diagnostic and prognostic tools. Hum Brain Mapp 38:2913–2922, 2017. © 2017 Wiley Periodicals, Inc.     

Necrostatin-1在小鼠脊髓损伤后继发性损伤中的作用

目的 探讨Necrostatin-1(Nec-1)在小鼠脊髓损伤后继发性损伤中的作用及机制。方法 将168只健康成年雌性LCR小鼠随机分为4组:对照组（48只）、脊髓损伤组（48只）、溶剂组（36只,鞘内注射4 μl二甲基亚砜）和治疗组[36只,鞘内注射4 μl Nec-1（4 mmol/L）]。采用血管夹钳夹小鼠脊髓建立脊髓损伤模型。伤后6、12、24、48 h采用免疫印迹法检测脊髓组织受体相互作用蛋白（RIP）1、3的表达;伤后24 h采用免疫共沉淀法评估RIP1和RIP3的相互作用;伤后24 h检测脊髓组织丙二醛（MDA）和活性氧簇（ROS）水平,电镜观察小鼠脊髓组织神经元线粒体损伤情况。结果 伤后48 h内,小鼠脊髓RIP1表达水平无明显变化;伤后6 h,小鼠脊髓RIP3表达水平明显增高,持续到伤后48 h。伤后24 h,治疗组和溶剂组RIP1和RIP3的表达水平均无明显差异;正常脊髓组织RIP1和RIP3相互作用较弱,脊髓损伤后RIP1和RIP3相互作用加强,而Nec-1显著抑制RIP1和RIP3相互作用。伤后24 h,脊髓神经元线粒体不同程度受损,而治疗组小鼠脊髓神经元线粒体结构保存相对较好。伤后24 h,脊髓组织MDA和ROS含量明显升高,而Nec-1能明显减少小鼠脊髓MDA和ROS含量。结论 小鼠脊髓损伤后,Nec-1通过抑制RIP1和RIP3的相互作用,进而抑制程序性坏死,减轻脊髓继发性损伤。Nec-1能降低ROS产物,减轻氧化应激损伤,保护线粒体功能。     

Vascular injury in neurotrauma

Traumatic vascular lesions can occur after severe or even the most mild of head and cervical trauma. The initial evaluation of the injured patient must be thorough and the clinical suspicion of vascular injury must be highly suspected based on the mechanism of injury. Traumatic vascular injuries can be broadly classified into traumatic aneurysms, dissections and occlusions and fistulae of the carotid or vertebral arteries. The current management and treatment options of each condition are discussed.