高同型半胱氨酸血症与脑梗死复发的关系

目的探讨高同型半胱氨酸血症(Hhcy)与脑梗死复发的关系。方法按血浆同型半胱氨酸(Hcy)水平,将139例急性脑梗死患者分为Hhcy组(42例,血Hcy≥15μmol/L)和非Hhcy(NHhcy)组(97例,血Hcy<15μmol/L)。给予入组者抗血小板治疗,以及控制已知的脑血管病危险因素等治疗;随访5年,观察两组脑梗死复发率及死亡率,分析影响脑梗死复发的危险因素。结果 Hhcy组脑梗死复发率(38.1%)和死亡率(19.0%)明显高于NHhcy组(15.5%,6.1%)(P<0.05～0.01)。Logistic回归分析显示,脑梗死复发与Hhcy(OR=1.110,95%CI:1.051～1.171,P<0.01)及糖尿病(OR=4.816,95%CI:1.693～13.697,P<0.01)有关。结论 Hhcy是脑梗死复发的独立危险因素之一。     

高同型半胱氨酸血症与急性脑梗死患者血脂水平相关性分析

目的探讨高同型半胱氨酸(Hhcy)血症与急性脑梗死的关系,说明Hhcy是脑血管病发生的重要危险因素。方法对86例急性脑梗死患者和41例健康对照者测定空腹血清Hcy及血脂水平。结果脑梗死组Hcy水平为32.69±12.43μmol/L,显著高于对照组13.24±4.62μmol/L(p<0.05)。结论血清Hcy水平升高与脑梗死密切相关,提示血清Hcy水平升高可为急性脑梗死的诊断提供新的依据。     

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.     

74例脑梗死血浆Hcy分析

近年来国内外研究认为高同型半胱氨酸(hyper-homocysteinemia,Hhcy)可能是导致动脉粥样硬化性血管疾病新的独立危险因素。关于Hhcy与缺血性脑血管病的关系尚有争论。我们观察了74例脑梗死患者血清同型半胱氨酸(Homocysteinemia,Hcy)水平,讨论Hcy与脑梗死的关系,以及糖尿病对Hcy     

血胱抑素C、同型半胱氨酸与急性脑梗死相关性

目的探讨血胱抑素C(Cys C)、同型半胱氨酸(Hcy)与急性脑梗死(ACI)发病的关系。方法采用胶体金颗粒免疫比浊法和酶循环法分别测定120例ACI患者和120例健康者血清中Cys C和Hcy的含量。用SPSS17.0软件进行统计学分析。结果病例组血清Cys C水平为(1.16±0.21)mg·L~(-1),Hcy水平(15.83±3.15)umol·L~(-1),显著高于对照组血清Cys C水平(0.97±0.18)mg·L~(-1),Hcy水平(13.55±2.22)umol·L~(-1)。病例组高血胱抑素C(HCys C)检出率为85.83%,高同型半胱氨酸(Hhcy)检出率为88.33%,显著高于对照组血清HCys C检出率12.50%,Hhcy检出率10.83%,差异有统计学意义(P<0.01)。结论 HCys C及Hhcy与ACI发病直接相关,检测Cys C和Hcy会对理解ACI的潜在发病机制有帮助。     

阿司匹林用于脑梗死二级预防中发生抵抗的原因分析及氯吡格雷干预效果研究

目的分析阿司匹林用于脑梗死二级预防中发生抵抗的原因及氯吡格雷干预效果。方法选择2014年1月—2015年9月256例脑梗死患者纳入研究对象,所有患者均于入院当日开始服用阿司匹林,服用7d后检测血小板聚集率,筛选出阿司匹林抵抗(AR)及阿司匹林半抵抗(ASR)患者共62例,分析引起AR相关因素。采用随机数字表法将62例AR患者分为观察组和对照组各31例,对照组继续服用阿司匹林治疗,观察组服用氯吡格雷联合阿司匹林治疗,观察两组患者血小板聚集率变化、再发脑梗死及出血情况。结果 256例脑梗死患者中,发生AR 62例,发生率24.22%。AR+ASR组患者女性、合并糖尿病、低密度脂蛋白(LDL)水平均明显高于阿司匹林敏感(AS)组(t/χ~2=4.396,4.083,11.191,P<0.05);治疗7d、14d后,观察组血小板聚集率均明显低于对照组(t=10.578,10.466,P<0.05);随访6个月(2014年7月—2016年3月)和12个月(2014年12月-2016年8月),观察组再发梗死率均明显低于对照组(3.23%vs19.38%,3.23%vs22.58%)(χ~2=4.026,5.167,P<0.05)。结论女性、糖尿病、高低密度脂蛋白是脑梗死二级预防中发生AR的高危因素,氯吡格雷联合阿司匹林治疗能降低血小板聚集率,预防脑梗死复发。     

急性脑梗死合并高血压与血浆同型半胱氨酸水平的关系

<正>研究[1]表明,高同型半胱氨酸血症(HHcy)是脑梗死的独立危险因素。本研究通过检测急性脑梗死(ACI)患者的血同型半胱氨酸(Hcy)水平和血压情况,探讨ACI与血Hcy水平、血压之间的关系。1对象与方法 1.1对象(1)ACI组:系2012年1~8月本院收治的ACI患者119例,均符合全国第四届脑血管病学术会议修订的诊断标准,并经头颅CT或MRI确诊,男77例,女42例;年龄     

高同型半胱氨酸血症与脑卒中患者关系的临床分析

目的 探讨高同型半胱氨酸血症与脑卒中的关系.方法 测定96例颈内动脉系统脑梗死患者和79例健康对照者空腹血浆同型半胱氨酸(Hcy),以对照组Hcy检测结果将患者分为Hcy(Hcy升高)组和非Hcy(Hcy正常)组.结果 Hcy组脑卒中发生率显著高于非Hcy组(63.78%、42.36%,P<0.05),Logistic回归分析显示,Hcy是脑卒中危险事件发生的独立危险因素(P<0.01),呈正相关系.结论 提示血清Hcy水平变化可为急性脑梗死的疗效观察及其预后的判断提供新的依据.     

急性脑梗死患者血小板聚集率和早期复发的相关性研究

目的探讨急性脑梗死早期复发的危险因素及与血小板聚集率的关系。方法选取我院神经内科2013-01—2013-03首次因急性脑梗死住院治疗的205例患者,电话或门诊随访6个月。用Logistic回归分析急性脑梗死早期复发的危险因素,并统计血小板聚集率的相关危险因素。结果复发组和未复发组患者的年龄、性别、高血压、糖尿病、吸烟、饮酒、同型半胱氨酸水平及NIHSS评分比较差异无统计学意义(P≥0.05),而复发者血小板聚集率增高、高脂血症比例较未复发者明显增多(P0.05)。回归分析表明高脂血症和血小板聚集率增高呈正相关。结论血小板聚集率升高显著增加急性脑梗死早期复发风险,高脂血症是血小板聚集率升高的独立危险因素。     

脑梗死二级预防中阿司匹林抵抗及其与血管事件的关系

目的 探讨脑梗死二级预防中阿司匹林抵抗(AR)发生率.随访期AR与脑梗死复发及其他血管事件发生的关系.方法 600例脑梗死患者,入院当Et开始服用阿司匹林,服用7～10 d后检测血小板聚集率,筛选出AR患者及敏感患者,并对患者进行6～24个月随访,观察脑梗死复发及其他血管事件发生情况,采用Logistic回归分析AR及血管事件发生的危险因素和预后.结果 600例脑梗死患者中有AR者150例(25.0%),敏感者450例(75.0%);AR组女性、糖尿病患者比例及血低密度脂蛋白(LDL)胆固醇水平均高于阿司匹林敏感组;糖尿病(OR=2.58,95% CI 1.37～4.85,P=0.003)、高LDL血症(OR=1.89,95% CI 1.21～2.93,P=0.005)为AR发生的独立危险因素;AR组随访期脑梗死复发率、心肌梗死发生率以及全因死亡率均高于阿司匹林敏感组;糖尿病(OR=2.47,95% CI 1.36～4.65,P=0.003)、动脉粥样硬化血栓型脑梗死(OR=2.13,95% CI 1.24～3.95,P=0.023)及AR(OR=3.86,95% CI 1.79～5.87,P=0.002)是随访期血管事件发生的独立危险因素,有AR者血管事件发生的风险增加3.86倍.结论 脑梗死二级预防中AR发生率高,AR与脑梗死复发及其他血管事件的发生密切相关.     

Satisfaction with quality of life varies with temperament types of patients with schizophrenia

We sought to explore the relationships of three temperament factors with domain-specific subjective quality of life (QOL) of patients with schizophrenia. Ninety patients with schizophrenia were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire, the Tridimensional Personality Questionnaire, the Positive and Negative Syndromes Scale, the Distress Scale for Adverse Symptoms, the Insight and Treatment Attitudes Questionnaire, the Insight Self-Report Scale, and standardized questionnaires for self-reported emotional distress and stress process-related variables. Predictors of domain-specific QOL were identified using multiple regression techniques. Temperament factors explain 6% to 16% of variability in QOL domain scores among patients with schizophrenia after controlling for the remaining variables (emotional distress, social support, self-esteem, avoidance coping, age, side effects, and depression). We found that higher levels of novelty seeking are associated with better general QOL, physical health, and more positive subjective feelings, whereas higher levels of reward dependence are related to better satisfaction from social relationships. Higher levels of harm avoidance are associated with poorer satisfaction with general activities, and medication. Thus, temperament factors, as assessed by the Tridimensional Personality Questionnaire, substantially influence satisfaction with life quality in schizophrenia. Novelty seeking, reward dependence, and harm avoidance are associated with different domains of QOL.     

Compliance with health regimens of adolescents with epilepsy

The purpose of this paper was to describe the compliance of adolescents with epilepsy and some factors connected to it. Altogether 300 individuals with epilepsy aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Seventy-seven per cent (n= 232) of the selected adolescents with epilepsy returned a questionnaire sent to them relating to compliance. The data were analysed using the SPSS software. Twenty-two per cent of the adolescents with epilepsy felt that they complied fully with their suggested health regimens, while 44% placed themselves in the category of "satisfactory compliance", and the remaining 34% reported poor compliance. Compliance with their recommended life-style was poorest, while the highest degree of compliance was recorded for medication. Background variables, such as the duration of the disease, exercise, smoking, alcohol-intake and the number of seizures, were statistically significantly related to compliance (P< 0.001). Good motivation, a strong sense of normality, experience of results, subjective outcome, energy and will-power, support from parents, physicians and nurses, and a positive attitude towards to the disease and its treatment, no threat to social and emotional well-being and no fears of complications and no fear of seizures explained good compliance (P< 0.001).     

血管内栓塞治疗未破裂脑动静脉畸形并发癫痫患者的预后分析

目的分析血管内栓塞治疗未破裂脑动静脉畸形(CAVM)并发癫痫患者的预后情况。方法选择2013年3月至2017年6月收治的符合诊断标准的CAVM并发癫痫发作患者49例为研究对象,分析血管内栓塞治疗后患者的临床症状、生活质量(QOLIE-31)改善情况。结果患者经血管内栓塞治疗后,QOLIE-31各项指标(除了药物影响)评分均明显提高,高于治疗前(P0.05);Spetzler-Martin分级与Engel分级的I~II级例数多于治疗前(P0.05),同时Spetzler-Martin分级I~II级生活质量评分(76.04±18.33)分明显高于III~V级的(65.65±16.76)分(P0.05);Engel分级I~II级的生活质量评分(75.25±17.78)分明显高于III~V级的(66.23±13.22)分(P0.05);血管内栓塞比例80%的生活质量总评分(78.37±18.87)分明显高于栓塞比例80%的(64.16±16.92)分(P0.05);术后患者的头疼症状中重度例数明显低于治疗前(P0.01);患者的NIHSS评分和MRS评分均明显低于治疗前,头疼症状的生活质量评分高于治疗前(均P0.05)。结论血管内栓塞能明显改善未破裂脑动静脉畸形并发癫痫患者的头疼症状、癫痫发作情况、神经功能缺损,提高血管内栓塞比例能够提高患者生活质量。     

Treatment of patients with tardive dystonia with olanzapine

Tardive dystonia represents a complication of long-term use of neuroleptics and its treatment is often unsatisfactory. Atypical neuroleptics appear to improve tardive dystonia, and cases of tardive dystonia successfully managed with clozapine have been reported. The aim of this open-label video-blinded study was to evaluate the antidystonic efficacy of olanzapine, a new atypical neuroleptic with a low risk of agranulocytosis, in a group of four patients (one man and three women) with tardive cervical dystonia. They developed severe dystonia after several years of neuroleptic treatment. Extensive laboratory evaluations, as well as neurophysiologic and neuroradiologic investigations, were negative. Olanzapine was started at a dose of 5 mg/d and increased up to 7.5 mg/d. All patients were evaluated at baseline and after 2, 4, 8, and 12 weeks of treatment, using the Toronto Western Spasmodic Torticollis Rating Scale, and videotaped. At the end of the trial, the videotapes were reviewed and scored by a blind observer. A self-rating visual analog scale completed the disability evaluation.A moderate to marked improvement in dystonia was observed in all patients, and significant differences were observed in Toronto Western Spasmodic Torticollis Rating Scale scores and videotape ratings after 8 and 12 weeks of treatment compared with the basal values (p < 0.05). The average percentage of improvement in Toronto Western Spasmodic Torticollis Rating Scale score and visual analog scale was 26.4% and 42.6%, respectively. No serious side effects were reported at the maximum dosage reached (7.5 mg/d). This study warrants a larger controlled study to conclusively demonstrate the efficacy of olanzapine in tardive dystonia.