非经典抗精神病药对代谢的影响

目的：探讨非经典抗精神病药对精神分裂症患者血糖、糖化血红蛋白（HbA1C）、三酰甘油（TG）、高密度脂蛋白（HDL）和体质量的影响。方法：将176例精神分裂症患者分成氯氮平组（30例）、奥氮平组（30例）、奎硫平组（30例）、利培酮组（30例）、阿立哌唑组（30例）和齐拉西酮组（26例）,治疗6周。于治疗前和治疗6周测量空腹血糖、HbA1C、TG、HDL和体质量。结果：治疗前后血糖、HbA1C、TG、HDL和体质量在阿立哌唑组和齐拉西酮组无显著变化,氯氮平组和奥氮平组治疗后显著增高（P〈0.05或P〈0.01）;奎硫平组和利培酮组可引起体质量显著增加（P〈0.01）,但对血糖、HbA1C、TG、HDL影响不大。结论：阿立哌唑、齐拉西酮对精神分裂症患者代谢的影响较小,奎硫平、利培酮次之,氯氮平、奥氮平对患者代谢的影响最大。     

齐拉西酮联合小剂量奎硫平治疗首次发病老年精神分裂症患者的对照研究

目的:探讨齐拉西酮联合小剂量奎硫平及齐拉西酮单药治疗首次发病的老年精神分裂症患者的疗效及对糖脂代谢的影响。方法:72例首次发病的老年期精神分裂症患者随机分为齐拉西酮联合小剂量奎硫平组(研究组)和齐拉西酮组(对照组)各36例,疗程8周。治疗前后给予阳性和阴性症状量表(PANSS)、临床总体印象量表(CGI-SI)及治疗中出现的症状量表(TESS)评定,比较两组体质量、血糖及血脂的变化。结果:治疗后两组PANSS及CGI-SI总分均较治疗前明显下降(P均0.01);且研究组减分明显多于对照组(P0.05或P0.01);总有效率研究组(88.9%)明显高于对照组(77.8%)(Z=2.101,P0.05)。治疗后两组血糖及血脂水平无明显变化且两组间差异无统计学意义;研究组体质量较治疗前及对照组明显增加(P均0.05);两组TESS评分和药物不良反应发生率比较差异无统计学意义。结论:齐拉西酮联合小剂量奎硫平治疗首次发病的老年精神分裂症患者的疗效优于单用齐拉西酮治疗,对血糖、血脂影响较小,但导致体质量的增加。     

第2代抗精神病药对代谢的影响

目的：探讨奥氮平、奎硫平和齐拉西酮对首发精神分裂症患者血脂和体质量的影响。方法：选择件院治疗的首发精神分裂症患者114例．随机分为奥氮平组35例、奎硫平组41例、齐拉西酮组38例治疗前、治疗4周和治疗8周检测血脂水平和体质量。结果：奥氮平组治疗4周、治疗8周总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL）和体质量均较治疗前显著升高（P〈0．05）;高密度脂蛋白胆固醇（HDL）水平垃著降低（P〈0．05）;奎硫平组至治疗8周时,TC、TG、低密度脂蛋白胆固醇（LDL）和体质量均较治疗前显著升高（P〈0．05）;而齐拉西酮组治疗4周和治疗8周与治疗前比较,TC、TG、HDL、LDL、体质量水平差异均无显著性。在治疗8周奥氮平组、奎硫平组TC、TG、HDL、LDL、体质餐变化与齐拉西酮组比较差异有显著性（P〈0．05）。结论：齐拉西酮对精神分裂症患者血脂和体质量的影响较奥氮平、奎硫平小,奥氮平和奎硫平在精神分裂症治疗过程中均可导致血脂异常和体质量增加。     

氯丙嗪与奎硫平对血脂和血糖的影响

目的:研究氯丙嗪与奎硫平对精神分裂症患者血脂与血糖的影响。方法:130例精神分裂症患者随机分为氯丙嗪组(65例)与奎硫平组(65例),治疗8周。所有患者于治疗前与治疗4、8周测空腹血糖、总胆固醇、三酰甘油和体质量(体重)。结果:氯丙嗪组总胆固醇、三酰甘油、体质量在治疗第4、8周均较治疗前显著升高(P<0.01);奎硫平组三酰甘油、体质量在治疗第4、8周均较治疗前显著升高(P<0.01)。治疗8周后,两组男性患者总胆固醇与空腹血糖较治疗前均显著升高(P<0.01),女性患者三酰甘油与总胆固醇治疗后较治疗前显著升高(P<0.01)。结论:氯丙嗪与奎硫平对血脂和血糖的影响不同,2药对血脂与血糖的影响存在性别差异。     

奎硫平单用与合并阿立哌唑对精神分裂症患者体质量的影响

目的:探讨奎硫平与阿立哌唑合用及单用奎硫平对精神分裂症患者体质量、腹围及体质量指数(BMI)的影响. 方法:将63例精神分裂症患者随机分为阿立哌唑合并奎硫平组31例(研究组)及单用奎硫平组32例(对照组).在治疗前及治疗6周,用阳性和阴性症状量表(PANSS)评定疗效,并进行体质量、腹围及BMI的测定. 结果:治疗6周两组PANSS评分差异无统计学意义(t=1.35,P＞0.05);研究组治疗后腹围值增加明显(t=7.76,P＜0.05),对照组体质量、腹围及BMI值均增加明显(P＜0.05);组间变化值的比较体质量、腹围及BMI增加值均较对照组小(P＜0.05). 结论:合用阿立哌唑能够明显减轻奎硫平对精神分裂症患者体质量增加的影响     

喹硫平与阿立哌唑对精神分裂症患者糖脂代谢影响的对照观察

目的探讨喹硫平与阿立哌唑对精神分裂症患者的体质量、血糖和血脂代谢的影响。方法对驻马店市精神病医院的门诊及住院的首发精神分裂症患者,随机分为喹硫平组(104例)和阿立哌唑组(100例),分别于治疗前和治疗后2周、4周、8周末,用PANSS量表评定病情,并进行空腹血糖、甘油三酯、总胆固醇及体质量测定。结果 (1)两种药物疗效相当。PANSS量表测定:阿立哌唑显效率60.4%,喹硫平组57.2%。(2)阿立哌唑组治疗前后空腹血糖、体质量、甘油三酯水平无明显变化。喹硫平组在治疗前后血糖变化不明显,而体质量、血脂在治疗后4周升高明显。结论阿立哌唑对糖脂代谢及体质量的影响小,而喹硫平对体质量、脂代谢有影响。     

奎硫平对精神分裂症患者生活质量研究

目的:探讨奎硫平、舒必利对精神分裂症患者生活质量的影响.方法:对70例精神分裂症患者随机分为两组,分别给予奎硫平、舒必利治疗6个月.用阳性症状与阴性症状量表(PANSS)评定精神症状,用世界卫生组织编制的生活质量量表(WHO QOL-100)评定生活质量.结果:治疗6个月后,奎硫平对精神分裂症阳性症状、阴性症状的改善和舒必利相似,PANSS两组间评分差异无显著性.奎硫平组WHO QOL-100各领域除精神支柱外均明显改善,在生活领域、心理领域、独立性领域、社会关系领域较舒必利组有显著改善.结论:奎硫平组患者生活质量优于舒必利组.     

奎硫平治疗女性精神分裂症患者临床观察

目的:了解奎硫平治疗女性精神分裂症患者疗效、体质量(体重)变化及依从性.方法:选择30例女性精神分裂症患者,给予奎硫平治疗,疗程8周.采用阳性与阴性症状量表(PANSS)、副反应量表(TESS)及体质量变化评定疗效及不良反应.结果:奎硫平有效率为86.7%,未明显增加体质量,有头晕、嗜睡、直立性低血压等不良反应.结论:奎硫平治疗女性精神分裂症患者有效,不增加体质量,不良反应少,依从性好.     

奥氮平与阿立哌唑对首发精神分裂症糖脂代谢影响的对照研究

目的 研究阿立哌唑、奥氮平对首发精神分裂症患者血糖及血脂代谢的影响.方法 随机将61例首发精神分裂症患者分为奥氮平组和阿立哌唑组,比较治疗前及治疗后第6周末两组患者身高、体质量、血糖（FBG）、胰岛素（INS）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、甘油三酯（TG）、总胆固醇（TC）变化.结果 治疗后第6周末奥氮平组FBG、INS、IRI、LDL、TG、TC、体质量及BMI均较治疗前明显升高（P＜0.05,P＜0.01）,治疗后第6周末奥氮平组上述指标较阿立哌唑组高（P＜0.05）.结论 与奥氮平相比,阿立哌唑对首发精神分裂症患者FBG及血脂代谢影响较轻.     

奎硫平与利培酮对血清催乳素影响对照研究

目的:探讨奎硫平与利培酮对女性患者血清催乳素(PRL)及体质量指数(BMI)的影响。方法:将60例精神分裂症或分裂样精神病女性患者随机分为奎硫平组和利培酮组,每组各30例,采用磁酶免疫法测定两组治疗前后的PRL水平,并计算治疗前后体质量指数。结果:治疗后利培酮组PRL显著高于治疗前PRL(t=6.165,P<0.01)。治疗后利培酮组BMI和奎硫平组BMI均显著高于治疗前(P均<0.05),利培酮组高于奎硫平组(t=3.013,P<0.01)。结论:奎硫平对PRL影响不明显,利培酮对PRL影响明显。     

血压及其变异性与脑白质疏松症的相关性研究进展

脑白质疏松症是指脑室周围或皮质下区(半卵圆中心)弥漫性非特异性白质损害。脑白质疏松症可以增加脑卒中的风险,并与认知功能下降和运动障碍等密切相关。已有研究认为高血压病是脑白质疏松症最主要的危险因素。但随着对脑白质疏松症形成的病理生理机制研究的不断完善,学者们发现低血压及血压变异性也与脑白质疏松症相关。文中旨在对血压及其变异性与脑白质疏松症之间的联系研究进行综述。     

MicroRNAs as diagnostic and prognostic biomarkers of age-related macular degeneration:advances and limitations

A main cause of vision loss in the elderly is age-related macular degeneration(AMD).Among the cellular,biochemical,and molecular changes linked to this disease,inflammation and angiogenesis appear as being crucial in AMD pathogenesis and progression.There are two forms of the disease:dry AMD,accounting for 80–90%of cases,and wet AMD.The disease usually begins as dry AMD associated with retinal pigment epithelium and photoreceptor degeneration,whereas wet AMD is associated with choroidal neovascularization resulting in severe vision impairment.The new vessels are largely malformed,leading to blood and fluid leakage within the disrupted tissue,which provokes inflammation and scar formation and results in retinal damage and detachment.Micro RNAs are dysregulated in AMD and may facilitate the early detection of the disease and monitoring disease progression.Two recent reviews of micro RNAs in AMD had indicated weaknesses or limitations in four earlier investigations.Studies in the last three years have shown considerable progress in overcoming some of these concerns and identifying specific micro RNAs as biomarkers for AMD.Further large-scale studies are warranted using appropriate statistical methods to take into account gender and age disparity in the study populations and confounding factors such as smoking status.     

Primary dysautonomia: cerebral blood flow and hemodynamic findings. Case report.

In a man with orthostatic and effort syncopes due to primary dysautonomia, we measured cerebral blood flow (CBF) — by the 133-Xenon inhalation method — in supine and in sitting positions, and after the i.v. administration of Acetazolamide, a potent cereral vasodilator. Heart rate (HR) and blood pressure (BP) were monitored over the 24 hours by a non-invasive device. The CBF was normal in supine position and significantly reduced when the patient was sitting. Despite che sympathetic denervation, good response to acetazolamide infusion was seen. BP changed with the position of the subject according to gravity, and HR was unresponsive to orthostatic and effort stimuli.

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Sommario Abbiamo misurato il Flusso Ematico Cerebrale (FEC) — con il metodo inalatorio allo Xenon-133 — in clinostatismo, in posizione seduta e dopo la somministrazione e.v. di Acetazolamide, un potente vasodilatatore cerebrale, in un uomo affetto da Sindrome Disautonomica Primitiva con ipotensione severa, ortostatica e da sforzo. Inoltre, abbiamo monitorato per 24 ore la Pressione Arteriosa (PA) e la Frequenza Cardiaca (FC) per mezzo di metodica non-invasiva. I nostri risultati dimostrano che il FEC è ridotto in posizione seduta, ma è normale in clinostatismo, e che mantiene la capacità di reagire a stimoli vasodilatatori, nonostante la denervazione simpatica. La PA è risultata dipendente dalla forza gravitazionale, mentre la FC è “fissa”, cioè non risponde agli stimoli ortostatici e allo sforzo.

     

不同剂量奥氮平治疗精神分裂症的疗效及对患者糖、脂代谢的影响

目的:探讨不同剂量奥氮平治疗精神分裂症的疗效及对患者糖、脂代谢的影响。方法:96例精神分裂症患者随机分为奥氮平低剂量组(50例,<10mg/d)和高剂量组(46例,>10mg/d);分别于治疗前、治疗2、4、8周末采用阳性与阴性症状量表(PANSS)进行评分,并检测体质量指数(BMI)、血糖及血脂;8周末评价疗效。结果:低剂量组和高剂量组起效时间和疗效比较差异无统计学意义;与治疗前相比,8周末低剂量组总胆固醇明显增高(P<0.05);高剂量组BMI、血糖、总胆固醇和甘油三酯明显增高(P<0.05或P<0.01)。结论:奥氮平治疗精神分裂症的剂量范围内,低剂量和高剂量起效时间及疗效相当,但均可影响脂代谢;高剂量对血糖、血脂代谢的影响更明显。     

Spontaneous blood pressure oscillations and cerebral autoregulation

The relationship between spontaneous oscillations in cerebral blood flow velocity (CBFV) and arterial blood pressure (ABP) was analysed in normal subjects in order to evaluate whether these relationships provide information about cerebral autoregulation. CBFV was measured using transcranial Doppler sonography and continuous ABP and heart rate using Finapres in 50 volunteers. Measurements were made over 5 min in a supine position and 6 min in a tilted position. Coefficients of variation were calculated using power- and cross-spectral analysis in order to quantify amplitudes within two frequency ranges: 3–9 cycles per min (cpm) (M-waves); and 9–20 cpm (R-waves). Correlations, coherence values, phase angle shifts and gains were also computed between corresponding waves in CBFV and in ABP. A clear correlation was seen for M-waves and R-waves between CBFV and ABP and coherence values were large enough to calculate phase angle shifts and gains. Phase angles for M-waves were larger and gains lower than was the case for R-waves, either tilted or supine. These data are consistent with a highpass filter model of cerebral autoregulation. Relatively high CBFV/ABP gain values (between 1.4 and 2.0) suggest that the principle of frequency-dependent vascular input impedances has to be considered in addition to autoregulatory feedback mechanisms. Spontaneous ABP oscillations in the M-wave and R-wave ranges may serve as a basis for continuous autoregulation monitoring.     

氯氮平对超敏C反应蛋白及糖脂代谢的影响

目的：探讨氯氮平对精神分裂症患者超敏C反应蛋白（hs-CRP）以及糖、脂代谢的影响。方法：对30例服用氯氮平治疗的精神分裂症患者（患者组）作hs-CRP、空腹血糖、三酰甘油、胆固醇、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、载脂蛋白A1（ApoA1）、载脂蛋白B（ApoB）检测，于治疗前、治疗第4、8、12周各检测1次。并与30名健康者（对照组）进行比较。结果：治疗前患者组和对照组糖脂各值差异无显著性。在治疗第4、8、12周的hs-CRP，第12周的空腹血糖、三酰甘油、胆固醇、LDL、ApoB比治疗前明显升高；治疗第12周的HDL、ApoA1比治疗前明显下降；hs-CRP与空腹血糖、三酰甘油、胆固醇以及氯氮平剂量呈正相关。结论：氯氮平对hs-CRP、糖脂代谢均会产生影响，氯氮平导致代谢综合征可能与hs-CRP有关。     

Associations between neuropeptide Y nerve terminals and intraparenchymal microvessels in rat and human cerebral cortex

Neuropeptide Y (NPY) can influence local brain perfusion, possibly via direct relationships with the microvascular bed. To evaluate this possibility, the authors quantitatively analyzed by light and electron microscopy the morphological associations between immunostained NPY neuronal elements and intraparenchymal microvessels in the rat and human cerebral cortex. At the light microscopic level in the rat frontoparietal cortex, about 16% of NPY neurons and large proximal processes as well as a subset of nerve terminals not affected by double sympathectomy were associated with penetrating arterioles and local microvessels. In human temporal cortex, a dense network of NPY nerve fibers was observed, many of which approached and/or contacted intracortical vessels. At the ultrastructural level, 14% of NPY axonal varicosities in the rat cerebral cortex were considered perivascular and associated with capillaries (∼70%) or microarterioles (∼30%). They were particularly enriched in the immediate vicinity (<0.25 μm) of the microvessels, where the perivascular astrocytic leaflets represented a frequent target. In human cerebral cortex, NPY varicosities were observed in proximity to microvessels corresponding primarily to capillaries. Perivascular NPY varicosities never established synaptic junctions with vascular or astroglial elements. The results show that central NPY nerve terminals associate with microvessels and perivascular astroglial cells in the rat and human cerebral cortex. Thus, NPY released from these nerves could possibly influence (via a parasynaptic mode of action) vascular and/or astrocytic functions depending on the distribution of NPY receptors in these cellular compartments. These results provide morphological support for the effects of NPY on brain perfusion and homeostasis. J. Comp. Neurol. 388:444–453, 1997. © 1997 Wiley-Liss, Inc.     

Parasympathetic innervation of cephalic arteries in rabbits: Comparison with sympathetic and sensory innervation

We investigated the distribution of parasympathetic, sympathetic, and sensory perivascular nerve fibers in rabbit cephalic arteries supplying the brain, exocrine glands, nasal mucosa, masseter muscles, tongue, and skin in the face and also examined cranial autonomic and sensory ganglia. NADPH diaphorase (NADPHd)-positive and vasoactive intestinal peptide–like immunoreactive (VIP-LI) neurons were located in the cranial parasympathetic ganglia. Neuropeptide Y (NPY)-LI neurons occurred mainly, and dopamine β-hydroxylase (DBH)-LI neurons occurred exclusively, in the superior cervical (sympathetic) ganglion. Substance P (SP)-LI and calcitonin gene-related peptide (CGRP)-LI neurons occurred only in the trigeminal (sensory) ganglion. Therefore, it was assumed that NADPHd-positive and VIP-LI perivascular nerve fibers in cephalic arteries were parasympathetic, all DBH-LI and most NPY-LI fibers were sympathetic, and SP-LI and CGRP-LI fibers were sensory in nature. In the cerebral arteries, NADPHd-positive and VIP-LI varicose fibers were more numerous in the rostral than in the caudal half of the Circle of Willis. In the extracranial arteries, NADPHd-positive and VIP-LI fibers were most abundant in the lingual, lacrimal, and supraorbital arteries; sparse in the parotid and submandibular arteries; and absent in the ear artery. There was an obvious proximal-to-distal density gradient along individual cephalic arterial trees. In contrast, DBH-LI, NPY-LI, SP-LI, and CGRP-LI varicose nerve fibers were similar in density in all cephalic arteries and their branches. These neuroanatomical findings suggest that differential parasympathetic innervation in cephalic arteries may play a role in the partitioning of blood flow between different cephalic tissues. J. Comp. Neurol. 389:484–495, 1997. © 1997 Wiley-Liss, Inc.     

Frequency of blood-retina and blood-brain barrier changes in multiple sclerosis

The frequency of blood-retina barrier (BRB) and blood-brain barrier (BBB) alterations was studied in 20 cases of Multiple Sclerosis (MS) (12 relapsing and 8 chronic-progressive). BBB impairment was found in 7 out of 20 patients (35%), 3 of whom had the chronic-progressive form of the disease. Alterations to BRB were found in 9 out 20 cases (45%): 2 out 12 (17%) of the relapsing cases and 7 out 8 of the chronic-progressive cases (87.5%). BBB impairment was found in 3 of the 9 cases (33%) with BRB alterations. Our findings indicate that BRB and BBB alterations do not occur simultaneously. We propose that the higher frequency of BRB alterations in chronic-progressive MS may be a sign of persistent antigenic stimulation.

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Sommario è stata studiata l'incidenza di alterazioni della barriera emato-retinica e emato-encefalica in 20 casi di Sclerosi a placche (12 recidivanti e 8 cronico-progressivi). è stato dimostrato un danno della barriera ematoencefalica nel 35% dei casi di cui 3 appartenevano alla forma cronico-progressiva. Il 45% dei casi, di cui il 17% recidivanti e l'87.5% cronico-progressivi, presentavano alterazioni della barriera emato-retinica. Il 33% dei casi con alterazioni della barriera emato-retinica avevano alterazioni della barriera emato-encefalica. I nostri risultati dimostrano che le alterazioni della barriera emato-retinica non sono simultanei a danni della barriera ematoencefalica. è ipotizzato che la maggiore incidenza di alterazioni della barriera emato-retinica nella S.P. cronico-progressiva può essere un segno di persistente stimolazione antigenica.