促红细胞生成素对癫痫大鼠神经元的保护作用

癫痫是小儿神经系统常见病之一。癫痫发作，尤其是癫痫持续状态对小儿危害大，严重影响小儿精神发育。癫痫脑损伤引起的神经元死亡包括凋亡和坏死两种形式，caspase家族是可直接导致凋亡细胞解体的蛋白酶系统，在细胞凋亡的分子机制网络中居中心地位，而caspase-3被认为是这一家族中的关键蛋白酶。     

重组人促红细胞生成素对大鼠颅脑损伤后Survivin表达的影响

目的观察重组人促红细胞生成素（r-HuEPO）对大鼠颅脑损伤后伤侧脑组织核因子-κB（NF-κB）和Survivin表达的影响,探讨其脑保护机制。方法选取78只健康雄性Wistar大鼠,随机分为假手术组（6只）、颅脑损伤对照组（36只）及r-HuEPO治疗组（36只）。采用自由落体法建立大鼠颅脑损伤模型,应用EpicsXL流式细胞仪检测细胞凋亡情况,并应用免疫组织化学SP法检测Survivin和NF-κB表达的变化。结果与假手术组相比,颅脑损伤对照组的细胞凋亡率及Survivin、NF-κB的表达水平明显升高（P〈0.01）;与颅脑损伤对照组相比,r-HuEPO治疗组除在伤后6h和7d外,其它各时相点的细胞凋亡率均明显降低（P〈0.05）,且在伤后1、2、3、5d的Survivin表达及伤后各时间点的NF-κB表达均较明显升高（P〈0.05）。结论r-HuEPO可促进NF-κB及抗凋亡因子Survivin的表达而减少颅脑损伤后的细胞凋亡,发挥脑保护作用。     

重组人促红细胞生成素对大鼠颅脑损伤后 Survivin表达的影响

目的 观察重组人促红细胞生成素(r-HuEPO)对大鼠颅脑损伤后伤侧脑组织核因子-κB(NF-κB)和Survivin表达的影响,探讨其脑保护机制.方法 选取78只健康雄性Wistar大鼠,随机分为假手术组(6只)、颅脑损伤对照组(36只)及r-HuEPO治疗组(36只).采用自由落体法建立大鼠颅脑损伤模型,应用Epics XL流式细胞仪检测细胞凋亡情况,并应用免疫组织化学SP法检测Survjvin和NF-κB表达的变化.结果 与假手术组相比,颅脑损伤对照组的细胞凋亡率及Survivin、NF-κB的表达水平明显升高(P＜0.01);与颅脑损伤对照组相比,r-HuEPO治疗组除在伤后6 h和7 d外,其它各时相点的细胞凋亡率均明显降低(P＜0.05),且在伤后1、2、3、5d的Survivin表达及伤后各时间点的NF-κB表达均较明显升高(P＜0.05).结论 r-HuEPO可促进NF-κB及抗凋亡因子Survivin的表达而减少颅脑损伤后的细胞凋亡,发挥脑保护作用.     

重组人促红细胞生成素对戊四氮致痫大鼠海马蛋白质组学的研究

目的 研究重组人促红细胞生成素（Recombinant human erythropoietin,r-HuEPO）对戊四氮（Pentetrazol,PTZ）致痫大鼠海马组织中差异表达的蛋白质,为探讨癫痫发病机制和寻找新的治疗靶点提供理论依据。方法 将12只体重为230～250 g的6～8周龄SD大鼠随机分为两组：PTZ组、PTZ+EPO组。运用基于质谱的TMT标记技术将r-HuEPO对PTZ致痫大鼠海马组织的差异蛋白进行分析鉴定。结果 检测到PTZ致痫大鼠海马组织中139个差异表达的蛋白质点,其中55个表达上调,84个表达下调。结论 r-HuEPO通过上调PTZ致痫大鼠海马组织中异柠檬酸脱氢酶（Isocitrate dehydrogenase,NADP）、还原型辅酶Ⅱ（Reduced nicotinamide purine dinucleotide phosphate,NADPH）、硫氧还蛋白还原酶（Thioredoxin reductase 2 mitochondrial,TrxR）,减轻神经细胞损伤。     

重组人促红细胞生成素联合高压氧对移植大鼠背部逆行超长缺血皮瓣

背景：有研究表明,重组人促红细胞生成素可诱导内皮前细胞分化成新生内皮细胞,高压氧则为新生内皮细胞提供增殖所需的充足氧分,加速了新生血管的发生。 目的：分析重组人红细胞生成素、高压氧及其联合应用时对大鼠背部逆行超长缺血皮瓣的影响。 设计、时间及地点：随机分组,细胞形态学观察,于2008-04/09在山东大学实验动物中心进行。 材料：40只Wistar大鼠,于背部制作逆行超长缺血皮瓣。 方法：于大鼠背部按4∶1设计逆行超长缺血随意皮瓣,皮瓣原位缝合后按照不同的干预方式均分为4组,常压氧组：给予生理盐水+常压氧;高压氧组：高压氧+生理盐水;重组人促红细胞生成素组：重组人促红细胞生成素+常压氧;综合组：重组人促红细胞生成素+常压氧。干预方法：重组人促红细胞生成素的注射量为400 IU/kg与生理盐水等量,1次/d,连用10 d。高压氧为202.65 kPa,体积分数为95%;常压氧为101 kPa;体积分数为35%,给氧均于缝合后8 h进行,1 h/次,2次/d,共10 d。 主要观察指标：于缝合后10 d测量各组皮瓣成活率。以血管内皮细胞生长因子和CD34作为血管标记行免疫组化染色,计数皮瓣新生血管密度。 结果：定性分析：常压氧组局部坏死,腺体萎缩。高压氧组腺体形态较好,重组人促红细胞生成素组腺体增生,而综合组增生更加明显。定量分析：与常压氧组比较,后3组的血管密度值均增高(P < 0.01),且呈递增趋势,以α=0.05的检验标准,各组之间的差别有显著性意义(P < 0.01),方差分析结果显示重组人促红细胞生成素和高压氧之间存在协同作用,同时使用效果更好。 结论：重组人促红细胞生成素和高压氧以及二者联合应用,可以促进缺血皮瓣下的毛细血管生成,提高皮瓣存活率并扩大皮瓣长宽比例,重组人促红细胞生成素促进皮瓣成活效果好于高压氧,二者同时使用效果更好。     

重组人促红细胞生成素预处理对帕金森病大鼠胶质细胞源性炎症因子表达的影响

目的探讨重组人促红细胞生成素(rhEPO)预处理对帕金森病(PD)大鼠胶质细胞源性炎症因子表达的影响。方法 40只SD大鼠随机分为4组,A组:右侧纹状体内注射rhEPO 24 h后,同侧黑质内注射6-羟基多巴胺(6-OHDA);B组:右侧纹状体内立体定向注射与rhEPO等量的生理盐水,24 h后同侧黑质内立体定向注射6-OHDA;C组:右侧黑质内立体定向注射6-OHDA;D组:右侧黑质内立体定向注射与6-OHDA等量的生理盐水。4周后采用酶联免疫吸附法检测血清诱导型一氧化氮合酶(iNOS)和肿瘤坏死因子(TNF)-α含量;逆转录(RT)-PCR法检测黑质iNOS和TNF-αmRNA的表达。结果与D组比较,A、B、C组大鼠血清iNOS、TNF-α含量增多,黑质iNOS、TNF-αmRNA表达增高(均P<0.05);与B组和C组比较,A组大鼠血清iNOS、TNF-α含量显著减少,黑质iNOS、TNF-αmRNA表达显著降低(均P<0.05)。结论 rhEPO可能通过抑制黑质TNF-α、iNOS表达,减轻6-OHDA对多巴胺能神经元的毒性损害,具有神经保护作用。     

癫痫持续状态中海马神经元的保护:现状及展望

<正> 癫痫持续状态是神经系统常见的急危重症,持续的癫痫发作可导致脑损伤,其主要损伤部位在海马。因此,海马神经元保护成为延缓或逆转癫痫病理过程,改善患者预后的重要手段。电刺激海马或杏仁核可点燃癫痫,刺激小脑、迷走神经可埘抗癫痫发作,据此学者们推测机体内存在着一个在生物进化过程中逐渐形成的自我保护系统。癫痫发作引起脑细胞坏死的同时,也激活了这个系统以对抗痫性损伤。癫痫患者脑细胞损     

基于PI3K/Akt通路研究右美托咪定对癫痫持续状态大鼠海马神经元自噬的调节作用

目的 探讨右美托咪定(Dexmedetomidine,Dex)对癫痫持续状态(Status epilepticus,SE)大鼠海马神经元自噬的调节作用及对磷脂酰肌醇-3-羟激酶/蛋白激酶B(PI3K/Akt)信号通路的影响。方法 采用戊四氮(PTZ)点燃制备SE大鼠模型,随机分为模型组(M组)、Dex低剂量(Dex-L)组、Dex高剂量(Dex-H)组、Dex-H +LY294002(Dex-H+LY)组,另取正常SD大鼠为对照组(NC组),每组各15只; Dex-L组、Dex-H组分别腹腔注射Dex 25、100 μg/kg; Dex-H+LY组脑室注射5 μL PI3K抑制剂LY294002+腹腔注射Dex 100 μg/kg,NC组、M组大鼠腹腔注射等量生理盐水; 观察大鼠行为学表现并进行脑电图描记; 原位末端标记法(TUNEL)检测各组大鼠海马神经元凋亡情况; 免疫印迹(WB)检测各组大鼠海马组织中LC3、PI3K、p-PI3K、Akt、p-Akt蛋白表达水平。结果 NC组大鼠脑电图无异常放电现象,主要以α、β波为主; M组大鼠出现大量阵发性棘波、高幅尖波、棘慢复合波、尖慢复合波等; Dex-L组、Dex-M组大鼠癫痫发作减少或波幅降低; Dex-H+LY组大鼠癫痫样放电较Dex-H组明显增加。与NC组比较,M组大鼠海马神经元凋亡细胞数、海马LC3-Ⅱ蛋白表达显著增加,海马LC3-Ⅰ,p-PI3K/PI3K,p-Akt/Akt蛋白表达水平显著降低(P<0.05); 与M组比较,Dex-L组、Dex-H组大鼠海马神经元凋亡细胞数、海马LC3-Ⅱ蛋白表达依次减少(P<0.05),海马LC3-Ⅰ,p-PI3K/PI3K,p-Akt/Akt蛋白表达水平依次增高(P<0.05); 与Dex-H组比较,Dex-H+LY组大鼠海马神经元凋亡细胞数、海马LC3-Ⅱ蛋白表达显著增加,海马LC3-Ⅰ,p-PI3K/PI3K,p-Akt/Akt蛋白表达水平显著降低(P<0.05)。结论 Dex可能通过促进PI3K/Akt信号通路激活来抑制SE大鼠海马神经元过度自噬,减轻神经元凋亡,发挥抗惊厥及脑保护作用。     

重组人促红细胞生成素治疗新生儿缺氧缺血性脑病疗效分析

目的探讨重组人促红细胞生成素（rhu—EPO）对新生儿缺氧缺血性脑病的治疗效果。方法将141例缺氧缺血性脑病患儿随机分为rhu—EPO治疗组（n=72）和对照组（n=69），治疗组于生后第5天给予rhu—EPO5001U／kg，每周3次，一个疗程4周，其它治疗措施同对照组。于胎龄40周时进行新生儿行为神经测定fNBNA），并随访后遗症的发生率。结果治疗组患儿在胎龄40周时的NBNA得分为38．10±1．91，明显高于对照组36.35±1．99（t=4．2330，P=0．000）。至2岁时后遗症的发生率明显降低。结论rhu—EPO对缺氧缺血性脑病患儿神经行为发育有促进作用，并能减少缺氧缺血性脑病后遗症的发生。     

癫痫持续状态后大鼠海马区钾离子通道Kv1.3的表达研究

目的研究氯化锂-匹罗卡品致癫痫持续状态(status epilepticus,SE)后大鼠海马区钾离子通道Kv1.3的表达及分布变化,探讨钾离子通道Kv1.3与癫痫发作的相关性。方法 48只健康雄性sprague-dawley大鼠随机平分为实验组和对照组,每组继续随机分为6 h、1 d、2 d和3 d 4个观察时间点亚组(n=6)。通过大鼠脑电监测记录大鼠脑电变化情况,通过尼氏染色观察脑组织病理改变,采用免疫组织化学染色和Western-blot方法检测各时间点大鼠海马区Kv1.3的表达及分布变化。结果 (1)脑电监测:正常大鼠脑电图表现为波幅较均匀一致的α波,痫性发作后开始出现慢波、棘波,波幅、节律不规则,SE过程中表现为长程的棘波活动。(2)尼氏染色:SE后6 h未发现明显形态学及神经元数量改变;SE后1 d,海马区神经元结构松散,神经元数量减少;SE后2 d、3 d,海马区神经元进一步减少,且出现神经元肿胀、变形、尼氏小体减少甚至消失。(3)免疫组织化学染色和Western-blot检测:SE后2 d,Kv1.3在海马CA_3和CA_1区表达较对照组明显减少(P0.05)。SE后6 h、1 d、3 d,Kv1.3在海马CA_3和CA_1区表达较对照组无明显变化(P0.05)。SE后6 h、1 d、2 d、3 d,Kv1.3在海马DG区表达较对照组无明显差异(P0.05)。结论 Kv1.3的表达下调可能与癫痫发作相关。     

Status epilepticus in the elderly

Children and the elderly (≥60 years of age) have the highest incidence of status epilepticus (SE). Because of their general health, elderly individuals are much more likely than younger (<60 years of age) persons to have more severe consequences from seizures. The incidence of SE is 15.5/100 000 in the 60‐69 age group, 21.5/100 000 in the 70‐79 age group and 25.9/100 000 in persons 80 and older. The most common cause in the elderly is acute symptomatic, with stroke and hypoxia the most frequent. The overall mortality of SE is quite high and occurs early, often within the first few days, and is related to the cause, with mortality of more than 80% in persons with anoxia. Although the cause of SE is an important factor in mortality, the aging body and brain may contribute to an unfavorable outcome. Treatment in the elderly is essentially the same as in younger adults with benzodiazepines (lorazepam, diazepam, clonazepam) and longer acting antiseizure drugs (phenytoin, fosphenytoin, valproate, levetiracetam, and lacosamide. At this time there are no evidence‐based studies regarding Axis 2 (etiology) and Axis 4 (age). All current interventions for SE involve antiseizure drugs that were developed for treatment of chronic epilepsy. Treatments should be developed that are more specific for the various etiologies and involve drugs that work on the underlying cause of the SE.     

EFNS guideline on the management of status epilepticus in adults

The objective of the current article was to review the literature and discuss the degree of evidence for various treatment strategies for status epilepticus (SE) in adults. We searched MEDLINE and EMBASE for relevant literature from 1966 to January 2005 and in the current updated version all pertinent publications from January 2005 to January 2009. Furthermore, the Cochrane Central Register of Controlled Trials (CENTRAL) was sought. Recommendations are based on this literature and on our judgement of the relevance of the references to the subject. Recommendations were reached by informative consensus approach. Where there was a lack of evidence but consensus was clear, we have stated our opinion as good practice points. The preferred treatment pathway for generalised convulsive status epilepticus (GCSE) is intravenous (i.v.) administration of 4–8 mg lorazepam or 10 mg diazepam directly followed by 18 mg/kg phenytoin. If seizures continue more than 10 min after first injection, another 4 mg lorazepam or 10 mg diazepam is recommended. Refractory GCSE is treated by anaesthetic doses of barbiturates, midazolam or propofol; the anaesthetics are titrated against an electroencephalogram burst suppression pattern for at least 24 h. The initial therapy of non‐convulsive SE depends on type and cause. Complex partial SE is initially treated in the same manner as GCSE. However, if it turns out to be refractory, further non‐anaesthetising i.v. substances such levetiracetam, phenobarbital or valproic acid should be given instead of anaesthetics. In subtle SE, in most patients, i.v. anaesthesia is required.     

巢蛋白阳性星形胶质细胞与癫痫持续状态后海马区胶质瘢痕形成的相关性研究

目的 了解癩痫持续状态(SE)后7d海马各区巢蛋白(nestin)阳性星形胶质细胞表达及数目的变化,探讨其与SE导致海马区胶质瘢痕形成的关系.方法 SD大鼠随机分为SE组和对照组,应用匹罗卡品建立SE大鼠模型;在SE后7d处死大鼠行盲法免疫荧光组化实验,观察大鼠海马各区nestin与胶质纤维酸性蛋白单克隆抗体(GFAP...     

海藻氨酸致癫痫状态大鼠海马区神经元损伤与Mg^2＋作用的研究

目的观察海藻氨酸(KA)诱导的癫癎状态(SE)大鼠海马神经元的形态学改变和Mg2+的神经保护作用.方法选用成年雄性Wistar大鼠75只,随机分为KA组、Mg2+组和生理盐水对照组.用KA诱导大鼠SE 3 h,Mg2+组大鼠在注射KA前腹腔内注射硫酸镁100 mg/kg,在癫癎发作终止后72 h将动物处死,分别用光镜和电镜观察海马神经元形态学改变.结果 KA组大鼠注射KA后(16.1±4.7)min出现癫癎发作,Mg2+组大鼠为(25.4±6.2)min,两组比较差异有显著性(P<0.05).KA组和Mg2+组大鼠在海马区均出现了嗜酸性神经元,Mg2+组大鼠神经元损伤程度明显低于KA组.结论 KA诱导的SE可导致海马神经元坏死,而 Mg2+作为兴奋性氨基酸拮抗剂对海马神经元具有保护作用.     

EFNS guideline on the management of status epilepticus

The objective of the current paper was to review the literature and discuss the degree of evidence for various treatment strategies for status epilepticus (SE) in adults. We searched MEDLINE and EMBASE for relevant literature from 1966 to January 2005. Furthermore, the Cochrane Central Register of Controlled Trials (CENTRAL) was sought. Recommendations are based on this literature and on our judgement of the relevance of the references to the subject. Recommendations were reached by informative consensus approach. Where there was a lack of evidence but consensus was clear we have stated our opinion as good practice points. The preferred treatment pathway for generalised convulsive status epilepticus (GCSE) is intravenous (i.v.) administration of 4 mg of lorazepam or 10 mg of diazepam directly followed by 15-18 mg/kg of phenytoin or equivalent fosphenytoin. If seizures continue for more than 10 min after first injection another 4 mg of lorazepam or 10 mg of diazepam is recommended. Refractory GCSE is treated by anaesthetic doses of midazolam, propofol or barbiturates; the anaesthetics are titrated against an electroencephalogram burst suppression pattern for at least 24 h. The initial therapy of non-convulsive SE depends on the type and the cause. In most cases of absence SE, a small i.v. dose of lorazepam or diazepam will terminate the attack. Complex partial SE is initially treated such as GCSE, however, when refractory further non-anaesthetising substances should be given instead of anaesthetics. In subtle SE i.v. anaesthesia is required.     

Effects of status epilepticus on extracellular amino acids in the hippocampus

Extracellular amino acids were followed in the hippocampus during sustained seizures induced by systemic administration of kainic acid (KA) or bicuculline (BC). KA epilepsy was associated with marked increases in phosphoethanolamine (PEA) and taurine. Alanine and ethanolamine were moderately raised while other amino acids were unaffected. BC seizures encompassed a slightly different pattern of alterations. In contrast to KA seizures, BC epilepsy had no effect on taurine. Significant increments were observed for PEA and alanine while elevations of ethanolamine were subtle. In both types of seizures, glutamate and GABA remained unaffected extracellularly, probably due to efficient recapture mechanisms.     

托吡酯对癫痫大鼠海马神经元超微结构及bcl-2表达的影响

目的观察托吡酯对癫痫大鼠海马神经元超微结构及bcl-2表达的影响,以探讨托吡酯可能的神经保护机制。方法将大鼠随机分为正常对照组、海人酸组(KA)和托吡酯预处理组(TPM)。采用海人酸腹膜腔注射制作癫痫持续状态(SE)模型。在SE模型制作前,TPM组大鼠用TPM(18mg/(kg·d))灌胃15d,同时用等量生理盐水给KA组大鼠灌胃。正常对照组大鼠不作任何处理。在痫性发作终止后6、24、48h取海马,电镜观察神经元的超微结构,免疫组化方法检测bcl-2的表达。结果KA组神经元呈凋亡特征。TPM组神经元结构大致正常,但出现核仁边聚和细胞器增多现象,亦观察到少量凋亡神经元。KA组于SE后6h观察到bcl-2表达增高(与对照组相比,P<0.05),于24h开始减弱,48h仅有微弱表达。TPM组在24h点有bcl-2的强表达(P<0.001),并持续至48h。结论托吡酯预处理能减轻癫痫大鼠神经元的损伤,其神经保护作用可能与bcl-2蛋白的表达上调有关。     

褪黑素对癫痫大鼠海马GABA、GABAARα5表达的影响

目的 探讨褪黑素(Mel)抗癫痫作用的机制.方法 采用匹罗卡品(PILO)诱导大鼠癫痫持续状态(SE)模型,用免疫组化技术检测大鼠SE后4个时相点即6 h、48 h、72 h和7 d海马γ-氨基丁酸(GABA)和GABAA受体α5(GABAARα5)亚单位表达的动态变化,以及Mel对其变化的影响.结果 PILO组大鼠SE后6h,海马内GABA能神经元和GABAARα5亚单位表达均开始减少,尤其以SE后72 h～7 d改变最为明显,与对照组比较差异有极显著意义(P＜0.01);而Mel组大鼠在SE后72 h～7 d,海马各区的GABA能神经元和GABAARα5亚单位表达均显著高于PILO组大鼠(P＜0.05).结论 Mel可能通过上调GABA和GABAARα5亚单位的表达来发挥抗癫痫作用.     

红藻氨酸致癫痫持续状态大鼠海马neuropilin-2 mRNA及其蛋白表达的研究

目的研究轴索导向分子NPN-2mRNA及其蛋白对癫痫持续状态(SE)后大鼠海马内神经纤维外向性生长和突触重建中的调控作用。方法采用侧脑室内注射红藻氨酸(KA)制作TLE大鼠模型,用Nissl染色、原位杂交和免疫组织化学的方法,分别检测致SE后1d、1w、2w、3w、4w大鼠海马齿状回(DG)、CA1区、CA3区、门区神经元丢失程度以及NPN-2mRNA及其蛋白的表达。结果 KA致SE后1d开始出现神经元丢失,至4w神经元丢失明显增多。KA致SE后1d,NPN-2mRNA及其蛋白在DG和CA1区表达明显下降,持续至3w(P0.01),4w恢复至正常(P0.05);NPN-2mRNA及其蛋白在门区、CA3区表达实验组与对照组无明显差别(P0.05)。结论 KA致SE后,海马DG及CA1区神经元下调NPN-2mRNA及其蛋白的表达,促进DG及CA1区神经纤维外向性生长和突触的重建。