扁平疣患者的抑郁情绪和细胞免疫功能的研究

目的 探讨扁平疣患者抑郁情绪障碍与细胞免疫功能的关系.方法 采用自评抑郁量表(SDS)对68例扁平疣患者抑郁情绪进行评定,并比较分析有无抑郁的扁平疣患者外周血单一核细胞产生白介素-2(IL-2)的能力和天然杀伤(NK)细胞活性.结果 扁平疣患者的SDS标准分显著高于全国常模[(46.08±12.76)分vs(41.88±10.57)分;t=3.71,P＜0.01],差异有统计学意义.抑郁障碍的发生率为38%(26例).扁平疣患者中未婚者SDS标准分(48.89±11.52)分,抑郁发生率29%(20例),已婚者SDS标准分(43.16±10.17)分,抑郁发生率9%(6例),差异有统计学意义(t=2.28,x2=4.86,P＜0.05).女性患者SDS标准分(49.01±11.36)分,男性(41.96±10.48)分,差异有统计学意义(t=2.21,P＜0.05).具有抑郁情绪障碍者外周血单一核细胞产生IL-2的能力、NK细胞活性分别为(46.64±12.28)×103U/L、(19.23±5.60)%,低于无抑郁情绪患者[(56.15±18.32)×103 U/L、(24.65±6.89)%,t=3.18、3.32,P＜0.01].结论 部分扁平疣患者存在明显的抑郁情绪障碍,且抑郁者多伴有细胞免疫功能异常.

Abstract：

Objective To evaluate the possible association between depression and cellular immunologic status in patients with verruca planea. Methods Depression was assessed with the Self-rating Depression Scale (SDS), and the inteleukin-2 (IL-2)produced by peripheral blood mononuclear cells (PBMC) and the activity of natural killer (NK) cells were measured in 68 patients with verruca planea. Results The SDS scores in patients with verruca planea(46. 08 ± 12.76) were significantly higher than those in the controls(41.88 ± 10. 57, t = 3.71, P ＜ 0. 01 ), and 38% of the patients were affected by depression. The mean scores of depression (48.89 ± 11. 52 ) and the rate ( 29% ) of depressive disorder among patients unmarried (single) were significantly higher than those married [(43. 16 ± 10. 17 ), 9%;t = 2. 28, x2 = 4. 86, P ＜ 0. 05] . The mean scores of depression among female patients (49. 01 ± 11.36 )were significantly higher than male patients [(41.96 ± 10.48 ) ,t =2. 21 ,P ＜0. 05] . In patients affected by depression, the level of the IL-2[(46. 64 ± 12. 28) × 103 U/L] produced by PBMC and the activity of NK cells[( 19. 23 ±5.60)%] were significantly decreased than those in undepressive group[(56. 15 ± 18. 32) ×103 U/L, (24.65 ± 6. 89)%; t = 3.18, 3. 32, P ＜ 0.01] . The differences above were all significant. Conclusions Patients with vermca planea are partly affected by depression and the cellular immunologic status may be abnormal among the patients with depression.     

等电聚焦电泳联合免疫印迹法检测寡克隆区带诊断神经系统炎性脱髓鞘疾病

目的 探讨等电聚焦电泳(IEF)联合免疫印迹法检测寡克隆区带(OB)在神经系统炎性脱髓鞘疾病(IDD)中的应用.方法 IEF联合免疫印迹法检测112例IDD及24例神经系统非炎性疾病(NIND)患者血清和脑脊液中OB,并进行对比分析.结果 与视神经脊髓炎(5/21,23.8%,x2=32.679)、急性播散性脑脊髓炎(1/4,Fisher精确检验)、系统性自身免疫病继发中枢神经系统IDD(3/19,15.8%,x2=37.425)、周围神经系统IDD(0,x2=51.944)和NIND(0,x2=51.944)患者比较,多发性硬化(MS)患者脑脊液OB阳性率(44/46,91.7%)显著升高(P＜0.01).IEF联合免疫印迹法检测OB诊断MS的敏感度为91.7%,特异度为89.8%,高于其他检测方法.2例急性播散性脑脊髓炎患者和1例MS患者血清和脑脊液OB有相同条带,呈"镜像分布".结论 IEF联合免疫印迹法检测OB在MS诊断中具有一定的临床价值.

Abstract：

Objective To explore the diagnostic value of oligoclonal band (OB) detected by isoelectric focusing (IEF) with immunoblotting in inflammatory demyelinating diseases (IDD) in nervous system.Methods Serum and cerebrospinal fluid (CSF) OB was detected by IEF with immunoblotting in 112 patients with IDD ( multiple sclerosis ( MS):n = 48;neuromyelitis optica ( NMO):n = 21:acute disseminated encephalomyelitis ( ADEM):n = 4;secondary IDD from systemic autoimmune diseases:n = 19;peripheral nervous system IDD:n =20) and 24 patients with non-inflammatory neurological disease (NIND).Results CSF-restricted OB was detected in 91.7% (44/48) of MS patients,23.8% (5/21) of NMO patients(x2nmO vs MS= 32.679),1/4 of ADEM patients (Fisher' s excact test),15.8% (3/19) of secondary IDD patients (x2secondary IDD vs MS = 37.425 ),0 of peripheral nervous system IDD patients (x2peripheral nervous system IDD vs MS =37.425) and 0 of NIND patients (x2NIND vs MS =37.425).MS patients had significantly higher percentage of patients with CSF-restricted OB ( all P ＜0.01),compared with NIND and other IDD patients.The sensitivity and specificity of OB detected by IEF with immunoblotting for MS were 91.7% and 89.8%,which were higher than that of OB detected by other methods.Identical serum and CSF OB ( "mirror pattern" ) was detected in 2 of 4 ADEM patients and 1 of 48 MS patients.Conclusion IEF with immunoblotting to detect OB is a reliable method of diagnosis for MS.     

Decreased b-Cell Function is Associated with Cardiovascular Autonomic Neuropathy in Chinese Patients Newly Diagnosed with Type 2 Diabetes

The influence of b-cell function on cardiovascular autonomic neuropathy(CAN), an important diabetesrelated complication, is still unclear. In this study, we aimed to investigate the association between residual b-cell function and CAN in patients newly diagnosed with type 2 diabetes. We enrolled 90 newly-diagnosed type 2 diabetic patients and 37 participants with normal glucose tolerance as controls. The patients were divided into a CAN? group(diabetic patients with CAN, n = 20) and a CAN-group(diabetic patients without CAN, n = 70) according to the standard Ewing battery of tests. Fasting and postprandial plasma glucose, insulin, and C-peptide were measured.Homeostasis model assessment-beta cells(HOMA-B) and HOMA-insulin resistance(IR) were calculated. The prevalence of CAN in this population was 22.2%. Compared with the CAN-group, the CAN? group had significantly lower fasting plasma insulin(6.60 ± 4.39 vs 10.45 ± 7.82 l/L, P = 0.029), fasting C-peptide(0.51 ± 0.20 vs0.82 ± 0.51 nmol/L, P = 0.004), and HOMA-B(21.44 ± 17.06 vs 44.17 ± 38.49, P = 0.002). Fasting C-peptide was correlated with the Valsalva ratio(r = 0.24, P = 0.043) and the 30:15 test(r = 0.26,P = 0.023). Further analysis showed that fasting C-peptide(OR: 0.041, 95% CI 0.003–0.501, P = 0.012) and HOMAB(OR: 0.965, 95% CI 0.934–0.996, P = 0.028) were independently associated with cardiovascular autonomic nerve function in this population. The patients with fasting C-peptide values \ 0.67 nmol/L were more likely to have CAN than those with C-peptide levels C0.67 nmol/L(OR:6.00, 95% CI 1.815–19.830, P = 0.003). A high prevalence of CAN was found in patients with newly-diagnosed type 2 diabetes. Decreased b-cell function was closely associated with CAN in this population.     

即刻和延迟治疗对新诊断癫痫患者复发的影响

目的 探讨不同治疗时机(即刻和延迟治疗)对新诊断癫痫患者复发的影响.方法 前瞻性收集新诊断癫痫患者的临床资料,根据治疗前发作次数将患者分为即刻治疗组(≤2次)及延迟治疗组(＞2次),给予合理抗癫痫药物治疗,至少观察2年.采用Kaplan-Meier统计分析比较2组患者治疗后至第1、2次复发的时间,同时比较治疗后不同随访时间点(3、6、12、24个月)的累计复发率.结果 共收集162例癫痫患者,其中即刻治疗组65例,延迟治疗组97例,随访2～14年(中位数3年).即刻治疗组治疗后至第1、2次复发时间均明显长于延迟治疗组,差异均有统计学意义(x2=5.94,P=0.020;x2=7.210,P=0.007).至随访终点,即刻治疗组有58.5%患者复发,低于延迟治疗组的72.2%,但差异没有统计学意义(x2=3.289,P=0.070).即刻治疗组和延迟治疗组治疗后3、6、12、24个月累计癫痫复发率分别为16.9%vs 35.1%、26.2%vs 48.5%、41.5%vs 56.7%、50.8%vs64.9%,仅在3、6月时差异均有统计学意义(x2=6.376,P=0.012;x2=8.098,P=0.004).结论 ≤2次癫痫发作后即刻给予合理抗癫痫药治疗可降低癫痫患者早期的复发风险.

Abstract：

Objective To explore the influences of immediate and deferred treatment with antiepileptic drugs (AEDs) on relapse of epilepsy in newly diagnosed patients. Methods The clinical data of newly diagnosed epileptic patients were collected prospectively and the patients were divided into immediate (seizures≤2) and deferred (seizures＞2) treatment groups according to times of seizures before treatment; these patients were treated with antiepileptic drugs reasonably. The patients were followed up for at least 2 years. Kaplan-Meier statistics was used to analyze the times to the first and second seizures after treatment. We also observed and compared their cumulative recurrence rate during the follow-up.Results One hundred and sixty-two patients were collected, 65 of which were in the immediate treatment group and 97 of which were in the deferred treatment group; The patients were followed up for 2-14 years(median 3 years). Times to the first and second seizures in the immediate treatment group were significantly longer than those in the deferred treatment group (x2=5.394, P=0.020; x2=7.210, P=0.007,respectively). Till the end of follow-up, 58.5% patients relapsed in the immediate treatment group, which was lower than that in the deferred treatment group (72.2%), but no statistical difference was noted (x2=3.289, P=0.07). The cumulative recurrence rates in the immediate and deferred treatment groups were 16.9% vs. 35.1% (x2=6.376, P=0.012), 26.2% vs. 48.5% (x2=8.098, P=0.004), 41.5% vs. 56.7% (x2=3.580,P=0.058) and 50.8% vs. 64.9% (x2=3.241, P=0.072) in the 3rd, 6th, 12th and 24th month of follow-up.Conclusion Immediate treatment with AEDs could reduce early recurrence rate of epilepsy in newly diagnosed epileptic patients with a few seizures (seizures ≤2).     

前额叶损伤患者情绪记忆的改变

目的 探讨前额叶损伤患者情绪记忆的损害情况,验证前额叶参与情绪记忆神经机制的假说.方法 建立情绪记忆的神经心理学测验方法,测试年龄、教育程度相匹配的40名健康人和40例前额叶损伤患者的情绪记忆情况.结果 与健康对照组[正性(11.68±2.18)分和负性(12.93±1.33)分]相比,前额叶损伤组[正性(8.20±2.02)分和负性(8.68±1.14)分]情绪效价图片再认成绩差异有统计学意义(t=7.41、-2.75,P＜0.05),而中性的情绪效价图片再认成绩差异无统计学意义.左、右侧前额叶损伤组的正性[(8.90±2.01)分、(7.50±1.79)分]和负性[(7.30±1.10)分、(9.05±1.00)分]情绪效价图片再认成绩差异均有统计学意义(Z=-2.15、-2.07,P＜0.05).结论 前额叶损伤患者的情绪记忆存在损害,且左、右侧前额叶损伤患者的正性与负性效价记忆相对存在不同差别的损害,表明其可能有不同的神经机制.

Abstract：

Objective To investigate the emotional memory impairment in patients with lesions located in prefrontal cortex(PFC), and to test the hypothesis that prefrontal cortex is involved in the emotional memory network. Methods The 40 patients with lesions in PFC and forty age-education-level matched healthy adults were given emotional memory tasks using positive, neutral and negative valence images. Results Compared with the healthy adults(positively(11.68 ± 2. 18)and negatively(12. 93 ±1.33)), the patients had significant loss in positively(8. 20 ± 2.02)and negatively(8. 68 ± 1.14)valence image memorizing(t = 7.41, - 2. 75, both P ＜ 0. 05). There was no insignificant impairment in neutral stimuli. Performance difference between left PFC and right PFC in positively(8. 90 ±2. 01 vs 7.50 ± 1.79)and negatively(7.30 ± 1.10 vs 9. 05 ± 1. 00)valence image recognition was significant(Z = -2. 15,-2. 07,both P ＜ 0. 05). Conclusion The results suggest that emotional memory is impaired in the patients with lesions in PFC. The impairment difference between left PFC and right PFC indicates that they may have different neuromechanisms.     

视神经脊髓炎高危综合征患者血清尿酸水平与临床特征的相关性

目的 探讨视神经脊髓炎高危综合征患者血清尿酸水平与临床特征的关系.方法 尿酶法检测51例急性期视神经脊髓炎高危综合征(34例长节段脊髓炎,17例视神经炎),48例视神经脊髓炎,45例神经科其他疾病,65名健康对照的血清尿酸水平.采用扩展残疾状态量表(EDSS)评价病情严重程度,MRI评估受累病灶,细胞免疫荧光法检测水通道蛋白4抗体水平.结果 长节段脊髓炎组尿酸水平(189.84±85.65)μmol/L,视神经炎组(222.12±61.68)μmol/L,低于其他疾病组[(315.90±71.36)μmol/L]和健康对照组[(291.05±76.64)μmol/L,P＜0.01],与视神经脊髓炎[(219.19±76.47)μmol/L]比较差异无统计学意义.各组女性患者尿酸水平[(158.24±55.92)、(187.00±47.52)、(198.21±62.62)、(274.51±70.66)和(243.26±60.65)μmol/L]均低于男性组[(262.09±101.63)、(262.45±62.13)、(298.90±74.14)、(355.37±50.30)和(340.34±58.23)μmol/L,t=3.183、2.578、4.356、4.365、6.579,P＜0.05].高危综合征组患者不同病程组,水通道蛋白4抗体阳性、阴性组尿酸差异无统计学意义.长节段脊髓炎组尿酸水平与EDSS评分呈负相关(r=-0.714,P＜0.01).结论 低尿酸可能与视神经脊髓炎高危综合征发病相关,且与长节段脊髓炎患者疾病严重程度有关.

Abstract：

Objective To investigate serum uric acid (UA) levels and related clinical features in patients with high risk syndrome of neuromyelitis optica. Methods UA levels were measured in 51 patients with high risk syndrome of neuromyelitis optica including 34 with longitudinally extensive transverse myelitis (LETM) and 17 with optic neuritis (ON), 48 with neuromyelitis optica (NMO), 45 with other neurological diseases (OND) and 65 with healthy controls (HC). The disability severity was assessed by the expanded disability status scale (EDSS). Spinal lesions were viewed by MRI. Serum aquaporin-4(AQP4) antibody was tested in cell based immunofluorescence assay. Results Serum UA levels in LETM ( ( 189. 84 ±85. 65) μmol/L) and ON patients ( (222. 12 ±61.68) μmol/L) were significantly lower than that in OND ((315.90±71.36) μ mol/L) and HC ((291.05 ±76.64) μ mol/L) subjects (P＜0.01). No difference was found between LETM, ON and NMO groups. UA levels were significantly lower in females ( ( 158.24 ±55.92), (187.00±47.52), (198.21 ±62.62), (274.51 ±70.66)and (243.26±60.65) μmol/L)than in males ( ( 262. 09 ± 101.63 ), ( 262. 45 ± 62. 13 ), ( 298.90 ± 74. 14 ), ( 355.37 ± 50. 30 ) and (340. 34 ±58. 23) μmol/L) in all groups (t=3. 183, 2.578, 4.356, 4.365 and 6.579, all P＜0.05).UA levels in patients with high risk syndrome of NMO were not correlated with mono or relapse course,duration or status of serum AQP4 antibody. UA were negatively correlated with EDSS in patients with LETM (r= -0.714, P＜0.01). Conclusion Lower serum UA levels were found in patients with high risk syndrome of NMO and related to more severe symptoms in LETM group.     

血清MOG抗体阳性炎性脱髓鞘疾病患者临床特征分析

目的探讨MOG抗体阳性炎性脱髓鞘疾病患者的临床特征。方法回顾性分析36例血清MOG抗体阳性炎性脱髓鞘疾病患者(MOG抗体阳性组)与87例血清AQP4抗体阳性NMOSD患者(AQP4抗体阳性组)的临床信息,分析比较两组患者的临床特征。结果 MOG抗体阳性组与AQP4抗体阳性组患者相比,患病男女比例(1︰1.77 vs.1︰6.25,P=0.005)及发病年龄[(23.17±14.37)岁vs.(35.91±12.91)岁,P=0.000]差异存在统计学意义,两组患者均以女性为多,MOG抗体阳性组患者以儿童和青年为主。MOG抗体阳性组首发脱髓鞘事件中ADEM患者比例高于AQP4抗体阳性组[7例(19.4%)vs.0例(0%),P=0.000],脊髓炎[11例(30.6%)vs.47例(50.4%),P=0.018)]和脑干综合征[5例(13.9%)vs.25例(28.7%),P=0.049)]患者比例低于AQP4抗体阳性组。MOG抗体阳性组患者出现肢体抽搐症状患者比例高于AQP4抗体阳性组[5例(13.9%)vs.0(0%),P=0.002]。影像学表现上,MOG抗体阳性组头部总病灶[27例(75.0%)vs.33例(37.9%)]及NMO非典型病灶[23例(85.2%)vs.4例(12.1%)]患者比例高于AQP4抗体阳性组,头部NMO典型病灶[4例(14.8%)vs.29例(87.9%)]患者比例低于AQP4抗体阳性组(均P=0.000),仅14.8%MOG抗体阳性炎性脱髓鞘疾病患者存在典型NMO头部病灶。MOG抗体阳性组患者截访时EDSS评分低于AQP4抗体阳性组[(2.36±1.66)分vs.(3.83±1.66)分,P=0.000]。结论 MOG抗体阳性炎性脱髓鞘疾病患者男女比例差异较小,与AQP4抗体阳性NMOSD患者相比发病年龄小,首次发作以ADEM、视神经炎及脊髓炎为主,易出现肢体抽搐症状,少见NMO典型头部病灶,倾向于累及下段脊髓,预后较好。     

急性脑梗死散在和单一弥散加权成像病损与其供血动脉狭窄的关系

目的 探讨急性脑梗死弥散加权磁共振成像(DWI)上大脑中动脉(MCA)供血区散在性或单一性缺血性病损与其脑供血动脉狭窄或闭塞的关系.方法 回顾性分析73例连续积累的DWI显示一侧MCA供血区脑梗死的病例,入组病例均排除心源性栓塞性脑梗死,所有患者均在发病24 h内进行MRI和MRA等检查,7例患者并进行DSA.采用DWI急性缺血性病损分类方法 分为散在病损组和单一病损组,比较两组的病灶同侧MCA、颈内动脉(ICA)颅内段和颅外段狭窄或闭塞的发生率.结果 散在病损组42例,单一病损组31例.在病损同侧ICA颅外段和MCA闭塞或重度狭窄方面两组差异有统计学意义(28.6%与0,x2=10.6,P=0.001).在病损同侧ICA颅内段并MCA轻中度狭窄方面,两组间差异具有统计学意义(31.0%与9.7%,x2=4.717,P=0.03).散在病损与MCA和(或)ICA严重或多发狭窄呈正相关(OR值为13.7,95%CI:3.6～52.5).在MRA或DSA未发现颅内外大血管狭窄方面,两组间差异具有统计学意义(11.9%与32.3%,x2=4.526,P=0.033).散在病损组与无明显血管狭窄呈负相关(OR值为0.284,95%CI:0.09～0.94).结论 (1)脑梗死急性期DWI显示的MCA区散在性病损患者,MCA和ICA狭窄、甚至闭塞的可能性较大,以ICA颅外段闭塞较为常见;(2)DWI显示单一病损时提示脑供血动脉狭窄程度较轻,范围较局限,小血管病变的可能性相对较高,很少为严重的ICA颅外段狭窄或闭塞.

Abstract：

Objective To investigate the relationship between scattered or single lesion of acute cerebral infarction in middle cerebral artery territory on diffusion-weighted imaging (DWI) and stenosis of middle cerebral artery (MCA) or internal carotid artery (ICA). Methods With exclusion of cardioembolism, 73 consecutive patients with acute cerebral infarction of the unilateral MCA territory on DWI were analyzed. All patients got magnetic resonance imaging (MRI) and angiography (MRA) within 24 hours after onset, and 7 patients also had digital subtraction angiography (DSA). The patients were classified into single lesion group or scattered lesions group according to the DWI findings. The incidence of stenosis or occlusion of ipsolateral MCA, intracranial and extracranial ICA were compared between the two groups. Results 42 patients had scattered lesions and 31 patients had single lesion. The scattered-lesions group had a high incidence of ipsilateral extracranial ICA or MCA occlusion or severe stenosis ( 25.6%versus 0, x2 = 10.6, P = 0.001 ) and a high incidence of ipsilateral intracranial ICA or MCA moderate or mild stenosis (31.0% versus 9.7% ,x2 =4.717, P =0.03 ). A positive correlation was found between the scattered lesions and severe or multifocal stenosis of ipsilateral ICA and MCA ( OR: 13.7, 95% CI: 3.6 to 52.5). There was a low incidence of absence of extra- and intracranial stenosis on MRA or DSA in the scattered-lesions group ( 11.9% versus 32.3%, x2= 4.526, P = 0.033 ). A negative correlation was found between the scattered lesions and absence of large-artery stenosis ( OR: 0.284, 95% CI: 0.09 to 0.94).Conclusions ( 1 ) Patients with acute cerebral infarction and scattered lesions on DWI were more likely to suffer from stenosis or occlusion of ICA or MCA, especially over the extracranial ICA. (2) Patients with single lesion were less likely to have severe or multiple stenosis of MCA and ICA, indicating the relevance of small-vessel pathogenesis.     

抑郁症患者治疗前后血浆孤啡肽的研究

Objective To explore the changes of plasma orphanin FQ (OFQ) level in depressive patients before and after treatment. Methods The plasma OFQ levels of 38 depressive patients were determined with radioimmunoassay at baseline and after 8 week antidepressant treatment, and 32 healthy persons were examined once as controls. Results The concentrations of OFQ in patients were significantly higher at baseline than after treatent and in controls [(21.9 ± 2. 3 ) ng/L vs. ( 10. 9 ± 2. 1 ) ng/L; (21.9±2. 3) ng/L vs. (10. 2 ± 1.8 )ng/L; all P < 0. 01]. There were no significant differences in OFQ between patients after treatment and in controls. The OFQ concentration in patients at baseline was positively correlated to the scores of 24-items Hamilton Depression Scale (HAMD) (r =0. 857,P <0. 01 ), the change of OFQ concentration between baseline and after treatment was also positively correlated to the alteration of HAMD scores (r = 0. 342, P < 0. 05 ). Conclusions The results suggest that the alteration of OFQ may be involved in depression.     

基质金属蛋白酶-7血清水平及其基因-181A/G多态性对颈动脉斑块稳定性的影响

Objective To explore the influence of plasma matrix metalloproteinase-7 ( MMP-7 ) levels and genetic polymorphism of MMP-7 - 181 A/G on the stability of carotid plaque.Method According to carotid ultrasound examination, 503 patients with carotid atherosclerotic lesions were consecutively recruited and divided into vulnerable plaque group (n = 118) and stable plaque group (n = 385).Plasma MMP-7 levels were measured by enzyme-linked immunosorbent assay (ELISA), and MMP-7 -181 A/G genotypes were determined by polymerase chain reaction-restiction fragment length polymorphism (PCR-RFLP).Results Plasma MMP-7 levels in carotid vulnerable plaque group were significantly enhanced as compared to stable plaque group (t =5.49, P =0.00).The frequency of MMP-7 -181G allele in vulnerable plaque group was significantly higher than that in stable plaque group (11.4% vs 7.0% ,χ2 = 4.78, P= 0.029).Compared to AA genotype, the genotypes with - 181G allele (AG + GG) significantly increased susceptibility to carotid vulnerable plaque ( χ2 = 5.01, OR = 1.81, P = 0.025 ) .When further analyzing the relationship between genotype and plasma MMP-7 levels, no significant differences of plasma MMP-7 levels were observed between AA genotype and AG + GG genotype in stable plaque group.However, in vulnerable plaque group, plasma MMP-7 levels of AG + GG genotype were significantly higher than that of AA genotype( t = 2.62, P = 0.01).Conclusion The present findings suggest that plasma MMP-7 level may be a biomarker for carotid vulnerable plaque.Genetic polymorphism of - 181 A/G in MMP-7 promoter may affect the expression of MMP-7, and seems to be implicated in susceptibility to carotid vulnerable plaque.     

复发-缓解型多发性硬化患者丘脑扩散张量成像研究

目的 通过扩散张量成像研究复发-缓解型多发性硬化患者常规MRI表现正常的丘脑扩散参数异常,以及与临床残疾程度和认知损害间的相关性.方法 24例复发-缓解型多发性硬化患者和与之性别、年龄相匹配的健康志愿者分别接受常规MRI和扩散张量成像检查,利用兴趣区法测量影像正常的丘脑扩散参数,比较两组受试者丘脑平均扩散率和部分各向异性间的差异性,并评价患者丘脑扩散参数与临床相关评分及病灶体积之间的相关关系.结果 复发-缓解型多发性硬化组患者丘脑平均扩散率[(85.34+14.68)x10-3mm2/s]低于正常对照组[(98.42±13.10)×10-3mm2/s],组间差异具有统计学意义(t=-3.257,P=0.002);丘脑部分各向异性(0.40±0.04)高于正常对照组(0.36±0.05),差异亦有统计学意义(t=3.163,P=0.003).复发-缓解型多发性硬化组患者丘脑平均扩散率与同步听觉连续加法测验评分呈显著正相关(r= 0.711,P=0.000).结论 对常规MRI表现正常的复发-缓解型多发性硬化患者,扩散张量成像可以发现丘脑异常.而且丘脑扩散异常与患者认知损害存在相关性,提示扩散张量成像作为评价临床功能的重要指标,具有很好的应用前景.     

表观弥散系数在急性缺血性卒中分期及判断脑组织灌注状态中的作用

目的探索表观弥散系数(apparent diffusion coefficient,ADC)在急性缺血性卒中患者分期及判断缺血半暗带中的价值。方法收集经临床和影像确诊为急性缺血性卒中的患者,根据行磁共振成像(magnetic resonance imaging,MRI)检查距起病时间的长短分为6 h组,6~24 h组,24~48 h组,48~72 h组,所有患者在治疗前行MRI弥散加权像(diffusionweighted imaging,DWI)检查,评估DWI图像及常规MRI图像显示病变的情况,测定各时间段病灶的ADC、健康对侧相应位置的ADC值、病灶中心及边缘的ADC值。结果共纳入62例患者,发病时间6 h的病例10例,常规MRI图像阳性检出率为0(0/10),DWI阳性检出率为100%(10/10);发病6~24 h的病例27例、24~48 h的病例13例、48~72 h的病例12例,总共52例,其中常规MRI阳性检出率为88.4%(46/52),DWI阳性检出率为100%(52/52)。不同时间段病灶侧ADC值与健侧ADC值分别为:6 h组(0.601±0.079,1.261±0.085)×10~(-3)mm~2/s,6~24 h组(0.623±0.097,1.152±0.083)×10~(-3)mm~2/s,24~48 h组(0.635±0.103,1.036±0.112)×10~(-3)mm~2/s,48~72 h组(0.631±0.082,1.225±0.097)×10~(-3)mm~2/s;不同时间段病灶侧ADC值与健侧ADC值之间均有显著性差异(P分别为0.006,0.007,0.008和0.017)。不同时间段组病灶侧ADC值之间无显著差异。不同时间段组病灶中心及边缘的ADC值分别为:6 h组(0.547±0.089,0.624±0.096)×10~(-3)mm~2/s,两者之间有显著性差异(P=0.027);6~24 h组(0.572±0.074,0.647±0.107)×10~(-3)mm~2/s,两者之间有显著性差异(P=0.032);24~48 h组(0.615±0.104,0.636±0.082)×10~(-3)mm~2/s,两者之间无显著差异;48~72 h组(0.631±0.081,0.625±0.102)×10~(-3)mm~2/s,两者之间无显著差异。结论 DWI的ADC值可以早期准确发现急性缺血性卒中的责任病灶,而且可以区分24 h梗死灶的中心和边缘,边缘区可能为缺血半暗带,但对于急性缺血性卒中(0~3 d)的细化分期意义不大。     

基层医院中西医结合组织化卒中医疗模式的临床研究

目的对比观察基层医院应用组织化卒中医疗模式,辅助中医药和针灸等康复方法治疗脑卒中的临床效果。方法符合纳入标准的236例脑卒中患者随机分为组织化卒中组和传统治疗组(对照组),分别比较两组患者住院期间美国国立卫生研究院卒中量表(NIIISS)评分、Barthel指数(BI)评分、牛津残障评分(OHS)、短期临床疗效、病死率及并发症发生率。结果组织化卒中组患者治疗第21和90天时,NIHSS评分为11.28±4.25和4.76±3.16,BI评分为78.00±22.50和84.00±20.10,OHS评分为1.85±1.40和1.30±0.98,神经功能缺损程度显著改善、日常生活活动能力增强、社会功能提高,与对照组相比差异具有统计学意义(均P=0.000)。组织化卒中组患者治疗第21和90天总有效率分别为80.99%(98/121)和88.43%(107/121),高于对照组的61.74%(71,115)和72.17%(83/115;第21天:Z=6.207,P=0.013;第90天:Z=8.302,P=0.004);但常见并发症发生率(37例,30.58%)低于对照组(80例,69.57%),差异有统计学意义(χ~2=35.851,P=0.000)。结论基层医院以组织化卒中医疗模式管理和治疗脑卒中,并在康复治疗中辅助中医药和针灸治疗,效果优于传统治疗方法。     

Tourette综合征患者血清可溶性白细胞介素6受体与自身抗体表达水平的研究

目的 通过研究Tourette综合征(TS)患者血清自身抗体和可溶性白细胞介素6受体表达水平改变及其之间的相关性,探讨白细胞介素6受体介导的免疫调节在疾病发生中的作用.方法 应用抗脑抗体(ABAb)、抗核抗体(ANA)、可溶性白细胞介素-6受体(sIL-6R)及可溶性细胞因子受体gp130(sgp 130)的酶联免疫吸附法商品试剂盒,检测67例TS患者(TS组)和64名正常人(对照组)血清sIL-6R、sgp130及相应抗体的浓度,同时采用胶乳增强免疫比浊法检测抗链球菌溶血素O(ASO)水平.结果 TS组血清sIL-6R(44±16)pg/L,sgp130(69±25)pg/L,均显著高于对照组[(30±9)pg/L,(47±14)pg/L];差异均有统计学意义(P=0.000,P=0.000,P均＜0.01).TS组血清ABAb检出率为(67%)、ANA为(53%),均显著高于对照组(3%,25%),差异均有统计学意义(P=0.000,P＜0.01;P=0.001,P＜0.01);且ASO增高的比例(20%)高于对照组(0%)(P=0.000,P＜0.01).TS组ABAb浓度与sgp130呈负相关(r=-0.375,P＜0.05).结论 TS患者IL-6受体和自身抗体表达异常,中枢神经组织的自身免疫损伤可能参与了疾病发生发展的病理生理过程.     

阿立哌唑治疗利培酮所致精神分裂症女性患者高催乳素血症的研究

目的 探讨阿立哌唑治疗利培酮所致女性患者高催乳素血症的疗效及安全性.方法 117例利培酮所致高催乳素血症的女性患者,随机分为治疗组(60例)和对照组(57例).维持原有利培酮治疗不变,治疗组加用阿立哌唑5 mg,对照组加用安慰剂治疗,疗程均为6周.于治疗第0,6周末检测催乳素,评定简明精神病量表(BPRS)、治疗中需处理的不良反应症状量表(TESS).结果 (1)治疗第6周末,治疗组催乳素[(26±6)μg/L]较基线[(112±40)μg/L]下降,差异有统计学意义(P=0.000);对照组催乳素[(99±44)μg/L]与基线[(104±34)μg/L]比较,差异无统计学意义(P=0.180).(2)治疗第6周末,治疗组催乳素下降率[(75±8)%]、正常率(82%),均高于对照组[分别为(5+30)%,4%];P均=0.000.(3)治疗第6周末,治疗组[(20.4±2.1)分]、对照组[(20.8±1.9)分]BPRS评分均较基线[分别为(21.1±1.8)分,(21.4±1.9)分]下降,P均=0.045;两组不良反应发生率相近(P=0.553).结论 阿立哌唑治疗利培酮所致精神分裂症女性患者的血高催乳症有效、安全.     

神经生长因子对糖皮质激素诱导大鼠海马神经元凋亡的保护作用

目的探讨神经生长因子对糖皮质激素诱导的大鼠海马神经元凋亡的保护作用。方法体外分离原代培养18只新生Wister大鼠海马神经元,噻唑蓝法测定地塞米松诱导海马神经元凋亡的最低敏感剂量,观察不同质量浓度神经生长因子对地塞米松(0.10×10~(-6)mol/L)诱导海马神经元凋亡的保护作用。结果与阴性对照组相比,地塞米松Ⅰ组(10×10~(-6)mol/L)、Ⅱ组(1×10~(-6)mol/L)和Ⅲ组(0.10×10~(-6)mol/L)大鼠海马神经元活性均降低(P=0.000,0.000,0.000)。予不同质量浓度神经生长因子后,神经生长因子0.18 ng/ml组大鼠海马神经元活性低于阴性对照组(P=0.000)和阳性对照组(P=0.010),神经生长因子18 ng/ml组大鼠海马神经元活性高于阳性对照组(P=0.000)和神经生长因子0.18 ng/ml组(P=0.000)。结论糖皮质激素可以诱导体外培养的大鼠海马神经元凋亡,地塞米松0.10×10~(-6)mol/L是诱导海马神经元凋亡的最低敏感剂量,神经生长因子可以拮抗地塞米松诱导的大鼠海马神经元凋亡。     

不同炎症反应在脑梗死与短暂性脑缺血发作患者中表达及意义研究

目的探讨不同炎症因子在脑梗死与短暂性脑缺血发作患者的表达情况。方法选取64例短暂性脑缺血发作患者(TIA组)、58例脑梗死患者(CI组)以及50例健康人员(NC组),分析并统计3组受试对象炎症因子表达情况。结果 CI组MMP-9(83.14±9.27)μg/L、NF-κB(36.88±6.27)%、IL-33(71.63±4.83)ng/m L及hs-CRP(12.57±1.29)mg/L,TIA组分别为(29.17±4.54)μg/L、NF-κB(31.20±5.97)%、IL-33(104.59±8.27)ng/m L及hs-CRP(6.23±1.04)mg/L,两组间比较差异具有统计学意义(P=0.026、P=0.032、P=0.025和P=0.009)。Logistic回归分析显示,TC、MMP-9、IL-33及hs-CRP为CI的独立危险因素。TC、hs-CRP为TIA的独立危险因素。MMP-9+IL-33+hs-CRP预测CI发生的AUC为0.859(95%CI:0.751~0.911),显著高于MMP-9(AUC为0.711,95%CI:0.649~0.824)、IL-33(AUC为0.698,95%CI:0.659~0.855)和hs-CRP(AUC为0.705,95%CI:0.671~0.848)的诊断效能(Z=9.267、11.553和10.234,均P=0.000)。结论脑梗死、短暂性脑缺血发作患者存在炎症因子表达差异,MMP-9、IL-33及hsCRP联合检测对CI具有较高的诊断价值。     

节段性运动神经传导测定在慢性炎性脱髓鞘性多发性神经根神经病和腓骨肌萎缩症1型之间的差异

目的 探讨节段性运动神经传导测定在慢性炎性脱髓鞘性多发性神经根神经病(chronic inflammatory demyelinating polyradiculoneuropathy,CIDP)和腓骨肌萎缩症1型(Charcot-MarieTooth type1,CMT1)鉴别诊断中的价值.方法 收集16例CIDP和13例CMT1患者,进行节段性运动神经传导测定,比较两组远端运动潜伏期、运动神经传导速度,以及近端和远端比较复合肌肉动作电位波幅、面积和时限变化的差异.结果 CIDP和CMT1患者远端运动潜伏期分别为(5.6±3.4)、(9.3±2.1)ms(t=5.347,P=0.000),运动传导速度分别为(31.1±14.3)、(22.2±5.8)m/s(t=6.369,P=0.000),近端和远端比较波幅下降百分比M5o分别为29.7%和4.9%(Z=7.141,P=0.000).在CIDP患者,所有测定神经中40.3%(25/62)远端潜伏期正常,18.1%(26/144)的神经节段传导速度正常,而在CMT1中所有测定神经的远端潜伏期均延长,所有测定节段的传导速度均减慢.在CIDP患者29.2%的神经节段可见传导阻滞或异常波形离散,而在CMT1仅有3.0%的节段可见传导阻滞(x2=20.829,P=0.000).结论 当针对CIDP和CMT1进行鉴别时,如果节段性运动神经传导测定发现传导阻滞和异常波形离散、不同神经节段传导速度下降程度差别较大,可以支持 CIDP的诊断.     

利培酮对精神分裂症首次发病患者超氧化物歧化酶和丙二醛及S100B蛋白的影响

目的 探讨自由基、抗氧化酶在精神分裂症病理机制中的作用,并观察利培酮对抗氧化酶、丙二醛的影响.方法 符合美国精神障碍诊断与统计手册第4版诊断标准的精神分裂症首次发病(以下简称首发)住院患者90例(患者组),采用单一利培酮4～6 mg治疗,观察周期为12周,以阳性和阴性症状量表(PANSS)评定精神症状,并检测血清总抗氧化活力(TAC)、总超氧化物歧化酶(T-SOD)活力、铜锌超氧化物歧化酶(Cu-ZnSOD)活力、锰超氧化物歧化酶(Mn-SOD)活力及丙二醛(MDA)和S100B的含量.选择87名正常健康人作为对照(对照组).结果 患者组T-SOD(732±126)×102U/L,Cu-ZnSOD活力(578±175)×102U/L,S100B蛋白含量(180±181)ng/L,均显著高于对照组[(672±115)×102U/L,(440±148)×102U/L,(101±115)ng/L;t=3.2,5.6,2.2;v=169,169,60;P均<0.05].而Mn-SOD活力[(153±145)×102 U/L]显著低于对照组[(232±161)×102 U/L;t=-3.3,v=169,P<0.05].治疗后TAC活力[(150±54)×102 U/L]较治疗前[(174±59)×102U/L]显著提高;t=-2.6,v=66,P<0.05.治疗前Mn-SOD与PANSS总分减分值可建立回归方程(R=0.62,R2=0.38,F=7.89,P=0.02);治疗前TAC与阳性症状减分值可建立回归方程(R=0.71,R2=0.50,F=12.9,P=0.00);治疗前Mn-SOD、治疗前后TAC差值与阴性症状减分值可建立回归方程(R=0.76,R2=0.58,F=8.24,P=0.00).结论 自由基代谢、氧化应激可能参与精神分裂症发病机制;利醅酮提高了首发患者的总抗氧化活力.