中度高原地区正常及妊高征孕妇超氧化物歧化酶和丙二醛水平的初步研究

本文测定了未孕妇女、正常孕妇和妊高征孕妇的超氧化物歧化酶（ＳＯＤ），丙二醛（ＭＤＡ）和维生素Ｅ（ＶＥ）水平。结果为正常孕妇ＳＯＤ低于未孕妇女，而ＭＤＡ和ＶＥ高子未孕妇女（Ｐ均＜０．０１），提示孕妇抗氧化能力可能增强。妊高征孕妇与正常孕妇相比，ＳＯＤ、ＶＥ更低（Ｐ＜０．０１），而ＭＤＡ则更高（Ｐ＜０．０５），而且妊高征孕妇的ＭＤＡ与ＳＯＤ、ＭＤＡ与ＶＥ呈负相关（ｒ＝－０．９５６，－０．７０４８、Ｐ＜０．０５），提示可能有脂质过氧化反应的增强和氧化能力下降，为妊高征的急性动脉硬化提供了条件。     

运用经颅多普勒超声对脑损伤血流动力学变化与脑顺应性关系的研究

目的：探讨脑血流动力学变化与脑顺应性的关系。方法：制作中、重度脑损伤动物模型，分别于伤后不同时相点用经颅多普勒超声（ＴＣＤ）仪探测猫大脑中动脉（ＭＣＡ）血流速度，计算搏动指数（ＰＩ），阻力系数（ＲＩ）及收缩峰与舒张期末血流速度比值（Ｓ／Ｄ），同时测量颅内压（ＩＣＰ）、容积压力反应（ＶＰＲ）及压力容积指数（ＰＶＩ），比较各指标间的关系。结果：脑损伤早期，ＭＣＡ血流速度增快，６小时后达高峰，以后逐渐减慢，２４小时后血流速度显著低于伤前；ＰＩ、ＲＩ及Ｓ／Ｄ值逐渐增大，２４小时后明显高于伤前（Ｐ＜０．０５）；损伤越重，变化越明显。ＩＣＰ、ＶＰＲ逐渐增大，ＰＶＩ降低。ＩＣＰ与收缩峰血流速度（Ｖｓ）、平均血流速度（Ｖｍ）、搏动指数（ＰＩ）及Ｓ／Ｄ值间有良好线性关系（Ｐ＜０．０１）；ＰＶＩ与Ｖｓ、舒张期末血流速度（Ｖｄ）、Ｖｍ及ＰＩ间有良好线性关系（Ｐ＜０．０１），但ＶＰＲ与ＭＣＡ各测量值间关系不明显。结论：ＴＣＤ仪能较好地反映脑损伤后血流动力学变化，以此可推测ＩＣＰ及脑顺应性的改变。     

高压氧对大鼠颅脑创伤后脑损伤和脑水肿的影响

目的：探讨高压氧对大鼠颅脑创伤后脑损伤和脑水肿的影响。方法：将大鼠随机分为对照组、脑创伤组和高压氧（ＨＢＯ）组。采用ＢＩＭ－Ⅲ型撞击机撞击大鼠右侧颅顶，复制闭合性颅脑损伤，于伤后２４小时由心脏取血处死，测定脑组织含水率、伊文斯蓝（ＥＢ）含量及脑组织和血浆脂质过氧化物──丙二醛（ＭＤＡ）含量。结果：（１）脑外伤组大鼠右侧脑组织含水率、脑组织及血浆ＭＤＡ含量均显著高于对照组（Ｐ＜０．０１或Ｐ＜０．０５）；右侧脑组织含水率及ＭＤＡ含量显著高于对侧（Ｐ＜０．０１或Ｐ＜０．０５），右侧脑组织ＥＢ含量较对照组升高，但Ｐ＞０．０５；（２）ＨＢＯ组右侧脑组织含水率及脑组织ＭＤＡ含量显著低于脑外伤组（Ｐ＜０．０１或Ｐ＜０．０５），而与对照组及左侧无明显差别；血浆ＭＤＡ、脑ＥＢ含量与对照组、脑外伤组及左侧均无明显差别。结论：ＨＢＯ能减少脑外伤脑组织氧自由基的生成，减轻脑损伤和脑水肿。     

Alzheimer病与血管性痴呆的SPECT

目的：研究脑ＳＰＥＣＴ在诊断及鉴别Ａｌｚｈｅｉｍｅｒ病（ＡＤ）和血管性痴呆（ＶＤ）方面的作用。材料和方法：分别选择符合《精神障碍诊断和统计手册》第４版（ＤＳＭ—ＩＶ）中ＡＤ或ＶＤ诊断标准的患者各１７例和１２例，进行ＳＰＥＣＴ检查，兼作ＣＴ（或ＭＲＩ），并作神经心理测定及其它相关量表评分。将ＡＤ、ＶＤ和ＳＰＥＣＴ结果，以及ＳＰＥＣＴ和ＣＴ（或ＭＲＩ）的结果进行比较。结果：ＡＤ的ＳＰＥＣＴ以颞、顶叶低灌注为典型表现，ＶＤ以局灶性低灌注为主。在右颞下回和右枕叶，ＡＤ组ＳＰＥＣＴ放射性计数比值显著低于ＶＤ组（Ｐ＜０．０５，Ｐ＜０．０１），而在左顶叶显著高于ＶＤ组（Ｐ＜０．０５）。两组左半球的放射性计数比值普遍低于右半球，但ＶＤ的左右不对称性明显重于ＡＤ，以左顶叶最为突出（Ｐ＜０．０１）。ＭＲＩ结果与ＳＰＥＣＴ有较多的一致性。各量表评分除Ｈａｃｈｉｎｓｋｉ缺血指数外，均无显著差异。结论：ＳＰＥＣＴ在诊断和鉴别ＡＤ与ＶＤ方面有一定实用价值     

精氨酸加压素对内皮细胞脂质过氧化的影响

以培养的大鼠血管内皮细胞为模型，观察了精氨酸加压素对其脂质过氧化的影响及相关血管活性肽的调节作用，旨在探讨ＡＶＰ等血管活性肽对ＶＥＣ脂质过氧化的影响及与高血压病发病的关系。结果表明：（１）１０－７Ｍ的ＡＶＰ作用后，ＶＥＣ的丙二醛含量明显高于对照组（Ｐ＜０．０１）；（２）１０－７Ｍ的降钙素基因相关肽（ＣＧＲＰ）、Ｐ物质分别与１０－７Ｍ的ＡＶＰ共同作用后，ＶＥＣ的ＭＤＡ含量均减少，与ＡＶＰ对照组比较差异非常显著（Ｐ＜０．０１）。此表明，ＡＶＰ可能通过增强ＶＥＣ脂质过氧化作用引起ＶＥＣ损伤，与高血压病发病有一定关系。ＣＧＲＰ、ＳＰ对ＡＶＰ有拮抗作用     

大鼠脑缺血时血与脑中一氧化氮、超氧化物歧化酶和丙二醛含量的变化

目的探讨一氧化氮（ＮＯ）、超氧化物歧化酶（ＳＯＤ）和丙二醛（ＭＤＡ）在急性脑缺血时血与脑中的含量变化及其作用。方法４６只Ｗｉｓｔａｒ大鼠分为假手术组和缺血组。假手术组颈部正中切口，分离两侧颈总动脉；缺血组，结扎大鼠双侧颈总动脉，对缺血不同时相血清、脑皮层和丘脑组织中的ＮＯ、ＳＯＤ和ＭＤＡ含量进行测定。结果大鼠脑缺血１０分钟血清、脑组织ＮＯ浓度增高，３０分钟血清和脑组织中ＮＯ浓度最高，于６０分钟血清和脑组织中ＮＯ浓度下降至脑缺血１０分钟时的水平；而缺血１８０分钟血清和脑组织中ＮＯ浓度最低，并于３６０分钟后血清和脑组织中ＮＯ浓度回升，且较对照组升高但无显著性差异（Ｐ＞０．０５）。脑缺血１０，３０与６０分钟大鼠血清、脑组织中ＮＯ显著高于对照组（Ｐ＜０．０１和Ｐ＜０．００１）。脑缺血３０，６０，１８０与３６０分钟，大鼠ＳＯＤ活力显著低于对照组（Ｐ＜０．０５，Ｐ＜０．０１和Ｐ＜０．００１）；而ＭＤＡ显著高于对照组（Ｐ＜０．０５，Ｐ＜０．０１和Ｐ＜０．００１）。结论脑缺血时间越长ＳＯＤ酶活力越低而ＭＤＡ含量越高，长时间将大量产生释放具有神经毒性及细胞毒性作用的ＮＯ，可引起神经元死亡及细胞和组织损伤。     

亚低温对完全性脑缺血再灌注后丙二醛含量和超氧化物歧化酶活性的影响

目的：观察完全性脑缺血再灌注后全脑亚低温对脑组织丙二醛（ＭＤＡ）含量和超氧化物歧化酶（ＳＯＤ）活性的影响．方法：将１７只犬随机分为三组：非缺血对照组、缺血对照组和亚低温治疗组，采用谭秀娟等建立的心脏停跳复苏动物模型，于心肺复苏后４小时取脑组织测定ＭＤＡ含量和ＳＯＤ活性．结果：全脑缺血１０分钟后再灌流４小时，脑组织ＭＤＡ含量明显上升（Ｐ＜０．０１），ＳＯＤ活性下降（Ｐ＜０．０１）；而３４℃亚低温治疗组与缺血对照组比较，ＭＤＡ含量明显下降（Ｐ＜０．０１），ＳＯＤ活性上升（Ｐ＜０．０１）．结论：完全性脑缺血再灌注后全脑亚低温可抑制脑内脂质过氧化反应，保护脑组织自身抗氧化能力，有利于脑复苏．     

中度高原地区肺心病患者血中丙二醛及超氧化物歧化酶的测定

对中度高原地区（海拔２２６０ｍ）肺心病患者血中丙二醛（ＭＤＡ）的含量及超氧化物歧化酶（ＳＯＤ）的活性进行了测定，并与正常同龄人作对照。结果显示：肺心病患者血中ＭＤＡ含量明显增高（Ｐ＜０．０１），ＳＯＤ活性明显降低，（Ｐ＜０．０１）。提示中度高原地区肺心病患者体内存在着自由基代谢失衡。     

肾上腺髓质素与高血压病关系的初步探讨

目的：探讨肾上腺髓质素（ａｄｒｅｎｏｍｅｄｕｌｌｉｎ,ＡＤＭ）在高血压病中的病理生理作用。方法：观察高血压病患者治疗前、后ＡＤＭ的变化及与血压等的关系。在大鼠离体主动脉血管条上观察ＡＤＭ与血管紧张素Ⅱ（ａｎｇｉｏｔｅｎｓｉｎ　Ⅱ,Ａｎｇ　Ⅱ）释放的相互影响。结果：ＥＨ病人血浆ＡＤＭ水平明显升高,ＡＤＭ与 Ａｎｇ Ⅱ水平、动脉舒张压、动脉平均压（ＭＢＰ）呈显著正相关（相关系数ｒ分别为０．４７１,Ｐ＜０．０１;０．４３５７,Ｐ＜０．０１和０．５５０８,Ｐ＜０．０１）,而与心输出量等无明显相关。使用巯甲丙脯酸和硝苯地平治疗后,ＡＤＭ分别下降约１９．９％（Ｐ＜０．０５）和 １４．５％（Ｐ＞０．０５）,Ａｎｇ Ⅱ下降约 １０．４％（Ｐ＜０．０５）和 １０．０（Ｐ＜０．０５）。药物治疗后,伴随 ＭＢＰ和血浆 Ａｎｇ　Ⅱ降低,ＡＤＭ水平亦有不同程度的下降。Ａｎｇ　Ⅱ增加大鼠离体主动脉血管条ＡＤＭ的分泌,ＡＤＭ则抑制 Ａｎｇ　Ⅱ的释放。结论：血压和 Ａｎｇ　Ⅱ可能与 ＡＤＭ的分泌及／或合成有关,ＥＨ病人血浆 ＡＤＭ水平升高可能是机体的代偿反应。药物治疗后的不同反应与药物的特性有关。     

L-精氨酸对缺氧性肺动脉高压大鼠内皮素释放的影响

为了探讨Ｌ—精氨酸（Ｌ－Ａｒｇ）对缺氧性肺动脉高压（ＨＰＨ）大鼠血浆内皮素释放的影响。本文建立了ＨＰＨ大鼠模型,将Ｗｉｓｔａｒ大鼠４０只分为;对照组、缺氧组、缺氧＋Ｎ－硝基Ｌ精氨酸甲脂（ＬＮＡＭＥ）组和缺氧ＬＡｒｇ组四组进行研究,结果显示：缺氧组的肺动脉平均压（ｍＰＡＰ）显著高于对照组（Ｐ＜００５）,缺氧组＋Ｌ－Ａｒｇ组的ＭＰＡＰ显著低于缺氧组（Ｐ＜００５）及缺氧＋Ｌ－ＮＡＭＥ组（Ｐ＜００１）,缺氧组的ＲＶ／（ＬＶ＋Ｓ）比值显著高于对照组（Ｐ＜００１）,缺氧＋ＬＮＡＭＥ组的ＰＶ…     

DSA全脑血管造影431例分析

目的:分析431例全脑血管造影,探讨颅内血管病变用DSA全脑血管造影的价值。材料和方法:92年至96年行DSA全脑血管造影431例。采用Seldinger技术,经股动脉穿刺置管行选择性或/和超选择性全脑血管造影。前交通及后交通动脉瘤经显微神经外科证实。结果:动脉瘤155例,血管畸形76例,占位性病变48例。颅内动脉瘤发生在大脑前动脉系统为42.58％,而前交通动脉瘤为大脑前动脉系统的74.24％。颅内动脉瘤为全脑血管造影阳性发现的首位,其次为血管畸形,颅内占位。本组阴性率为25.75％。结论:CT、MR发现颅内出血或血管畸形时,不一定全脑血管造影有阳性改变。     

Spontaneous Partial Regression of Cerebral Arteriovenous Malformation

Arteriovenous malformation (AVM) of the brain is one of the important pathologic conditions which cause intracerebral or subarachnoid hemorrhage, epilepsy, or chronic cerebral ischemia. The spontaneous regression of cerebral AVM is reported to be very rare and more likely to occur when the AVM is small, is accompanied by hemorrhage, and has fewer arterial feeders. We report a case of right occipital AVM which at follow-up angiography performed four years later showed near-complete spontaneous regression.     

Revisiting normal perfusion pressure breakthrough in light of hemorrhage-induced vasospasm

Cerebral arteriovenous malformations (AVMs) have abnormally enlarged arteries and veins prone to spontaneous hemorrhage. Immediately following surgical excision of a cerebral AVM, even normal brain tissue surrounding the lesion is subject to hemorrhage, a phenomenon termed normal perfusion pressure breakthrough (NPPB) syndrome. According to this theory, arteries supplying cerebral AVMs become dilated and lose their capacity to dilate or constrict to autoregulate pressure. Acutely after removal of a cerebral AVM, excessive blood pressure in these arterial feeders can cause normal brain tissue to bleed. However, this theory remains controversial. We present a patient with a cerebral AVM that demonstrated cerebrovascular reactivity and argues against an assumption underlying the theory of NPPB syndrome.     

Association of cerebral arteriovenous malformation with cerebral arterial fenestration

Cerebral arteriovenous malformations (AVMs) are rarely associated with other vascular lesions. Our goal was to examine the incidence of the coexistence of cerebral AVMs and cerebral arterial fenestrations. During the past 18 years, 51 patients with a cerebral AVM were examined with selective cerebral angiography in our institution. We retrospectively reviewed these cerebral angiographies and noted associated cerebral arterial fenestrations. We found five fenestrations distributed among 3 patients. In each patient one fenestration was located in the vertebral artery (VA). In 1 patient there were additional basilar and left middle cerebral artery fenestrations. Vertebral artery angiography was performed in 43 of the 51 patients; thus, the frequency of coexistence of AVM and VA fenestration was 7 % (3 of 43). Although the clinical significance may not be great, we found a noteworthy incidence of associated VA fenestrations in AVM cases. Received: 3 February 2000 Revised: 24 July 2000 Accepted: 25 July 2000     

螺旋CT血管造影在诊断脑动静脉畸形中的应用

目的探讨脑动静脉畸形(AVM)CT血管造影(CTA)的价值.材料与方法19例脑AVM病例行CTA检查,其中MRA、DSA检查各5例、8例.12例手术证实,7例保守治疗.CTA、MRA经工作站处理,获得三维血管图像;DSA通过股动脉插管技术,获得减影后血管图像.结果CTA能显示AVM的病变形态及准确部位,有效显示供养动脉、引流静脉及血管巢.但供养动脉显示不及MRA,引流静脉的显示较MRA为佳.结论CTA诊断脑AVM的图像质量、病变显示接近MRA、DSA,对制定治疗方案、指导手术和预后有重要意义.     

Angiographic follow-up of large cerebral AVMs incompletely embolized with isobutyl-2-cyanoacrylate

This study evaluated the long-term angiographic results in large cerebral arteriovenous malformations (AVMs) partially embolized with isobutyl-2-cyanoacrylate. Preembolization, immediate postembolization, and long-term follow-up angiograms were performed in 30 large, partially embolized brain AVMs. Particular attention was paid to the relative size of the residual AVM nidus and the embolized arterial feeders, to recruitment of new feeders, to the size of residual draining veins, and to the speed of arteriovenous shunt. Nine cases with less than 50% AVM nidus obliteration showed no significant morphologic changes. In 18 cases with 50-75% obliteration of the AVM nidus, 11 (61.1%) showed no significant changes, six (33.3%) showed enlargement of the AVM nidus, and one (5.5%) evolved to complete angiographic obliteration. In three cases with 75-99% AVM nidus obliteration, one remained unchanged, one showed an increase in the size of the AVM nidus, and one evolved to complete obliteration. Evaluation by plain film, CT, and cerebral angiography of the isobutyl-2-cyanoacrylate deposits showed that when the polymer was positioned predominantly in arterial feeders there was invariably reconstitution of the AVM nidus through leptomeningeal, deep medullary, and/or dural collaterals. This phenomenon did not occur when the isobutyl-2-cyanoacrylate was deposited mainly in the AVM nidus.     

64层螺旋CT减影血管成像诊断脑动静脉畸形的价值

目的：探讨64层螺旋CT减影血管成像诊断脑动静脉畸形（AVM）的价值。材料和方法：26例脑AVM患者,均经64层螺旋CT平扫、增强动脉期和静脉期扫描。将动脉期数据减去平扫数据获得减影动脉期数据,静脉期数据减去动脉期数据获得减影静脉期数据,静脉期数据减去平扫数据获得减影混合动静脉期数据。采用容积再现（VR）、最大密度投影（MIP）重建脑血管图像。结果：本组病例减影脑血管图像均去除了颅骨的干扰,清楚显示大小不等的畸形血管巢及供血动脉和引流静脉。畸形血管巢位于颞叶7例,顶叶5例,额叶5例、枕叶6例和小脑半球3例。发现供血动脉39支,其中单支供血动脉15例,多支供血动脉9例;引流静脉33支,单支引流10例,多支引流16例。结论：64层螺旋CT减影血管成像可以去除颅骨干扰,显示AVM的供血动脉、畸形血管巢和引流静脉,为临床治疗方案的制定及术后随访提供可靠的依据。     

Spontaneous regression of cerebral arteriovenous malformations: clinical and angiographic analysis with review of the literature

Spontaneous regression of cerebral arteriovenous malformation (AVM) is rare and poorly understood. We reviewed the clinical and angiographic findings in patients who had spontaneous regression of cerebral AVMs to determine whether common features were present. The clinical and angiographic findings of four cases from our series and 29 cases from the literature were retrospectively reviewed. The clinical and angiographic features analyzed were: age at diagnosis, initial presentation, venous drainage pattern, number of draining veins, location of the AVM, number of arterial feeders, clinical events during the interval period to thrombosis, and interval period to spontaneous thrombosis. Common clinical and angiographic features of spontaneous regression of cerebral AVMs are: intracranial hemorrhage as an initial presentation, small AVMs, and a single draining vein. Spontaneous regression of cerebral AVMs can not be predicted by clinical or angiographic features, therefore it should not be considered as an option in cerebral AVM management, despite its proven occurrence.     

3D-TOF MRA及SWI对脑血管畸形的对照研究

目的:通过分析脑动静脉畸形和海绵状血管瘤的的3D-TOF MRA及SWI磁共振表现,探讨3D-TOF MRA及SWI对脑血管畸形的诊断价值。方法:对我院收治的44例血管畸形进行高场磁共振成像,并加扫3D-TOF MRA及SWI序列,其中26例海绵状血管瘤、18例动静脉畸形。通过分析SW I和3D-TOF-MRA技术对脑血管畸形的显示情况,比较二者对脑血管畸形的检出率以及细微特征的鉴别能力等。结果:3D-TOF MRA可以清晰显示动静脉畸形的部位、大小、输入动脉的来源、输出静脉的去向等;海绵状血管瘤MRA检查均未见异常供血动脉,病灶内无异常流空信号。SWI可清晰显示海绵状血管瘤,病灶的数目及范围较常规序列增大;SWI只能显示动静脉畸形迂曲的小静脉,但不能直观显示畸形血管团的全貌及输入动脉等粗大血管的情况。结论:3D-TOF MRA技术对于AVM之类高流速低阻力的血管畸形的显示具有独特的价值,而SWI技术则对于海绵状血管瘤等小血管或低流速的血管畸形的显示具有明显的优势。     

Cerebral arteriovenous malformation: Complex 3D hemodynamics and 3D blood flow alterations during staged embolization

Complex hemodynamics in cerebral arteriovenous malformations (AVM) are thought to play a key role in their pathophysiology. We applied 4D flow magnetic resonance imaging (MRI) for the detailed evaluation of AVM function at baseline and to investigate the impact of staged embolization on AVM hemodynamics in a patient with a Spetzler‐Martin grade III AVM. The patient underwent three embolization procedures resulting in >50% nidal casting and obliteration of several arteriovenous fistulae. 4D flow MRI demonstrated highly complex 3D hemodynamics at baseline and revealed intricate arterial feeding, a large vascularized nidus with high variability in regional blood flow velocities, and clearly visible venous drainage with high flow velocities above 50 cm/s. 3D blood flow visualization and quantification during follow‐up illustrated the systemic impact of focal embolization on cerebral hemodynamics resulting in compaction of the AVM, redistribution of blood flow velocities, and altered peak flow velocities and blood flow in multiple vascular territories. 4D flow MRI may offer a useful noninvasive tool to help to identify subtleties and nuances of the quantitative hemodynamic alterations in AVM vascular architecture as a supplement to established imaging modalities. J. Magn. Reson. Imaging 2013;38:946–950 . © 2013 Wiley Periodicals, Inc .