电针及电针合并麦普替林治疗抑郁症临床疗效观察

目的：评价电针及电针合并麦普替林下的疗效。方法：采用随机分组方法,将抑郁症患者发为电针加麦普替林组和电针组,治疗６周。以汉密尔顿抑郁量表,抑郁自评量表,焦虑自评量表评定疗效。结果：第二周后两组ＨＡＭＤ,ＳＤＳ,ＳＡＳ评分降低均显著大于治疗前,合并组ＨＡＭＤ降分率显著大于电针组,但第四,第六周降分率无明显差异。     

用认知行为疗法治疗精神分裂症的继发抑郁

目的：探讨认知行为疗法治疗精神分裂症的继发抑郁的疗效。方法：使用“旧金山预防抑郁研究”教材录制的录像带，对２３例伴有抑郁症状，且符合ＤＳＭ－Ⅳ有关精神分裂症和分裂样精神障碍诊断标准患者，通过看录像进行认知行为疗法，每周一次，８周为一疗程。治疗前后用ＨＡＭＤ、ＣＥＳ－Ｄ、ＨＡＭＡ、ＢＰＲＳ、ＧＡＳ量表评定。结果：认知行为治疗后ＨＡＭＤ、ＣＥＳ－Ｄ、ＨＡＭＡ评分均有逐渐下降趋势、ＧＡＳ评分有逐渐上升趋势（Ｐ＜０．０５），而ＢＰＲＳ评分无显著差异（Ｐ＞０．０５）；治疗６周及８周ＨＡＭＤ减分率与ＢＰＲＳ减分率、ＧＡＳ变化值之间均呈密切相关（Ｐ＜０．０１）。结论：认知行为疗法能改善精神分裂症的抑郁和焦虑症状，能提高患者临床总体情况和功能水平     

诊断试验中患病构成比、灵敏度及特异度与准确度的数学关系及变化规律研究

本文研究患病构成比ＣＲＤ、灵敏度Ｓｅ及特异度Ｓｐ与准确度ＳＡｃ和标化准确度ＳＡｃ的数学关系，导出公式如下：Ａｃ＝Ｓｅ×ＣＲＤ＋Ｓｐ（１－ＣＲＤ）；Ａｃ与ＳＡｃ的关系如下：当ＣＲＤ＝５０％时，Ａｃ＝ＳＡｃ。分析了Ａｃ随Ｓｅ、Ｓｐ）和ＣＲＤ的变化规律，即：①当Ｓｅ＝Ｓｐ，无论ＣＲＤ大小，均有Ａｃ＝Ｓｅ＝Ｓｐ；当Ｓｅ＜ｓＰ，则Ａｃ随ＣＲＤ增大而变小；当Ｓｅ＞Ｓｐ，则Ａｃ随ＣＲＤ增大而增大。Ａｃ随ＣＲＤ变动的心减幅度△Ａｃ．ＣＲＤ用公式表示为：△Ａｃ．ＣＲＤ＝△ＣＲＤ（Ｓｅ－Ｓｐ），△ＣＲＤ为ＣＲＤ的增减量。②当ＣＲＤ不变，则Ａｃ随Ｓｅ和Ｓｐ增大而增大，Ａｃ随Ｓｅ和Ｓｐ改变的增减幅度△Ａｃ．ｓｅｓｐ为：△Ａｃ．ｓｅｓｐ＝ＣＲＤ（△Ｓｅ－△Ｓｐ）＋△Ｓｐ．式中△Ｓｅ和△Ｓｐ分别为Ｓｅ和Ｓｐ的增减量。     

缓解期精神分裂症抑郁症的特征及社会支持

为探讨精神分裂症缓解期病人抑郁症状的临床牲及其相关因素，对７４例缓解期患者进行抑郁量表（ＨＡＭＤ）、抑郁自评量表（ＳＤＳ）、社会支持评定量表（ＳＳＲＳ）的评定及其相关分析，并与４０例原发性抑郁症的抑郁症状进行对照，结果显示，ＨＡＭＤ≥８者５５５例（７４％），ＨＡＭＤ≥１７者２７例（３７６．５％），抑郁症状主要表现在迟缓与绝望感２因子；精神分裂症组性功能障碍高于抑郁症组，ＨＡＭＤ≥１７的主观支持分明     

老年精神评定量表（PAS）的初步测试

目的： 对老年精神评定量表（ＰＡＳ） 初步测试, 以适应国内更广泛开展老年期痴呆与老年抑郁流行病学调查的需要。方法： 引入国外近年发展起来的老年精神评定量表（ＰＡＳ）, 通过临床及社区测试, 对其在国内适用性做出评价。结果： ＰＡＳ量表具有良好信度; 能提供与ＭＭＳＥ、ＧＤＳ、Ｈａｃｈｉｎｓｋｉ缺血指数量表、ＡＤＬ相仿的信息。ＰＡＳ各分量表得分影响因素中,教育程度对认知受损分量表得分影响较大,但其对认知下降分量表影响相对较小。依社区调查结果建立起ＰＡＳ参考常模, 其中认知受损分量表按不同教育程度选取界值, 灵敏度则均可达１．００。     

住院神经症患者治疗前后MMPI-2结果分析

目的 了解住院神经症患者治疗前后ＭＭＰＩ－２评分变化。方法 用ＭＭＰＩ－２对患者进行治疗前后的测评。结果 临床量表中Ｈｓ、Ｄ、Ｈｙ、Ｐｄ、Ｐａ、Ｐｔ、Ｓｃ等项目均分及内容量表中ＡＮＸ、ＤＥＰ、ＤＥＡ、ＬＳＥ、ＳＯＤ等项目均分在治疗后显著减少。结论 患者诊疗后ＭＭＰＩ－２分值下降,进行ＭＭＰＩ动态观察可以为患者是否需要继续治疗提供信息。     

CLINICAL SIMULATED EXPERIMENT ON THE SYNDROMI STANDARDS OF PULMONARY SYSTEM DISEASES

ＣＬＩＮＩＣＡＬＳＩＭＵＬＡＴＥＤＥＸＰＥＲＩＭＥＮＴＯＮＴＨＥＳＹＮＤＲＯＭＩＳＴＡＮＤＡＲＤＳＯＦＰＵＬＭＯＮＡＲＹＳＹＳＴＥＭＤＩＳＥＡＳＥＳＭｕｌｉｎＸｕＱｉｏｕｑｉｎＷａｎｇ（ＨｕｂｅｉＡｃａｄｅｍｙｏｆＴｒａｄｉｔｉｏｎａｌＣｈｉｎｅｓｅ...     

THE CURATIVE EFFECT OF HIGH EFFICIENCY HEMODIALYSIS AND THE GRADIENT CHANGE OF PLASMA OSMOTIC PRESSURE(Report of 27 Cases)

ＴＨＥＣＵＲＡＴＩＶＥＥＦＦＥＣＴＯＦＨＩＧＨＥＦＦＩＣＩＥＮＣＹＨＥＭＯＤＩＡＬＹＳＩＳＡＮＤＴＨＥＧＲＡＤＩＥＮＴＣＨＡＮＧＥＯＦＰＬＡＳＭＡＯＳＭＯＴＩＣＰＲＥＳＳＵＲＥ（Ｒｅｐｏｒｔｏｆ２７Ｃａｓｅｓ）ＣｈｅｎＨｕａｊｉ（ＣｅｎｔｒａｌＨｏｓ...     

Ⅱ型糖尿病患者红细胞膜MDA与膜钠泵K~＋－pNPPase活性的关系

本文测定５５例ＮＩＤＤＭ患者血浆及红细胞膜ＭＤＡ水平和钠泵Ｋ＋－ｐＮＰＰａｓｅ活性。结果显示，ＮＩＤＤＭ患者血浆和红细胞膜ＭＤＡ水平明显高于正常对照组，钠泵Ｋ＋－ｐＮＰＰａｓｅ活性明显低于对照，在伴有视网膜病变者上述改变更为显著，红细胞膜ＭＤＡ升高和钠泵Ｋ＋－ｐＮＰＰａｓｅ活性降低呈明显负相关。提示红细胞膜ＭＤＡ升高可能是导致Ｋ＋－ｐＮＰＰａｓｅ活性降低的一重要因素。     

功能性消化不良患者的情绪障碍及治疗

目的：探讨抗抑郁药对功能性消化不良（ＦＤ）患者情绪障碍的疗效。方法：分别对２４例健康人和２４例ＦＤ病人进行汉密尔顿抑郁量表（ＨＡＭＤ）、汉密尔顿焦虑量表（ＨＡＭＡ）和症状自评量表（ＳＣＬ９０）评分；用抗抑郁药，５羟色胺再摄取抑制剂（ＳＳＲＩ）盐酸氟西汀（百忧解）、帕罗西丁（赛尔特）治疗２４例ＦＤ病人，疗程均为８周，治疗后再进行上述量表评分。结果：ＦＤ患者和正常人的三种量表（ＨＡＭＤ、ＨＡＭＡ、ＳＣＬ９０）评分对比，均显示ＦＤ患者的精神和躯体症状与正常人之间存在着显著差异（ｐ＜０００１）；而在日夜变化和精神病理上，差异无显著性；ＦＤ病人接受抗抑郁药治疗８周后，前后评分对比，患者的精神和躯体症状均有明显改善。结论：提示ＦＤ患者普遍存在抑郁和焦虑情绪，用抗抑郁药治疗ＦＤ能显著改善患者的症状，包括精神和躯体两方面的症状     

Altered ionized magnesium levels in mild-to-moderate Alzheimer's disease

Magnesium deficiency is present in several chronic, age-related diseases, including cardiovascular, metabolic and neurodegenerative diseases. Alzheimer's disease (AD) is the most common cause of dementia. The aim of the present study was to study magnesium homeostasis in patients with mild to moderate AD. One hundred and one elderly (≥65 years) patients were consecutively recruited (mean age: 73.4±0.8 years; M/F: 42/59). In all patients, a comprehensive geriatric assessment was performed including cognitive and functional status. Admission criteria for the AD group (diagnosed according to the DSM-IV and the NINCDS-ADRDA criteria) included: mild to moderate cognitive impairment (MMSE score: 11-24/30, corrected for age and education). Blood samples were analyzed for serum total magnesium (Mg-tot) and serum ionized magnesium (Mg-ion). AD patients had significantly lower MMSE scores (20.5±0.7 vs 27.9±0.2; p<0.001), and for the physical function tests. Mg-ion was significantly lower in the AD group as compared to age-matched control adults without AD (0.50±0.01 mmol/L vs 0.53±0.01 mmol/L; p<0.01). No significant differences were found in Mg-tot between the two groups (1.91±0.03 mEq/L vs 1.95±0.03 mEq/L; p=NS). For all subjects, Mg-ion levels were significantly and directly related only to cognitive function (Mg-ion/MMSE r=0.24 p<0.05), while no significant correlations were found in this group of patients between magnesium and ADL or IADL. Our results show the presence of subclinical alterations in Mg-ion in patients with mild to moderate AD.     

老年性痴呆康复训练对患者静脉血TGF-β1的影响

目的 探讨老年性痴呆行为康复训练效果与患者静脉血浆中转化生长因子β1(TGF-β1)水平的相关性.方法 将84例诊断为老年性痴呆的患者,随机分为康复组和对照组.康复组根椐认知功能减退MMSE评分、ADL水平、CMAI评定等综合评估结果参加不同康复训练小组,并对比一年康复训练前、后的血浆TGF-β1水平.结果 两组患者康复训练前MMSE评分、ADL Barthel指数评分和血浆TGF-β1水平比较差异无统计学意义(P＞0.05);康复训练后两组MMSE评分、ADL barthel指数评分和血浆TGF-β1水平差异均有统计学意义(P＜0.05).康复组康复训练前与对照组CMAI评定、血浆TGF-β1水平比较,差异无统计学意义(P＞0.05);康复训练后两组比较,差异有统计学意义(P＜0.01).康复训练后血浆中TGF-β1水平与MMSE评分、barthel指数均无明显相关性,但与CMAI呈强烈负相关(r=-0.903).结论 行为康复训练在延缓老年性痴呆患者的认知功能和自我照顾能力随龄减退的同时,可显著提高静脉血浆中TGF-β1的水平.静脉血浆中TGF-β1水平的测定,对老年性痴呆的诊断及对康复治疗效果的评价有积极的临床参考价值.     

Behavioural and neuropsychological correlates of frontal lobe features in dementia

BACKGROUND: In order to characterize frontal lobe features and their behavioural and cognitive correlates across diagnostic categories, we performed a cross-sectional analysis of behavioural and neuropsychological data from a large, prospective Belgian study on behavioural and psychological signs and symptoms of dementia (BPSD). METHOD: Patients with probable Alzheimer's disease (AD) (n=170), frontotemporal dementia (FTD) (n=28), mixed dementia (MXD) (n=29) and dementia with Lewy bodies (DLB) (n=21) were included and underwent neuropsychological and behavioural assessment by means of a battery of tests and scales. Frontal lobe symptoms were quantified by means of the Middelheim Frontality Score (MFS). RESULTS: In AD (and to a lesser extent in MXD), MFS total scores were negatively correlated with scores on MMSE (Spearman: r=-0.36, p<0.001) and a Verbal Fluency Task (r=-0.38, p<0.001) and were associated with increased severity and frequency of psychosis (r=0.24, p<0.01), activity disturbances (r=0.44, p<0.001) and aggressiveness (r=0.43, p<0.001). In DLB, MFS total scores were negatively correlated with MMSE scores (r=-0.50, p=0.020). No associations were found in FTD patients. CONCLUSIONS: A cross-sectional analysis of frontal lobe features, behavioural characteristics and neuropsychological data demonstrated that, in AD (and to a lesser extent in MXD) patients, frontal lobe symptoms were associated with more pronounced cognitive deficits (of frontal origin), with increased severity and frequency of agitated and aggressive behaviour, and with increased severity of psychosis and depressive symptoms. Given the small sample sizes of the DLB and FTD patient groups, negative findings in these patient groups should be interpreted cautiously.     

异性魅力自知量表的编制

目的编制异性魅力自知量表,并检验其信效度。方法在借鉴国外相关量表及开放式访谈的基础上,通过对3个样本共计250名大学生和研究生的调查,编制了异性魅力自知量表。结果探索性因素分析表明一维结构更适合,验证性因素分析表明一因素模型对数据的拟合可以接受(NFI=0.91,NNFI=0.93,RFI=0.89,IFI=0.94,CFI=0.94,GFI=0.87,AGFI=0.84,RMSEA=0.067,χ2=120.95,df=44,χ2/df=2.75)。内部一致性信度系数和重测信度系数分别为0.892和0.826,题总相关介于0.534～0.812,异性魅力自知与负面身体自我显著负相关(r=-0.393,P<0.01),与社会期许性仅有微弱且不显著的正相关(r=0.102,P>0.05),异性魅力自知与3年来的追求者数量(r=0.391,P<0.01)和目前潜在追求者数量(r=0.340,P<0.01)间显著正相关,但与谈恋爱的时间长短(r=0.085,P>0.05)和年龄(r=0.092,P>0.05)无关,异性魅力自知在是否有男女朋友上的差异显著(t=3.889,P<0.001)。结论异性魅力自知量表具有良好的信效度,可作为爱情及恋爱心理学等研究领域对异性魅力进行自我评定与判断的有效工具。     

认知促进治疗对于老年性痴呆患者治疗效果的meta分析

目的:系统评价认知促进治疗(CST)对老年性痴呆患者的治疗效果,为临床实践提供依据。方法:检索外文数据库PubMed、Embase、Cochrane library及中文数据库知网、维普和万方数据库中建库至2019年6月间采用随机对照研究(RCT)设计的CST对于老年性痴呆患者治疗效果的文献,采用Cochrane风险偏倚评估工具进行文献质量评价后,使用ReVMan5.3软件进行meta分析。结果:共纳入9篇研究,合计样本量684人。2篇文献仅以阿尔茨海默病评估量表-认知分表(ADAS-Cog)评分为效果评价指标,3篇文献仅以简易智力状态检查量表(MMSE)评分为效果评价指标,其余4篇采用了上述两种评价指标。以ADAS-Cog评分为效果评价指标的meta分析结果显示,CST与对照组均显示有改善效果,但差异无统计学意义(SMD=0.02,Z=0.22,P>0.05)。以MMSE评分为效果评价指标的meta分析结果显示,CST对老年性痴呆的认知功能改善优于对照组(SMD=0.47,Z=2.73,P<0.01)。结论:CST可以在一定程度上改善老年性痴呆患者的认知功能,但需要在大样本研究以及发展中国家中进一步验证。     

晚发性抑郁症患者血清神经元特异性烯醇化酶及与认知功能的关系

目的观察晚发性抑郁症(LOD)患者血清神经元特异性烯醇化酶(NSE)的变化情况并探讨其与认知功能的关系。方法分别检测35例晚发性抑郁症患者(LOD组)、35例老年健康者(对照组)血清NSE水平,以简易智能状态检查量表(MMSE)评定LOD患者认知功能,以17项汉密尔顿抑郁量表(HAMD)评定抑郁的严重程度。结果 1LOD组血清NSE水平显著高于对照组,差异有统计学意义(t=4.504,P0.001);2LOD患者MMSE评分显著低于对照组,差异有统计学意义(t=-3.457,P0.01);3LOD患者血清NSE水平与MMSE评分负相关(r=-0.388,P0.05),MMSE评分与HAMD评分负相关(r=-0.413,P0.05)。结论晚发性抑郁患者血清NSE增高,并与其认知功能的改变存在相关性。     

Enhanced soluble CD40 ligand and Alzheimer's disease: evidence of a possible pathogenetic role

It has been suggested that cerebrovascular factors contribute to Alzheimer's disease. Soluble CD40 ligand (sCD40L) is directly involved in the development of vascular damage. We tested the hypothesis that sCD40L may be enhanced in Alzheimer's disease and predictive of its clinical course. Plasma sCD40L levels were evaluated in three groups of 40 consecutive patients each referring for mild or moderate or severe Alzheimer's disease, as assessed by the Clinical Dementia Rating (CDR), and in 40 healthy subjects. Seventy-seven patients with mild or moderate disease were re-evaluated after 2 years. Cross-sectional comparisons revealed higher plasma sCD40L levels in Alzheimer's disease patients than in controls (9.3+/-4.7 ng/mL versus 3.4+/-1.3 ng/mL, p<0.0001). Circulating sCD40L levels significantly increased through the three CDR stages (p=0.0011 or less) and were correlated with MMSE (r=-0.574, p<0.0001) and ADAS-cog subscale (r=0.538, p<0.0001) scores. Longitudinal evaluation identified sCD40L as an independent predictor of MMSE (beta=-0.157, t=-3.650, p=0.0005) and ADAS-cog subscale (beta=0.484, t=3.890, p=0.0002) score changes after 2 years. Patients with plasma sCD40L level>or=6.0 ng/mL, identified by ROC curve analysis as the best discriminating value for disease progression, had a three-fold increase in the risk of progression toward a worse CDR stage (odd ratio: 3.0, C.I. 95% 1.2-8.1). In conclusion, circulating sCD40L is enhanced in patients with Alzheimer's disease and independently associated with the severity and progression of the disease. These data might suggest a pathogenetic role for sCD40L in Alzheimer's disease.     

中文版《独处偏好量表》的信效度检验

目的检验"独处偏好量表"(Preference for Solitude Scale,PSS)中文版的适用性。方法通过对原始问卷"翻译-回译"形成中文版,选取317名大学生进行测试,其中44人在2周后进行重测。结果 1PSS的Kuder-Richardson 20(K-R20)系数为0.72,2周后重测信度为(r=0.92);2探索性因素分析显示,该量表分为独处需要/享受、独处价值及独处方式偏好3个因子;3聚合与区分效度分析显示独处需要/享受与孤独感、社交回避/苦恼、交往焦虑、抑郁均呈显著正相关(r=0.324,0.438,0.323,0.189,P<0.01;r=0.122,P<0.05),而与自尊和生活满意度均无显著相关;独处价值与孤独感、社交回避/苦恼、交往焦虑、抑郁均呈显著负相关(r=-0.225,P<0.01,r=-0.131,P<0.05,r=-0.158,P<0.01,r=-0.132,P<0.05,r=-0.241,P<0.01),而与自尊、生活满意度均呈显著正相关(r=0.153,0.242;P<0.01);独处方式偏好只与社交回避/苦恼、交往焦虑呈显著正相关(r=0.287,0.210,P<0.01;r=0.124,P<0.05)。结论独处偏好既包含积极的成分也包含消极的成分;PSS中文版符合心理测量学的要求,可以作为测量中国被试独处偏好的工具。     

生活定向测验在大学生中的信效度

目的:检验气质性乐观测量量表-生活定向测验(LOT)在大学生群体应用的信度和效度。方法:按量表双翻程序将LOT翻译成中文版。方便抽取479名大学生进行LOT测验。采用验证性因素分析对其结构效度进行分析,以生活满意度量表(SWLS)、积极-消极情感量表(PANAS)、Beck抑郁量表(BDI)作为校标工具。随机选取152名学生于初评2周后进行重测,以检验其重测效度。结果:LOT中文版共6个题项,所有题项的决断值(CR)均达到0.001的显著水平,每个题项与对应量表的相关系数在0.61～0.74之间。验证性因素分析表明,中国大学生的气质性乐观是2因素模型结构(χ2/df=1.90,RM-SEA=0.059,NNFI=0.92,CFI=0.96),由2个相对独立的乐观因子和悲观因子组成。气质性乐观因子与SWLS、积极情感得分呈正相关(r=0.22、0.28,均P0.01),与消极情感和BDI得分呈负相关(r=-0.17、-0.23,均P0.01),悲观因子与SWLS和积极情感得分呈负相关(r=-0.22,-0.23,均P0.01),与消极情感和BDI得分呈正相关(r=0.15、0.12,均P0.05)。量表两个因子的内部一致性信度Cronbachα系数分别是0.73和0.82,2周后的重测信度分别是0.76和0.79。结论:生活定向测验中文版具有较好的信度和效度,可用于评定中国大学生的气质性乐观水平。     

神经心理测验和轻性痴呆

应用简易痴呆筛查量表（ＢＳＳＤ）、简易智力检查表（ＭＭＳＥ）、常识记忆注意测验（ＩＭＣＴ）、长谷川痴呆量表（ＨＤＳ）、Ｆｕｌｄ物体记忆测验（ＦＯＭ）、言语流畅性测验（ＲＶＲ）、积木测验（ＢＤ）、数字广度测验（ＤＳ）、日常生活功能量表（ＡＤＬ）检测３０７５例社区老人，结果发现对轻性痴呆诊断敏感的指标有（１）由ＢＳＳＤ、ＭＭＳＥ、ＨＤＳ筛选出的４个因子：时间定向、计算／注意、常识／图片理解、名词即刻记忆；（２）ＦＯＭ、ＲＶＲ、ＢＤ、ＤＳ中２项或２项以上阳性