TCD对正常人大脑中动脉血流储备功能的评价

目的 探讨经颅超声多普勒(TCD)屏气试验对健康人群脑血流储备能力的评价.方法 试验组90例健康人,TCD检测双侧大脑中动脉的血流频谱,经过屏气试验,观察试验前后血流速度的变化值.结果 18 ～ 39岁脑血流储备能力(CVR)为(41.44+12.56)％,40 ～ 59岁为(36.36±12.15)％,≥60岁为(33.80±10.12)％,组间比较差异均有统计学意义.结论 健康人群CVR随着年龄的增长而下降;超声多普勒屏气试验评价CVR安全可靠.     

The relationship between bronchial responsiveness to methacholine and bronchial responsiveness to histamine in asthmatic subjects

There is widespread belief that methacholine responsiveness in asthmatic subjects is closely related to histamine responsiveness, and that the two agents may be used interchangeably in the measurement of non-specific bronchial responsiveness (NSBR). Because this view has been challenged, we have examined the repeatability of measurements of bronchial responsiveness to methacholine and histamine and the relationship between them, in groups of 20 adult asthmatic subjects. Bronchial responsiveness was expressed as the cumulative dose (in both μg and mmols) provoking a 20% fall in FEV₁ (PD₂₀). The predicted 95% confidence limits for the second PD₂₀ measurement of a further pair were within the range 0.5–2.0 x first PD₂₀ for both agents. When the two agonists were compared in the same subjects, a significant difference in potency was noted (ratio of geometric means PD_20.methacholine to PD_20.histamine 2.19 [μg], 3.43 [mmols]; p = 0.0003). Furthermore, the variance of the differences of the pairs of log PD_20.methacholine and PD_20.histamine measurements was found to be significantly greater than that of either the paired methacholine measurements or the paired histamine measurements (p < 0.01). We conclude firstly that methacholine is a less potent bronchoconstrictor than histamine and secondly that, while inhalation tests with either agent broadly reflect the degree of NSBR, they measure different phenomena and cannot be used interchangeably even after allowance is made for the difference in potency.     

甘露糖结合凝集素与缺血性脑血管病的相关性

目的 检测缺血性脑血管病(ICVD)与甘露糖结合凝集素(MBL)基因单倍型、基因型频率及血浆含量的相关性.方法 采集100例ICVD患者(ICVD组)和60例健康人群(对照组)抗凝血,序列特异性引物-聚合酶链反应(SSP-PCR)法检测MBL单倍型,ELISA法检测血浆MBL含量.结果 ICVD组与对照组MBL基因单倍型和基因型构成比均不同(P＜0.05);ICVD组血浆MBL含量明显高于对照组[(3372.18±660.90)μg/L vs.(2065.29±195.67)μg/L](P＜0.01).结论 MBL可能参与ICVD发生发展过程.     

性激素与缺血性脑血管疾病关系的研究

目的：研究性激素对脑梗塞发病的影响。方法：应用放射免疫分析法测定了48例男性脑梗塞患者及相应30例男性健康对照组的血清孕酮（P）雌二醇（E2）和睾酮（T）水平，用化学比色方法测定了血脂（TG、TC、HDL－C）。结果：血清P、HDL－C在脑梗塞患者较对照组显著降低，P＜0．01。血清E2在脑梗塞患者较对照组显著升高，P＜0．05，而TG、TC两组间无显著差异（P＞0．05），脑梗塞组血清P水平与HDL－C水平呈显著正相关P＜0．05，而血清E2水平与HLD－C水平无明显相关，血清T在脑梗塞组和对照组无明显差异，结论：P水平过低，E2水平过高影响了男性缺血性中风的发病机理，性激素比例失衡与脑梗塞的发病有密切关系。     

代谢综合征及相关因子与急性脑血管病研究

目的探讨代谢综合征及相关因子在急性脑血管病人中的发生情况。方法收集急性住院脑梗塞、脑出血患者各200例及健康体检者80例并采集腰围、血压、血糖、血脂等资料。结果脑梗塞组分别和脑出血组、对照组比较代谢综合征发生率均有显著性差异（P〈0.05）;而脑出血和对照组比较无统计学意义（P〉0.05）。脑梗塞相关的独立危险因素依次为：代谢综合征、高血压病、高血糖、甘油三酯增高、高密度脂蛋白降低;而脑出血仅为高血压病。结论代谢综合征是脑梗塞的独立危险因素,代谢紊乱程度越重,患脑梗塞的风险越大。代谢综合征与脑出血无明显相关。     

Correlations between left ventricular mass index and cerebrovascular lesion

Left ventricular (LV) mass and LV geometry are well-established measures of hypertension chronicity and severity, have a prognostic value on cardiovascular morbidity and mortality, and are related to asymptomatic cerebral small-artery disease (SAD) and largeartery disease (LAD). The aim of the present study was to clarify the different effects of LV mass and LV geometry on underlying SAD compared with its effects on underlying LAD in ischemic stroke patients. Four hundred three ischemic stroke patients underwent echocardiography to determine LV mass index and relative wall thickness. Brain magnetic resonance imaging, angiography, and carotid magnetic resonance angiography were preformed to detect LAD (≥50% stenosis) and SAD (leukoaraiosis, microbleeds, and old lacunar infarction) in the brain. Multivariate analyses showed that the LV mass index was highly associated with underlying SAD but not with underlying LAD. Among the various subtypes of SAD, only cerebral microbleeds were closely related to the LV mass index. Concentric LV hypertrophy was not related to the presence of either SAD or LAD. Subgroup analyses revealed that, among the various subtypes of SAD, only cerebral microbleeds were associated with concentric LV hypertrophy. In conclusion, cerebral microbleeds may imply more advanced target organ damage than underlying LAD and ischemic subtypes of SAD.     

Dissociation between clinical and exercise responsiveness to beta-blockade in angina.

Twenty outpatients with mild angina were prescribed placebo tablets b.i.d. for 7 weeks followed by acebutolol, a cardioselective beta-blocker, 200 mg b.i.d. for 21 weeks under single-blind conditions. One graded multistage treadmill test was carried out after each treatment period and an angina diary was filled daily for the 6 months of the trial. Attack frequency declined by 71% from 2.59 per week on placebo to 0.76 per week on acebutolol (p less than 0.05). Exercise duration on the treadmill increased by 56%, from 5.95 minutes on placebo to 9.32 minutes on acebutolol (p less than 0.001). A satisfactory clinical response (50% or greater decline in attack frequency per week) occurred in 15 out of 19 patients (79%; a 100% or greater increase in exercise duration on the treadmill was observed in 10 out of 19 cases (53%). Exercise responsiveness was well predicted by exercise duration on placebo (r = 0.91, p less than 0.0005), patients with the least initial tolerance being the most improved. Clinical responsiveness was not well predicted by initial exercise tolerance (r = 0.38, N;S.) or by the improvement in exercise tolerance (r = 0.33, N.S.). It is concluded that acebutolol substantially reduces anginal attack frequency even in patients in whom exercise tolerance is not significantly improved, at the dose of 400 mg/day.     

Relationship between lymphocyte and clinical steroid responsiveness in focal segmental glomerulosclerosis

A remission in nephrotic proteinuria with steroid treatment appears to favorably alter the natural history of focal segmental glomerulosclerosis (FSGS). It is not known why some patients have a favorable response to steroid treatment whereas others do not. Considering the possibility that differences in the pharmacodynamic responsiveness to steroids among patients might be one factor, the authors examined the relationship between the pretreatment suppressive effect of steroids on lymphocyte proliferation (% inhibition) in vitro and the short- and intermediate-term responses of creatinine clearance (Clcr) and/or nephrotic proteinuria (urine protein/creatinine ratio = Up/c) in 13 patients with FSGS. There were significant correlations between % inhibition and the changes in Clcr at 3 (r = 0.92, p < 0.001) and 6 (r = 0.86, p < 0.01) months and the changes in Up/c at 3 months (r = -0.74, p = 0.02). Thus, the greater the pretreatment lymphocyte steroid sensitivity, the greater the increase in Clcr or decrease in Up/c. The changes in these parameters could not be accounted for on the basis of steroid dose or histopathology. The in vitro sensitivity of FSGS patients' lymphocytes to steroids may be of value in anticipating their clinical response to treatment.     

季节变化对天津市急性脑梗死患者转归影响的研究

【摘要】目的 探讨季节变化对天津市急性脑梗死患者转归的影响。方法 回顾性分析2009年1月～2012年12月的1871例天津市急性脑梗死患者的住院资料,按发病时间分组,分析季节变化对急性脑梗死患者发病30d内出院转归的影响。结果 ①发病于夏季的患者转归良好百分比最高,较其他三季有统计学意义(P<0.05)。②急性脑梗死患者转归不良百分比以发病于冬季12月份为月高峰,而夏季8月为月低谷,4月份为转归不良次高峰,转归良好的月变异情况与之相反（P<0.05）。③在转归不良组,合并肺炎的患者在冬季发病较夏秋季多,既往有脑血管病史的患者在冬季发病较夏季多（P<0.05）。④季节变化对急性脑梗死患者转归的影响主要集中在年龄≥65岁的老年人。结论 天津市急性脑梗死患者转归具有季节性差异。      

Variations in permeability of human skin within and between specimens

Regional differences in the permeability of human skin are well known but few investigators attempt to quantify the variability at specific sites as distinct from site-to-site differences. We assessed the variability at a site, within and between specimens (individuals). We defined the ultra-specimen variation (intra-s.v.) at a site as the coefficient of variation for a parameter measured for samples within a specimen; inter-specimen variation (inter-s.v.) was the coefficient for several specimens. We measured the steady-state diffusion of phenol, methanol, octanol and caffeine, and the finite dose diffusion of aspirin and caffeine and performed a vasoconstrictor assay with betamethasone-17-benzoate in 9 vehicles. From these data and from published results, we estimated inter-s.v. and intra-s.v. The overall mean, in vitro estimates of inter-s.v. (66% ± S.D. 25, n = 45) and intra-s.v. (43% ± 25, n = 32) were higher than the mean, in vivo, estimates of inter-s.v. (45% ± 18, n = 114) and intra-s.v. (27% ± 9, n = 4). Inter-s.v. was higher than intra-s.v. both in vivo and in vitro.     

老年骨质疏松与心脑血管疾病的相关分析

目的 探究老年骨质疏松与心脑血管疾病的相关性,旨在降低老年冠心病患者骨质疏松的发病率.方法 回顾性分析2014年6月至2017年1月衡水市人民医院207例冠心病患者,根据双能X线骨密度结果,分为骨质疏松组(骨量减低)和非骨质疏松组(骨量正常),应用单因素相关分析比较2组患者的患者BMI指数、血压、血糖、总胆固醇、甘油三...     

141例出血性脑血管病与心电图关系分析

目的 :观察出血性脑血管病患者心电图改变与临床分型、意识和预后的相关性。方法 :对141例出血性脑血管病患者进行12导联常规心电图检查 ,检查有心电图异常者均进行一次或多次复查。结果 :心电图异常率为85.8 % ;中型和重型患者心电图异常率分别高于轻型患者 (P<0.05) ;有意识障碍者心电图异常率显著高于意识清者 (P<0.01) ;死亡组心电图异常率高于存活组 (P<0.05) ;复查心电图示心电图恢复正常或有所改善者死亡率显著低于心电图趋于恶化或无改善者 (P<0.01)。结论 :心电图变化与出血性脑血管病患者病型、意识有一定关系 ,其变化可作为判断出血性脑血管病患者预后的参考指标。     

颈动脉粥样硬化斑块形成与缺血性脑血管疾病的相关性分析

目的探讨颈动脉粥样硬化斑块形成与缺血性脑血管疾病的相关性。方法选取本院2011年5月～2013年5月诊治的缺血性脑血管疾病患者137例,根据脑血管斑块支数分组：无斑块患者43例为A组。1～2支存在斑块的患者52例为B组,3支及以上存在斑块的患者42例为C组,比较各组患者的临床指标。再根据脑血管病症分组：一过性脑缺血患者41例为D组,单发性脑梗死患者47例为E组,多发性脑梗死患者49例为F组,分析各组患者不同部位的斑块面积。结果B组总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL—C）、尿酸（UA）、纤维蛋白原（FIB）均明显高于A组,B组高密度脂蛋白胆固醇（HDL-C）明显低于A组。C组TC、TG、LDL—C、UA、FIB均明显高于A、B组,C组HDL—C明显低于A、B组。E组颈总动脉主干部、颈总动脉膨大部、颈内动脉起始部的斑块面积均明显大于D组,F组颈总动脉主干部、颈总动脉膨大部、颈内动脉起始部的斑块面积均明显大于D、E组,差异有统计学意义（P〈O．05）。结论颈动脉粥样硬化斑块越多,缺血性脑血管疾病的发病风险越高,两者具有正相关性。     

急性脑血管病患者血清超敏C反应蛋白水平变化及意义

目的 观察急性脑血管病患者血清超敏C反应蛋白（hs-CRP）水平变化及其临床意义. 方法 通过检测60例急性脑梗死患者（脑梗死组）、60例脑出血患者（脑出血组）和40名健康体检者（对照组）血清hs-CRP水平,比较三组血清hs-CRP水平变化情况. 结果 脑梗死组和脑出血组血清hs-CRP水平明显高于对照组（t=19.712、13.217,均P＜0.01）,脑梗死组与脑出血组hs-CRP水平差异无统计学意义（P＞0.05）. 结论 血清hs-CRP水平增高与脑血管病的发生有密切关系.     

糖尿病性脑血管病与情绪障碍关系的研究

目的：探讨糖尿病性脑血管病患者与情绪障碍的高危险因素及其对预后的影响。方法将133例糖尿病性脑血管伴发情绪障碍的患者作为观察组;选择同时间就诊的129例无情绪障碍的糖尿病性脑血管病患者作为对照组;并比较两组的临床效果。结果两组患者FBG、PBG、HbA1C随治疗进行明显下降,观察组FBG治疗4周、24周后与对照组比较（t1=2.69,t2=2.90,P＜0.05）;观察组的神经缺损程度和生活质量治疗前均重于对照组（t3=27.10,t4=-28.61,P＜0.05）;观察组随着治疗的进行神经缺损程度与情感障碍得到明显改善（t4w=7.76,t24w=8.13,均P＜0.05）;观察组随着治疗的进行生活质量逐渐的明显改善（t4w=-12.26,t24w=-13.12,均P＜0.05）;观察组的SAS和SDS评分随治疗的进行逐渐降低,在4周、24周后与治疗前比较（SAS：t4w=7.37,t24w=7.10,SDS：t4w=5.85,t24w=5.58,P均＜0.05））。结论情绪障碍的改善,有助于患者的血糖控制,可明显降低脑血管疾病的发生率和死亡率,可有效促进神经功能的康复及患者生活质量的提高。     

缺血性脑血管病的DSA与B超诊断对比

目的探讨缺血性脑血管病数字减影全脑血管造影（DSA）与B超检测颈动脉粥样硬化的优势。方法对80例缺血性脑血管病患者行DSA检查以及B超观察及对比评价颈动脉粥样硬化检出率的情况,分析影像结果与临床表现的相关性。结果DSA检出颅外颈动脉病变者69例（检出率86．67％）,受累动脉132支,颈动脉狭窄伴斑块75支,颅内动脉狭窄32支,其他颅外动脉狭窄25支,颈动脉狭窄高于非颈动脉狭窄的发生率,不同受累动脉的狭窄程度分布：狭窄1级52支,2级41支,3级26支,4级13支。B超检出颈动脉狭窄（斑块）61例（检出率76．7％）,CCA16例,BIF35例,ICA20例,管腔确定为管腔狭窄23例,管腔明显狭窄30例,血管完全闭塞8例。结论颈动脉粥样硬化病变在缺血性脑血管病的发生中起重要作用,利用DSA检查在缺血性脑血管病的诊断中有重要的应用价值,对比B超具有检查广泛性、确切性的优点。     

脑血管病伴白质疏松

目的：探讨白质疏松与各类型脑血病的关系。方法：对50例正常对照组及110例脑血管病患者进行头颅MRI或CT检查。结果：脑血管病伴LA的发生率明显高于正常对照组，其中又以腔隙性梗死和脑出血伴LA的发生率高。结论：年龄增长，高血压、糖尿病及冠心病是LA发生的危险因素。     

Neuroprotection in cerebrovascular disease

The role of neuroprotection in the management of acute cerebrovascular disease is reviewed. Neuroprotection is a valuable adjunct to thrombolytic therapy in acute cerebral ischaemia. Various pharmacological approaches for neuroprotection are based on the current knowledge of molecular events in the pathophysiology of cerebral ischaemia. Reperfusion injury following restitution of circulation is also considered to be mediated by free radicals. Various strategies include free radical scavengers, anti-excitotoxic agents, apoptosis (programmed cell death) inhibitors, anti-inflammatory agents, metal ion chelators, ion channel modulatory, antisense oligonucleotides and gene therapy. The various agents aim to prevent the progression of ischaemic cascade therefore reducing brain damage and some of these intervene at more than one point in the ischaemic cascade. Neuroprotection is considered as an adjunct to therapies designed to improve cerebral circulation such as thrombolytic agents for arterial thrombosis. Clinical effectiveness of some of the strategies has not be proven in clinical trials, some of which had to be abandoned due to adverse effects outweighing the beneficial effects. Efforts to develop new neuroprotective agents continue and prospects for the introduction of an effective neuroprotective agent(s) in the next few years are good. Apart from acute cerebrovascular disease, neuroprotective therapy has a role in preventing cerebral ischaemia in high risk cardiovascular procedures as well as in neurodegenerative disorders which has some common pathomechanisms with cerebrovascular disease. Currently, the most promising agents are free radical scavengers. In the near future, gene therapy approaches are likely to prove more effective in neuroprotection.     

脑血管病患者血总同型半胱氨酸水平与肾小管损伤相关性分析

目的探讨正常血肌酐(Scr)水平脑血管病患者肾小管损伤对血总同型半胱氨酸(tHcy)水平的影响及其相关性。方法测定脑血管病患者(脑梗死63例、脑出血10例、短暂性脑缺血发作53例,共126例)空腹血清tHcy、Scr及晨尿中微量白蛋白(u-ALB)、α1-微球蛋白(α1-MG)。以u-ALB和α1-MG作为肾小球和肾小管损伤的分类依据,共分为4组:①肾小球和肾小管同时损伤组(组1,32例)。②单纯性肾小管损伤组(组2,18例)。③单纯肾小球损伤组(组3,22例)。④肾小球、肾小管无损伤组(组4,54例)。结果组间比较:血tHcy4组间比较有显著性差异(P=0.003),两两比较显示组1、组2明显高于组4(15.5μmol/L,14.2μmol/L vs12.1μmol/L,中位数,P<0.01),组3与组4之间无显著性差异(P>0.05)。组1高同型半胱氨酸血症发生率(53.1%)明显高于组3(22.7%)和组4(22.2%)(P<0.05,P<0.01),与组2(38.9%)无显著性差异。合并组(包括4组,126例)相关分析:①Pearson相关分析显示血LgtHcy与Scr显著相关(r=0.342,P<0.001),与Lg(α1-MG)显著相关(r=0.228,P=0.01),与Lg(u-ALB)无相关性(r=0.168,P=0.61)。②控制Scr后,偏相关分析显示LgtHcy与Lg(α1-MG)不再具有相关性(r=0.1318,P=0.143)。③控制Lg(u-ALB)和Lg(α1-MG)后,偏相关分析显示LgtHcy与Scr依然具有相关性(r=0.2961,P=0.001)。结论①单纯u-ALB升高,即早期肾小球损伤对血tHcy影响不显著。②早期单纯肾小管损伤可明显引起血tHcy升高。③与肾小球滤过功能相比,肾小管损伤不是血tHcy的独立影响因素。肾脏各部分的损伤中,肾小球滤过功能对血tHcy水平的影响起决定作用。