动脉硬化斑块在数字减影血管造影术中表现为颈内动脉动脉瘤1例

<正>1临床资料患者,男,55岁,以"间断性右侧肢体麻木无力1年,加重5天"入院。该患既往高血压、糖尿病病史6年;大量吸烟、饮酒史。入院查体:右侧肢体及面部浅感觉减退,余未见明显异常。头CT、头MRI示:双侧多发腔隙性脑梗死。颈部及颅内血管超声报告提示:颈部动脉多发斑块;多发脑动脉狭窄。结     

急性前循环缺血性脑卒中与颈动脉粥样硬化斑块的相关性研究

目的分析急性前循环缺血性脑卒中与颈动脉斑块的性质、狭窄率、分布之间的关系,探讨颈动脉斑块的影响因素。方法收集诊断为急性前循环缺血性脑卒中的患者188例,选取同期非脑梗死患者150例为对照组。均行颈部血管彩色多普勒超声及血液生化检查,比较两组之间的斑块稳定性、分布差异,分析颈动脉斑块的形成因素。结果脑梗死患者颈动脉斑块的检出率(72.3%)高于对照组患者(54.7%)(χ~2=11.38,P0.01)。脑梗死组比对照组不稳定斑块检出率更高(54.8%比31.3%,χ~2=18.59,P0.01)。与对照组相比,脑梗死患者颈动脉狭窄率更高(P0.01),分布范围更广,双侧颈动脉斑块检出率更高(P0.05)。相关分析显示,颈动脉斑块的形成与年龄、性别、高血压和吸烟有关。结论颈动脉粥样硬化斑块是急性前循环缺血性脑卒中的重要危险因素。颈动脉斑块的形成与年龄、性别、高血压、吸烟相关。     

彩色多普勒诊断糖尿病肾病中颈动脉病变的价值

目的 应用彩色多普勒研究糖尿病肾病患颈动脉血流动力学的改变。方法 检测30例非肾病和30例糖尿病肾病患就颈部血管各项测值进行对比．同时对血管内径内膜中层厚度进行测量分析。结果 糖尿病肾病组较对照组颈动脉损伤明显，表现为颈动脉斑块形成．病变组共28例，占93％，对照组11例，占36．7％。内膜增厚，病变组为14例，其中l例患存在较严重的颈动脉狭窄．狭窄程度大于50％。对照组4例。动脉阻力指数升高明显。动脉搏动指数升高也较明显，收缩期峰值血流速度明显增高，舒张末期流速降低。结论 糖尿病肾病患颈动脉有较明显损伤，内膜增厚，粥样斑块发生率明显增高。CDFI诊断颈动脉病变准确可信，有重要临床价值。     

应用彩色多普勒超声评估短暂性脑缺血发作与颈部大动脉粥样硬化的关系

目的 探讨短暂性脑缺血发作(transcient ischemic attacks，TIA)与颈部大动脉粥样硬化的关系。方法 选择2001-09／2004-02南京市中西医结合医院收治，临床确诊为TIA患者78例为TIA组，并设确诊为颈椎病无易患因素47例为对照组，通过颈血管彩色多普勒测量内膜厚度，观察粥样硬化斑块发生的部位及形态，测定血流速度，判定狭窄程度，同时测定血脂及纤维蛋白原。结果 与对照组比较，TIA组有不同程度内膜增厚(P&;lt;0．01)；粥样硬化斑块好发部位为颈总动脉及分叉处和颈内动脉处，共52例，2处或2处部位以上22例；粥样硬化斑块导致狭窄&;gt;51％有66例，均有不同程度的血脂异常，与纤维蛋白原含量关系不密切。结论 颈部大动脉内膜增厚、粥样硬化斑块形成所致不同程度的狭窄，是TIA的危险因子之一。     

慢性脑供血不足与颈动脉粥样硬化关系的研究

目的研究慢性脑供血不足（CCCI）患者脑血流动力学变化及其颈动脉粥样硬化特点。方法分别对50例CCCI患者（CCCI组）和50例正常对照者（正常对照组）及50例脑梗死患者（脑梗死对照组）行颈动脉彩色多普勒及经颅多普勒检查,并测量相关指标。结果 CCCI组颈动脉粥样斑块发生率为52.0%（26/50）,颈动脉内膜中层厚度〉1.00 mm者占24.0%（12/50）,颈动脉狭窄率为22.0%（11/50）,颅内血流异常率为60.0%（24/40）,颅内血管狭窄率为20.0%（8/40）,而正常对照组分别为14.0%（7/50）,4.0%（2/50）,4.0%（2/50）,16.7%（5/30）,3.3%（1/30）;脑梗死对照组分别为82.0%（41/50）,68.0%（34/50）,48.0%（24/50）,92.6%（25/27）,51.9%（14/27）,CCCI组与正常对照组比较差异有统计学意义（P〈0.01）,脑梗死对照组与CCCI组比较差异亦有统计学意义（P〈0.01）。CCCI组颈动脉彩色超声检查的斑块、不稳定斑块I、MT增厚和颈动脉狭窄发生率及TCD检查的血流速度异常率、RI、PI等介于正常对照组与脑梗死对照组之间。结论 CCCI是动脉粥样硬化过程的一个阶段,是脑梗死的预兆。CCCI是血栓前状态,是脑梗死的后备军,斑块的不稳定性是急性脑梗死重要危险因素。     

脑卒中的相关危险因素分析

对324例确诊脑卒中患者的临床资料进行回归性分析。结果缺血性脑卒中病例与对照组比较,相关危险因素中高血压、糖尿病、颈动脉斑块、吸烟、冠心病、饮酒、高血压家族史、糖尿病家族史有统计学意义(P0.05);出血性脑卒中病例与对照组比较,相关危险因素中高血压病、饮酒有统计学意义(P0.05)。高血压是脑卒中最重要的独立危险因素,糖尿病、冠心病、吸烟、颈动脉斑块是独立危险因素。饮酒、高血压家族史、糖尿病家族史是其相关危险因素。     

甲状腺功能减退合并脑梗死的临床研究

目的研究甲状腺功能减退(甲减)、亚临床甲减对脑梗死的影响。方法选取甲减合并脑梗死、亚临床甲减合并脑梗死的患者84例,无甲状腺功能异常病史且入院化验甲状腺功能无异常的同期脑梗死患者88例作为对照组。测定脑梗死患者甲状腺功能、血糖、血脂、血同型半胱氨酸和纤维蛋白原并行颈部血管彩色超声检查。结果甲减组和亚临床甲减组在血糖、血同型半胱氨酸、胆固醇、低密度脂蛋白、甘油三酯等方面均高于对照组,差异有统计学意义;在有无颈动脉粥样硬化斑块、有无血管狭窄方面均存在差异;甲减组斑块发生率、颈动脉狭窄发生率均高于亚临床甲减组;亚临床甲减组在斑块发生率、颈动脉狭窄发生率均方面高于对照组。结论甲状腺功能减退、亚临床甲状腺功能减退可能是脑梗死的危险因素之一。     

急性脑梗死患者的颈动脉超声及头部MRI的特征分析

[目的]探讨颈动脉粥样硬化及颅内外动脉狭窄与脑梗死的关系,为脑梗死的防治提供客观依据.[方法]对220例急性脑梗死患者行颈动脉超声及头部磁共振(MRI)检查,分析颈动脉粥样硬化斑块及颅内外动脉狭窄与脑梗死的关系.[结果]220例患者中145例(65.9%)检出有颈动脉粥样硬化斑块,梗死侧斑块的发生率为66.8%;38例(17.3%)发现有颈动脉中重度狭窄,28例(73.7%)在梗死灶同侧;48例(21.8%)有颅内动脉狭窄,32例(66.7%)梗死灶在狭窄动脉的供血区域.梗死侧颈动脉粥样硬化斑块的发生率及颅外颅内动脉的狭窄率明显高于非梗死侧.[结论]颈动脉粥样硬化斑块及颅外颅内动脉狭窄与脑梗死密切相关.高龄、高血压、糖尿病、高胆固醇及甘油三酯及吸烟是颈动脉粥样硬化斑块形成的危险因素.     

应用彩色多普勒超声评估短暂性脑缺血发作与颈部大动脉粥样硬化的关系

目的探讨短暂性脑缺血发作(transcientischemicattacks,TIA)与颈部大动脉粥样硬化的关系。方法选择2001-09/2004-02南京市中西医结合医院收治,临床确诊为TIA患者78例为TIA组,并设确诊为颈椎病无易患因素47例为对照组,通过颈血管彩色多普勒测量内膜厚度,观察粥样硬化斑块发生的部位及形态,测定血流速度,判定狭窄程度,同时测定血脂及纤维蛋白原。结果与对照组比较,TIA组有不同程度内膜增厚(P<0.01);粥样硬化斑块好发部位为颈总动脉及分叉处和颈内动脉处,共52例,2处或2处部位以上22例;粥样硬化斑块导致狭窄>51%有66例,均有不同程度的血脂异常,与纤维蛋白原含量关系不密切。结论颈部大动脉内膜增厚、粥样硬化斑块形成所致不同程度的狭窄,是TIA的危险因子之一。     

颅内动脉狭窄相关因素分析

【目的】探讨颅内动脉狭窄的相关危险因素。【方法】对320例急性缺血性脑卒中患者进行颅内血管磁共振血管成像（MRA）联合经颅多普勒超声（TCD）或脑血管数字减影血管造影（DsA）检查,其中270例（84．4％）颅内动脉存在不同程度狭窄患者作为病例组,50例（15．6％）无明显颅内动脉狭窄患者作为对照组,比较两组患者的临床特征。【结果】单变量分析发现两组患者间高血压、脂代谢紊乱、缺血性心脏病发生率差异均有显著性（P〈0．05）;多元logistic回归分析发现,高血压、糖尿病、脂代谢紊乱是颅内动脉狭窄的独立危险因素。【结论】高血压、糖尿病、脂代谢紊乱可能是导致颅内动脉狭窄形成的独立危险因素,应进行大样本的队列研究加以证实。     

Autonomic responses and pain perception in Alzheimer's disease.

We analysed the effects of electrical noxious stimulation on the autonomic nervous system of Alzheimer's disease (AD) patients who were assessed by means of the Mini Mental State Examination test (MMSE). To do this, we used electrical stimuli at two different intensities: just above pain threshold and twice pain threshold. We recorded heart rate and systolic blood pressure by using conventional electrocardiography and finger photo-plethysmography. When a pain stimulus just above threshold was delivered, AD patients were found to have blunted autonomic responses compared to controls of the same age. Similarly, prestimulus expectation produced a less pronounced increase of the responses in AD patients compared to the controls. However, when the painful stimulus was increased to twice the pain threshold, the systolic blood pressure increase of AD patients did not differ from the controls, whereas heart rate increase was still slightly diminished. By contrast, pain perception was similar in the two groups when the stimulus was at pain threshold, whereas it was blunted in AD patients when the stimulus was twice the pain threshold. These findings show that in AD mild noxious stimulation produces blunted autonomic responses and normal pain perception, whereas strong noxious stimulation produces quasi-normal autonomic responses and blunted pain perception. These results indicate that AD patients have an increased threshold for both autonomic activation and pain tolerance.     

Human kallikrein 6 as a biomarker of alzheimer's disease

Background: Alzheimer’s disease (AD) is a major cause of dementia in the elderly. It is generally difficult to diagnose accurately early AD. A few biomarkers, including τ protein and amyloid β-42, are now used as aids for diagnosis and monitoring of AD. Our aim was to examine the possible use of cerebrospinal fluid, blood and tissue, and human kallikrein 6 (hK6) concentration as a marker of AD.

Methods: We have used a highly sensitive and specific immunofluorometric procedure for measuring hK6. We measured hK6 in tissue extracts from AD brain or normal individuals, in cerebrospinal fluids of AD patients or normals and in whole blood of AD patients and normals and compared the findings. We have used ten pairs of AD/normal controls in all cases.

Results: We found that hK6 concentration is tissue extracts from AD brain were approximately twofold lower than extracts from normal controls. Further, we found that cerebrospinal fluid hK6 concentration is approximately a threefold increase, in comparison to cerebrospinal fluid controls (p = 0.001). We have also found that the whole blood hK6 concentration in AD patients is about ten times higher than hK6 concentration in normal controls (p = 0.002). We have immunohistochemically localized the expression of hK6 in epithelial cells of the chorioid plexus.

Conclusions: This is the first report describing significant elevations of cerebrospinal fluid and plasma and whole blood hK6 concentration in AD patients, in comparison to controls. These data suggest that hK6 may constitute a new biomarker for diagnosis and monitoring of AD.     

阿尔茨海默病患者外周血淋巴细胞中G蛋白偶联受体激酶5水平与疾病及程度间相关性探讨

目的：探讨外周血淋巴细胞中G蛋白偶联受体激酶5（G protein-coupled receptor kinase-5,GRK5）水平与阿尔茨海默病（Alzheimer′s disease, AD）患者认知障碍间的相关性。方法：选择2015年1月至2017年12月期间我院住院和门诊的AD患者,根据简易智能精神状态量表（mini-mental state examination, MMSE）评分分为轻度AD（27例）和中-重度AD组（37例）,另选择30名健康体检者作为对照。应用酶联免疫吸附试验（enzyme linked immunosorbent assay, ELISA）检测所有研究对象外周血淋巴细胞中的GRK5蛋白表达情况,进行组间比较,并分析外周血GRK水平与患者疾病间的相关性。结果：轻度[（7.58±0.50） ng/mL]及中-重度AD组[（4.37±0.26） ng/mL]外周血淋巴细胞中GRK5水平与对照组[（15.65±0.74） ng/mL]相比,差异均有统计学意义（P<0.001）;轻度AD组与中-重度AD组相比,差异亦有统计学意义（P<0.001）;线性回归分析显示,外周血淋巴细胞中GRK5蛋白水平与MMSE评分呈显著正相关（R²=0.678 1）。结论：AD患者存在GRK5水平下降;外周血淋巴细胞GRK5可能作为早期诊断AD的一种新型生物标志物。     

轻度阿尔茨海默病的PET与SPECT特征与对比

目的研究轻度阿尔茨海默病(AD)18F-FDG PET与99Tcm-ECD SPECT影像特征,并进行对比.方法受检者分为两组,正常对照组10例,轻度AD组 15例.利用ROI技术获得受检者的脑代谢比值(RARmetab)和脑血流比值(RARflow).结果与正常老年人比较,AD病人的RARmetab和RARflow减低,经统计学t检验均有显著性差异.结论轻度AD葡萄糖代谢影像特征是出现单侧顶叶、颞叶或颞顶叶代谢减低,额叶代谢保留在正常水平.SPECT脑血流显像特征与PET相似,但其灵敏度低于PET.     

阿尔茨海默氏病患者不同中医证型血液流变性及甲皱微循环的研究

目的研究阿尔茨海默氏病不同中医证型患者血液流变性及甲皱微循环的特点。方法阿尔茨海默氏病气虚证、肾虚证、血瘀证患者各30例及30例健康者,采用平行对照法,应用LBY-N6型旋转式血液粘度计检测血粘度,应用MCAS-2011型临床微循环图象分析系统检测甲皱微循环。结果阿尔茨海默氏病患者各不同证型组与正常对照组血液流变学指标及甲皱微循环主要指标有显著性差异（P〈0.05）,气虚证组、肾虚证组与血瘀证组血液流变学指标及甲皱微循环有显著性差异（P〈0.05）,而气虚证组与肾虚证组之间无显著性差异（P〉0.05）。结论血粘度增高及甲皱微循环异常是患阿尔茨海默氏病危险因素之一,其指标可提供阿尔茨海默氏病的病因诊断及中医辨证参考。     

Delayed rather than decreased BOLD response as a marker for early Alzheimer's disease

Functional MRI (fMRI) in established Alzheimer's disease (AD) shows regionally altered blood oxygenation level dependent (BOLD) responses. Mild cognitive impairment (MCI) is thought to represent an intermediate state between health and early Alzheimer's disease. To study this probable early dementia stage pathology, we studied in detail the BOLD response in MCI during visual encoding. 28 MCI patients, 18 AD patients, and 41 healthy elderly controls performed a face encoding task during fMRI scanning. Data were analyzed using orthogonal regressors, each representing different phases of the BOLD response (from slow to fast). Using a mixed effects model, regressor x group interactions were analyzed applying P < 0.05, corrected. In occipital regions, MCI patients could be distinguished significantly better from controls and AD patients with a regressor of the early phase of the (fast) BOLD response than with the regressor of the late (slow) BOLD phase. Occipitally, the early phase BOLD response was significantly diminished in MCI patients compared to controls, and significantly increased when compared to AD. AD patients showed diminished early phase activation in widespread regions throughout the brain when compared to controls. There were no differences in the late (slow) phase of the BOLD response. This study stresses the importance of analyzing early phase BOLD responses and not only using one model of the BOLD response in neurodegenerative diseases. The increasing delay of the BOLD response from controls to MCI to AD may be consistent with the idea that MCI is a transitional state between healthy aging and dementia. Analyzing differences in different phases of the BOLD response introduces new opportunities to understand changes in regional brain dynamics in MCI and how well this may serve as an early marker of AD pathology.     

Impaired cardiovagal and vasomotor responses to baroreceptor stimulation in type II diabetes mellitus

BACKGROUND: In diabetic patients, impairment of the cardiovagal limb of the baroreflex has been well established. However, the role of sympathetic mediated baroreflex vasomotor control of the blood vessels is not well defined. We therefore assessed the vasomotor responses to sinusoidal baroreceptor stimulation in diabetic patients. MATERIALS AND METHODS: We studied 14 type II diabetic patients (age; 57 +/- 7 years) and 18 healthy controls (age; 59 +/- 11 years). Oscillatory neck suction was applied at 0.1 Hz to assess the sympathetic modulation of the heart and blood vessels, and at 0.2 Hz to assess the effect of parasympathetic stimulation on the heart. Breathing was paced at 0.25 Hz. Spectral analysis was used to evaluate the oscillatory responses of RR-interval and blood pressure. RESULTS: The diabetic patients showed a significantly lower RR-interval response (P < 0.05) to the 0.1 Hz neck suction (2.52 +/- 0.50-3.62 +/- 0.54 ln ms2) than the controls (4.23 +/- 0.31-6.74 +/- 0.36 ln ms2). The increase in power of 0.1 Hz systolic blood pressure oscillations during 0.1 Hz suction was also significantly smaller (P < 0.05) in the diabetics (1.17 +/- 0.44-1.69 +/- 0.44 mmHg2) than in the controls (1.60 +/- 0.29 mmHg2-5.87 +/- 1.25 mmHg2). The magnitude of the peak of the 0.2 Hz oscillation in the RR-interval in response to 0.2 Hz neck stimulation was significantly greater (P < 0.05) in the controls (3.42 +/- 0.46 ln ms2) than in the diabetics (1.58 +/- 0.44 ln ms2). CONCLUSION: In addition to cardiovagal dysfunction, baroreflex-mediated sympathetic modulation of the blood vessels is impaired in type II diabetic patients.     

军人创伤后应激障碍与适应障碍的视觉和听觉诱发电位研究

目的 探讨军人创伤后应激障碍和适应障碍的视觉诱发电位和听觉诱发电位的特征。方法 对33例创伤后应激障碍患者和34例适应障碍患者及30名健康军人(对照组)，应用Nicolet Bravo型脑电生理仪及光、声刺激，完成视觉诱发电位和听觉诱发电位检测。结果 应激障碍组和适应障碍组Cz脑区视觉诱发电位／P2波幅较对照组为低，应激障碍组Pz脑区视觉诱发电位／P3波幅分别较对照组和适应障碍组为低；应激障碍组Oz脑区听觉诱发电位／P3潜伏期较对照组延迟，Cz脑区听觉诱发电位／P2波幅分别较对照组和适应障碍组为低，Cz脑区听觉诱发电位／P3波幅分别较对照组和适应障碍组为高。结论 应激障碍和适应障碍的诱发电位有一定的特征，值得进一步随访观察。     

阿尔茨海默病与血管性痴呆的临床、神经心理、影像学对比

目的研究阿尔茨海默病(Alzheimerdisease,AD)和血管性痴呆(vasculardementia,VD)在临床表现、认知功能、脑CT/MRI及单光子发射断层扫描(SPECT)的不同表现及特点。方法从临床表现、脑CT/MRI、神经心理测验、脑SPECT扫描对27例AD、26例VD及25例健康对照进行研究。结果(1)AD的精神症状频率显著高于VD。(2)脑CT/MRI上VD以皮质下双侧多发病灶为主;AD以脑萎缩为著;两者差异显著。(3)AD及VD的认知功能显著降低。(4)VD的脑血流低灌注/缺损灶分布广泛;皮层的病灶以不对称性分布为主。而AD的病灶位于皮层,呈对称分布为主。(5)AD与血管性痴呆神经心理测验结果与脑血流灌注的改变相关。结论临床表现、神经心理测验、脑CT/MRI及SPECT扫描对诊断及鉴别诊断AD与VD有一定价值。     

老年痴呆患者的血脂水平分析

目的 收集郴州市精神病医院老年科阿尔茨海默病(AD)又称为老年性痴呆患者的血脂指标,以期发现本地区人群中AD患者血脂水平的特点.方法 选取AD患者206例,健康对照267名,于清晨对AD患者及健康对照采集空腹静脉血,分离血清,采用全自动生物化学分析仪直接法测定血脂指标,并对数据进行统计分析.结果 (1)AD组血浆胆固醇水平低于对照组,差异有统计学意义,u=12.33,P<0.01.(2)女性AD组血浆三酰甘油水平高于对照组,差异有统计学意义,u=2.32,P<0.05,男性AD组血浆三酰甘油水平低于对照组,差异有统计学意义,u=4.29,P<0.01.(3)AD组血浆高密度脂蛋白水平低于对照组,差异有统计学意义,u=16.64,P<0.01.(4)AD组血浆低密度脂蛋白水平低于对照组,差异有统计学意义,u=14.52,P<0.01.结论 郴州地区AD患者血浆胆固醇、高密度脂蛋白、低密度脂蛋白水平均降低,女性AD患者血浆三酰甘油水平增高,而男性AD患者血浆三酰甘油水平降低.