慢性焦虑抑郁与缺血性脑血管病的相关性

目的探讨慢性焦虑和抑郁与缺血性脑血管病(ICVD)的相关性。方法选取我院神经科的住院患者220例,按照DMS-Ⅳ慢性焦虑抑郁诊断标准,分为慢性焦虑组107例和无慢性焦虑组113例;慢性抑郁组98例和无慢性抑郁组122例。并依据CT、MRI及磁共振血管造影检查,对患者进行脑梗死、缺血性脑白质病变及脑动脉粥样硬化影像学评分及分析。结果慢性焦虑组与无慢性焦虑组脑梗死、缺血性脑白质病变和脑动脉粥样硬化影像学评分比较,差异有统计学意义[(0.83±0.94)分vs(1.48±1.19)分,(0.71±1.00)分vs(1.32±1.27)分,(1.27±1.02)分vs(1.80±1.12)分,P=0.000,P=0.025];慢性抑郁组与无慢性抑郁组上述3项比较,差异无统计学意义(P>0.05)。慢性焦虑评分与脑梗死、缺血性脑白质病变和脑动脉粥样硬化影像评分均呈负相关(r=-0.335,-0.213,-0.246;P=0.000,0.001,0.023);慢性抑郁评分与上述3项评分无相关性(P>0.05)。结论适度的慢性焦虑对人体ICVD的发生、发展可能有延缓或减轻的作用,但需更进一步研究证实。     

老老年缺血性脑白质病变患者严重程度与血清胱抑素C的关系

目的探讨老老年(85岁)缺血性脑白质病变患者严重程度与血清胱抑素C的相关性。方法选择行头颅MRI检查的缺血性脑白质病变患者115例,根据年龄相关的白质改变量表进行分组,轻度组(1~4分)42例,中度组(5~8分)42例,重度组(≥9分)31例。收集各组患者年龄、高血压、糖尿病、肾脏疾病、冠心病、慢性支气管炎、高脂血症、腔隙性脑梗死等病史,血清胱抑素C、肌酐、尿素等指标并进行比较,采用有序多分类logistic回归分析血清胱抑素C与缺血性脑白质病变的相关性。结果与轻度组比较,中度组和重度组糖尿病比例明显升高(P0.05,P0.01)。重度组血清胱抑素C水平明显高于轻度组和中度组[(1.7±1.8)mg/L vs(0.7±0.6)mg/L、(0.9±0.6)mg/L,P0.05]。校正年龄、高血压、糖尿病等因素后,多因素logistic回归分析显示,血清胱抑素C水平是缺血性脑白质病变严重程度增加的独立危险因素(OR=2.743,95%CI:0.497~1.527,P=0.000)。Spearman等级相关分析显示,血清胱抑素C水平升高与缺血性脑白质病变严重程度呈正相关(r=0.344,P=0.000)。结论血清胱抑素C水平升高可能与老老年患者缺血性脑白质病变的严重程度相关。     

血管周围间隙扩大与颅内外动脉粥样硬化性狭窄的相关性

目的探讨不同部位血管周围间隙扩大(EPVS)的危险因素,以及不同部位EPVS与颅内动脉粥样硬化狭窄(ICAS)和颅外动脉粥样硬化狭窄(ECAS)的相关性。方法选择住院治疗且完善头颅MRI及颈动脉和脑血管影像学检查的脑梗死患者72例,根据脑血管狭窄部位将患者分为无血管狭窄(NS)组37例、ICAS组25例和ECAS组10例,收集患者相关信息,根据头颅MRI分别对患者基底节区及脑白质区EPVS分级,将分级2级为高分组,分级≤2级为低分组。比较不同部位EPVS的危险因素。结果 3组C反应蛋白和TG水平比较,差异有统计学意义(P0.01)。基底节区高分组年龄≥65岁比例明显高于低分组患者(94.44%vs 59.26%,P=0.006);ICAS组基底节区EPVS高分比例明显高于NS组(36.00%vs 13.51%,P=0.038),脑白质区高分组冠心病比例高于低分组(P=0.024),TG水平明显低于低分组(P=0.016)。脑白质区EPVS严重性与有无脑血管狭窄及部位无明显相关性(P0.05)。结论严重ICAS或许与基底节区严重的EPVS有关。     

脑血管病患者脑微出血磁共振成像筛查及相关因素的分析

目的对临床疑似脑血管病的惠音进行脑微出血(cerebral microbleeds,CMBs)病变的磁共振筛查,探讨CMBs程度与高血压严重程度和脑白质改变的关系。方法连续对447例疑似脑血管病患者应用梯度回波T!_2~k序列检查,依据有无CMBs,将患者分为CMBs组(95例)和无CMBs组(352例)。记录CMBs数量、部位、脑白质改变程度及其血压水平,并进行相关分析。结果 CMBs发生率21.25%。CMBs组患者的年龄、高血压、皮质下动脉硬化性脑病影像改变、大脑白质稿变与无CMBs组比较,差异有统计学意义(P<0.01);CMBs组患者病灶分布于脑叶(42.09%)、丘脑(19.77%)、脑干(14.41%)、小脑(11.58%)、侧脑室旁(6.21%)和基底节(5.65%)。logistic回归分析显示,CMBs发生的相关因素有高血压(OR=2.208,P<0.01)、年龄(OR=2.082,P<0.01)。CMBs分级与高血压严重程度及脑白质改变的严重程度呈正相关(r=0.224,r=0.376,P<0.001)。结论脑血管病患者CMBs发生率较高,CMBs与高血压严重程度、脑白质改变程度有明显的相关性。     

血浆同型半胱氨酸水平与缺血性脑血管病的关系

目的 探讨血浆同型半胱氨酸(Hcy)水平与缺血性脑血管病的关系及其与病情严重程度的关系.方法 酶联免疫吸附法检测90例脑梗死患者、44例短暂性脑缺血发作(TIA)患者和40例同期门诊体检者(对照组)血浆Hcy水平,并记录脑血管病患者的传统危险因素;对脑梗死组患者进行神经系统功能缺损评分(NIHSS).分析血浆Hcy水平与缺血性脑血管病的关系及其与缺血性脑血管病的部分类型以及病情严重程度的相关性.结果 缺血性脑血管病组、脑梗死组与TIA组患者血浆Hcy水平均高于对照组(P＜0.05),脑梗死与TIA患者血浆Hcy水平比较无差异(P＞0.05);血浆Hcy水平与NIHSS评分无明显相关性(r =0.155,P=0.323).结论 血浆Hcy水平升高可能是与传统危险因素无关的缺血性脑血管病的独立危险因素,但Hcy水平与其类型及临床表现严重程度无关.     

脑白质疏松症与多因素的相关性研究

目的研究脑白质疏松症（LA）与多种因素的相关性。方法筛查出LA患者188例,非LA 142例。入院后采集病史,测量血压,化验血糖、血脂,行心电图、心脏彩超、颈部血管超声、睡眠呼吸监测等检查,通过头颅MRI检查,分析脑白质损害程度,并进行分级。应用SPSS13.0软件进行多因素Logistic回归分析。结果脑白质病变及程度与年龄、性别、吸烟、冠心病、高血压、糖尿病并发血管病变、动脉粥样硬化程度、高脂血症、睡眠呼吸暂停综合征多因素呈正相关,与冠心病无明显相关性。结论脑白质疏松症的发生发展受到多种因素影响,控制危险因素,有利于阻止疾病进展。     

缺血性脑卒中患者脑内微出血的磁共振成像研究

目的分析缺血性脑卒中患者脑内微出血(CBMs)的分布特点及其与陈旧性腔隙性脑梗死和脑白质改变严重程度的关系。方法连续选取住院的缺血性脑卒中患者247例,分析其MRI表现。根据有无CMBs将患者分为CMBs组(72例)和无CMBs组(175例)。记录CMBs的位置和个数、陈旧性腔隙性脑梗死的个数和脑白质改变的严重程度。结果与无CMBs组患者比较,CMBs组患者年龄大、高血压、脑梗死病史、脑白质改变比例均高。CMBs组患者CMBs常见的部位依次为:基底节、皮质及皮质下区、丘脑、脑干及小脑。CMBs的分级与陈旧性腔隙性脑梗死及脑白质改变的严重程度之间具有显著相关性。结论CMBs与脑微血管病变之间有密切关系,其可能是晚期脑微血管病变的标志。     

缺血性脑血管病患者颈动脉颅外段病变的临床研究

目的探讨缺血性脑血管病患者颈动脉颅外段动脉粥样硬化严重程度的改变特征及对缺血性脑血管病诊断的价值。方法对142例颈内动脉系统脑梗死患者及45名健康对照人群进行血清同型半胱氨酸(HCY)、超敏C反应蛋白(hs-CRP)和彩色血管超声检查。结果各类型缺血性脑血管病患者颈动脉颅外段硬化严重,缺血性脑血管病患者颈动脉颅外段斑块发生率高(71.8%),且以软斑、硬斑构成为主。缺血性脑血管病组颈动脉颅外段狭窄发生率57.1%,狭窄主要与软斑、混合斑有关。缺血性脑血管病组血清HCY和hs-CRP水平高于对照组(P<0.01)。结论颈动脉颅外段动脉粥样硬化严重程度对缺血性脑血管病患者有重要的临床诊治价值。     

485例脑白质改变的影像学与血管性因素的相关性研究

目的探讨脑白质MRI高信号表现特征及相关病理机制。方法对485例连续住院患者行头颅MRI检查,并将其脑室周围高信号严重程度分级,对不同级别脑白质损害与患者年龄、性别以及相关疾病间联系进行统计学分析。结果脑白质高信号严重程度随年龄增长而加重,性别对脑白质信号没有明显影响。脑室周围脑白质高信号与脑梗死、糖尿病、高血压、心房颤动呈正相关,深部脑白质高信号与脑梗死和高血压呈正相关,差异有统计学意义。短暂性脑缺血发作、脑出血及高脂血症与脑白质高信号没有显著联系。结论脑白质高信号与脑梗死、高血压、糖尿病有密切联系,脑白质改变与脑出血不相关。脑脊液回流障碍、大血管病变以及低灌注状态可能参与脑白质高信号的形成。     

高龄糖尿病患者缺血性脑白质病变严重程度及其危险因素分析

目的探讨高龄(≥80岁)糖尿病患者缺血性脑白质病变(WML)严重程度及其相关危险因素分析。方法选择安徽医科大学第三附属医院神经内科及干部病房住院的行头颅MRI检查的缺血性WML患者202例,分为糖尿病组105例和非糖尿病组97例,糖尿病组根据年龄相关性脑白质改变(ARWMC)评分为WML轻度患者(1~4分)35例、中度患者(5~8分)46例和重度患者(≥9分)24例。收集患者临床基线资料,采用Kendall等级相关分析,采用多因素logistic回归分析WML相关危险因素。结果糖尿病组空腹血糖、餐后2 h血糖、ARWMC评分明显高于非糖尿病组,HDL-C水平明显低于非糖尿病组(P<0.05)。糖尿病组不同程度WML患者年龄、空腹血糖、餐后2 h血糖及糖化血红蛋白(HbA1c)水平比较,差异有统计学意义(P<0.05,P<0.01)。轻度、重度及重度患者随症状加重其空腹血糖、餐后2 h血糖及HbA1c水平明显升高(P<0.05)。与轻度患者比较,中度和重度患者年龄更高,重度患者糖尿病病程更长(P<0.05)。多因素logistic回归分析显示,年龄、HbA1c水平升高是缺血性WML严重程度的独立危险因素(95%CI=0.128~0.454,P=0.000;95%CI=1.941~5.623,P=0.000)。所有缺血性WML患者,年龄与WML严重程度呈正相关(P=0.000)。糖尿病患者年龄、HbA1c水平、糖尿病病程与缺血性WML严重程度呈正相关(P<0.05,P<0.01)。在校正高血压、血脂、尿酸水平等危险因素后,糖尿病病程与缺血性WML严重程度的无关(P=0.210)。结论年龄是缺血性WML的独立危险因素,在糖尿病患者中,HbA1c水平可能与缺血性WML严重程度相关。     

Periodontal disease and systemic disease

Periodontal diseases are now recognized as bacterial infections among the chronic diseases of humans. The influence of the oral environment on systemic health, especially the periodontium, has long been supported by scientific evidence. However, an evidence base for the influence of periodontal disease on vital organs such as heart, lung has only recently begun to be established. We are hopeful that this information will stimulate new collaborations between physicians and dentist and serve as basis for studies to help improve the total health.     

Lung disease in Niemann-Pick disease

BACKGROUND: Lung involvement in children with Niemann-Pick disease has rarely been studied systematically. OBJECTIVE: To assess the involvement of the lung and the value of bronchoalveolar lavage in children with Niemann-Pick diseases. DESIGN: Retrospective analysis of patient records. PATIENTS: Thirteen patients, with type A (n = 1), type B (n = 10), and type C (n = 2) Niemann-Pick disease, aged 2 months to 9 years at diagnosis, were included in the study. INTERVENTIONS: Lung involvement was assessed by clinical evaluation, chest radiograph, lung computed tomography (CT) scan, pulmonary function tests, and bronchoalveolar lavage fluid analysis. RESULTS: Respiratory symptoms were present at diagnosis in 10 patients and developed during follow up in the three other patients. All patients showed signs of interstitial lung disease on chest X-ray and lung CT scan. Bronchoalveolar lavage fluid analysis (n = 7) revealed a marked accumulation of foamy macrophages (Niemann-Pick cells) in all patients. At follow up, one patient died of respiratory failure, five patients required long term oxygen therapy and seven other patients presented a chronic obstructive pulmonary disease (n = 6) or chronic cough (n = 1). CONCLUSION: Lung disease was observed in all the patients included in the present study. Bronchoalveolar lavage may be useful in Niemann-Pick diseases by showing the presence of characteristic Niemann-Pick cells.     

Buerger's disease and coronary disease

The authors report the case of a 33 year old man with distal occlusive arterial disease diagnosed as Buerger's disease, with two previous transient ischaemic attacks and coronary disease resulting in myocardial infarction. Coronary angiography showed narrowing of the second segment of the left anterior descending artery, occluded distally and not suitable for revascularisation. The observation of coronary artery disease is very rare in Buerger's disease and data of coronary angiography are very sparse in this context. The occurrence of myocardial infarction and the angiographic appearances of the left anterior descending artery raise the question of coronary involvement of Buerger's disease.     

Hepatobiliary disease in inflammatory bowel disease

Many hepatobiliary diseases are seen in IBD. PSC is the most common, occurring in 7.5% of patients with UC. The cause of PSC is not well understood, but PSC seems to be associated with genetic susceptibility, sharing some immunologic abnormalities with UC. A characteristic cholangiogram in a patient with abnormal liver function tests usually establishes the diagnosis. Liver biopsy is not essential but can help make the diagnosis of small duct PSC in patients with a normal cholangiogram. There are no medications that treat PSC effectively. Endoscopic dilation of dominant strictures reduces the frequency of cholangitis and may improve survival. OLT remains the only proven treatment of advanced PSC. Cholangiocarcinoma is a feared complication of PSC that is difficult to diagnose. Cholelithiasis, PBC, portal vein thrombosis, and hepatic abscess are hepatobiliary disorders that occur less frequently in IBD patients.     

Joint disease in inflammatory bowel disease

The joint disorders taxonomically included in the group of seronegative spondyloarthropathies under the generic name of enteropathic arthropathy represent the most frequent extra-intestinal manifestation of inflammatory bowel disease (IBD), affecting 33% of patients. Their frequency is similar to that of ulcerative colitis and Crohn's disease. Enteropathic arthropathy consists of two main joint alterations, peripheral and axial arthritis, as well as a variable group of other peri-articular disorders. Type 1, or pauciarticular, peripheral arthritis generally coincides with IBD exacerbations, while type 2, or polyarticular, peripheral arthritis follows an independent course from IBD. Axial involvement precedes and follows an independent course from IBD and can behave as ankylosing spondylitis or asymptomatic sacroiliitis. The treatment of these rheumatologic disorders is based on the application of general measures and the use of nonsteroidal anti-inflammatory agents; intraarticular corticosteroid administration may eventually become necessary. Sulphasalazine and/or infliximab, which are indicated when the previously mentioned measures fail, can be used to treat both the articular and intestinal diseases simultaneously.     

冠状动脉硬化性心脏病和老年性痴呆

弄清冠状动脉硬化性心脏病是否与老年性痴呆有关联,有助于老年性痴呆的防治。我们从共同的危险因素载脂蛋白E4基因型以及二者的临床、病理的相关性方面,综述了冠状动脉硬化性心脏病与老年性痴呆的关系。其机制有待进一步研究。     

Borna病病毒及Borna病

20 0多年前 ,Ｂｏｒｎａ病 (ＢｏｒｎａｄｉｓｅａｓｅＢＤ)首先被描述为发生在德国东南部的一种马致死性神经疾病。 1885年 ,该病在德国Ｓａｘｏｎｙ州的Ｂｏｒｎａ镇周围流行而导致大批的马匹死亡 ,因而本病即以该镇命名〔1〕。研究表明 ,该病是一种以行为异常、脑实质和脑膜     

Gastroesophageal reflux disease and extraesophageal disease

The patient with extraesophageal manifestations of gastroesophageal reflux disease presents a clinical challenge. Symptom presentation overlaps with other otolaryngologic and pulmonary disease, and heartburn might be infrequent or absent. Endoscopy and pH monitoring are insensitive and therefore not useful in many patients as diagnostic modalities. Thus, antisecretory therapy is used as both a diagnostic trial and as therapy in the majority. Attention to optimizing therapy and judicious use of endoscopy and reflux monitoring are needed to minimize cost and maximize success.