首发抑郁症患者重复神经心理测查系统临床应用研究

目的 用重复神经心理测查系统(RBANS)和Stroop色词测验探讨首发抑郁症的认知功能损害特点.方法 采用重复神经心理测查系统(RBANS)和Stroop色词测验分别对230例首发抑郁症患者和178例健康对照进行检测.结果 在Stroop色词测验中,抑郁症患者完成单字、单色、双字、双色所需要的时间[(14.37±6.65)s,(21.58±8.70)s,(16.56±8.23)s,(37.88±13.67)s]均长于对照组[(12.38±3.34)s,(18.01±5.51)s,(14.17±4.37)s,(32.87±10.28)s],差异有显著性(P＜0.05),但颜色干扰、字义干扰两组的结果没有明显差异,无统计学意义(P＞0.05).在RBANS测查中,抑郁症患者5个因子所得的分数[(72.19 ± 17.22)分,(80.89 ± 15.29)分,(82.00±16.37)分,(98.74±17.01)分,(82.09±14.62)分]均差于对照组,且差异有统计学意义(P＜0.05).相关分析显示,RBANS总分及5因子与HAMD总分及各因子相关无统计学意义;与教育程度正相关(P＜0.05),与性别相关无统计学意义(P＞0.05).RBANS总分及5因子中的即刻记忆、言语功能、延时记忆分别与年龄、病程呈负相关(P＜0.05).而视觉广度、注意与年龄、病程相关无统计学意义(P＞0.05).结论 首发抑郁症患者存在比较严重的记忆、注意、执行功能等全面认知功能的损害.

Abstract：

Objective To investigate the damaging traits of cognitive function in first episode depression patients with the assessment of neuropsychological status ( RBANS) and Stroop Color-word Test. Methods Two hundred and thirty first-episode depression patients as experimental group and one hundred and seventy-eight health person as control were evaluated separately by repeatable battery for the RBANS and Stroop Color-word Test. Results In Stroop Color-word Test,the time required for completing the words,color,double-word,two-color in depression patients ( (14.37 ±6.65)s,(21. 58 ±8. 70) s,( 16. 56 ±8. 23)s, (37. 88 ± 13. 67) s) were longer than the control group ((12.38 ±3.34)s, (18.01 ±5.51) s, (14. 17 ±4. 37) s, (32. 87 ± 10.28) s). The difference between the two groups was found in cognitive function in first episode depression patients (P ＜ 0.05). The scores of color interference and meaning interference were no difference between the two groups (P＞0.05) . The patients'scores of the RBANS test in all items( (72.19 ± 17.22), (80.89 ± 15.29), (82.00 ± 16.37) , (98.74 ± 17.01) ,(82.09 ± 14.62) )were significantly poorer than those in healthy controls. Compared with control group, scores of the scales were significant difference between two groups. Pearson correlation analysis showed that RBANS total score and five factors had no correlation with HAMD total score and factors. It positively correlated with education level (P＜0.05) ,but not with sex (P＞0.05). Immediate memory,verbal function,delayed memory in five factors and RBANS total score negatively correlated with age and course of disease respectively, but breadth of vision,attention were not did(P＜0.05). Conclusion First-episode depression patients suffer from more serious and comprehensive damage of cognitive function such as memory,attention,executive function.     

利培酮、奥氮平、喹硫平对首发精神分裂症患者认知功能和社会功能的影响

Objective To compare the influence of risperidone,olanzapine and quetiapine on cognitive function and social functioning in patients with first-episode schizophrenia. Methods Total of 61 patients diag-nosed with first-episode schizophrenia were evaluated on efficacy, social functioning and cognitive function in 6 weeks,and 42 healthy controls were given a same cognitive function assessment. Results Mean doses were 4.2 mg/d, 18.6 mg/d,and 561.3 mg/d for risperidone,olanzapine,and quetiapine respectively. The mean change from baseline to end point in PANSS and PSP total score in three groups were 19.7±20.2,20.2±21.0,15.8±19.4 and 7.8±16.3,8.2±15.2,6.8±14.8 respectively. Significant improvements from baseline to end point were observed on the CGI-S scale in the three treatment groups (P<0.05). All the patients before treatment compare with normal controled group in cognitive function measurement such as WCST,TMT and WMS,were sig-nificant differences (P<0.05). Executive function and memory after treatment had not improved in risperidone and quetiapine group, while three indices of WCST has improved in olanzapine group (P<0.05) ,rate of motion percep-tion,attention and capacity of concept conversion had be improved in all groups (P<0.05). The most frequently adverse events reported in Risperidone group was EPS which were mild in severity,in olanzapine and quetiapine group,the most frequently adverse events were somnolence. Conclusion Risperidone,olanzapine and quetiapine can improve part of cognitive function and social functioning in patients with first-episode schizophrenia, and the effects of them were similar.     

未有效治疗的中年原发性高血压患者认知功能研究

Objective To explore change of cognitive function in middle-aged patients with primary hy-pertension receiving no effective ,persistent and steady decreasing blood pressure treatment. Methods Thirty-four patients with hypertension from 40 to 60 years old, with course of disease of more than one year,who hardly re-ceived effective,persistent and steady decreasing blood pressure treatment, were enrolled ,while 34 normal control population,matched with hypertension group in age, gender and educational duration, were recruited. The MAT-RICS Consensus Cognitive Battery (MCCB) ,as a neuropsychological test used for measuring the subjects' cogni-tive function, included, Trail Making Test (TMT), BACS-Symbol Coding Test(SC), HVLT-R-Verbal Learning(HV-LT-R), WMS-III-Spatial Span(SS) , BACS-Digit Sequencing (DS), NAB-Mazes (MAZES), BVMT-R-Visuospatial Memory (BVMT-R), BACS-Category Fluency-Animal Naming (CF), MSCEIT-Managing Emotions (ME) and Con-tinuous Performing Test-Identical Pairs(CPT-IP). Results There was significant difference in TMT and CF and ME scores between hypertension group(47.81±10.85 ;48.04±9.42 ;47.36±10.39) and control group(54.79 ±13.75;53.22±12.1 ;52.1±9.01) (t=2.19, P=0.03;t=2.03, P=0.04;t=1.98, P=0.04) ,and no signif-icant difference in other subtests scores and MCCB composite score between hypertension group and control group (P>0.05). Conclusion The different extents of damage of cognitive function may appear in middle-aged pa-tients with primary hypertension receiving no specified treatment.     

One Year Follow-up Study on Cognitive Performances in Patients with Ischemic Vascular Events

Objective To assess the cognitive state in patients after first ever stroke/transient ischemic attack. Methods We studied 82 patients who were hospitalized in The Clinic of Neurology from Craiova between 2007 February-2008 February, for first ever ischemic stroke or transient ischemic attack. We have also studied a control group composed of 96 control subjects without signs of cerebrovascular disease but with vascular risk factors present. To assess the cognitive state we tested the patients using Mini Mental State Examination and Addenbrooke＇s Cognitive Examination revised version at baseline, after 6 months respectively one year. We performed in both of groups brain computed tomography for a correct diagnosis. Results At baseline the patient group showed a mean Mini Mental State Score 27.9 and a mean Addenbrooke＇s Cognitive score 89.7. The control subjects showed a mean Mini Mental State score 28.7 and a mean Addenbrooke＇s Cognitive score 90.3. One year later the patient group showed a mean Mini Mental State score 25.1 and mean Addenbrooke＇s Cognitive score 84.2 points. In the control group we obtained a mean Mini Mental State score 27.7 and Addenbrooke＇s Cognitive score 88.1. Multiple risk factors were present in 59 （71.95%） patients. Conclusions The patients with cerebrovascular disease showed a greater cognitive impairment than control group. We observed in patients with ischemic stroke a greater cognitive impairment than in the patients with transient ischemic attack. In subjects with cerebrovascular risk factors there were signs of cognitive impairment even before the cerebrovascular disease became clinically evident. Addenbrooke＇s Cognitive Examination proved to be an appropriate scale for cognitive assessment of patients with vascular cognitive impairment.     

Differential acetylcholine and choline concentrations in the cerebrospinal fluid of patients with Alzheimer’s disease and vascular dementia

Background An important aspect of Alzheimer’s disease (AD) is loss or impairment of cholinergic neurons. It is controversial whether there is a similar cholinergic impairment and cerebral deficit of acetylcholine (ACh) in the case of vascular dementia (VD). The purpose of this study was to explore the levels of ACh and choline (Ch) in the cerebrospinal fluid (CSF) of patients with AD and VD, and their possible relationship with cognitive impairment.Methods Twenty-two AD patients, twenty-two VD patients, and twenty normal controls were recruited and scored with a Mini-Mental State Examination (MMSE). CSF concentrations of ACh and Ch were measured using high-performance liquid chromatography with an electrochemical detector (HPLC-ECD) and the results were then compared to cognitive status.Results ACh concentrations in CSF of AD patients ［(10.7±5.1） nmol/L］ and VD patients ［(16.8±7.4） nmol/L］ were both significantly lower than in controls ［(34.5±9.0） nmol/L, t=10.67, P&lt;0.001; t=6.91, P&lt;0.001］. Both results correlated positively with MMSE scores (rs=0.88 and rs=0.85, respectively, P&lt;0.01). The CSF concentration of Ch was significantly higher in VD patients ［(887.4±187.4） nmol/L］ compared to AD patients ［(627.6±145.1） nmol/L, t=6.4, P&lt;0.001］ and controls ［(716.0±159.4） nmol/L, t=4.2, P=0.002］. CSF Ch concentration showed no difference between AD patients and normal controls, nor did it correlate with MMSE score in any of the three groups. Conclusions The positive correlation between ACh deficit and cognitive impairment suggests that ACh is an important neurotransmitter for memory. The similar decrease in ACh concentration in AD and VD patients may imply a similar pathogenesis for the process of cognitive impairment involved in these two disorders. The elevated CSF levels of Ch in VD patients compared to AD patients may be useful diagnostically. Cholinesterase inhibitors may be helpful not only for AD patients, but also for VD patients.     

剑桥神经心理自动化成套测试在偏执型精神分裂症与双相躁狂患者中的应用

Objective To detect the patterns of cognitive impairment between patients with paranoid schizophrenia and patients with bipolar mania by using the Cambridge Neuropsychological Test Automated Battery (CANTAB) ,and to explore research clues for finding of cognitive endophenotype in patients with paranoid schizophrenia or bipolar mania. Methods Six CANTAB subtests and the seven subtests of the Wechsler Abbreviated Scale of Intelligence (WAIS short form) were administered to 35 patients with paranoid schizophrenia and 33 patients with bipolar mania who were drug naive experiencing an acute episode, as well as 30 healthy controls. Results Patients with paranoid schizophrenia and bipolar mania demonstrated impairments in 13 of the 15 cognitive indicators in CANTAB. After controlling IQ, both patient groups remained as significantly different from normal controls in terms of search strategy(36. 8 ±3.56,37.24 ±4. 21,30. 33 ±6.24) ,between-search errors(40. 86 ± 19.97,40.24 ± 18.92,15.4 ±17.22) on the SWM test,the proportion of hits(0.54 ±0. 18,0.56 ±0.15,0.78 ± 0.17) on the RVIP test,total errors(45.26 ±36.36,46.61 ±33.32,14 ± 11.7) and EDS errors (12.43 ±9.96, 13.18 ±8.98,4.97 ±6.09)on the IED test. Between search error in the SWM test was positively correlation with YMRS scores ( r=0.38, P=0.039) in bipolar patients. Conclusion Both patient groups demonstrated a comparable profile of cognitive impairments during active periods of their condition. The cognitive impairment index may be a discreet cognitive endophenotype overlapping the disorders.     

维持性血液透析述情障碍患者医学应对方式和生活质量的研究

Objective To discuss alexithymia in patients with maintenance hemodialysis and its impact on medical coping style and the ability of daily living. Methods The patients with end-stage renal disease treated by the maintenance hemodialysis (MHD) were divided into 2 groups, namely, alexithymia group (total score>60) and non-alexithymia group (total score <50) ,according to the Toronto Alexithymia Scale (TAS-20). The Medical response to the questionnaire (MCMQ) and the activities of daily living scale (ADL) were used to evaluate the patients. Results The TAS-20 score was (72.31±12.28) in 67 cases of patients with MHD. Among these, 31 cases for TAS-20 total score>60 points ,with an average score (82.37±15.84) and 26 cases for TAS-20 total score <50 points, with an average score (50.17±10.24). There was significant difference (t=8.90, P<0.01). The face factor score of MCMQ was significantly lower in alexithymia groups than that in non-alexithymia group,while the avoidance and subordination factor score was significantly higher than that in non-alexithymia group(P<0.01 or 0.05). The ADL scores and factor scores of the alexithymia group were significantly higher than that of non-alexithymia group,and there was a significant difference (t=3.53, P<0.01). Correlation analysis showed that TAS-20 score and the face factor score of MCMQ was significantly negatively correlated with MCMQ e-vasive and subordination factor,and factor scores and ADL score was significantly positively correlated (P<0.01 or 0.05). Conclusion MHD patients in the alexithymia group tend to use and yield response to avoid negative cop-ing style and less use of active coping style. The quality of life and activities of daily living of MHD patients in alex-ithymia group are worse than that of the non-alexithymia group.     

Tiaobu Xinshen Recipe (调补心肾方) Improved Mild Cognitive Impairment of Alzheimer's Disease Patients with Xin (Heart) and Shen (Kidney) Deficiency

Objective: To observe the intervention effects of Tiaobu Xinshen Recipe(调补心肾方, TXR) on patients with mild cognitive impairment caused by Alzheimer's disease(MCI-AD). Methods: Totally 88 MCI-AD patients with syndrome of Xin(Heart) and Shen(Kidney) deficiency were assigned to the experimental group(47 cases, treated with TXR) and the control group(41 cases, treated with donepezil hydrochloride) using a random number table. Final recruited qualified patients were 44 cases in the experimental group and 39 cases in the control group. The therapeutic course was 12 weeks. Neuropsychological scales [mini mental state examination(MMSE) and Montreal cognitive assessment(MoCA)], and Chinese medicine(CM) dementia syndromes scales were performed in all patients, and results were compared between groups or intra-group before and after treatment. Results: MMSE and Mo CA scores of the two groups were increased after treatment compared with those before treatment(P0.05). But there was no statistical difference in MMSE or MOCA scores after treatment between the two groups(P0.05). CM dementia syndrome score was significantly decreased after treatment in the experimental group compared with the control group(P0.01). Visual spatial and executive function scores and delayed recall scores of the two groups were increased compared with those before treatment(P0.01). Conclusion: TXR could effectively improve cognitive impairment of MCI-AD patients with syndrome of Xin and Shen deficiency.     

蛋白激酶B1基因多态性与重性抑郁障碍事件相关电位的关联性研究

Objective To explore the relationship of protein kinase B1 ( PKB1 ) gene polymorphisms in PI3-K pathway of BDNF and event-related potentials in depression.Methods The design of case-control research was used ,and 91 major depressive patients and 65 normal controls who were made in age and gender matched with patients were measured auditory event-related potential P300 and contingent negative variation ( CNV ) in the day when two groups were collected.Polymerase chain reaction (PCR) and direct DNA sequencing technology were used to detect PKB1 gene polymorphisms.Three SNPs that named rs3001371 ,rs2494738 ,rs1130214 were selected from 3 representative BLOCK Districts of PKB1.Two independent samples t test was used to analysis P300 and CNV between two groups,and the same way to analysis the average level of P300 and CNV and PKB1 SNP genolatency of P2(P＜0.05) and lower amplitude of P3a(P＜0.01 ) ,P3b(P＜0.01 ) and P3 (P＜0.01 ) ;CNV had der had statistical difference (P＜ 0.05 )in PKB1 rs3001371 gene between C/C and C/T genotype combined which included C allele, and T/T genotype.The amplitude of P3a( (5.93 ± 2.35 ) μV, P3b(6.51 ± 3.00) μV, P3 (6.27±2.43) μV) were lower than TT Genotype ( (7.45 ±2.19)μV, (8.63 ±3.57)μV,(8.04 ±2.57)μV,respectively).The mean of CNV indicators were not found different in statistics among the rs3001371 genotypes.Conclusions PKB1 gene rs3001371 polymorphism is associated with the principal component of P300 amplitude in patients with Major depressive disorder which suggest that genetic factors may have a certain impact on cognitive function in the patients with Major depressive disorder.     

蛋白激酶B1基因多态性与重性抑郁障碍事件相关电位的关联性研究

Objective To explore the relationship of protein kinase B1 ( PKB1 ) gene polymorphisms in PI3-K pathway of BDNF and event-related potentials in depression.Methods The design of case-control research was used ,and 91 major depressive patients and 65 normal controls who were made in age and gender matched with patients were measured auditory event-related potential P300 and contingent negative variation ( CNV ) in the day when two groups were collected.Polymerase chain reaction (PCR) and direct DNA sequencing technology were used to detect PKB1 gene polymorphisms.Three SNPs that named rs3001371 ,rs2494738 ,rs1130214 were selected from 3 representative BLOCK Districts of PKB1.Two independent samples t test was used to analysis P300 and CNV between two groups,and the same way to analysis the average level of P300 and CNV and PKB1 SNP genolatency of P2(P＜0.05) and lower amplitude of P3a(P＜0.01 ) ,P3b(P＜0.01 ) and P3 (P＜0.01 ) ;CNV had der had statistical difference (P＜ 0.05 )in PKB1 rs3001371 gene between C/C and C/T genotype combined which included C allele, and T/T genotype.The amplitude of P3a( (5.93 ± 2.35 ) μV, P3b(6.51 ± 3.00) μV, P3 (6.27±2.43) μV) were lower than TT Genotype ( (7.45 ±2.19)μV, (8.63 ±3.57)μV,(8.04 ±2.57)μV,respectively).The mean of CNV indicators were not found different in statistics among the rs3001371 genotypes.Conclusions PKB1 gene rs3001371 polymorphism is associated with the principal component of P300 amplitude in patients with Major depressive disorder which suggest that genetic factors may have a certain impact on cognitive function in the patients with Major depressive disorder.     

麻疹的双相移位研究进展

近年新生儿、婴儿、成人麻疹患者逐年增加,临床表现一般仍较典型,成年人麻疹患者全身中毒症状较重。麻疹抗体检测结果阳性是主要的诊断依据。麻疹发病的双相移位的机理可能是,免疫保护力不足,婴儿出生时麻疹抗体力低。孕期母传胎的麻疹抗体减弱,母经乳汁传给婴儿的抗体减弱,成人麻疹抗体水平逐年下降。预防措施是怀孕前给予育龄妇女麻疹疫苗接种,鼓励母乳喂养,麻疹疫苗计划免疫适当提前,在成人追加麻疹疫苗的免疫,加强病毒变异的研究等。     

正常增殖期子宫内膜细胞增生状态的定量观察

以＾３氢－胸腺嘧啶核苷放射自显影法及ＨＥ染色，观察并分别测定了１８例正常子宫内膜增殖中期，１５例增殖晚期的腺上皮细胞或间质细胞的标记指数、分裂指数。结果显示：子宫内膜增殖晚期腺上皮细胞或间质细胞之ＬＩ均明显高于增殖中期。同时，增殖晚间质细胞之ＭＩ也明显高于增殖中期，即此两种细胞在增殖晚期中增生明显，其增生状态初步获得了定位定量测定的正常值。     

尿微量白蛋白检测在继发性肾脏疾病中的临床意义

目的探讨尿微量白蛋白（m-Alb）检测在继发性肾脏疾病中的临床意义。方法采用Beckman Immage全自动特种蛋白分析仪对糖尿病组、高血压组、心脏病组患者进行了m-Alb测定,同时与健康组结果作对比。结果m-Alb检测糖尿病组为3.7±5.26mg/dl,高血压组为7.5±8.18mg/dl,心脏病组为7.8±3.76mg/dl,健康组为0.66±0.48mg/dl,各试验组m-Alb增高百分率为糖尿病组48.9%,高血压组37.5%,心脏病组26.9%。结论尿蛋白阴性的糖尿病、高血压、心脏病患者进行m-Alb检测,可以监测病程的进展。     

人工全髋关节置换术的手术配合

目的：介绍人工全髋关节置换术的手术配合做法;方法：主要在手术配合的六个方面,解决防感染、防栓塞等问题。结果：30例人工全髋关节置换术均获成功,结论：手术配合是护士责任心和基本功的全面体现,对提高手术效果有至关重要的影响。     

80例局限性银屑病误诊原因分析

本文报告80例局限于小腿或手或足的银屑病。均经皮肤组织病理检查确诊。因部位比较特殊。受多种理化因素影响,使皮疹形态发生轻重程度不同的变化,常看不到典型损害,因而误诊为神经性皮炎,湿疹,慢性皮炎及癣等。作者对误诊原因进行了分析后,提出了鉴别诊断方法。     

腰椎间盘突出症再次手术的原因分析

目的解决腰椎间盘突出症手术中神经压迫。方法对1980～1998年再手术资料进行统计分析,讨论分析再手术原因,再次手术前影像学检查,观察病理变化以确定再手术方法。结果对11例随访6个月～1年,优7例(68．4％),良3例(36．8％),差1例(2．8％)。结论初次手术前详细查体和分析X线片,术中用导尿管和神经剥离探查,尽量避免髓核遗留,手术范围不宜太大,尽量减少对软组织和脊柱结构的破坏,避免形成硬膜囊与神经根粘连而致单纯形疤痕。     

妊娠晚期重度妊高征的监测

重度妊高征表现为高血压、蛋白尿、浮肿等症状 ,严重可以导致母婴死亡。对妊娠足月的重度妊高征 ,可以根据其临产与否及宫颈条件 ,立即决定其为阴道分娩或是剖宫产术。对于妊娠晚期的重度妊高征 ,因其胎龄不足月 ,胎儿生长发育及胎肺成熟度情况需通过一定时间的治疗 ,根据其病情变化来决定其治疗方案或终止妊娠的时机[1,2 ] 。这就需要我们对这一阶段的治疗进行监测 ,防止母儿并发症的发生。现将 2 0 0 0年至今我院收治妊娠晚期重度妊高征 30例的监测结果回顾分析如下。1　资料和方法1.1　研究对象　选择孕 31～ 36周重度妊高征 30例 ,其中 …