高同型半胱氨酸和相关危险因素对青年脑梗死的影响

目的:探讨高同型半胱氨酸血症对青年脑卒中的影响,以及同型半胱氨酸与血脂、脂蛋白(α)、血压、血糖和血液流变学的相关性。方法:于2002-10/2004-10在武汉大学中南医院神经内科病房收集45岁以下的脑梗死患者47例,对照组为与脑血管病无关的同期住院患者23例。对所有研究对象都检测血压、血脂、脂蛋白(α)、血糖和血液流变学及同型半胱氨酸水平。结果:青年脑梗死患者的血清同型半胱氨酸浓度犤(13.64±6.65)μmol/L犦明显高于对照组犤(10.27±3.77)μmol/L犦,差异有统计学意义(t=2.252,P<0.05);并且血清同型半胱氨酸浓度与舒张压(r=0.570,P<0.05)、全血低切黏度(r=0.551,P<0.05)、全血高切黏度(r=0.463,P<0.05)、血浆黏度(r=0.465,P<0.05)具有正相关性;与血脂、脂蛋白和血糖无相关性。结论:青年脑梗死患者的血清同型半胱氨酸水平高于同龄健康人,是青年脑梗死的危险因素之一。     

同型半胱氨酸与脑梗死大小的相关性研究

目的探讨血浆同型半胱氨酸水平与脑梗死及其不同亚型之间的关系。方法选取105 例脑梗死患者,参照TOAST标准分为大梗死(56例)和小梗死(49例)2个亚组。对照组为健康体检者50名。采用酶联免疫吸附法测定空腹血浆总同型半胱氨酸水平。结果脑梗死组血浆同型半胱氨酸水平为(24. 85±24. 56)μmol/L,高于对照组(16 .18±6. 97)μmol/L(P<0. 05);大梗死组血浆同型半胱氨酸水平为(30 .46±31. 16)μmol/L,高于小梗死组(18 .43±10. 73)μmol/L和对照组(均P<0. 05);小梗死组和对照组之间无显著性差异。结论大梗死组血浆同型半胱氨酸水平升高,提示同型半胱氨酸水平升高是动脉粥样硬化性脑梗死的独立危险因素。     

高同型半胱氨酸和相关危险因素对青年脑梗死的影响

目的：探讨高同型半胱氨酸血症对青年脑卒中的影响，以及同型半胱氨酸与血脂、脂蛋白(α)、血压、血糖和血液流变学的相关性。方法：于2002-10／2004-10在武汉大学中南医院神经内科病房收集45岁以下的脑梗死患者47例，对照组为与脑血管病无关的同期住院患者23例。对所有研究对象都检测血压、血脂、脂蛋白(α)、血糖和血液流变学及同型半胱氨酸水平。结果：青年脑梗死患者的血清同型半胱氨酸浓度[(13．64&;#177;6．65)μmol／L]明显高于对照组[(10．27&;#177;3．77)μmol／L]，差异有统计学意义(t=2．252，P(0．05)；并且血清同型半胱氨酸浓度与舒张压(r=0．570，P(0．05)、全血低切黏度(r=0．551，P&;lt;0．05)、全血高切黏度(r=0．463，P(0．05)、血浆黏度(r=0．465，P(0．05)具有正相关性；与血脂、脂蛋白和血糖无相关性。结论：青年脑梗死患者的血清同型半胱氨酸水平高于同龄健康人，是青年脑梗死的危险因素之一。     

脑卒中类型、病变程度与血清同型半胱氨酸水平的相关性

背景越来越多的研究表明高同型巯乙胺酸(homocysteine,Hcy)是脑血管病的一个独立危险因素,控制Hcy水平对脑血管病发病率、复发率的影响是目前研究的焦点.目的研究不同类型脑卒中血清Hcy水平与常见危险因素的关系.设计病例对照研究.地点和对象2003-01/2003-06北京京煤集团总医院神经内科住院急性脑血管病患者75例,男64例,女11例,年龄33～80岁,均经头颅CT或MRI确诊.选择同期门诊非心脑血管病36例患者为对照组,男29例,女7例,年龄30～70岁.干预采用高压液相层析原理测定血清Hcy水平,用全自动生化仪测血脂、血糖.主要观察指标观察组和对照组血清Hcy水平,血糖、血脂水平,患高血压、脑血管病史者比例.结果血清Hcy水平脑卒中组[(18.75±1.8)μmol/L]与对照组[(12.84±2.36)μmol/L]比较(t=2.618,P＜0.05);脑梗死组[(20.59±1.78)μmol/L]与短暂性脑缺血组[(15.6±1.50)μmol/L]比较(t=2.012,P＜0.05);脑梗死组与脑出血组、短暂性脑缺血组与脑出血组间比较(P＞0.05);脑梗死组[(20.59±1.78)μmol/L]与对照组[(12.84±2.36)μmol/L]比较(t=2.872,P＜0.01);大面积(＞ 2 cm2)梗死组[(34.80±2.41)μmol/L]与一般脑梗死组[(18.79±1.62)μmol/L]比较(t=2.463,P＜0.05);有高血压组与无高血压组,高血脂组与血脂正常组,既往有脑血管病史者与无脑血管病者;有糖尿病者与无糖尿病者比较,差异均无显著性意义.结论高Hcy是脑血管病独立危险因素,与高血压、高血脂、糖尿病关系不大,在不同类型脑血管病中,与脑梗死关系密切,Hcy增高水平可能与梗死程度有关.     

系统性红斑狼疮血清同型半胱氨酸检测的临床意义

目的 :探讨血清同型半胱氨酸 (Hcy)检测对系统性红斑狼疮 (SLE)患者的临床意义。方法 :应用荧光偏振免疫分析法 (FPIA)测定 68例SLE患者和 40例正常人的血清Hcy水平 ,并与常用实验室指标ANA、抗ds DNA、抗DNP作比较。结果 :SLE患者血清Hcy水平为 ( 17 17± 4 0 5 ) μmol/L ,活动期SLE组血清Hcy水平为( 18 64± 3 63 ) μmol/L ,缓解期SLE组血清Hcy水平为 ( 16 45± 4 60 ) μmol/L ,分别与正常对照组的 ( 10 12± 3 15 )μmol/L相比较差异均有极显著性 (P <0 0 1) ,活动期与缓解期血清Hcy水平相比较差异有显著性 (P <0 0 5 ) ;SLE患者在ANA阳性组血清Hcy水平 ( 17 3 6± 4 0 3 ) μmol/L较ANA阴性组 ( 12 99± 1 94) μmol/L有极显著增高 (P <0 0 1) ;在抗ds DNA阳性组血清Hcy水平 ( 18 3 8± 3 60 ) μmol/L较阴性组 ( 16 2 9± 4 61) μmol/L差异有显著性 (P<0 0 5 ) ;抗DNP阳性组 ( 18 10± 3 0 4) μmol/L与阴性组 ( 16 2 8± 4 3 9) μmol/L血清Hcy水平比较差异有显著性 (P<0 0 5 )。结论 :血清Hcy水平在SLE患者中明显升高 ,提示Hcy检测对SLE有临床意义     

亚甲基四氢叶酸还原酶基因多态性及血浆同型半胱氨酸水平与脑血管病的关系

目的探讨亚甲基四氢叶酸还原酶(MTHFR)基因多态性及同型半胱氨酸(Hcy)水平与脑血管病的关系.方法应用聚合酶链反应-限制性片断长度多态性(PCR-RFLP)技术分析223例脑血管病患者及100名正常对照者的MTHFR基因多态性,同时应用高效液相色谱法(HPLC)测定其血浆Hcy水平.结果 MTHFR基因677位T等位基因携带频率脑血管病组(48.9%)显著高于正常对照组(30.5%,P<0.05),在脑出血患者组(53.3%)与脑梗死患者组(47.2%)之间差异无显著性(P>0.05);脑血管病组血浆Hcy水平[(20.01±8.89) μmol/L]显著高于对照组[(9.12±3.19) μmol/L,P<0.05],而脑出血患者组[(21.71±7.72) μmol/L]与脑梗死患者组[(19.35±8.51) μmol/L]间差异无显著性(P>0.05);各组中MTHFR TT型、TC型血浆Hcy浓度明显高于CC型.结论 MTHFR C677T突变可引起血浆Hcy水平升高,从而增加患脑血管病的危险度.     

循环酶法测定血清同型半胱氨酸的临床应用研究

目的探讨循环酶法(Enzymaticcyclingassay)测定血清同型半胱氨酸水平的临床应用价值。方法将循环酶方法与荧光偏振免疫法测定结果进行比较;首先利用高低值质控血清评价循环酶方法测定同型半胱氨酸的稳定性,并收集在我院住院且明确诊断的各20例糖尿病患者、高血压患者、冠心病患者、心梗脑梗患者、慢性肾功能不全患者及20名健康查体者的血清标本;另收集53例不同疾病患者血清标本,利用循环酶法与荧光偏振免疫法(FPIA)同时平行测定血清同型半胱氨酸水平。结果本方法的批内变异系数为3.07%(低值),3.99%(中值),4.21%(高值);批间变异系数分别为4.00%(低值),4.79%(中值)与4.58%(高值)。本法与荧光偏振免疫法相关性良好(r=0.994,n=53)。循环酶法测定不同疾病患者血清同型半胱氨酸水平分别为健康人(8.15±1.89)μmol/L,糖尿病组(8.88±1.36)μmol/L,高血压组(10.66±1.60)μmol/L,冠心病组(14.02±3.42)μmol/L,心梗或脑梗组(14.45±3.83)μmol/L,慢性肾功能不全组(15.21±3.50)μmol/L,结果与FPIA法测定值差异无统计学意义。结论循环酶法测定不同疾病患者血清同型半胱氨酸结果与临床上常规应用的FPIA法结果一致,但循环酶法可利用全自动生化分析仪快速、简便测定血清同型半胱氨酸。     

慢性肾功能衰竭患者高同型半胱氨酸血症与血清维生素B12、叶酸、脂蛋白(α)水平的关系

目的 探讨慢性肾功能衰竭(CRF)患者血清同型半胱氨酸(HCY)水平与其代谢因子叶酸、维生素B_(12)水平、血肌酐(SCr)及有关生化指标之间的关系。方法 本研究分为两组:正常对照组47例,慢性肾功能衰竭组46例。应用荧光偏振免疫分析(FPIA)方法测定血清HCY浓度,同时测定血清叶酸、维生素B_(12)、SCr、ALB、血脂、脂蛋白及瘦素(Leptin)浓度。结果 CRF患者血清HCY浓度(24.6±8.1)μmol/L比正常对照组(10.7±3.8)μmol/L,显著升高(P<0.001);CRF患者叶酸水平(14.5±8.8)ng/ml比正常人(5.5±2.5)ng/ml显著升高(P<0.001),血清维生素B_(12)(456±309)pg/ml比正常人(346±117)pg/ml明显升高(P<0.05);血清HCY浓度与叶酸、维生素B_(12)浓度呈明显负相关(分别为r=-0.586,P<0.01;r=-0.442,P<0.05);血清HCY浓度与SCr、Lp(a)浓度呈明显正相关,与瘦素及其它血脂水平无明显相关;血液透析患者透析后血清HCY水平(17.6±6.2)μmol/L比透析前(25.4±8.2)μmol/L明显下降(P<0.001)。结论CRF患者血清HCY水平比正常人明显升高;CRF患者肾功能、血清叶酸、维生素B_(12)水平是影响HCY水平的重要因素;血清脂蛋白(a)增高与高HCY血症密切相关;口服叶酸治疗不能满意纠正高HCY血症;血液透析可清除体内部分HCY。如何完全纠正CRF患者高HCY血症尚     

测定急性脑血管病患者血清白介素-8的临床意义

目的　了解急性脑血管病患者血清白介素-8(IL-8)改变的意义。方法　采用ELISA方法测定了74例急性脑血管病患者(40例脑出血,34例脑梗死)和30例健康对照者的血清IL-8含量。结果　急性脑血管病患者血清IL-8水平(10728±3816ng/L),明显高于正常对照组(5135±1329ng/L)。急性脑出血和急性脑梗死组患者血清IL-8水平(11332±3955ng/L和9773±4388ng/L)均明显高于正常对照组,而它们之间则无明显差别。结论　急性脑血管病患者急性期血清IL-8水平明显升高,提示IL-8可能参与了急性脑血管病的发病过程。     

脑卒中与血浆同型半胱氨酸水平的关系

背景很多研究表明高同型半胱氨酸血症可能是导致脑卒中发病的独立危险因素.目的探讨高同型半胱氨酸血症与脑梗死和脑出血发生之间的关系,并分析可能影响同型半胱氨酸水平的相关因素.设计病例-对照实验.单位浙江大学医学院附属第二医院神经内科.对象选择2003-01/11在浙江大学医学院附属第二医院的住院患者57例,其中脑卒中57例(脑出血组21例,脑梗死组36例),并以同期到本院作体检的健康人28例作为对照组.方法所有被试者均晨起空腹抽取静脉血2 mL,测定血浆同型半胱氨酸、维生素B12、叶酸、肌酐等含量,并对所有患者进行临床神经功能缺损程度评分,脑出血组患者根据CT摄片计算出每例患者的血肿体积.主要观察指标①各组被试者血浆同型半胱氨酸水平.②血浆同型半胱氨酸水平与叶酸,维生素B12,临床神经功能缺损程度评分及血肿体积的相关性.结果57例脑卒中患者和28例健康者全部进入结果分析.①脑梗死组、脑出血组男性和女性同型半胱氨酸的水平均高于同性别对照组[(25.2±21.4),(18.3±10.9),(11.5±2.9)μ mol/L;(22.8±18.9),(14.7±7.4),(10.8±2.6)μ mol/L,P＜0.05-0.01].脑梗死组和脑出血组基本接近(P＞0.05).②脑梗死组、脑出血组患者同型半胱氨酸水平与叶酸水平呈极显著负相关(r=-0.442,-0.531,P＜0.05),与维生素B12水平无显著相关性(r=-0.086,-0.111,P＞0.05).脑梗死组同型半胱氨酸水平与临床神经功能缺损程度评分无显著相关性(r=-0.139,P＞0.05),脑出血组同型半胱氨酸水平与临床神经功能缺损程度评分和血肿体积无显著相关性(r=0.225,0.425,P＞0.05).结论高同型半胱氨酸血症是脑梗死和脑出血的危险因素.血浆同型半胱氨酸水平与叶酸水平呈负相关,与维生素B12、临床神经功能缺损程度评分、血肿体积无显著相关.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.