双相障碍躁狂发作患者背外侧前额叶皮质氢质子磁共振波谱研究

目的：研究双相障碍躁狂发作患者背外侧前额叶皮质氢质子磁共振波谱(1H magnetic resonance spectroscopy, 1H-MRS)的特点。方法：选择20例双相躁狂发作未服药患者(双相躁狂组)和20例健康志愿者(正常对照组),对其背外侧前额叶皮质行1H-MRS扫描,检测N-乙酰天门冬氨酸(NAA)、谷氨酸复合物(Glx)和肌酸(Cr)3种代谢物含量。比较两组代谢物含量,计算NAA/Cr、Glx/Cr值,并对代谢指标与病程及Bech-Rafaelsen躁狂量表(BRMS)评分的相关性进行分析。结果：双相躁狂组左侧和右侧背外侧前额叶皮质NAA/Cr值明显低于正常对照组。双相躁狂组左侧背外侧前额叶皮质Glx/Cr值明显高于正常对照组(P<0.05),而其右侧背外侧前额叶皮质Glx/Cr值与正常对照组比较,差异无统计学意义(P>0.05)。双相躁狂组背外侧前额叶皮质的代谢指标与病程及BRMS无相关性(P均>0.05)。结论：双相障碍躁狂发作患者可能存在背外侧前额叶神经生化异常。     

偏执型精神分裂症和双相I型躁狂发作患者额叶氢质子波谱比较研究

目的 比较偏执型精神分裂症和双相障碍I型躁狂发作患者额叶氢质子波谱代谢物的异同.方法 对符合美国精神障碍诊断统计手册第4版(DSM-Ⅳ)诊断标准的25例精神分裂症偏执型患者、20例双相I型躁狂发作患者和32名正常对照进行氢质子波谱扫描,检测双侧额叶白质的N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌醇(mI)及肌酸(Cr)4种代谢产物,以Cr为参照物,分别计算双侧NAA/Cr、Cho/Cr及mI/Cr.统计方法采用多组间单因素方差分析、偏相关分析及额叶代谢物的左右对称性分析.结果 偏执型精神分裂症组左侧额叶Cho/Cr比双相I型躁狂组、正常对照组都升高[分别为(1.14±0.14)、(1.06±0.08)、(1.04±0.14)],差异有显著性(P=0.03,P=0.01);双相I型躁狂组与正常对照组相比差异无显著性(P>0.05).3组之间左侧额叶NAA/Cr、mI/Cr;右侧额叶NAA/Cr、Cho/Cr、mI/Cr;左右额叶代谢物的单侧化指数与1.0相比差异均无显著性(P均>0.05).未发现两患者组额叶代谢物与症状量表分、病程相关.结论 偏执型精神分裂症患者可能存在左侧额叶Cho/Cr的特异性升高.     

急性脑梗死代谢物变化的磁共振波谱定量分析及其与预后的相关性研究

目的应用质子磁共振波谱技术,研究急性脑梗死患者脑代谢物绝对浓度的变化及其中预后的相关性。方法选择2011年9月至2012年9月在汕头大学医学院第二附属医院就诊的25例急性缺血性脑梗死患者,行常规磁共振成像及磁共振波谱检查,采用LCModel频谱定量软件完成代谢物绝对浓度的定量分析,脑梗死3个月时的临床预后评分采用Barthel指数（BI）进行评定。结果急性脑梗死区NAA、肌酸、胆碱复合物、肌醇浓度显著下降,与对侧比较有显著性差异;脑梗死区乳酸浓度显著升高．与临床预后BI评分密切相关。结论磁共振波谱结合绝对定量技术,能直观、准确地显示急性脑梗死代谢物的变化;乳酸浓度对脑梗死的预后有预测价值。     

丙戊酸钠联合齐拉西酮对双相情感障碍Ⅰ型患者精神行为症状的影响

目的:探究丙戊酸钠联合齐拉西酮对双相情感障碍Ⅰ型患者精神行为症状的影响。方法:选取2018年8月—2019年2月在我院接受治疗的90例双相情感障碍Ⅰ型患者,采用随机数字表法将患者分为观察组与对照组,每组45例。对照组给予丙戊酸钠与奥氮平,观察组采用丙戊酸钠与齐拉西酮。对比两组临床疗效、治疗前后躁狂症状评分。结果:相较于对照组,观察组治疗总有效率较高、治疗后躁狂症状评分较低,差异有统计学意义(P<0.05)。结论:与奥氮平联合丙戊酸钠治疗相比,丙戊酸钠联合齐拉西酮在改善双相情感障碍Ⅰ型患者中具有较好的临床疗效,且躁狂症状得到较好控制,值得临床推广应用。     

丙戊酸钠缓释片联合盐酸齐拉西酮治疗双相情感障碍躁狂发作患者的临床疗效及对认知功能的影响

目的 探究丙戊酸钠缓释片与盐酸齐拉西酮联合应用于双相情感障碍躁狂发作症患者临床治疗中的疗效及其对患者认知功能的影响.方法 选取本院2018年1月至2019年12月收治的86例双相情感障碍躁狂发作症患者作为研究对象,按治疗方法分为参照组和研究组,各43例.参照组予以丙戊酸钠缓释片治疗,研究组予以丙戊酸钠缓释片与盐酸齐拉西...     

丙戊酸钠预防性治疗双相情感障碍的对照研究

以丙戊酸钠与碳酸锂对照预防性治疗４５例双相情戊障碍１年的随访观察，结果显示：两药的复发率近似；丙戊酸钠组的复发几乎都在前６周内，副反应较少，主要是胃肠道症状。对双相情感障碍的预防效果丙戊酸钠与碳酸锂相等。     

首发精神分裂症患者额叶白质及海马中脑代谢物质的变化

目的 利用氢质子磁共振波谱(1H-MRS)分析首发精神分裂症患者额叶白质及海马脑代谢物质的变化.方法 对符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的63例首发未经过药物治疗的精神分裂症患者和63例健康对照,分别测定额叶白质和海马脑代谢产物N-乙酰基天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、肌醇...     

青少年抑郁症患者额叶、海马及丘脑的1H-MRS分析研究

目的探讨青少年抑郁症患者额叶、海马及丘脑部位的神经生化代谢物质水平变化。方法利用质子磁共振波谱分析（1H-MRS）技术分别定量分析28例青少年抑郁症患者（抑郁组）和28例健康青少年（对照组）的前额叶皮质、海马及丘脑中生化代谢物质N-乙酰天门冬氨酸（NAA）、胆碱复合物（Cho）、谷氨酸复合物（Glx）、肌酸复合物（Cr2、Cr）及肌醇（mI）的水平,并计算NAA/Cr、Cho/Cr、GLx/Cr、mI/Cr、Cr2/Cr的值。结果抑郁症组双侧前额叶皮质和海马组织的NAA/Cr值均明显低于正常对照组（P〈0.01或P〈0.05）。抑郁症组双侧前额叶皮质Cho/Cr值均高于正常对照组（P〈0.05或P〈0.01）。右侧额叶和右侧海马的Glx/Cr值均低于正常对照组（P〈0.05）,差异有统计学意义。右侧海马mI/Cr值高于正常对照组（P〈0.05）。丘脑中各种代谢物的相对含量在抑郁症组与对照组间的比较,差异不显著（P〉0.05）。结论青少年抑郁症患者的额叶和海马是发病过程中的主要影响部位,其中NAA水平的变化与抑郁症的发生最为密切。     

丙戊酸镁与丙戊酸钠及碳酸锂治疗躁狂发作对照研究

目的：比较丙戊酸镁与丙戊酸钠及碳酸锂治疗双向情感障碍的疗效及不良反应。方法：将120例双相情感障碍躁狂发作的患者随机均分为丙戊酸镁组、丙戊酸钠组及碳酸锂组,在治疗前,治疗2、4、6周末分别用Bech-Rafaels—en躁狂量表（BRMS）和临床疗效总评量表（CGI）及副反应量表（T段S）评定疗效和不良反应。结果：三组治疗2、4、6周后BRMS总分,及各因子分比治疗前明显降低,差异显著。治疗2、4、6周末TESS评分,丙戊酸镁组分别显著低于丙戊酸钠及碳酸锂组,差异有显著性,丙戊酸钠组显著低于碳酸锂组,差异有显著性。结论：丙戊酸镁治疗躁狂发作疗效好,起效快,不良反应小。     

喹硫平联合丙戊酸钠治疗双相情感障碍伴躁狂发作的疗效

目的:观察丙戊酸钠联合喹硫平治疗双相情感障碍伴躁狂发作的临床疗效。方法:选取60例双相情感障碍伴躁狂发作患者,采用随机数字表法分为对照组和观察组各30例,对照组给予小剂量氯氮平联合丙戊酸钠治疗,观察组给予喹硫平联合丙戊酸钠治疗,比较治疗6周后两组的临床疗效。结果:治疗前,两组患者的杨氏躁狂评定量表(YMRS)评分、贝克-拉范森躁狂量表(BRMS)评分比较,差异无统计学意义(P>0.05);治疗后,观察组YMRS评分、BRMS评分水平均明显低于对照组,差异有统计学意义(P<0.05);观察组患者治疗总有效率为96.7%,明显高于对照组的80.0%,差异有统计学意义(P<0.05)。结论:喹硫平联合丙戊酸钠治疗双相情感障碍伴躁狂发作的效果优于小剂量氯氮平联合丙戊酸钠,能有效抑制患者躁狂发作,且有助于促进患者认知功能的恢复。     

Initial study of magnetic resonance diffusion tensor imaging in brain white matter of early AIDS patients

Background HIV is a neurotropic virus which can cause brain white matter demyelination,gliosis,and other pathological changes that appear as H IV encephalitis or AIDS dementia.The purpose of this study...     

扩散峰度成像评估复发缓解型多发性硬化正常表现脑白质微结构变化

目的 采用扩散峰度成像(diffusion kurtosis imaging,DKI)评估复发缓解型多发性硬化(relapsing remit-ting multiple sclerosis,RRMS)正常表现脑白质微结构变化.方法 对24例RRMS患者(RRMS组)及28例健康志愿者(对照组)进行DKI扫描,获得DKI相关参数,测量额叶、顶叶、枕叶、颞叶白质、胼胝体膝部、胼胝体压部、内囊前后肢,包括FA(fractional anisotropy),MD(mean diffusivity),DR(radial diffusivity),MK(mean kurtosis)及KA(axial kurtosis)值,进行比较分析.结果 与健康对照组相比,RRMS患者额叶(0.39±0.06)、顶叶(0.40±0.05)、枕叶(0.43±0.07)、颞叶(0.42±0.06)白质及内囊后肢(0.69±0.04)FA值明显降低(P＜0.05),而额叶[(0.97±0.08) μm2/ms]、顶叶[(0.93±0.08) μm2/ms]白质、内囊前肢[(0.95±0.10) μm2/ms]、内囊后肢[(0.91±0.05)μm2/ms] MD值显著升高(P＜0.05),内囊前肢(0.89±0.09)、内囊后肢(1.13±0.11)MK值显著降低(P＜0.05),额叶[(0.76±0.09)μm2/ms]、顶叶[(0.73±0.07)μm2/ms]、颞叶[(0.77±0.08)μm2/ms]白质、内囊前肢[(0.58±0.06)μm2/ms]、内囊后肢[(0.47±0.05)μm2/ms]DR值及顶叶(0.95±0.07)白质MK值显著升高(P＜0.05),额叶(0.74±0.07)、枕叶(0.71±0.06)、颞叶(0.65±0.06)白质及内囊前肢(0.65±0.06)、内囊后肢(0.57±0.06)、胼胝体膝部(0.48±0.05)、胼胝体压部(0.46±0.07) KA值显著降低(P＜0.05).结论 DKI可评估RRMS正常表现脑白质微结构的变化.     

Screening for bipolar disorder in a primary care practice

Context  Bipolar disorder consists of episodes of manic and depressive symptoms. Efforts to screen for depression in a primary care setting without assessment of past manic symptoms can lead to incorrect diagnosis and treatment of bipolar disorder. Objectives  To screen for bipolar disorder in adult primary care patients and to examine its clinical presentation and effect on functioning. Design, Setting, and Participants  A systematic sample of 1157 patients between 18 and 70 years of age who were seeking primary care at an urban general medicine clinic serving a low-income population. The study was conducted between December 2001 and January 2003. Main Outcome Measures  Prevalence of bipolar disorder, its treatment and patient functioning. Study measures included the Mood Disorder Questionnaire, the PRIME-MD Patient Health Questionnaire, the Medical Outcomes Study 12-Item Short Form health survey, the Sheehan Disability Scale, data on past mental health treatments, and a review of medical records and International Classification of Diseases, Ninth Revision codes for each visit dating from 6 months prior to the screening day. Results  The prevalence of receiving positive screening results for lifetime bipolar disorder was 9.8% (n = 112; 95% confidence interval, 8.0%-11.5%) and did not differ significantly by age, sex, or race/ethnicity. Eighty-one patients (72.3%) who screened positive for bipolar disorder sought professional help for their symptoms, but only 9 (8.4%) reported receiving a diagnosis of bipolar disorder. Seventy-five patients (68.2%) who screened positive for bipolar disorder had a current major depressive episode or an anxiety or substance use disorder. Of 112 patients, only 7 (6.5%) reported taking a mood-stabilizing agent in the past month. Primary care physicians recorded evidence of current depression in 47 patients (49.0%) who screened positive for bipolar disorder, but did not record a bipolar disorder diagnosis either in administrative billing or the medical record of any of these patients. Patients who screened positive for bipolar disorder reported worse health-related quality of life as well as increased social and family life impairment compared with those who screened negative. Conclusions  In an urban general medicine clinic, a positive screen for bipolar disorder appears to be common, clinically significant, and underrecognized. Because of the risks associated with treating bipolar disorder with antidepressant monotherapy, efforts are needed to educate primary care physicians about the screening, management, and pharmacotherapy of bipolar disorders.      

肺癌患者外周血CD4+T淋巴细胞Th1/Th2分化情况检测与分析

目的观察肺癌患者外周血CD4+T淋巴细胞中Th1/Th2分化情况与反应状态,为肺癌的诊断和免疫治疗研究提供依据。方法以干扰素-γ(IFN-γ)和白细胞介素-4(IL-4)代表Th1和Th2细胞功能,应用细胞因子诱生技术和流式细胞仪,检测25例肺癌患者及25例健康志愿者外周血CD4+T淋巴细胞诱生的IFN-γ和IL-4水平。结果肺癌患者外周血CD4+T淋巴细胞诱生的IFN-γ水平与健康对照组比较明显降低,差异有统计学意义(P<0.05),IL-4水平在2组间差异无统计学意义(P>0.05)。结论肺癌患者外周血CD4+T淋巴细胞向Th1细胞的分化明显减少,向Th2细胞的分化无明显变化,Th1向Th2方向的漂移可能是肺癌细胞生长和免疫逃避的机制之一。     

正常人脑~1H-MRS代谢产物定量的相关影响因素分析

目的探讨不同回波时间(TE)、受检者年龄、性别、侧别对正常成人脑1H-MRS额叶及基底节区磁共振波谱(magneticresonance spectroscopy MRS)代谢物定量的影响。方法通过对17位健康志愿者(20-60岁)采用多体素点分辨波谱(PRESS)序列进行1H-MRS检查,TE分别采用30ms、135ms,对比双侧额叶及基底节区同一感兴趣区NAA/Cr,Cho/Cr值,并且按照TE、年龄、性别、左右分组比较各组间结果。结果 (1)TE为135时可以获得更高质量的图像;长、短TE两组间左右额叶及基底节区NAA/Cr比值及左右基底节区Cho/Cr比值对比有显著性差异。(2)在同一TE参数下,左右额叶对称部位感兴趣区NAA/Cr值对比有显著差异,而性别对波谱代谢物相对定量值的无显著影响;(3)双侧额叶NAA/CR及右侧基底节区NAA/CR值与年龄呈显著负相关。结论不同回波时间、年龄及侧别对MRS代谢物会产生影响,而性别对MRS代谢产物无影响。     

弥散张量成像揭示部分及全面发作癫痫患者的丘脑改变

目的分析部分发作(PS)及部分继发全面发作癫痫患者(SGC)脑弥散张量的改变情况。方法本研究纳入11例PS患者,11例SGC患者及15例正常对照者。弥散张量成像采集采用3.0T磁共振仪,用15个方向的单次激发平面回波序列。采集数据用DTI-Studio软件计算每个受试者表观弥散系数图,然后用基于体素(VBA)的方法进行分析,取校正后P<0.05为有意义区域。基于VBA的发现,本研究对双侧丘脑的表现弥散系数图(ADC)值进行感兴趣区(ROI)分析,采用SPSS 11.5统计软件包进行统计分析,以P<0.05为差异有统计学意义。结果VBA结果显示PS和SGC患者均存在双侧上纵束、胼胝体及双侧颞叶等区域白质ADC值的增加。但双侧丘脑ADC值增加只有在SGC患者才能观察到。ROI分析结果同样显示SGC患者双侧丘脑ADC值的增加。结论本研究结果支持皮质丘脑环路假说,即丘脑功能的异常导致继发全面癫痫的发作。     

METABOLIC ABNORMALITIES IN MESIAL TEMPORAL LOBE EPILEPSY PATIENTS DEPICTED BY PROTON MR SPECTROSCOPY USING A 3.0T MR SCANNER

MESIAL temporal lobe epilepsy(MTLE)isthe most prevalent cause of both focal andrefractory seizures·Surgical removal of thefocus eliminates or greatly reduces seizures in about90%of the patients with MTLE who have concordant hippocam-pal atrophy·1Mesial …     

脑卒中后抑郁患者的磁共振波谱分析

目的应用磁共振波谱（MRS）分析技术,探讨脑卒中后抑郁（PSD）患者前额、颞叶、基底节区的MRS的变化特征。方法将48例PSD患者组、27例卒中后无抑郁组（no-PSD组）和15例正常对照组（NC）予以MRS检查,分析其变化特点,并进行对比。结果MRS检查显示：PSD组双侧额叶、基底节区ROI的NAA/Cr比值低于no-PSD、NC组;Cho/Cr的比值高于no-PSD、NC组（P〈0.05）,PSD组双侧颞叶ROI的比值低于NC组,Cho/Cr的比值高于no-PSD、NC组（P〈0.05）,而双侧颞叶ROI的NAA/Cr比值与no-PSD组比较差异无统计学意义;PSD组、no-PSD组的NAA/Cr比值左侧较右侧高（P〉0.05）,Cho/Cr比值的无明显差异。结论额叶、颞叶、基底节区等部位的脑血管病导致的神经化学的改变可能构成神经生物学基础,也说明了额叶、颞叶、基底节区在抑郁症的发病机制中的重要作用。     

Application of T2* measurement on gradient echo T2*-weighted imaging in differential diagnosis of intracranial hemorrhage and calcification

Background  Differential diagnosis of intracranial hemorrhage and calcification is a common problem encountered in clinical imaging diagnosis. The purpose of this study was to investigate the feasibility of T2^* measurement on gradient echo (GRE) T2^*-weighted imaging (T2^*WI) in differential diagnosis of intracranial hemorrhage and calcification.

Methods  Thirty-eight hemorrhagic foci in 18 patients and 11 calcification foci in seven patients were included in this study. The diagnosis of hemorrhage and calcification was confirmed in all cases with enhanced T2^* weighted angiography (ESWAN) magnetic resonance imaging (MRI) and CT respectively. The significance for the difference of T2^* value between the central and peripheral areas of hemorrhage and calcification lesions was tested with univariate analysis of variance.

Results  The detection rate of GRE T2^*WI on intracranial hemorrhage was 1.9-fold higher than that of CT, especially for the hemorrhage in the brainstem and cerebellum. However, GRE T2^*WI was far less sensitive to calcification than CT. There was a significant difference in the T2^* value between the central area of hemorrhage and calcification (P <0.001), though no difference in the T2^* value was obtained between the peripheral area of hemorrhage and calcification (P >0.05).

Conclusions  Quantitative measurement of T2^* value on GRE T2^*WI with a single MRI examination provides a fast, convenient, and effective means in differential diagnosis between intracranial hemorrhage and calcification, which may thus reduce the medical cost and save precious time for clinical management.