轻度血管性认知障碍的结构影像学研究

血管性认知障碍(vascular cognitive impairment,VCI)包括无痴呆型血管性认知障碍(vascular cognitive impairment no dementia,VCIND)、血管性痴呆(vascular dementia,VaD)及混合性痴呆这一过程[1].神经影像学是VCI研究和诊...     

中枢神经系统肿瘤中英文对照名词词汇（五）

血管内皮生长因子vascular endothelial growth factor(VEGF)血管内皮生长因子受体vascular endothelial growth factor receptor(VEGFR)血管生成vasculogenesis血管生成拟态vasculogenic mimicry(VM)血管生成素angiogenin(Ang)血管通透性因子vascular permeability factor(VPF     

Combined measurement of thyroid and plasma homocysteic acid for detecting the severity of vascular dementia

BACKGROUND: Recent researches demonstrate that onset of cerebral infarction always accompanies with obvious changes of function of thyroid axis; while, high-homocysteic acidemia has been proved as one of risk factors of vascular dementia and Alzheimer disease. Meanwhile, it is found that level of plasma homocysteic acid is positive correlation with injured degrees of cognitive function and brain damage. OBJECTIVE: To observe the changes of function of thyroid and level of homocysteic acid among patients with vascular dementia and compare with those patients without dementia cerebral infarction. DESIGN: Randomized grouping and contrast observation. SETTING: Department of Neurology, People's Hospital Affiliated to Yunyang Medical College, South China Hospital of Wuhan University. PARTICIPANTS: A total of 38 patients with vascular dementia were hospitalized in the Department of Neurology, People's Hospital Affiliated to Yunyang Medical College from February 2004 to December 2005. All patients met the diagnostic criteria of the Fourth Edition of Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) established by American Psychiatric Association. Based on educational degrees, Mini-mental Status Examination (MMSE) was classified into illiteracy (≤ 17 points), education of primary school (educational duration ≤ 6 years, ≤ 24 points) and education of middle school or above (educational duration > 6 years, ≤ 24 points). Forty patients with non-dementia cerebral infarction were regarded as the control group and checked with CT examination. There were no significant differences of sex and age between the two groups. All patients and relatives were provided the consent. METHODS: Within 24 hours after hospitalization, patients with vascular dementia received MMSE scores, and the degrees were classified based on the scoring results: mild (20-24 points), moderate (10-19 points) and severe (below 10 points). Levels of thyroxine were measured with radioimmunodetection and content of homocysteic acid was measured with high performance liquid chromatogram (HPLC) electrochemical detection. MAIN OUTCOME MEASURES: Levels of homocysteic acid and thyroxine among patients with vascular dementia and non-dementia cerebral infarction. RESULTS: A total of 38 patients with vascular dementia and 40 patients with non-dementia cerebral infarction were involved in the final analysis. ① Levels of triiodothyronine (T3), thyroxine (T4) and free T3 (FT3) were (0.9±0.4) μg/L, (92.9±26.4) μg/L and (3.9±1.8) pmol/L in vascular dementia group respectively, which were higher than those in control group [(1.3±0.3) μg/L, (110.2±28.7) μg/L, (7.2±2.1) pmol/L, t =2.766 6-7.433 6, P < 0.01]; while, level of homocysteic acid was (29.57±7.12) μmol/L in vascular dementia group, which was higher than that in control group [(24.53±4.98) μmol/L, t =3.637 7, P < 0.01]. There were no significant differences of free T4 (FT4) and thyrotropic-stimulating hormone (TSH) between the two groups (P > 0.05). ② Levels of FT3 of patients with mild, moderate and severe vascular dementia were (1.0±0.2), (0.9±0.1) and (0.8±0.1) μg/L, respectively; levels of homocysteic acid were (26.52±4.84), (29.59±5.56) and (32.71±6.17) μmol/L, respectively. There were significant differences among patients at the three degrees of vascular dementia (F =3.59－32.4, P < 0.01). However, there were no significant differences of T4, FT4 and TSH among the three kinds of patients (P > 0.05). CONCLUSION: Levels of thyroxine of patients with vascular dementia decrease; however, levels of homocysteic acid increase. Therefore, the results can indirectly reflect severities of vascular dementia.     

皮质下缺血性脑血管病的神经心理学改变

概述皮质下缺血性脑血管病(subcortical ischemic vascular diseases,SIVD)是造成血管性认知功能损害(vascular cognitive impairment,VCI)的重要原因,它所导致的认知损害是VCI中具有同质性和最为常见的亚型(皮质下型VCI)。VCI覆盖了从轻微的     

血管性认知障碍的诊断标准:国际血管性行为与认知障碍学会的申明

<正>长期以来,脑血管病(CVD)就被认为是认知损害的一个重要原因,但是有关脑血管病后认知障碍的概念化却有着一段多变的历史。"动脉变硬"或脑的动脉粥样硬化是"老化"的原因,是存在已久的观点,在20世纪60年代受到了来自英格兰纽卡斯尔的神经病理学研究的质疑。这些研究表明,血管性痴呆(vascular dementia,Va D)与超过一定程度的多发性脑梗死有关,而且与阿尔茨海默病(Alzheimer's     

血管性认知障碍诊断标准的演变与解读

正1血管性认知障碍的概念血管性认知障碍(vascular cognitive impairment,VCI)这一概念在1995年由Bowler等提出~([1]),包括重度血管性痴呆(vascular dementia,VaD)、伴血管病变的阿尔茨海默病(Alzheimer’s disease,AD)和非     

Doppler examination and cerebral arterial stricture in patients with ischemic stroke

With the development of interventional therapy, it is necessary for evaluating cerebral vessels to instruct treatment and determine prognosis of patients with ischemic stroke; however, correlation of distribution of infarction focus and clinical symptoms with degrees of cerebrovasoular stricture is still unclear.OBJECTIVE: To evaluate the characteristics of cerebral arterial stricture of patients with ischemic stroke with transcranial Doppler (TCD) and color duplex flow imaging (CDFI) and compare the correlation between distribution of cerebral infarction focus and clinical types with magnetic resonance imaging (MRI).DESIGN: Contrast observation.SETTING: Department of Neurology, the First Hospital of Jilin University.PARTICIPANTS: A total of 159 patients with ischemic stroke were selected from the Department of Neurology, the First Hospital of Jilin University from January to December 2005, including 106 males and 53 females aged from 27 to 88 years. Bases on diagnostic criteria of cerebrovascular disease established by Rao et al, clinical manifestations of all patients were evaluated with CT or nuclear magnetic resonance. All patients provided the confirmed consent.METHODS: The accepted patients received TCD and CDFI examination at 1 week after onset of ischemic stroke. Among them, 112 patients received cerebrovascular imaging examination simultaneously. MRI was used to check cerebral infarction focus and cerebrovascular stricture ＞ 50% was regarded as the accepted vessels. In addition, DWI-T2 TCD (Germany) was used to check middle cerebral artery, and degrees of middle cerebral artery were classified into mild, moderate and severe stricture based on blood velocity (140 cm/s,180 cm/s). Stroke was classified based on characteristics of infarction focus and clinical symptoms showed with MRI and correlation with degrees of cerebrovascular stricture was analyzed simultaneously.MAIN OUTCOME MEASURES: Correlation between the characteristics of ischemic stroke and clinical symptoms checked with TCD and CDFI.RESULTS: A total of 159 patients with ischemic stroke were involved in the final analysis; in addition, 112 oases received cerebrovascular imaging examination simultaneously. ① MRI results of 159 patients with cerebral artery occlusive disease (CAOD): There were 131 patients (82.3%) with cerebral infarction, 40 (25.2%)with transient ischemic attack and 4 (2.5%) with subclavian steal syndrome (SSS). ② Infarction types with MRI examination: There were 33 patients (20.8%) with solitary cerebral infarction and 98 (61.6%) with multiple-cerebral infarction. ③ Results of TCD, CDFI, MRI angiography, CT angiography and digital subtraction angiography (DSA): Among 112 patients, 181 lesion sites (61 .8%) were located in cranium and 112 lesion sites were located out of cranium; especially, lesion site was mostly observed in stem of middle cerebral artery (31.2%) and watershed of basilar artery (7.2%) in cranium and the beginning site of internal carotid artery (21 .4%) out of cranium. ④ Correlation of vascular stricture checking with TCD, MRI and clinical diagnosis: On one hand, MRI and clinical diagnosis demonstrated that 68 patients had a watershed infarction; meanwhile,TCD examination indicated that there were 3 patients with mild vascular stricture, 24 with moderate vascular stricture and 36 with severe vascular stricture. On the other hand, among 68 patients with non-watershed infarction, there were 27 patient with mild vascular stricture, 26 with moderate vascular stricture and 15 with severe vascular stricture. There were significant differences (x2 =26.854, P =0.001 ). Clinical diagnosis indicated that 40 patients had transient ischemic attack and TCD examination demonstrated that there were 8 patient with mild vascular stricture, 12 with moderate vascular stricture and 20 with severe vascular stricture. There were significant differences as compared with 68 patients with watershed infarction (x2 =21.258, P =0.001). ⑤Correlation of vascular stricture checking with CDFI, MRI and clinical diagnosis: On one hand, among patients who were determined as watershed infarction with MRI and clinical diagnosis, CDFI examination indicated that there were 32 patients with mild vascular stricture at neck, 25 with moderate vascular stricture and 6 with severe vascular stricture. On the other hand, among patients with non-watershed infarction, there were 48 patient with mild vascular stricture, 18 with moderate vascular stricture and 2 with severe vascular stricture.There were significant differences (x2 =6.018, P =0.019). Among patients with transient ischemic attack checking with clinical diagnosis, there were 23 patient with mild vascular stricture, 9 with moderate vascular stricture and 8 with severe vascular stricture. There were no significant differences as compared with patients with non-watershed infarction (x2 =0.597, P=0.440).CONCLUSION: ① TCD and CDFI are effective marks to determine cerebral arterial stricture and hemodynamical changes. ② Infarction and transient ischemic attack at watershed are generally clinical phenotypes of CAOD patients and infarction at watershed is correlated with degrees of cerebrovascular stricture.③ TCD, MRI and clinical analysis of stroke types are significant for instructing treatment and evaluate prognosis.     

面肌痉挛显微血管减压术后迟发性面瘫

显微血管减压(micro vascular decompression,MVD)手术是治疗面肌痉挛(faeial spasm)的有效方法.MVD术后,部分患者会出现患侧迟发性面瘫(deIayed facial palsy,DFP),表现为患侧非手术即刻出现的周围性面瘫.迟发性面瘫的发生率、发生时间、可能病因、治疗和预后都有一定的规律.     

血管性认知功能障碍与C-反应蛋白、同型半胱氨酸、维生素B12及叶酸的相关性研究

目的 探讨血管性认知功能障碍(vascular cognitive impairment,VCI)患者血C-反应蛋白(CRP)、血浆同型半胱氨酸(homocystine,Hcy)、VitB12、叶酸(folic acid,FA)水平的差异及其与认知功能障碍严重程度的相关性。方法 选择2014年12月～2016年6月南京鼓楼医院集团宿迁市人民医院神经内科门诊及住院患者共100例,根据MoCA量表评分划分为3组,具体为正常对照(normal control,NC)组30例、非痴呆型血管性认知障碍(vascular cognitive impairment no dementia, VCIND)组 39例和血管性痴呆(vascular dementia,VD)组31例; 所有患者均取晨起空腹肘静脉血测定血CRP、血Hcy、VitB12、FA水平。结果(1)VCIND组患者 CRP和Hcy水平较NC组高,VtimaniB12和血清FA水平较NC组低(P<0.05);(2)VD组患者与VCIND组患者比较血CRP和Hcy水平明显升高(P<0.05),血VitB12和血FA水平明显下降(P<0.05);(3)VD组患者CRP和Hcy水平较NC组高,VtimaniB12和血清FA水平较 NC组低(P<0.01);(4)VCI(VD组+VCIND组)患者血CRP、Hcy水平与MoCA量表评分呈负相关(r=-0.56,P<0.05),血VitB12和FA水平与MoCA量表评分无明显相关性(r=0,P>0.05)。结论 VCI患者血清CRP水平升高,血浆Hcy水平升高与VCI具有相关性,血CRP水平升高及高Hcy可能是VCI发病及认知损害进展的重要因素。     

皮质下缺血性血管病患者认知功能的弥散张量磁共振研究

目的明确弥散张量成像(diffusion tensor imaging,DTI)对皮质下型血管性认知障碍的识别作用。方法42例皮质下缺血性血管病(subcortical ischemic vascular desease,SIVD)患者经过认知测试,被分为无认知障碍(no cognitive impairment,NCI)组,血管性认知障碍非痴呆(vascular cognitive impairment no dementia,VCIND)组和血管性痴呆(vascular dementia,VaD)组。分析其认知测试指标与DTI参数之间的关系。结果VCIND组、VaD组全脑白质平均弥散度(mean diffusivity,MD)分别为(0.89±0.05)×10-9m2.s-1和(0.93±0.05)×10-9m2.s-1,与NCI组(0.84±0.03)×10-9m2.s-1相比,有统计学差异(均P<0.01),VCIND组、VaD组各向异性分数(fractional anisotropy,FA)分别为(0.35±0.02)和(0.34±0.02),与NCI组(0.37±0.02)相比,亦有统计学差异(均P<0.01)。全脑白质MD与注意执行功能和记忆功能测验评分的相关系数分别为-0.538和-0.500,均P<0.01;FA值与注意执行功能和记忆功能测验评分的相关系数分别是0.439和0.411,均P<0.01。排除VaD患者后,MD与注意执行功能的相关系数为-0.401,P<0.05。结论 VCIND和VaD组的MD和FA值与NCI组有统计学差异,SIVD患者的注意执行与记忆功能与白质完整性独立相关。     

血浆同型半胱氨酸水平对血管性帕金森综合征的影响

<正>近来研究表明,同型半胱氨酸(homocysteine,Hcy)增高引发的高Hcy血症与脑血管病、痴呆、帕金森病等疾病的发生和发展有十分密切的关系。本文对中老年人群的血浆同型Hcy与脑梗死、血管性帕金森综合征(vascular parkinsonism,VP)的相关性进行探讨。     

血管性痴呆临床诊断标准探讨

<正> 血管性痴呆(vascular dementia,VaD)是指由各种脑血管病引起脑组织损害而产生的痴呆综合征,是临床常见的老年期痴呆的一种类型,其患病率位居老年期痴呆类型的第二位,仅次于阿尔茨海默病(Alzheimer disease,AD)。VaD病因复杂,症状表现多样,临床诊断存在一定困难。随着对痴呆研究的不断深入,VaD的概念已不足以涵盖所有与血管因素有关的各种水平的认知障碍,表现出明显的滞后性和局限性,其目前的诊断标准也存在很大的局限性,不利于VaD的早期诊治和预防。本     

啮齿类血管性痴呆动物模型

<正>由脑血管因素引起脑组织血液供应障碍导致的脑功能衰退,表现为认知功能缺损,统称为血管性痴呆(vascular dementia,VD)[1],亦称血管性认知障碍(vascular cognitive impairment,VCI)[2]。VD不是一个单一的疾病,而是一类综合征,大、小动脉病变,弥漫性缺血性白质病变,心脏脱落栓子的栓塞,血流动力学改变,出血,血液学因素和遗传性疾病等不同的血管病理变化均可引起VD症状。流行病学研究显示在欧洲和北美,VD是继老年性痴呆(Alzheimer’s disease,AD)之后引起老     

血管性认知损害

随着老龄化社会的到来,老年期痴呆越来越成为严重的社会公共卫生问题。血管性痴呆(vascular dementia,VaD)是继阿尔茨 海默病(Alzheimer disease,AD)之后第二位常见的老年期痴呆。血管性认知损害(vascular cognitive impairment,VCI)指由于血管因素引起的不同程度的认知障碍。这一概念的提出,能早期识别由于血管因素引起的智能衰退,通过积极干预,减缓或避免脑功能严重损害,因而引起了广泛关注。     

脑小血管病与血管性认知功能损害

血管性痴呆(vascular dementia,VaD)是第二常见的痴呆类型,在65岁以上的人群中占10%～15%,其患病率每5.3年即增加1倍,是血管性认知功能损害(vascular cognitiveimpairment,VCI)最严重的形式。2011年7月21日,美国心脏学会/美国卒中学会(AmericanHeart Association/American StrokeAssociation,AHA/ASA)发表联合声明,系统阐述了VCI,并进一步强调血管性因素是VCI和痴呆的重要病因。     

血管性痴呆与神经多肽

<正>血管性痴呆(vascular dementia,VD)是由脑血管病导致的获得性、持续性智能障碍综合征。随着社会结构的日益老龄化,VD的发病率与日俱增,给社会和家庭带来极大的负担。近年来的研究证明,脑内神经递质的含量变化与VD的发生关系密切。乙酰胆碱(acetylcholine,Ach)、一氧化氮(nitricoxide,     

Effects of electroacupuncture on the expression of p70 ribosomal protein S6 kinase and ribosomal protein S6 in the hippocampus of rats with vascular dementia

This study investigated the mechanism underlying electroacupuncture therapy for vascular dementia through electroacupuncture at the acupoints of Baihui (DU20), Dazhui (DU14), and bilateral Shenshu (BL23) in a rat model of vascular dementia produced by bilateral middle cerebral artery occlusion. Morris water maze test showed that electroacupuncture improved the learning ability of vascular dementia rats. Western blot assay revealed that the expression of p70 ribosomal protein S6 kinase and ribosomal protein S6 in vascular dementia rats was significantly increased after electroacupuncture, compared with the model group that was not treated with acupuncture. The average escape latency was also shortened after electroacupuncture, and escape strategies in the spatial probe test improved from edge and random searches, to linear and trending swim pathways. The experimental findings indicate that electroacupuncture improves learning and memory ability by up-regulating expression of p70 ribosomal protein S6 kinase and ribosomal protein S6 in the hippocampus of vascular dementia rats.     

A meta-analysis of Chinese herbal medicines for vascular dementia

OBJECTIVE: To investigate the efficacy and safety of Chinese herbal medicines in the treatment of patients with vascular dementia. DATA RETRIEVAL: We retrieved publications from Cochrane Library (2004 to July 2011), PubMed (1966 to July 2011), the Chinese Science and Technique Journals Database (1977 to July 2011), the China National Knowledge Infrastructure (1979 to July 2011), Google Scholar (July 2011), and the Chinese Biomedical Database (1977 to July 2011) using the"Chinese medicine OR Chinese herbal medicine" and "vascular dementia OR mild cognition impair OR multi-infarct dementia OR small-vessel dementia OR strategic infarct dementia OR hypoperfusion dementia OR hemorrhagic dementia OR hereditary vascular dementia". SELECTION CRITERIA: Randomized controlled trials comparing Chinese herbal medicines with placebo/western medicine in the treatment of patients with vascular dementia were included. Diagnostic standards included Diagnostic and Statistical Manual of Mental Disorders-IV, and National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherché et l’Enseignement en Neurosciences. Two participants independently conducted literature screening, quality evaluation and data extraction. The quality of each trial was assessed according to the Cochrane Reviewers’ Handbook 5.0. MAIN OUTCOME MEASURES: Effective rate, Mini-Mental State Examination scores, Hasegawa Dementia Scale scores, and incidence of adverse reactions. RESULTS: We identified 1 143 articles discussing the effects of Chinese medicine on vascular dementia. Thirty-one of these were included in the analysis. These studies involved a total of 2 868 participants (1 605 patients took Chinese medicine decoctions (treatment group); 1 263 patients took western medicine or placebo). The results of our meta-analysis revealed that Chinese herbal remedies in the treatment group were more efficacious than the control intervention (relative risk (RR)=1.27; 95% confidence interval (CI): 1.18-1.38, P<0.01). Mini-Mental State Examination scores were higher in patients taking Chinese herbal medicines than in those in the control group (weighted mean difference (WMD)=2.83; 95%CI: 2.55-3.12, P<0.01). Patients in the treatment group showed better disease amelioration than those in the control group (Hasegawa Dementia Scale scores; WMD=2.41, 95%CI: 1.48-3.34, P<0.01). There were also considerably fewer adverse reactions among those in the treatment group compared with those in the control group (RR=0.20, 95%CI: 0.08-0.47, P<0.01). CONCLUSION: Chinese herbal medicine appears to be safer and more effective than control measures in the treatment of vascular dementia. However, the included trials were generally low in quality. More well-designed, high-quality trials are needed to provide better evidence for the assessment of the efficacy and safety of Chinese medicines for vascular dementia.     

Neuroprotection against vascular dementia after acupuncture combined with donepezil hydrochloride:P300 event related potential

Acupuncture can be used to treat various nervous system diseases. Here, 168 vascular dementia patients were orally administered donepezil hydrochloride alone (5 mg/day, once a day for 56 days), or combined with acupuncture atShenting (DU24),Tianzhu (BL10),Sishencong (Extra), Yintang (Extra),Renzhong (DU26),Neiguan (PC6),Shenmen (HT7),Fengchi (GB20),Wangu (GB12) andBaihui (DU20) (once a day for 56 days). Compared with donepezil hydrochloride alone, P300 event related potential latency was shorter with an increased ampli-tude in patients treated with donepezil hydrochloride and acupuncture. Mini-Mental State Examination score was also higher. Moreover, these differences in P300 latency were identiifed within different infarcted regions in patients treated with donepezil hydrochloride and acupuncture. These ifndings indicate that acupuncture combined with donepezil hydrochloride noticeably improves cognitive function in patients with vascular dementia, and exerts neuroprotective effects against vascular dementia.     

人胚胎干细胞神经分化中VEGF作用的分子机制研究

目的 观察血管内皮生长因子(vascular endothelial growth factor,VEGF)对人胚胎干细胞分化为神经元的促进作用是否与p38MAPK信号通路相关.方法 人胚胎干细胞经拟胚体向神经元分化,分为3组:A组:常规诱导组;B组:常规诱导+VEGF(10 ng/mL)作用组;C组:常规诱导+p38...