轻度血管性认知功能损害患者血浆同型半胱氨酸及脑白质损害情况的临床研究

目的 探讨轻度血管性认知损害(mild vascular cognitive impairment,MVCI)与脑白质损害及血浆同型半胱氨酸(homocysteine,Hcy)间的关系及意义.方法 对56例MVCI患者及60例认知功能正常的老年人完成神经心理学评估,头颅MRI检查和测定血浆同型半胱氨酸.结果 (1)MVCI组血浆Hcy浓度(31.28±2.19) μmol/L显著高于正常对照组(18.37±1.34) μmol/L(P＜0.05);(2)MCVI组有显著脑白质损害(P＜0.05);(3)Hcy浓度越高,脑白质损害越显著(P＜0.05);(4)轻度血管性认知损害与年龄,高Hcy,中、重度WML有关.结论 高Hcy血症可能通过引起脑内小动脉硬化而导致WML.MVCI与年龄,高Hcy,中、重度WML有关,这为早期预警及干预提供一定帮助.     

慢性肾脏病患者认知功能障碍与胰岛素抵抗的相关研究

目的：探讨慢性肾脏病（ chronic kidney disease,CKD）患者认知功能与胰岛素抵抗（ IR）的关系。方法将101例CKD3～4期患者分为两组：合并认知功能损害患者组38例,认知功能正常组63例,比较两组间性别、年龄、BMI、TC、TG、CRP、内生肌酐清除率（ CCr）、HOMA－IR、颈动脉内膜中层厚度（ intima －media thickness, IMT）、收缩压（ SBP）和舒张压（ DBP）的差别,并进行Logistic回归分析。结果与认知功能正常组相比,慢性肾脏病合并认知功能损害组BMI、TG、FINS、CRP、IMT及HOMA－IR较高（ P＜0．05）;Logistic回归分析显示IMT、CCr及HOMA－IR对认知功能障碍的发病具有相关性。结论 HOMA－IR、IMT及CCr是认知功能障碍的独立危险因素。     

高同型半胱氨酸血症患者认知功能状况及其血清神经元特异性烯醇化酶水平变化的临床研究

目的探讨高同型半胱氨酸血症(HHe)患者认知功能状况及其血清神经元特异性烯醇化酶(NSE)水平变化和其对认知功能损害的预测价值。方法严格选择122例住院脑动脉硬化症患者,应用彩超检查颈动脉粥样斑块及颈总动脉内膜-中膜厚度(IMT),检测血清NSE、血浆同型半胱氨酸(Hcy)水平,简易精神状态检查(MMSE)评估其认知功能。根据Hcy水平分为两组:正常水平组和高Hcy组。结果 (1)与正常Hcy组比较,高Hcy患者IMT明显增厚,差异有统计学意义(P<0.05);颈动脉粥样斑块形成显著,差异有统计学意义(P<0.05);(2)与正常Hcy组比较,高Hcy患者血清NSE水平明显升高[(16.93±5.33)μg/L],差异有统计学意义(P<0.05);(3)与正常Hcy组比较,高Hcy患者即刻记忆功能和延迟回忆的差异均有统计学意义(P<0.01);(4)血浆Hcy与左侧IMT、颈动脉粥样斑块呈正相关(r=0.671,P=0.009;r=0.632,P=0.025);血清NSE与血浆Hcy和左侧IMT呈正相关(r=0.602,P=0.032;r=0.621,P=0.028);血清NSE与即刻记忆功能、延迟回忆呈负相关(r=-0.589,P=0.021;r=-0.563,P=0.015);(5)ROC曲线分析显示血清NSE的最佳诊断界点为15.21μg/L,敏感性88.23%,特异性85.70%。结论高Hcy可能通过引起动脉粥样硬化及神经细胞毒性作用参与神经元损害,从而引起认知损害。血清NSE对预测其认知功能损害,可能有一定帮助。     

鲍曼不动杆菌荚膜通过抑制PI3K/Akt/mTOR信号通路促进鼠巨噬细胞自噬和凋亡

[Abstract\]Objective: To study the capability of Acinetobacter baumannii with different thickness capsules induce Raw 264.7 cell autophagy and apoptosis, and its potential mechanisms. Methods: A baumannii was isolated from the sputum of patients with pneumonia. The bacterial capsule was stained by Congo red staining, and the bacterial strains with significantly different capsule thickness were selected for subsequent study. Raw 264.7 cells were infected with thick capsular strain (Ab H strain) or thin capsular strain (Ab B strain), and the cells were harvested at 1 h, 3 h and 6 h after infection. The expression of autophagy related proteins LC 3 and Beclin 1, as well as the phosphorylation levels of PI3K, Akt and mTOR were determined by Western blotting. Flow cytometry was used to determine the reactive oxygen species(ROS) production and apoptosis rate. Results: After A. baumannii was stained with Congo red, the cells were shown purple black, the background was red, and the capsule was not stained. The bacterial capsule thickness was clearly judged. Two strains with significant differences in capsular thickness were grouped, namely thick capsular strain (Ab H strain) and thin capsular strain (Ab B strain). The expression of autophagy related protein Beclin 1 of Raw 264.7 cells induced by Ab H strain were significantly higher than that of Ab B strain (P<0.05), and the apoptosis rate of Raw 264.7 cells induced by Ab H strain was also significantly higher than that of Ab B strain (P<0.05). Two strains of A. baumannii could induce a significant increase in the production of ROS in Raw 264.7 cells (P<0.05), and the ability of Ab H strain to induce ROS production was significantly higher than that of Ab B strains (P<0.05). After Raw 264.7 cells were infected with two strains respectively, the phosphorylation levels of PI3K, Akt and mTOR were significantly inhibited, and the inhibition increased when the time prolonged (P<0.05). Conclusion: A. baumannii could induce autophagy and apoptosis of Raw 264.7 cells, and the induction ability is positively correlated with bacterial capsule thickness. A. baumannii with thick capsule has a stronger ability to induce ROS production in Raw 264.7 cells and inhibit the activation of PI3K/Akt/mTOR signaling pathway, which ultimately enhances autophagy and apoptosis of Raw 264.7 cells.     

24例脑出血并发高钠血症的临床分析

目的研究脑出血后高钠血症发生的原因及预后。方法对我院2006年5月-2007年12月神经科住院救治的259例脑出血患者的临床资料进行回顾分析。结果出现高钠血痘24例,占9.3％,高钠血症病死率70.8％。结论脑出血后发生高钠血症病死率较高,应注意防范,丘脑出血病人更应高度重视。严密监测电解质,及早发现,及早控制。甘露醇使用剂量不宜过大,时间不宜过长．     

静脉滴注大剂量免疫球蛋白治疗急性格林巴利综合征疗效观察

近3年来我们采用大剂量免疫球蛋白治疗格林-巴利综合征(GBS)6例,疗效较好,现报告如下.     

中年睡眠呼吸暂停综合征患者与颈动脉内膜中层厚度的临床研究

目的探讨中年睡眠呼吸暂停综合征（obstructive sleep apnea-hypopnea syndrome,OS-AHS）对颈动脉内膜中层厚度影响,及其机制。方法收集我院58例中年睡眠呼吸暂停综合征患者及60例单纯肥胖为对照组,采用彩超检测颈动脉内膜中层厚度（intima-media thickness,IMT）,同时测定血清超敏C-反应蛋白（hish-sensitivity-C response protein,hs-CRP）和血浆同型半胱氨酸（Homo-cysteine,Hcy）指标,分析其差异及相关性。结果 1）与单纯肥胖组比较,两组间年龄、性别、BMI无明显统计学差异（P〉0.05）,而AHI,平均SaO2%和平均最低SaO2%有显著统计学差异;（P〈0.05）;2）OSAHS患者IMT、hs-CRP和Hcy较单纯肥胖者明显异常,差异有统计学意义（P〈0.05）;3）相关性分析显示,AHI与IMT、hs-CRP和Hcy呈正相关（r=0.562,P=0.036;r=0.639,P=0.019;r=0.591,P=0.021）;平均SaO2%与hs-CRP和Hcy负相关（r=-0.489,P=0.041;r=-0.612,P=0.034）;最低SaO2%与IMT和Hcy负相关（r=-0.511,P=0.039;r=-0.635,P=0.022）;IMT与hs-CRP和Hcy呈正相关（r=0.601,P=0.024;r=0.572,P=0.041）。结论中年OSAHS患者颈动脉内膜厚度明显增厚,其是监测OSAHS患者动脉粥样硬化的重要无创指标。而hsCRP和Hcy在其病理过程中起着重要作用,因此为早期干预OSAHS患者动脉粥样硬化过程提供新的靶点。     

脑卒中后抑郁状态的临床分析

目的：提高临床医生对脑卒中后抑郁症的认识,提高诊断及治疗水平。方法：对卒中后抑郁患者67例资料进行分析。结果：急性脑卒中抑郁发生率为38．0％．抑郁症状与病变部位、病程长短、肢体瘫痪及社会家庭因素有关。多发病灶及额叶病灶与PSD发生密切相关。卒中后抑郁与卒中病灶有关,与神经功能缺损程度和损伤体积大小有关,与人的性格特征也有关。应给予早期治疗,包括心理治疗和药物治疗两方面。