H型高血压增加脑梗死的复发风险

目的 探讨H 型高血压与脑梗死复发风险的相关性.方法 前瞻性观察2004 年1 月至2008 年1 月于北京朝阳医院神经内科住院的急性脑梗死患者656 例,随访1 年记录卒中复发情况并分为复发组和非复发组.同时于急性发病3 d 内采用高效液相色谱法测定血清同型半胱氨酸(Hcy)水平,以Hcy≥10 μmol/L 作为高同型半胱氨酸血症(HHcy)的标准.高血压伴HHcy 者为H 型高血压组,单纯高血压或单纯HHcy 为非H 型高血压组.结果 (1)656 例急性脑梗死患者中111 例复发,1 年复发率为16.9%.(2)复发组患者83.8%具有高血压病史,明显高于非复发组的70.6%;血清同型半胱氨酸水平[(22.39 ±9.45)μmol/L]亦明显高于非复发组[(16.94 ±9.85)μmol/L],两组比较均具有统计学差异(P ＜0.01);复发组H 型高血压的比例为78.2%,明显高于非复发组的65.1%(P ＜0.01).(3)多因素Logistic 回归分析结果显示影响脑梗死复发的独立危险因素有H 型高血压、高龄、高血压、HHcy 和低高密度脂蛋白.结论 H 型高血压是脑梗死复发的独立危险因素,应综合防治卒中复发.     

脂质运载蛋白型前列腺素D合酶在脑胶质瘤中的表达研究

目的　研究脂质运载蛋白型前列腺素D合酶 (L PGDS)mRNA及其蛋白在脑胶质瘤中的表达。方法　用实时荧光定量逆转录聚合酶链反应 (RT PCR)和免疫印记 (westernblot)检测L PGDSmRNA及其蛋白在脑胶质瘤组织和脑脊液中的表达水平。结果　实时荧光定量RT PCR显示 ,L PGDS的mRNA在 2 3例脑胶质瘤组织中的表达水平范围为 1 5× 10 3～ 7 0× 10 4 copy/μgRNA ,均值为 1 6×10 4 copy/μgRNA ,而在 5名正常组织中的表达水平均值为 8 1× 10 5copy/μgRNA。经统计学分析 ,两组间差异有显著性 (P <0 0 5 ) ,且表达水平与胶质瘤恶性程度相关。胶质瘤细胞株U 2 5 1的表达水平为4 7× 10 3copy/μgRNA。蛋白定量显示 ,脑胶质瘤患者脑脊液中L PGDS的吸光度比率均值为 0 47±0 12 ,而正常脑脊液中为 0 92± 0 2 6 ,两组间差异有非常显著性 (P <0 0 1)。结论　发现在脑胶质瘤中L PGDSmRNA及其蛋白表达水平下降 ,这可能对脑胶质瘤的诊断、治疗有潜在的应用价值。     

运用高分辨率熔解技术检测骨髓增殖性疾病患者JAK2 V617F突变

JAK2基因V617F突变与真性红细胞增多症(PV)、原发性血小板增多症(ET)、原发性骨髓纤维化(PMF)等慢性骨髓增殖性疾病(MPD)的病理变化明显相关,在新修订的2008年WHO分类系统中,有无JAK2突变已经成为慢性MPD主要的诊断指标[1].     

全麻下血管化游离皮瓣修复术后患者谵妄的危险因素

Objective To investigate the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.Methods Two hundred and sixteen ASA Ⅰ-Ⅲ patients aged 18-80 yr undergoing vascular free flap reconstruction surgery were enrolled in this study.Patient characteristics before and during operation were recorded.The patients were followed up for 5 days after operation.Their level of consciousness,severity of pain and sleep quality were evaluated daily.The patients were divided into 2 groups according to the occurrence of delirium during the 5 days after operation:delirium group and non-delirium group.The method of CAM-ICU was reed in the diagnosis of postoperative delirium.Multivariate logistic regression was used to analyze the risk factors for postoperative delirium.Results logistic regression analysis showed that old age,history of alcohol abuse and sleep diacrder after operation were risk factors for delirium developed after free flap surgery.Conclusion Old age,history of alcohol abuse and sleep disorder after operation were the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.