血清miRNA-494和miRNA-125a表达在腰椎间盘退变疾病中的临床应用

［摘要］ 目的 探讨血清miRNA-494和miRNA-125a表达与腰椎间盘退变程度的相关性。 方法 选择腰椎间盘膨出或突出患者45例为退变组,下腰痛患者42例为对照组,所有患者均行腰椎MRI,通过磁共振弥散加权成像技术分析腰椎间盘退变程度与椎间盘Pfirrmann(PM)分级的关系。 结果 对照组共检查126个椎间盘,其中分级在Ⅰ级和Ⅱ级（正常）99个椎间盘,占78.6%（99/126）, Ⅲ级、Ⅳ级和Ⅴ级27个椎间盘,占21.4%（27/126）;退变组共检查135个椎间盘,其中分级在Ⅰ级和Ⅱ级（正常）17个椎间盘,占12.6%（17/135）,Ⅲ级、Ⅳ级和Ⅴ级118个椎间盘,占87.4%（118/135）。2组PM分级构成比差异有统计学意义（P＜0.05）, 退变组表观弥散系数(apparent diffusion coefficient,ADC）值低于对照组（P＜0.05）。退变组血清miRNA-125a较对照组明显降低,血清miRNA-494水平较对照组明显升高（P＜0.05）。退变组miRNA-125a表达水平与ADC值呈正相关（r=0.853,P＜0.01）,miRNA-494表达水平与ADC值呈负相关（r=-0.897,P＜0.01）。血清miRNA-125a和miRNA-494的ROC曲线分析显示miRNA-125a和miRNA-494的曲线下区域面积分别为0.893（95%CI=0.815～0.971,P＜0.01）、0.852（95%CI=0.762～0.932,P＜0.01）,敏感度分别为87.9%和93.7%,特异度分别为77.0%和67.7%,准确度分别为80.0%和77.7%,阳性预测值分别为92.3%和92.1%,阴性预测值分别为81.8%和76.9%。 结论 血清miRNA-494和miRNA-125a的表达可能与椎间盘退变疾病的发病机制有关,检测其表达水平可为椎间盘退变疾病的早期诊断及治疗提供基因依据。     

MR-DWI与MSCT对原发性腹膜后肿瘤的诊断价值研究

目的分析磁共振扫描弥散成像（magnetic resonance diffusion-weighted imaging,MR-DWI）和多层螺旋CT（multi-slice spiral CT,MSCT）在原发性腹膜后肿瘤（primary retroperitoneal tumor,PRT）中的评估与应用价值。     

系统性红斑狼疮合并颅内静脉窦血栓的临床特点

目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)合并颅内静脉窦血栓(cerebral venous sinus thrombosis,CVST)的临床特点。方法回顾性分析北京协和医院2000年1月至2013年6月SLE中合并CVST患者的神经系统表现、全身病情活动度、血栓形成部位、影像学特点及治疗和预后。结果 SLE并发CVST患者13例,占同期SLE住院患者(4540例)的0.29%。女10例,男3例,平均年龄30.5岁。神经系统表现以头痛(1113)、视力下降(713)、意识障碍(513)、癫痫(413)最为常见。脑脊液压力升高9例,其中7例330 mm H2O,脑脊液蛋白升高5例。磁共振静脉血管成像提示血栓形成部位常见于横窦(1113)、乙状窦(813)、上矢状窦(413)等,多数(1013)患者为2处以上静脉窦血栓形成。患者平均SLE疾病活动指数为(11.7±2.8)分(不包括CVST)。经脱水降颅压、抗凝、糖皮质激素冲击、免疫抑制剂及地塞米松鞘注治疗,9例患者好转,3例死亡,1例失访。结论 CVST是SLE的罕见并发症,多发生于SLE活动期,有特殊的临床症状、体征及脑脊液压力升高等提示,需早期识别、积极治疗以改善预后。     

Modulation of intracortical inhibition in response to acute psychosocial stress is impaired among individuals with chronic neck pain

Objective

Psychosocial stress has been associated with a variety of chronic pain disorders although the mechanisms responsible for this relationship are unknown. The purpose of this study was to compare the excitability of intracortical and corticospinal pathways to the trapezius muscle in individuals with and without chronic neck pain during exposure to low and high levels of psychosocial stress.

Methods

Single and paired-pulse transcranial magnetic stimulation was used to assess motor evoked potentials (MEPs) and short-interval intracortical inhibition (SICI) during mental math performed in the presence and absence of social evaluative threat.

Results

All participants demonstrated higher amplitude MEPs in the high stress compared to the low stress condition (p < 0.01). Participants with chronic neck pain had significantly greater SICI than healthy participants in the low stress condition (p = 0.03). During exposure to the stressor, healthy participants showed an increase in SICI, whereas participants with neck pain showed no change (group difference for change in SICI, p < 0.01).

Conclusions

These findings suggest that individuals with chronic neck pain inhibit motor output to the trapezius in the presence of minor stressors, and are unable to compensate for additional stress-evoked increases in corticospinal excitability through further modulation of SICI. This observation has potential implications for the management of patients who have difficulty relaxing painful muscles during times of stress.