急性脑血管病肿瘤坏死因子-α的临床研究

目的：探讨肿瘤坏死因子-α（TNF-α）在急性脑血管病（ACVD）中的作用及其变化的临床意义。方法：选取95例ACVD患者，并设性别及年龄相匹配的血清对照组（20例）及脑脊液对照组（10例）。应用酶联免疫吸附法（ELISA）于发病后第1、3、7、14d测定血清和脑脊液中TNF-α。结果：①三种脑血管病患者血清TNF-α动态变化存在差异，脑出血和脑梗死组的峰值单间为发病后第3d，而蛛网膜下腔出血（SAH）组为第1d。②脑梗死患者血清TNF-α水平与梗死面积、神经功能缺损程度及病情恶化与否相关。③SAH组于发病后第1d、3d、7d脑脊液TNF-α值高于血清，14d时降至对照组水平并与血清无差异。结论：①脑梗死患者血清TNF-α的动态观察，可为临床预测梗死灶大小、神经功能缺损程度及病情恶化与否提供依据。②发病早期的脑梗死患者若CT未能显示病灶时，血清TNF-α的明显升高有助于临床诊断和治疗。③SAH患者脑脊液中TNF-α水平明显高于血清，进一步提示脑内神经组织可产生TNF-α。脑脊液中TNF-α的持续明显升高可能与SAH后脑血管痉挛有关。④TNF-α参与了ACVD的炎性反应过程，早期抑制TNF产生及抗炎性反应的治疗可能具有潜在的临床价值。     

冠状动脉造影正常的急性心肌梗死患者的临床特点

目的：探讨冠状动脉造影（CAG）正常的急性心肌梗死（AMI）患者的发生机制及临床特点。方法：分析2000年6月至2001年10月86例AMI患者的CAG结果及冠心病相关危险因素。结果：86例中CAG正常者8例，年龄（39＋11．4）（25－52）岁；多无心绞痛史、高血压史、糖尿病史、血脂异常史及家族史；以情绪波动、精神压抑、大量吸烟、饮酒史者居多。结论：冠状动脉痉挛、血栓自溶或溶栓治疗后血栓消失是其主要发生机制；冠状动脉正常的AMI患者其貌似正常，实属高危人群，应高度重视。     

尿激酶对脑梗死特异性烯醇化酶的影响及其临床意义

目的：探讨尿激酶与急性脑梗死（ACI）患者特异性烯醇化酶（NSE）的关系。方法：该实验采用酶联免疫吸附法（EusA）测定脑梗死常规治疗组、尿激酶治疗组血清NSE水平。结果：尿激酶组NSE值显著低于ACI常规治疗组。结论：尿激酶能降低血清酶活性，使已形成的纤维蛋白水解，从而缩小梗死灶体积，改善脑缺血、缺氧，从而起到保护脑细胞的作用。     

老年脑梗死患者急性期血小板活化功能定量检测

目的 :探讨老年脑梗死患者外周血中血小板膜糖蛋白变化的临床意义。　方法 :应用流式细胞术检测了 6 8例急性期老年脑梗死患者外周血血小板活化分子标记物CD4 1、CD6 2p和CD6 3的含量水平 ,与 4 2例正常老年人对照 ;并对脑梗死组病灶大小、梗死部位、病情分级等与血小板活化分子表达的变化进行分析 ,应用统计学进行处理。　结果 :急性期脑梗死患者血小板粘附分子CD4 1、CD6 2 p和CD6 3的表达水平显著高于正常对照组 (P <0 .0 1) ,且与梗死灶大小及病情分级密切相关 ,与梗死部位无关。　结论 :老年脑梗死患者急性期外周血血小板活化功能明显增强 ,为早期应用抗血小板聚集药物的治疗提供了实验依据     

Multiple sclerosis patients have reduced HLA class II-restricted cytotoxic responses specific for both measles and herpes virus

It has been previously demonstrated that the generation of measles virus (MV)-specific cytotoxicity (CTL) is reduced in patients with multiple sclerosis (MS). By contrast, CTL specific for influenza virus (FLU) and mumps virus is normal. It is uncertain if reduced CTL is limited to MV in MS patients, or if reduced CTL may be found to other viruses as well. Since MV-specific CTL is predominantly restricted by HLA class II molecules, while FLU-specific and mumps-specific CTL have large HLA class I-restricted components, reduced MV-specific CTL may reflect a broader reduction in HLA class II-restricted CTL in patients with MS. To examine this question we studied the generation of CTL specific for herpes simplex virus type I (HSV). HSV-specific CTL, like MV-specific CTL is predominantly restricted by HLA class II molecules. We found that patients with MS had reduced generation of CTL to both MV and HSV. Most, but not all patients who had reduced generation of CTL to one virus also had a similar impairment with respect to the second virus. Some patients, however, had a reduction in the generation of CTL only to MV or to HSV. These findings extend our earlier observations regarding reduced MV-specific CTL in patients with MS to a second HLA class II-restricted virus, HSV. Such a reduction may reflect discrete impairments in immune function to separate viruses, possibly those that are associated with viral persistence, or may reflect a more generalized defect in HLA class II-restricted CTL.     

HLA-DPB1 gene polymorphism and multiple sclerosis: a large case-control study in the southwest of France

The polymorphism at the HLA-DPB1 locus has been characterized in a large number of patients with multiple sclerosis (n = 112) and in healthy controls (n = 115). Both patients and controls lived in the southwest of France (in the Pyrénées Atlantiques) and had similar ethnic background. The typing procedure involved the selective amplification of the second exon of the DPB1 locus by polymerase chain reaction, followed by hybridization of the amplified DNA with 14 sequence-specific oligonucleotide probes. Individual alleles were identified by the pattern of hybridization of the different probes. The distribution of the DPB1 alleles was not significantly different in multiple sclerosis patients and controls (p = 0.11). This does not corroborate the reported association of multiple sclerosis with the primed lymphocyte typing (PLT)-defined DPw4 specificity and is not in favour of a role played by polymorphic residues of the DP molecule in susceptibility to multiple sclerosis.     

ASSOCIATION OF PLASMA HOMOCYSTEINE LEVEL AND N^5,N^10—METHYLENETETRAHYDROFOLATE REDUCTASE GENE POLYMORPHISM WITH CEREBRAL INFARCTION

OBJECTIVE: To investigate the relationship of plasma homocysteine (Hcy) level to stroke and genetic factor to elevated plasma Hcy level. METHODS: The plasma Hcy level was measured by capillary electrophoresis-ultraviolet detection and the gene polymorphism of N5,N10-methylenetetrahydrofolate reductase (MTHFR) was studied with PCR-RFLP assay in 43 patients with cortical cerebral infarction and 42 healthy control. RESULTS: The plasma Hcy level of the patients (19.3 +/- 6.0 micromol/L) was markedly higher than that of the controls (13.7 +/- 5.4 micromol/L) (t = 4.16, P < 0.001). There are 3 genotypes, C/C, C/T and T/T, about base-variation of MTHFR gene at locus 677. The plasma Hcy level of the subjects with T/T genotype was higher than that of subjects with other genotypes. However, the frequencies of each genotype and allele were not significantly different between the patients and the controls. CONCLUSIONS: The elevated plasma Hcy level is a risk factor for atherothrombotic cerebral infarction, and is related to the C-->T mutation at locus 677 of MTHFR gene.     

Multiple spike-train analysis using mutual interval matrix

The principal-component approach is applied to the analysis of sequences of neuronal action potentials (spike trains). Multiple spike trains are represented as a sequence of vectors of mutual interspike intervals and are considered to be part of the trajectory of a dynamic system. The trajectory matrix is decomposed into a number of ‘basic spike patterns’ and their relative magnitudes by singular-value decomposition. The representation provides a convenient framework for analysis of dynamic relations and cooperation between neurons in an observed network. Examples of applications to simulated and cerebellar data are presented.     

Intracoronary thrombolysis: Organizational prerequisites,technique, and results

Reestablishing myocardial perfusion during evolving myocardial infarction may limit the ultimate extent of infarction if viable myocardial tissue is present when recanalization of the occluded vessel is achieved. This will result in improved left ventricular function and decreased mortality. In addition to their therapeutic benefits, recanalization procedures have contributed greatly to our knowledge of acute myocardial infarction. It has been demonstrated that myocardial infarction most often occurs after thrombotic occlusion of a coronary artery. This has settled a controversy that has preoccupied cardiologists for decades. Selective intracoronary administration of fibrinolytic agents is followed by recanalization in approximately 80% of cases. Therapeutic failures are attributable to occlusion caused by other factors, to inactivation of streptokinase by high antibody concentrations, and to insufficient concentrations of streptokinase at the thrombus as a results of unfavorable flow conditions. This study is dedicated to Prof. Dr. Med. Horst Schmutzler on the occasion of his 60th birthday.     

普拉固和鱼油对高胆固醇血症患者血脂与心脑血管事件影响的比较

目的:比较普拉固和鱼油对高胆固醇血症患者的血脂、血粘度、血管内皮功能和心脑血管事件的影响。方法:对266例原发性高胆固醇血症患者经2周洗脱期后,随机分为两组,普拉固组,初服10mg,每晚一次,8周后若TC仍>5.2mmol/L,LDL—ch>3.12mmol/L,则加量至20mg/d,每8周再查血脂,以达到TC<5.2mmol/L,LDL—ch<3.12mmol/L的量作治疗量继续服用。鱼油组,服美国深海鱼油一日三次,一次3g,均于服药8周复查血脂、血粘度及血管内皮功能等并作16月随访。结果:治疗8周,TC,普拉固组下降26％,鱼油组下降12％(P<0.01)。LDL—ch,普拉固组下降31％,鱼油组下降11％(P<0.01),肱动脉流量介导的舒张与硝酸甘油介导的舒张,普拉固组分别增加104％和19％,鱼油组无明显改变。全血低切粘度,普拉固组减少23％,鱼油组减少10％(P<0.01)。平均随访16月,普拉固组中脑出血1例(0.8％),鱼油组发生心脑血管事件7例(5.3％),死亡1例(P<0.05)。两组均无明显的不良反应。结论:普拉固是一个安全有效的降脂药,能改善血管内皮功能,降低血粘度,减少高胆固醇血症病人心脑血管事件发生。