妊娠期阻塞性睡眠呼吸暂停筛查的研究进展

阻塞性睡眠呼吸暂停（OSA）是妊娠人群中常见的睡眠呼吸障碍性疾病,不仅与多种不良妊娠结局相关,也可能对母婴远期健康产生重要影响。目前诊断OSA的金标准多导睡眠监测在妊娠人群中难以大规模开展,导致绝大多数妊娠期OSA未能得到及时诊断。寻求其他筛查策略和筛查工具准确识别具有OSA风险的孕妇并进行及时诊治,对于改善不良妊娠结局具有重要意义。本文针对妊娠期OSA患病率、筛查现状、筛查时机、目标人群、筛查工具的研究进展进行综述,以期为妊娠期OSA的筛查提供参考和理论依据。     

住院肝炎病人睡眠质量及影响因素调查分析

目的了解肝炎病人住院期间睡眠质量及影响因素,提出针对性改进建议,以提高病人睡眠质量。方法采用睡眠状况自评量表(SRSS)和自制影响睡眠因素调查表,对180例住院肝炎病人进行问卷调查。结果69．4％住院肝炎病人存在不同程度睡眠障碍;主要影响因素为身体不适、担心疾病、生活习惯及环境改变、经济负担、噪声等。结论住院肝炎病人睡眠质量明显低于健康人群,应加强肝炎病人的睡眠护理,提高其睡眠质量,促进疾病康复。     

破裂型椎间盘突出动物模型中自身免疫反应的实验研究

目的:从动物实验的角度探讨破裂型椎间盘突出动物模型中的自身免疫反应.方法:20只SD大鼠分为两组,实验组采用自体髓核移植于坐骨神经旁的方法建立破裂型椎间盘突出动物模型(坐骨神经痛模型);对照组大鼠手术方法同实验组,但不放置髓核.术前及术后1、2、3周时采用爬坡实验及后肢机械缩爪阈值测定评估大鼠造模前后后肢运动能力及痛觉过敏的变化.术后3周时处死动物应用透射比浊法检测大鼠血清中免疫球蛋白IgG、IgM的含量,ELISA法测定血清中TNF-α、IL-6、IL-12的含量;采用免疫组化染色观察移植髓核中抗原抗体复合物沉积情况;应用BCA蛋白定量法观察坐骨神经中磷脂酶A2(PLA2)的活性.结果:所有大鼠模型建立前爬坡试验结果均为Ⅳ级,造模后对照组爬坡试验仍为Ⅳ级,实验组在造模后1、2及3周时爬坡试验均为Ⅲ级.实验组大鼠造模后1、2、3周时的后肢机械缩爪阈值分别为67.2±8.4、41.3±5.2及40.7±5.3mmHg,较术前(90.4±5.0mmHg)及对照组明显降低(P＜0.01),出现较为明显的痛觉过敏.术后3周实验组大鼠血清中IgG含量4.98±0.96g/L及IgM含量1.45±0.37g/L较对照组(4.31±0.77g/L及0.79±0.35g/L)明显上升(P＜0.05);血清中TNF-α、IL-6、IL-12的含量(205.77±46.32pg/L,186.4±87.3pg/L,69.23±27.46pg/L)较对照组(11.01±2.53pg/L,85.0± 13.2pg/L,21.65±11.93pg/L)均明显升高(P＜0.05).实验组大鼠移植髓核中出现抗原抗体复合物阳性沉积,阳性率为80％,明显高于对照组(P＜0.01);其坐骨神经中PLA2活性为0.0766±0.0039μmoL/(min·L),较对照组0.0006±0.0010μmoL/(min·L)明显升高(P＜0.05).结论:破裂型椎间盘突出动物模型中存在着由移植髓核引起的全身及局部异常的自身免疫反应,这可能是导致其疼痛的主要原因.     

Clinical correlates of poor sleep quality in posttraumatic stress disorder

Sleep disturbances (SD) are a core clinical feature of PTSD. The goal of the study was to determine the influence of patient-related characteristics, disorder-related characteristics, and psychiatric comorbidity on the severity of SD in PTSD outpatients (n = 367) who were not recruited for a sleep study. Increased severity of SD paralleled increasing overall PTSD severity. The severity of SD did not differ according to gender, age groups, types of trauma, PTSD chronicity, or psychiatric comorbidity. Results suggest that age, gender, and psychiatric comorbidity have minimal impact on sleep quality in this PTSD sample. The inclusion of PTSD patients who were not specifically seeking treatment for SD reinforces the study findings.     

周期性肢动症相关心率变化特点的研究进展

周期性肢动症(Periodic Limb Movement Dur-ing Sleep ,PLMS)是一种睡眠相关的运动障碍 ,以睡眠期出现反复发作的刻板性肢体运动为特征[1] .国外研究证实,伴随 PLMS 的发生 ,心率出现典型的"心动过速-过缓"变化,并提示 PL MS 与交感系统活性存在一定关系 ,从而对心脑血管系统产生一定的影响.相关研究还提示 ,PL M S 相关的心率变化受多种客观因素影响 ,并且涉及多种疾病.现就不同客观因素及疾病状态时PLMS相关心率变化的特点作一综述.     

伴焦虑、抑郁短暂性脑缺血发作患者多导睡眠图分析

目的探讨伴焦虑、抑郁短暂性脑缺血发作(TIA)患者多导睡眠图的特点。方法本研究对56例TIA患者进行临床评估、量表测评和多导睡眠图(PSG)检查,其中伴焦虑和(或)抑郁症状者33例(A组),不伴有焦虑、抑郁症状者(B组)23例。结果匹兹堡睡眠质量指数(PSQI)显示A组PSQI总分高于B组,差异有统计学意义(P0.05)。多导睡眠仪(PSG)显示A组较B组觉醒时间延长,非快速眼动(NREM)期N1、N2期睡眠时间延长,N3期睡眠时间明显缩短,差异有统计学意义(P0.05)。结论伴焦虑、抑郁症状TIA患者觉醒时间延长,NREM期N1、N2期睡眠时间延长,N3期睡眠时间明显缩短。     

健脾清化方对CKD2～3期患者慢性微炎症状态的随机对照多中心研究

目的:研究健脾清化方对慢性肾脏疾病(CKD)2～3期脾虚湿热患者慢性微炎症状态的作用。方法:3个中心的随机对照临床研究,随机分成中药组和对照组,并设20例健康体检患者为正常组。对照组予西医常规治疗,中药组在对照组基础上加用健脾清化方。共随访8周,观察治疗前后血肌酐(Scr)、超敏C反应蛋白(hs-CRP)、白细胞介素-17(IL-17)、干扰素-γ(IFN-γ)的变化。结果:最终中药组有74例、对照组有73例完成研究。治疗前两组的hs-CRP、IL-17、IFN-γ比正常组显著升高(P<0.05)。8周的治疗后,中药组的Scr有显著下降(P<0.05)。中药组hs-CRP平均下降了26.4%(P<0.05),而对照组有上升的趋势。中药组IL-17平均下降了73.5%(P<0.05),对照组平均下降了25.6%。中药组IFN-γ平均下降了48.3%(P<0.05),而对照组平均下降了23.3%。结论:CKD2～3期的脾虚湿热患者存在慢性微炎症状态,健脾清化方能明显改善微炎症状态。     

Effect of continuous positive airway pressure therapy on glucose control

Obstructive sleep apnea (OSA) and diabetes mellitus are both highly prevalent disorders.There has been a recent recognition of an association between insulin resistance and sleep apnea.Continuous positive airway pressure (CPAP) has emerged as an effective therapy for treatment of OSA and has been shown to positively influence numerous pathophysiological factors that con-tribute to cardiovascular risk.There is emerging data that explores the influence of CPAP therapy,insulin sensitivity and glycemic control.In the current review,we examine this literature critically and formulate a synopsis that summarizes the current knowledge in this field.     

颈椎无放射影像异常脊髓损伤的早期诊断和治疗

目的：探讨颈椎无放射影像异常脊髓损伤(SCIWORA)的早期诊断和治疗方法。方法：12例SCIWORA患入院后进行仔细的物理学检查了解神经系统定位体征，判定脊髓损伤平面，所有患常规作X线和CT检查，了解椎管指数，同时作MRI成像，了解颈椎间盘有无突出及脊髓损伤情况，从而作出早期诊断。对8例椎问盘突出行前路减压 植骨 颈椎前路钢板内固定。4例保守治疗。结果：1)75%患存在颈椎管狭窄；2)早期通过物理学检查确定的脊髓受损平面与MRI检查基本相似，MRI可进一步了解脊髓压迫和损伤的形态学改变；3)手术治疗8例神经功能大部分明显改善，非手术治疗改善不明显。结论：1)：椎管狭窄是SCIWORA重要的病理学基础；2)早期的物理学检查对SCIWORA的早期诊断与MRI检查一样重要；3)手术治疗是较好的治疗方法。     

Psychosocial work environment and psychological well‐being: assessment of the buffering effects in the job demand–control (–support) model in BELSTRESS

The Karasek Job Demand–Control model has as its central tenet the so‐called ‘strain hypothesis’, stating that the most adverse health outcomes are to be expected in ‘high strain’ jobs characterized by high job demands and low job control. Later, this model was elaborated, stating that ‘isolated’ high strain workers experiencing low worksite social support are even more worse off. This is labelled the ‘iso‐strain hypothesis’. However, in the literature, the question was raised whether a high level of job control may (1) mitigate or buffer the effects of high job demands on psychological well‐being, or alternatively whether (2) a high level of social support may buffer the negative impact of high strain on psychological well‐being. In this study among 16 335 male workers and 5084 female workers in Belgium, four indicators of psychological well‐being are considered: feelings of depression, feelings of fatigue, sleep problems and use of psychoactive drugs. Both in men and in women, the general strain hypothesis and the iso‐strain hypothesis alike are corroborated regarding the cross‐sectional associations adjusted for age, level of education and living situation. This is most clear with respect to feelings of depression, less so with respect to the use of psychotropic drugs. The buffer hypotheses however are definitely not supported by our data. Copyright © 2002 John Wiley & Sons, Ltd.