脑卒中患者高渗状态的危险因素研究

目的 探讨脑卒中患者高渗状态的危险因素. 方法 收集脑卒中合并高渗状态患者32例做为高渗状态组,抽取同期非高渗状态的脑卒中患者63例为对照组.采用Logistic回归分析确定脑卒中患者高渗状态的危险因素. 结果 高渗状态组平均血浆渗透压[(338.8±12.5)mOsm/L]明显高于对照组[(285.7±11.7)mOsm/L],高渗状态组平均GCS分值[(6.9±2.7)分)]明显低于对照组[(12.7±3.5)分],差异均有统计学意义(P<0.05).多因素Logistic回归分析证实,糖尿病(OR=0.043,95%CI=0.007～0.277,P=0.001)、全身炎症反应综合征(SIRS)(OR=0.550,95%CI=0.388～0.780,P=0.001)、甘露醇用量(OR=0.973,95%CI=0.955～0.991,P=0.004)是脑卒中患者高渗状态的危险因素. 结论 糖尿病、SIRS、甘露醇用量可以联合或单独作用引起高渗状态,治疗过程中重视这三项指标的监测将有助于卒中患者的康复.     

急性脑梗死患者血浆CD147水平与神经功能缺损程度的关系

目的探讨急性脑梗死(acute cerebral infarction,ACI)患者血浆CD147的水平及其与神经功能缺损的关系。方法选择2015年6月至2016年6月期间作者医院住院治疗的ACI患者79例(ACI组),另设对照组37例,选自门诊体检者,入选者均无脑血管病证据和(或)头颅MRI/CT检测正常者。以ELISA法检测两组血浆CD147水平,并比较两组CD147水平;以美国国立卫生研究院脑卒中量表(NIHSS)评分评估ACI组神经功能缺损情况;并分析其与CD147水平的关系。结果ACI组血浆CD147水平明显高于对照组〔(635.80±187.63)pg/mL比(352.70±91.32)pg/mL;t=8.693,P=0.000〕。ACI组患者NIHSS评分<8分组明显低于≥8分组〔(526.48±143.02)pg/mL比(761.02±150.56)pg/mL;t=-7.103,P=0.000〕。相关分析显示CD147水平与NIHSS评分成正相关(r=0.749,P=0.000)。结论ACI组患者血浆CD147水平明显升高,并且与神经功能缺损程度成正相关。     

慢性炎性脱髓鞘性多发性神经根神经病（附6例报告）

慢性炎性脱髓鞘性多发性神经根神经病(CIDP)是一种周围神经疾病。其临床特征是；(1)近端和远端肢体无力．腱反射减弱或消失：(2)脑脊液蛋白细胞分离；(3)神经传导速度减慢；(4)呈持续进展或缓解一复发病程。本文报告6例CIDP．均符合Dyck的有关诊断标准。结合文献对CIDP的临床表现、诊断、治疗和预后进行了讨论。     

Vasculitis of the nervous system

Vasculitis is inflammation of the blood vessels, which may involve either the central nervous system (CNS), or the peripheral nervous system (PNS), or both. This involvement may be primary and restricted to the CNS, and rarely to the PNS. Vasculitis is inflammation of the blood vessels, which may involve either the central nervous system (CNS), or the peripheral nervous system (PMS), or both. This involvement may be primary and restricted to the CNS, and rarely to the PNS. “Primary angiitis of the CNS” is the term used to describe isolated CNS involvement by vasculitis, in which neither the clinical presentation and behaviour of the disease, nor the histopathology is uniform. This heterogeneity indicates a spectrum, depending on the type and extent of the vascular involvement seen within the CNS, covering a group of disorders, rather than a single disease. This may explain the different prognosis and response to treatments.. In clinical practice vasculitis of the nervous system, secondary to a known cause or underlying disease is more commonly seen than as a primary disorder. Primary systemic vasculitides and connective-tissue disorders, Behçet's Disease, lymphoproliferative diseases and other malignancies, some infections and related conditions, drugs and substance abuse are some of the conditions known to cause vasculitis in the nervous system. There is a broad variety of pathogenetic mechanisms. Both the CNS and the PNS may be involved, either separately or together.     

瘤样炎性脱髓鞘病MRI的临床意义

目的分析瘤样炎性脱髓鞘病(TIDD)临床、影像与病理特点,探讨磁共振(MRI)检查对TIDD的诊断价值。方法对39例TIDD患者进行头颅、脊髓CT和MRI扫描,并分析临床和影像学特点。结果病灶在头颅CT均为低密度,常规MRI扫描呈T1WI低信号、T2WI高信号,T1WI增强扫描44%可见"开环征",发病早期DWI可见高信号,FLAIR较T1WI及T2WI更清晰显示病灶及其范围。结论 DWI能发现TIDD早期病变,FLAIR较常规T1WI、T2WI敏感,"开环征"是磁共振诊断TIDD的重要辅助依据。     

Electrophysiological findings in immune checkpoint inhibitor-related peripheral neuropathy

ObjectiveTo report the electrodiagnostic features of immune checkpoint inhibitor (ICI)-related neuropathy.MethodsWe retrospectively reviewed clinical presentations and electrodiagnostic features of 23 patients studied after receiving immune checkpoint inhibitors (ICIs). The presentations for electrodiagnostic evaluation included an acute neuropathy or neuromuscular junction disorder. We applied established electrodiagnostic criteria for polyneuropathy and acute demyelinating neuropathy.ResultsWe identified acute demyelinating neuropathy (13 cases), axonal sensory motor neuropathy (5), pure sensory neuropathy (4) and mononeuropathy (1). 13 patients had acute demyelinating neuropathy confirmed by demonstrating demyelination in 2 or more nerves; 3 additional patients had demyelination in only one nerve. Analysis of motor nerve conduction parameters revealed demyelination involving median and ulnar nerve distal motor latencies as well as median, ulnar and peroneal nerve conduction velocities. Conduction block was found in median, ulnar and peroneal nerves. The remaining one-third patients without demyelination had acute painful axonal neuropathy. Coexisting myopathic changes (6) and neuromuscular junction dysfunction (4) were also identified.ConclusionsOur findings suggest that, while immune-mediated motor nerve demyelination is the primary underlying mechanism of ICI-related neuropathy, axonal painful neuropathy can also be an important presentation. Early recognition and effective intervention may reduce morbidity and permanent disability.SignificanceElectrophysiological studies might be useful in the evaluation of ICI-related neuropathy.     

Incat disability score: A critical analysis of its measurement properties

Background: The INCAT (Inflammatory Neuropathy Cause and Treatment) disability score is a measure of activity limitation. It is used frequently as a primary endpoint in inflammatory polyneuropathy clinical trials. A comprehensive critical analysis of its measurement properties has not been performed. Methods: Critical analysis of measurement properties. Results: The INCAT disability score was derived based on items from Guy's Neurological Disability Scale (GNDS), a disability measure intended for application in multiple sclerosis. Strengths of the INCAT score include evaluation of upper and lower limb dysfunction, ease of administration (feasibility), high face validity, and high reliability. Weaknesses of the scale include concerns about methodological quality of validation studies; failure to properly capture activity limitations due to proximal arm weakness, or fatigue; heavy individual item weighting; and poor sensitivity for detection of clinically important change. Conclusions: Although the INCAT scale has been an effective tool in inflammatory polyneuropathy studies, its limitations may warrant development of new scales. Muscle Nerve 50:164–169, 2014     

抵挡汤对糖尿病心肌病小鼠NLRP3炎症小体的作用及机制

目的:探讨不同剂量抵挡汤对糖尿病小鼠心肌炎性病变的影响.方法:选取60只C57BL/6J小鼠,随机分为正常组(10只)和模型组(50只).模型组小鼠采用高脂饲料联合链脲佐菌素(STZ)腹腔注射制备糖尿病小鼠模型,模型制备成功后继续高脂饲料喂养,8周后采用超声成像平台检测小鼠心功能,出现心功能减退,则糖尿病心肌病小鼠造模...     

中医药基于炎症信号通路调控防治2型糖尿病的研究进展

2型糖尿病（T2DM）作为一种慢性疾病,伴随着日益增加的患病率,给患者的生活质量带来了较大负担,引发了社会的广泛关注。既往研究表明炎症与T2DM的发生发展息息相关,炎症反应及其信号调控通路在T2DM发病机制中的作用已成为研究热点,通过干预炎症反应控制T2DM的进展成为治疗的新途径。随着中医药研究领域的不断深入,中医理论将炎症的生成归因于痰浊与瘀血,二者相互转化影响致使机体功能受损。而运用中药单体及中药复方基于炎症信号通路治疗糖尿病具有多靶点,多通路且不良反应少的治疗优势,能够显著缓解T2DM的症状。近年来,关于中医药干预T2DM的研究逐渐增多,该文将阐述中医对T2DM与炎症关系的认识及中医药调控T2DM炎症反应相关的7条信号通路,即核转录因子-κB(NF-κB)信号通路、丝裂原活化蛋白激酶（MAPK）依赖性信号通路、磷脂酰肌醇3-激酶（PI3K）/蛋白激酶B(Akt)信号通路、蛋白激酶C(PKC)信号通路、腺苷酸活化蛋白激酶（AMPK）信号通路、Wnt信号通路、转化生长因子-β(TGF-β)信号通路。     

血管性认知障碍的分子机制和遗传学

随着对血管性认知障碍概念认识的加深以及对其发病机制的深入研究,近年来有关血管性认知障碍的研究报道日益增多。文章就血管性认知障碍的分子机制和遗传学等方面做了综述。