无症状性脑梗塞与抑郁状态的研究

目的 探讨无症状性脑梗塞（ACI）抑郁状态的发生率及抑郁状态与脑梗塞的关系。方法 采用24项汉密尔顿抑郁量表（HAMD）测定42例经CT或MRI证实的ACI患的情绪状态,并与对照组比较;根据脑梗塞灶的数量对ACI组患情绪状态进行了研究。结果 ①ACI组抑郁状态发生率为35．7％。②ACI组抑郁状态的发生率与脑梗塞灶数量及基底节区脑梗塞关系密切。结论 抑郁状态为ACI患较常见的症状,多灶性脑梗塞抑郁状态的发生率高于单灶性脑梗塞,基底节区梗塞易发生抑郁,ACI抑郁状态的发生有其生物学基础。     

急性脑梗死病因病机临床初步分析

目的 从中西医结合的角度探析急性脑梗死的病因病机特点.方法 对64例急性脑梗死患者的舌象、脉象内容进行归类统计,计算其出现频次及构成比等;对患者血压及实验室检查结果进行描述统计,计算其均值及标准差等.结果 患者舌质暗红48次（77.4％）;苔薄腻34次（54.8％）;苔腻黄或微黄20次（323％）;弦滑脉41次（64.1％）;收缩压（systolic blood pressure,SBP）、总胆固醇（totalcholesterol,TC）、白细胞（white blood cel,WBC）计数、中性粒细胞百分比（neutrophil percentage,NEUT％）、空腹血糖（fasting plasma glucose,FPG）、糖化血红蛋白（hemoglobin A1c,HbA1c）的均值及标准差分别为（141.20±19.20）mm Hg（1 mm Hg=0.133 kPa）、（4.47±0.97） mmol/L、（7.83±2.63）×109/L、（71.61±9.65）％、（6.16±2.25） mmol/L、（6.60±1.66）％.结论 病因方面,风、瘀、热（火）、浊（痰湿等）在急性脑梗死的发病中起着重要作用;病机特点,正气尚充、邪气盛实.血压、血糖、血脂等结果在脑梗死的病因、病机的判定中所起作用有待进一步探讨.     

血清尿酸、C反应蛋白检测对急性脑梗死患者病情及转归的评价

目的探讨血清尿酸（uricacid,UA）、C反应蛋白（Creactiveprotein,CRP）水平与急性脑梗死（acutecerebralinfarction,ACI）的病情严重程度及转归的相关性。方法ACI组按神经功能缺损程度分为轻型、中型及重型三组。ACI组及对照组均进行UA、CRP水平的检测。将ACI组与对照组、ACI三组间的UA、CRP水平及UA、CRP正常组与高UA、CRP组的转归情况进行统计学分析。结果ACI组UA、CRP水平较对照组明显增高;轻型、中型及重型三组间差异均具有统计学意义,P〈0．05。UA、CRP正常组与高UA、CRP组的预后比较,经治疗明显进步、无变化及死亡差异均具有统计学意义．P〈0．05。结论UA、CRP可作为急性梗死病情严重程度及其发展及预后判断的指标之一,可作为对ACI干预的实验依据。     

The WAG/Rij strain: a genetic animal model of absence epilepsy with comorbidity of depression [corrected

A great number of clinical observations show a relationship between epilepsy and depression. Idiopathic generalized epilepsy, including absence epilepsy, has a genetic basis. The review provides evidence that WAG/Rij rats can be regarded as a valid genetic animal model of absence epilepsy with comorbidity of depression. WAG/Rij rats, originally developed as an animal model of human absence epilepsy, share many EEG and behavioral characteristics resembling absence epilepsy in humans, including the similarity of action of various antiepileptic drugs. Behavioral studies indicate that WAG/Rij rats exhibit depression-like symptoms: decreased investigative activity in the open field test, increased immobility in the forced swimming test, and decreased sucrose consumption and preference (anhedonia). In addition, WAG/Rij rats adopt passive strategies in stressful situations, express some cognitive disturbances (reduced long-term memory), helplessness, and submissiveness, inability to make choice and overcome obstacles, which are typical for depressed patients. Elevated anxiety is not a characteristic (specific) feature of WAG/Rij rats; it is a characteristic for only a sub-strain of WAG/Rij rats susceptible to audiogenic seizures. Interestingly, WAG/Rij rats display a hyper-response to amphetamine similar to anhedonic depressed patients. WAG/Rij rats are sensitive only to chronic, but not acute, antidepressant treatments, suggesting that WAG/Rij rats fulfill a criterion of predictive validity for a putative animal model of depression. However, more and different antidepressant drugs still await evaluation. Depression-like behavioral symptoms in WAG/Rij rats are evident at baseline conditions, not exclusively after stress. Experiments with foot-shock stress do not point towards higher stress sensitivity at both behavioral and hormonal levels. However, freezing behavior (coping deficits) and blunted response of 5HT in the frontal cortex to uncontrollable sound stress, increased c-fos expression in the terminal regions of the meso-cortico-limbic brain systems and greater DA response of the mesolimbic system to forced swim stress suggest that WAG/Rij rats are vulnerable to some, but not to all types of stressors. We propose that genetic absence epileptic WAG/Rij rats have behavioral depression-like symptoms, are vulnerable to stress and might represent a model of chronic low-grade depression (dysthymia). Both 5HT and DAergic abnormalities detected in the brain of WAG/Rij rats are involved in modulation of vulnerability to stress and provocation of behavioral depression-like symptoms. The same neurotransmitter systems modulate SWDs as well. Recent studies suggest that the occurrence and repetition of absence seizures are a precipitant of depression-like behavior. Whether the neurochemical changes are primary to depression-like behavioral alterations remains to be determined. In conclusion, the WAG/Rij rats can be considered as a genetic animal model for absence epilepsy with comorbidity of dysthymia. This model can be used to investigate etiology, pathogenic mechanisms and treatment of a psychiatric comorbidity, such as depression in absence epilepsy, to reveal putative genes contributing to comorbid depressive disorder, and to screen novel psychotropic drugs with a selective and/or complex (dual) action on both pathologies.     

阿司匹林联合雷贝拉唑治疗急性脑梗死的效果观察

目的探讨阿司匹林联合雷贝拉唑治疗急性脑梗死的预后情况。方法对31例急性脑梗死患者随机分为治疗组和对照组,治疗组进行雷贝拉唑和阿司匹林两种药物治疗,对照组仅使用阿司匹林治疗。观察对比这两组患者治疗前后的神经功能缺损评分（NIHSS）、上肢运动功能评分（Fugl-Meyer）、日常生活能力评分（SF）的情况并进行分析。结果治疗组的Vugl—Meyer评分和SF评分高于对照组,两组相比较差异均有统计学显著意义（P〈0．05）。结论雷贝拉唑有利于改善神经功能,对于急性脑梗死治疗的效果较好。     

Nicotine prevents disruption of the late phase LTP-related molecular cascade in adult-onset hypothyroidism

We have shown previously that chronic nicotine treatment reverses adult-onset hypothyroidism-induced impairment of late-phase long-term potentiation (L-LTP) in area CA1 of the hippocampus. In the present study, basal and stimulated levels of signaling molecules essential for the expression of L-LTP were determined in area CA1. Immunoblots analysis showed that chronic nicotine treatment of hypothyroid rats prevented the reduction in the basal protein levels of adenylyl cyclase I (ACI), mitogen-activated protein kinases [MAPKp44/42 (ERK1/2)], calcium-calmodulin-dependent protein kinase IV (CaMKIV), and cyclic-AMP response element binding protein [CREB; phosphorylated (P-) and total]. A significant increase in the levels of P-CREB, P-MAPKp44, P-MAPKp42 and brain derived neurotrophic factor (BDNF) was seen 4 h after multiple train high frequency stimulation (MHFS) in nicotine-treated hypothyroid and control animals, but not in hypothyroid animals. The levels of total CREB, total MAPKp44, total MAPKp42, and CaMKIV were elevated in all groups 4 h after MHFS. These findings suggest that prevention of the reduced basal level of CaMKIV, MAPKp44/42, and CREB by nicotine along with the regained ability of MHFS to induce MAPKp44/42 and CREB phosphorylation in nicotine treated hypothyroid animals may be responsible for the reversal of L-LTP impairment by chronic nicotine treatment in this disease model.     

急性脑梗死血瘀证与活化血小板、胰岛素抵抗的相关性研究

目的研究活化血小板、胰岛素抵抗与急性脑梗死血瘀证的关系。方法应用CT/MRI、流式细胞仪对30例急行脑梗死患者和30例健康人进行检测与对比分析。30例急性脑梗死患者中血瘀证13例,非血瘀证17例。结果与对照组比较,脑梗死组活化血小板（CD62p、CD63）、空腹血糖（FPG）、空腹胰岛素（FINS）、胰岛素敏感指数（ISI）存在统计学差异（P〈0.05或P〈0.01）。直线相关分析表明：CD62p与ISI呈明显正相关（r=0.443,P〈0.05）。脑梗死血瘀证组FPG、FINS、ISI、CD62p、CD63水平较对照组、脑梗死非血瘀证组明显升高,差异有统计学意义（P〈0.05或P〈0.01）。结论急性脑梗死血瘀证患者存在着明显血小板活化及胰岛素抵抗的异常,CD62p、CD63、胰岛素敏感指数可能是血瘀证微观辨证的指标之一。     

天红口服液治疗急性脑梗死风痰瘀阻证临床研究

目的研究天红口服液治疗急性脑梗死风痰瘀阻证的临床疗效并探讨其可能的作用机制.方法对入选病例60例急性脑梗死风痰瘀阻证病人进行随机对照研究,治疗组用天红口服液结合西药治疗,对照组采用单纯西药治疗,治疗前及疗程结束后均进行神经功能缺损评分及中医证候评分,疗程结束后进行脑血流量(CBF)测定.结果治疗组与对照组相比,神经功能缺损评分和中医证候评分明显改善(P＜0.01),CBF增加(P＜0.01).结论天红口服液能改善急性脑梗死风痰瘀阻证病人神经功能缺损,改善其中医临床证候,可作为治疗急性脑梗死风痰瘀阻证的有效药物.     

中青年急性脑梗死患者的生活方式及颈动脉病变的特征分析

目的探讨中青年急性脑梗死(ACI)患者的生活方式及其颈动脉病变的特征。方法①小于45岁ACI患者87例为中青年组,与81例健康对照组比较,分析他们的生活方式(饮食结构,生活规律,睡眠状况,饮酒,吸烟,社会劳动性质,手机使用时间,运动时间等);②大于55岁的ACI患者95例为老年对照组,比较中青年ACI组与老年ACI对照组的颈动脉病变的特征。结果①中青年ACI患者多体型肥胖,大量吸烟,酗酒,生活无规律,以高盐,高脂注重口味饮食为主及运动量减少等;②颈动脉彩超示,中青年组患者颈动脉不稳定斑块检出率为32.18%(28/87),稳定斑块检出率21.84%(19/87),颈动脉狭窄主要为轻-中度狭窄;③老年组不稳定斑块检出率为47.37%(45/95),稳定型斑块检出率为23.16%(22/95),颈动脉狭窄主要为中-重度狭窄。结论不良生活方式是中青年脑梗死发病的重要危险因素,颈动脉病变以不稳定型斑块为主,颈动脉内径主要表现为轻-中度狭窄。     

Grosor íntima-media carotídeo en población española: valores de referencia y asociación con los factores de riesgo cardiovascular

Introduction and objectives

Carotid intima-media thickness as measured with ultrasonography is an inexpensive and noninvasive predictor of cardiovascular events. The objectives of this study were to determine the population reference ranges of carotid intima-media thickness for individuals aged 35-84 years in Spain and to analyze the association of carotid intima-media thickness with cardiovascular risk factors (age, smoking, diabetes, pulse pressure, lipid profile, and body mass index).

Methods

Population-based cross-sectional study conducted in Gerona (Spain). We described the mean and maximal values of carotid intima-media thickness of the carotid artery and of its 3 segments (common carotid, carotid bulb and internal carotid). We assessed cardiovascular risk factors and analyzed their association with carotid intima-media thickness using adjusted linear regression models.

Results

A total of 3161 individuals (54% women) were included, with mean age 58 years. Men showed significantly higher mean common carotid intima-media thickness than did women (0.71 vs 0.67 mm). The strongest predictors of this measure were age (coefficients for 10-year increase: 0.65 and 0.58 for women and men, respectively), smoking in men (coefficient: 0.26), high-density lipoprotein cholesterol in women (coefficient for 10 mg/dL, increase: −0.08) and pulse pressure in both sexes (coefficients for 10 mmHg increase: 0.08 and 0.23 for women and men, respectively). The results were similar for the mean carotid intima-media thickness of all the segments.

Conclusions

This population-based study presents the reference ranges for carotid intima-media thickness in the Spanish population. The main determinants of carotid intima-media thickness were age and pulse pressure in both sexes.Full English text available from:www.revespcardiol.org