A型肉毒毒素治疗偏头痛的临床研究

目的:观察A型肉毒毒素治疗预防偏头痛 发作的临床疗效和不良反应。方法:选取30例偏头 痛病人,应用A型肉毒毒素进行颅周肌内注射治 疗,问卷调查记录每例偏头痛病人治疗前3mo,治 疗后mo1,2,3偏头痛发作情况,比较偏头痛发作频 率、发作持续时间、发作严重程度及使用止痛药物情 况,观察不良反应。结果:A型肉毒毒素治疗后 mo1,偏头痛发作频率、发作持续时间、发作严重程 度均较治疗前明显下降(P<0.01),止痛药物的使 用较治疗前减少(P<0.01),疗效可至少维持3mo, 且不良反应轻微、短暂。结论:A型肉毒毒素颅周肌 内注射治疗预防偏头痛发作临床疗效显著,不良反 应轻微、短暂,值得临床研究。     

急性脑出血患者血液中微粒促凝活性的变化

Objective To study the procoagulant activity of microparticles (MP) in patients with acute in-tracerebral hemorrhage (ICH) and to evaluate the correlation between procoagulant activity of MPs and disease out-come. Method From August 2006 through August 2008, 83 consecutive patients with history of hypertension ad-mitted for spontaneous basal ganglia hemorrhage including 54 male and 29 female, aged (60.9±9.7) years ranged from 41 to 79 years, were enrolled into this study. The control group was consisted of 30 age- and sex-matched (P= 0.429; P = 0.415) patients admitted for mild soft tissue injury. Patients with history of head trauma or previ-ous stroke, under the antiplatelet or anticoagulant medication, severe infection, or presence of previous cerebrovas-cttlar disease were excluded. Venous blood sample was kaken within the first 24 hours after disease onset. The MPs procoaulant potential was measured with a prothrombinase assay, and the levels of IL-6,TNF-α, D-dimer (DD)and thrombin-antithrombin Ⅲ complex (TAT) in plasma were measured with enzyme-linked immunosorbent assay. The multivariate analysis was made with forward stepwise logistic regression to determined the predictors of one. month mortality. The plasma levels of MPs were compared between ICH group and control group, between patients with intraventricular hemorrhage (IVH) and those without IVH,and between survivors and non-survivors with the Mann-Whitney U-test. The Spearman' s rank correlation coefficient was used to analyze the correlations between the plasma levels of MPs and ICH volume, Glasgow coma scale (GCS), and plasma levels of IL-6, TNF-α, DD and TAT. A receiver operating characteristic curve (ROC curve) identified the plasma MPs cutoff levels that predicted one-month mortality of patients. Under ROC curve, z statistic analysis was used to compare the area under curves (AUCs) between plasma IMPs and Glasgow coma scale, ICH volumes, and plasma levels of IL-6, TNF-α, DD and TAT for one-month mortality. Results Thirty-six patients (43.4%) died of ICH in a month. The multivariate analyses sorted out the GCS (odds ratio = 0.558, 95%CI:0.367-0.850, P = 0.007), Hematoma volume (odds ratio= 1.061, 95%C1:1.012- 1.113, P = 0.015) and IVH (odds ratio= 5.537, 95%CI:1.035-29.629, P = 0.045) as the independent pcedictors for one-week mortality. The MPs procoagulant activity in the ICH group (6.72±3.26 U/mL) was significantly higher than that in control group (1.84±0.82) U/mL (P = 0.000). The IMPs procoagulant activity in the non-survival group (8.51±3.45) U/mL was significantly higher than that in the survival group (5.35±2.33) U/mL (P = 0.000). The MPs procoagulant activity in the IVH group (7.66±3.39) U/mL was significantly higher than that in the non-lVH group (5.36±2.53) U/mL (P = 0.001). The MPs procoagulant activity was highly associated with GCS scores (r = -0.690, P = 0.000), ICH volumes (r =0.590, P = 0.000), and plasma IL-6 (r = 0.465, P = 0.015), TNF-α (r = 0.464, P = 0.016), DD(r= 0.567, P = 0.001) and TAT(r = 0.469, P = 0.014) in ICH. The ROC curve identified cutoff levels of MPs procoagulant activity to be 7.47 U/mL that predicted one-month mortality of patients with high sensitivity (77.8%) and specificity values (76.6%). Areas under curves (AUCs) of MPs procoagulant activity (AUC =0.825±0.048) were significantly larger than those of plasma IL-6 (AUC = 0.685±0.060, P = 0.042), TNF-α(AUC = 0.681±0.060, P =0.036) and TAT (AUC = 0.644±0.062, P =0.008).The AUCs ofMPs procoag-ulant activity were larger than those of plasma DD (AUC = 0.743±0.056), but this difference was not statistical significance (p = 0.226). Conclusions The procoagulant activity of MPs may contribute to the pathophysiology of ICH. The propcoagulant activity of MPs after spontaneous onset of ICH seems to correlate with clinical outcome in these patients. Its procoagulant activity can be used as an useful clinical marker for evaluating the prognosis of ICH.     

颅脑外伤患者血液中微粒促凝活性的变化

目的 观察颅脑外伤患者血液中微粒促凝活性的时程变化规律,探讨其在脑损伤中的作用及对预后的预测价值.方法 收集中重型颅脑外伤患者139例作为颅脑外伤组;收集同期健康体检人群40例作为对照组.对照组静脉血体检时获得.颅脑外伤组静脉血在入院时及入院后第1、2、3、5和7天获得.利用发色底物法测定血液中微粒促凝活性.结果颅脑外伤患者入院后1个月内死亡50例(36.0%),血液中微粒促凝活性6 h内开始升高,24 h内到达高峰,后逐渐下降,6个时间点血液中微粒促凝活性分别为(10.5±4.3)、(14.7±6.9)、(12.4±5.4)、(10.0±4.6)、(7.8±3.8)、(6.0±3.0)U/ml,经协方差分析,均显著高于对照组(1.7±0.6)U/ml(P<0.001).经多因素分析,血液中微粒促凝活性(OR 1.432,95%CI 1.194～1.719,P<0.01)是颅脑外伤1个月内死亡的危险因素.经重复测量方差分析,死亡组血液中微粒促凝活性显著高于生存组(P=0.01),重型颅脑外伤组血液中微粒促凝活性显著高于中型颅脑外伤组(P=0.002).经Spearman相关分析,血液中微粒促凝活性与入院时GCS评分显著负相关(P<0.05).经多无线性同归分析,血液中微粒促凝活性与入院时血浆C-反应蛋白浓度(P=0.019)和D-二聚体浓度(P=0.012)显著正相关.ROC曲线辨别了血液中微粒促凝活性的预测界值(12.2 U/ml),对预测颅脑外伤1个月内死亡有较高的灵敏度(72.0%)和特异度(85.4%).血液中微粒促凝活性的曲线下面积(0.847±0.037)小于GCS评分(0.917±0.023)的曲线下面积,但差异无统计学意义(P=0.104).结论 颅腩外伤后血液中微粒促凝活性升高,可能参与脑损伤的炎症反应和凝血级联反应,检测这个指标有助于早期判断颅脑外伤患者的预后.     

急性脑出血患者血液中微粒促凝活性的变化

Objective To study the procoagulant activity of microparticles (MP) in patients with acute in-tracerebral hemorrhage (ICH) and to evaluate the correlation between procoagulant activity of MPs and disease out-come. Method From August 2006 through August 2008, 83 consecutive patients with history of hypertension ad-mitted for spontaneous basal ganglia hemorrhage including 54 male and 29 female, aged (60.9±9.7) years ranged from 41 to 79 years, were enrolled into this study. The control group was consisted of 30 age- and sex-matched (P= 0.429; P = 0.415) patients admitted for mild soft tissue injury. Patients with history of head trauma or previ-ous stroke, under the antiplatelet or anticoagulant medication, severe infection, or presence of previous cerebrovas-cttlar disease were excluded. Venous blood sample was kaken within the first 24 hours after disease onset. The MPs procoaulant potential was measured with a prothrombinase assay, and the levels of IL-6,TNF-α, D-dimer (DD)and thrombin-antithrombin Ⅲ complex (TAT) in plasma were measured with enzyme-linked immunosorbent assay. The multivariate analysis was made with forward stepwise logistic regression to determined the predictors of one. month mortality. The plasma levels of MPs were compared between ICH group and control group, between patients with intraventricular hemorrhage (IVH) and those without IVH,and between survivors and non-survivors with the Mann-Whitney U-test. The Spearman' s rank correlation coefficient was used to analyze the correlations between the plasma levels of MPs and ICH volume, Glasgow coma scale (GCS), and plasma levels of IL-6, TNF-α, DD and TAT. A receiver operating characteristic curve (ROC curve) identified the plasma MPs cutoff levels that predicted one-month mortality of patients. Under ROC curve, z statistic analysis was used to compare the area under curves (AUCs) between plasma IMPs and Glasgow coma scale, ICH volumes, and plasma levels of IL-6, TNF-α, DD and TAT for one-month mortality. Results Thirty-six patients (43.4%) died of ICH in a month. The multivariate analyses sorted out the GCS (odds ratio = 0.558, 95%CI:0.367-0.850, P = 0.007), Hematoma volume (odds ratio= 1.061, 95%C1:1.012- 1.113, P = 0.015) and IVH (odds ratio= 5.537, 95%CI:1.035-29.629, P = 0.045) as the independent pcedictors for one-week mortality. The MPs procoagulant activity in the ICH group (6.72±3.26 U/mL) was significantly higher than that in control group (1.84±0.82) U/mL (P = 0.000). The IMPs procoagulant activity in the non-survival group (8.51±3.45) U/mL was significantly higher than that in the survival group (5.35±2.33) U/mL (P = 0.000). The MPs procoagulant activity in the IVH group (7.66±3.39) U/mL was significantly higher than that in the non-lVH group (5.36±2.53) U/mL (P = 0.001). The MPs procoagulant activity was highly associated with GCS scores (r = -0.690, P = 0.000), ICH volumes (r =0.590, P = 0.000), and plasma IL-6 (r = 0.465, P = 0.015), TNF-α (r = 0.464, P = 0.016), DD(r= 0.567, P = 0.001) and TAT(r = 0.469, P = 0.014) in ICH. The ROC curve identified cutoff levels of MPs procoagulant activity to be 7.47 U/mL that predicted one-month mortality of patients with high sensitivity (77.8%) and specificity values (76.6%). Areas under curves (AUCs) of MPs procoagulant activity (AUC =0.825±0.048) were significantly larger than those of plasma IL-6 (AUC = 0.685±0.060, P = 0.042), TNF-α(AUC = 0.681±0.060, P =0.036) and TAT (AUC = 0.644±0.062, P =0.008).The AUCs ofMPs procoag-ulant activity were larger than those of plasma DD (AUC = 0.743±0.056), but this difference was not statistical significance (p = 0.226). Conclusions The procoagulant activity of MPs may contribute to the pathophysiology of ICH. The propcoagulant activity of MPs after spontaneous onset of ICH seems to correlate with clinical outcome in these patients. Its procoagulant activity can be used as an useful clinical marker for evaluating the prognosis of ICH.     

急性脑出血患者血液中微粒促凝活性的变化

目的 揭示急性脑出血患者血液中微粒促凝活性的变化,探讨其在脑出血发病机制中的作用及对预后的预测价值.方法 采用前瞻性研究,脑出血组病例为2006年8月到2008年8月浙江大学医学院附属邵逸夫医院危重病医学科收治的高血压性摹底节区脑出血患者,共83例,男54例,女29例;年龄41～79岁,(60.9±9.7)岁.对照组病例为同期急诊治疗的轻微软组织挫伤患者,共30例,男17例,女13例;年龄47～79岁,(62.9±8.4)岁.两组病例均除外既往脑血管性疾病、使用抗凝剂、严重感染、严重心肺肝肾疾病及严重外伤史,两组间年龄(P=0.429)、性别(P=0.415)比较差异无统计学意义.两组病例在发病或外伤后24 h内抽取外周血,发色底物法测定血液中微粒促凝活性,ELJSA法测定血浆白介素-6、肿瘤坏死因子-α、D-二聚体及凝血酶-抗凝血酶Ⅲ复合物浓度.二分类Logistic回归分析脑出血后死亡的危险因素,Mann-Whitney U检验比较脑出血组与对照组、非生存组与生存组、脑室出血组与非脑室出血组血液中微粒促凝活性,Speaman相关检验分析血液中微粒促凝活性与入院时GCS评分、入院时血肿量、血浆白介素-6浓度、血浆肿瘤坏死因子-α浓度、血浆D-二聚体浓度和凝血酶-抗凝血酶Ⅲ复合物浓度的相关性,ROC曲线评价血液中微粒对脑出血死亡的预测价值,Z检验比较血液中微粒促凝活性、血浆白介素-6浓度、血浆肿瘤坏死因子-α浓度、血浆D-二聚体浓度和凝血酶-抗凝血酶Ⅲ复合物浓度预测脑出血死亡的曲线下面积.结果脑出血患者入院后1个月内死亡36例(43.4%),多因素分析显示入院时GCS评分(OR=0.558,95%CI=0.367～0.850,P=0.007)、血肿量(OR=1.061,95%C1=1.012～1.113,P=0.015)及伴有脑室出血(OR=5.537,95%CI=1.035～29.629,P=0.045)是脑出血1个月内死亡的危险因素.脑出血患者血液中微粒促凝活性(6.72±3.26)U/mL较对照组(1.84±0.82)U/mL明显升高(P=0.030),非生存组组患者血液中微粒促凝活性(8.51±3.45)较生存组(5.35±2.33)明显升高(P=0.000),脑事出血组患者血液中微粒促凝活性(7.66±3.39)较非脑室出血组(5.36±2.53)明显升高(P=0.001).血液中微粒促凝活性与入院时GCS评分(r=-0.690,P=0.000)、血肿量(r=0.590,P=0.000)、血浆白介素-6浓度(r=0.465,P=0.015)、血浆肿瘤坏死因子-α浓度(r=0.464,P=0.016)、血浆D-二聚体浓度(r=0.567,P=0.001)和凝血酶-抗凝血酶Ⅲ复合物浓度(r=0.469,P=0.014)有显著相关性.ROC曲线辨别了血液中微粒促凝活性的预测界值(7.47 U/mL),对预测脑出血1个月内死亡有较高的灵敏度(77.8%)和特异度(76.6%).血液中微粒促凝活性的曲线下面积(0.825±0.048)显著大于血浆白介素-6浓度(0.685±0.060,P=0.042)、血浆肿瘤坏死因子-α浓度(0.681±0.060,P=0.036)及血浆凝血酶-抗凝血酶Ⅲ复合物浓度(0.644±0.062,P=0.008)的曲线下面积,而与血浆D-二聚体浓度的曲线下面积(0.743±0.056,P=0.226)差异无统计学意义.结论 血液中微粒参与脑出血后脑损害的病理生理过程,凋亡细胞可能通过血液中微粒作为"载体"促进凝血级联反应和炎症反应,从而进一步加重脑出血后继发性脑损伤,而降低血液中微粒水平有望成为脑出血治疗的新策略,临床检测这个指标有助于早期判断脑出血患者的预后.     

p21和PCNA在星形细胞瘤中的表达和相互关系

目的探讨p21蛋白和增殖细胞核抗原(PCNA)在星形细胞瘤中的表达和相互关系,以及p21阳性表达率与患者预后之间的关系。方法对63例幕上星形细胞瘤标本及8例正常对照标本,采用链霉菌抗生物素蛋白过氧化酶连接法染色观察,测定其p21、PCNA阳性率,并换算成标记指数(LI),比较不同级别肿瘤及不同临床影响因素者之间的差异。结果低级别星形细胞瘤中p21的LI明显低于高级别肿瘤(58.072±14.424VS26.630±5.570,P=0.00999)。PCNA的LI也随着肿瘤级别的升高而增强,低级别与高级别之间的差异也有统计学意义(40.192±11.407VS23.493±5.487,P=0.00134)。p21与PCNA呈正相关(r=0.672,P<0.01)。结论p21可能参与了星形细胞瘤的发生发展。p21和PCNA在星形细胞瘤中的表达呈正相关,在一定程度上提示p21强阳性的患者预后较差。     

急性脑出血患者血液中微粒促凝活性的变化

Objective To study the procoagulant activity of microparticles (MP) in patients with acute in-tracerebral hemorrhage (ICH) and to evaluate the correlation between procoagulant activity of MPs and disease out-come. Method From August 2006 through August 2008, 83 consecutive patients with history of hypertension ad-mitted for spontaneous basal ganglia hemorrhage including 54 male and 29 female, aged (60.9±9.7) years ranged from 41 to 79 years, were enrolled into this study. The control group was consisted of 30 age- and sex-matched (P= 0.429; P = 0.415) patients admitted for mild soft tissue injury. Patients with history of head trauma or previ-ous stroke, under the antiplatelet or anticoagulant medication, severe infection, or presence of previous cerebrovas-cttlar disease were excluded. Venous blood sample was kaken within the first 24 hours after disease onset. The MPs procoaulant potential was measured with a prothrombinase assay, and the levels of IL-6,TNF-α, D-dimer (DD)and thrombin-antithrombin Ⅲ complex (TAT) in plasma were measured with enzyme-linked immunosorbent assay. The multivariate analysis was made with forward stepwise logistic regression to determined the predictors of one. month mortality. The plasma levels of MPs were compared between ICH group and control group, between patients with intraventricular hemorrhage (IVH) and those without IVH,and between survivors and non-survivors with the Mann-Whitney U-test. The Spearman' s rank correlation coefficient was used to analyze the correlations between the plasma levels of MPs and ICH volume, Glasgow coma scale (GCS), and plasma levels of IL-6, TNF-α, DD and TAT. A receiver operating characteristic curve (ROC curve) identified the plasma MPs cutoff levels that predicted one-month mortality of patients. Under ROC curve, z statistic analysis was used to compare the area under curves (AUCs) between plasma IMPs and Glasgow coma scale, ICH volumes, and plasma levels of IL-6, TNF-α, DD and TAT for one-month mortality. Results Thirty-six patients (43.4%) died of ICH in a month. The multivariate analyses sorted out the GCS (odds ratio = 0.558, 95%CI:0.367-0.850, P = 0.007), Hematoma volume (odds ratio= 1.061, 95%C1:1.012- 1.113, P = 0.015) and IVH (odds ratio= 5.537, 95%CI:1.035-29.629, P = 0.045) as the independent pcedictors for one-week mortality. The MPs procoagulant activity in the ICH group (6.72±3.26 U/mL) was significantly higher than that in control group (1.84±0.82) U/mL (P = 0.000). The IMPs procoagulant activity in the non-survival group (8.51±3.45) U/mL was significantly higher than that in the survival group (5.35±2.33) U/mL (P = 0.000). The MPs procoagulant activity in the IVH group (7.66±3.39) U/mL was significantly higher than that in the non-lVH group (5.36±2.53) U/mL (P = 0.001). The MPs procoagulant activity was highly associated with GCS scores (r = -0.690, P = 0.000), ICH volumes (r =0.590, P = 0.000), and plasma IL-6 (r = 0.465, P = 0.015), TNF-α (r = 0.464, P = 0.016), DD(r= 0.567, P = 0.001) and TAT(r = 0.469, P = 0.014) in ICH. The ROC curve identified cutoff levels of MPs procoagulant activity to be 7.47 U/mL that predicted one-month mortality of patients with high sensitivity (77.8%) and specificity values (76.6%). Areas under curves (AUCs) of MPs procoagulant activity (AUC =0.825±0.048) were significantly larger than those of plasma IL-6 (AUC = 0.685±0.060, P = 0.042), TNF-α(AUC = 0.681±0.060, P =0.036) and TAT (AUC = 0.644±0.062, P =0.008).The AUCs ofMPs procoag-ulant activity were larger than those of plasma DD (AUC = 0.743±0.056), but this difference was not statistical significance (p = 0.226). Conclusions The procoagulant activity of MPs may contribute to the pathophysiology of ICH. The propcoagulant activity of MPs after spontaneous onset of ICH seems to correlate with clinical outcome in these patients. Its procoagulant activity can be used as an useful clinical marker for evaluating the prognosis of ICH.     

急性脑出血患者血液中微粒促凝活性的变化

Objective To study the procoagulant activity of microparticles (MP) in patients with acute in-tracerebral hemorrhage (ICH) and to evaluate the correlation between procoagulant activity of MPs and disease out-come. Method From August 2006 through August 2008, 83 consecutive patients with history of hypertension ad-mitted for spontaneous basal ganglia hemorrhage including 54 male and 29 female, aged (60.9±9.7) years ranged from 41 to 79 years, were enrolled into this study. The control group was consisted of 30 age- and sex-matched (P= 0.429; P = 0.415) patients admitted for mild soft tissue injury. Patients with history of head trauma or previ-ous stroke, under the antiplatelet or anticoagulant medication, severe infection, or presence of previous cerebrovas-cttlar disease were excluded. Venous blood sample was kaken within the first 24 hours after disease onset. The MPs procoaulant potential was measured with a prothrombinase assay, and the levels of IL-6,TNF-α, D-dimer (DD)and thrombin-antithrombin Ⅲ complex (TAT) in plasma were measured with enzyme-linked immunosorbent assay. The multivariate analysis was made with forward stepwise logistic regression to determined the predictors of one. month mortality. The plasma levels of MPs were compared between ICH group and control group, between patients with intraventricular hemorrhage (IVH) and those without IVH,and between survivors and non-survivors with the Mann-Whitney U-test. The Spearman' s rank correlation coefficient was used to analyze the correlations between the plasma levels of MPs and ICH volume, Glasgow coma scale (GCS), and plasma levels of IL-6, TNF-α, DD and TAT. A receiver operating characteristic curve (ROC curve) identified the plasma MPs cutoff levels that predicted one-month mortality of patients. Under ROC curve, z statistic analysis was used to compare the area under curves (AUCs) between plasma IMPs and Glasgow coma scale, ICH volumes, and plasma levels of IL-6, TNF-α, DD and TAT for one-month mortality. Results Thirty-six patients (43.4%) died of ICH in a month. The multivariate analyses sorted out the GCS (odds ratio = 0.558, 95%CI:0.367-0.850, P = 0.007), Hematoma volume (odds ratio= 1.061, 95%C1:1.012- 1.113, P = 0.015) and IVH (odds ratio= 5.537, 95%CI:1.035-29.629, P = 0.045) as the independent pcedictors for one-week mortality. The MPs procoagulant activity in the ICH group (6.72±3.26 U/mL) was significantly higher than that in control group (1.84±0.82) U/mL (P = 0.000). The IMPs procoagulant activity in the non-survival group (8.51±3.45) U/mL was significantly higher than that in the survival group (5.35±2.33) U/mL (P = 0.000). The MPs procoagulant activity in the IVH group (7.66±3.39) U/mL was significantly higher than that in the non-lVH group (5.36±2.53) U/mL (P = 0.001). The MPs procoagulant activity was highly associated with GCS scores (r = -0.690, P = 0.000), ICH volumes (r =0.590, P = 0.000), and plasma IL-6 (r = 0.465, P = 0.015), TNF-α (r = 0.464, P = 0.016), DD(r= 0.567, P = 0.001) and TAT(r = 0.469, P = 0.014) in ICH. The ROC curve identified cutoff levels of MPs procoagulant activity to be 7.47 U/mL that predicted one-month mortality of patients with high sensitivity (77.8%) and specificity values (76.6%). Areas under curves (AUCs) of MPs procoagulant activity (AUC =0.825±0.048) were significantly larger than those of plasma IL-6 (AUC = 0.685±0.060, P = 0.042), TNF-α(AUC = 0.681±0.060, P =0.036) and TAT (AUC = 0.644±0.062, P =0.008).The AUCs ofMPs procoag-ulant activity were larger than those of plasma DD (AUC = 0.743±0.056), but this difference was not statistical significance (p = 0.226). Conclusions The procoagulant activity of MPs may contribute to the pathophysiology of ICH. The propcoagulant activity of MPs after spontaneous onset of ICH seems to correlate with clinical outcome in these patients. Its procoagulant activity can be used as an useful clinical marker for evaluating the prognosis of ICH.     

抑郁症患者REM睡眠脑电图的研究

目的 探讨抑郁症患者睡眠脑电图的特点。方法 对50例抑郁症患者和50例正常对照者进行睡眠脑电图检测，并进行对照。结果 抑郁症患者REM睡眠密度增加、潜伏期缩短、时间缩短、周期减少。结论 抑郁症患者睡眠脑电图中的REM指标，可作为抑郁症临床诊断的参考指标。     

A型肉毒毒素局部注射对远隔部位F波影响的临床研究

目的观察A型肉毒毒素局部注射后远隔部位F波改变，揭示对脊髓运动神经元兴奋性的影响，探讨其机制。方法选取29例原发性痉挛性斜颈患者，应用A型肉毒毒素进行颈部肌肉注射治疗，检测和比较注射前、注射后1周和12-16周尺神经及胫神经F波的潜伏期及出现率。结果痉挛性斜颈患者A型肉毒毒素局部注射后1周及12～16周，尺神经及胫神经M波波幅、潜伏期和神经传导速度与注射前差异无统计学意义；局部注射后1周，尺神经及胫神经F波潜伏期较注射前显著延长（P〈0．05），出现率差异无统计学意义；注射后12～16周，尺神经及胫神经F波潜伏期及出现率与注射前差异无统计学意义；胫神经和尺神经F波潜伏期变化值（注射前后差值）差异元统计学意义，与A型肉毒毒素注射剂量元明显相关性。结论A型肉毒毒素局部注射存在“远隔效应”，远隔部位F波潜伏期显著延长，脊髓运动神经元兴奋性显著降低。注射部位距离及剂量不起决定作用，其发生机制复杂，可能有多因素参与。