神经疾病专题讲座在神经病学研究生临床技能训练中的应用

医学不同于其他学科,不仅要理论扎实,更重要的是要医术精湛,必然要求医学生抓住临床实践机会,积累临床经验[1]。神经病学是专业性较强的学科,神经解剖的复杂性使得医学生学习神经病学普遍感到困难。我院神经病学研究生的临床技能培养历时2 a,研究生在病房和住院医师共同管床,在临床实践中培养临床技能。为了更好地培养他们专科技能,我们在教学实践中引入了神经疾病专题讲座,以此来加强神经病学研究生的临床技能训练。     

动脉粥样硬化性类烟雾病缺血性卒中患者危险因素分析

目的探讨成人动脉粥样硬化性类烟雾病缺血性卒中的危险因素。方法选取缺血型动脉粥样硬化性类烟雾病患者(类烟雾病组)95例、健康志愿者(正常对照组)94例,检测所有对象血浆Hcy,同时记录所有对象的人口学、病史资料、临床数据,进行组间对比及Logistic回归分析。根据铃木分期,将类烟雾病患者分为烟雾血管逐渐形成组(铃木分期Ⅰ、Ⅱ期)、烟雾血管发展加重组(铃木分期Ⅲ期)、烟雾血管形状缩小组(铃木分期Ⅳ期)、烟雾血管逐渐消失组(铃木分期Ⅴ、Ⅵ期),比较4亚组间血浆Hcy水平,并进行统计学分析。结果 Logistic回归分析显示血浆Hcy、LDL水平升高,HDL水平下降是动脉粥样硬化性类烟雾病缺血性卒中的独立危险因素(P0.05)。烟雾血管逐渐消失组血浆Hcy水平[(20.85±4.49)μmol/L]分别显著高于其余3亚组[(17.24±3.14)μmol/L]、[(17.98±4.07)μmol/L]、[(17.97±3.41)μmol/L](P0.05),余各亚组间血浆Hcy水平差异无统计学意义(P0.05)。结论 Hcy、LDL水平升高,HDL水平下降是动脉粥样硬化性类烟雾病缺血性卒中的独立危险因素。血浆Hcy水平与缺血型动脉粥样硬化性类烟雾病患者分期的严重程度有关。     

超选择动脉溶栓治疗80岁以上脑梗死的安全性及疗效评估-两中心研究

Objective To evaluate the feasibility, safety and efficacy of intra-arterial thrombolytic therapy on elderly patients (≥ 80 years old) with acute ischemic stroke. Methods The clinical data of 86 patients with acute ischemic stroke, received intra-arterial thrombolytic therapy, were retrospectively analyzed; according to age differences, these patients were divided into advanced age group (≥80 years old, n=21) and common age group (<80 years old, n=65); and control group (≥80 years old, not receiving thrombolytic therapy, n=50) was established. The recanalization rate and early clinical improvement rate, and the incidence, recover rate and death rate of symptomatic intracerebral hemorrhage were evaluated in these patients after treatment. Results No significant differences in the favorite recanalization rate and short-term outcome, and the incidence of symptom intracranial hemorrhage were noted between the advanced age group and common age group (P=0.528, P=0.102,P=0.353). The incidence of symptom intracranial hemorrhage in the advanced age group was obviously higher than that in the control group (P=0.034); the recover rate of symptom ntracranial hemorrhage in the advanced age group (42.9%) was obviously lower than that in the common age group (50.8%), but significantly higher than that in the control group (16%, P=0.042, P=0.017). The mortality of the advanced age group was similar to that of the control group (23.8% versus 28%, P=0.816), but higher than that of common age group (23.8% versus 10.8%, P=0.034). Conclusion Relatively high feasibility, safety and efficacy of intra-arterial thrombolytic therapy are noted in elderly patients (≥80 years old) with acute ischemic stroke, demonstrating that the use of intra-arterial thrombolytic therapy in very elderly patients should not be avoided but pursued advisably.     

视神经脊髓炎患者NMOIgG抗体阳性与阴性患者临床症状对比及预后分析

目的:对NMOIgG抗体表达阳性的视神经脊髓炎患者与其表达阴性患者的不同临床症状与其治疗后预后的情况进行分析与探究。方法:收集在我院接受治疗的100例视神经脊髓炎患者,采集患者的血清学标本,并且对其血清标本进行NMOIgG抗体检测,根据检测的结果将其分为抗体阳性组与抗体阴性组,每组患者50例,对比分析两组患者的临床症状以及治疗的效果与预后的情况。结果:抗体阳性组患者的病程(3.8±0.8)年、脑脊液克隆带数(37.1±6.9)个以及脊髓病灶节段数(67.2±10.8)个与抗体阴性组患者的病程(1.9±0.5)年、脑脊液克隆带数(28.3±5.7)个以及脊髓病灶节段数(34.6±9.5)个相比明显较高,结果有统计学意义(P0.05)。两组患者经治疗后,病程、脑脊液克隆带数以及脊髓病灶节段数等临床症状中,抗体阳性组患者的EDSS评分与抗体阴性组患者的EDSS评分相比明显较高,结果有统计学意义(P0.05)。结论:NMOIgG抗体在视神经脊髓炎患者体内表达阳性时,其病程、脑脊液克隆数等临床症状相对较为显著,且其治疗的预后效果较差,可以用于临床上对该疾病病情变化的判断与研究等。     

利尿剂治疗高血压应用研究

目的:探究利尿剂治疗高血压的临床效果.方法:以我院2013年12月~2014年12月接诊的120例高血压患者为研究对象,随机分成非利尿剂组和利尿剂组,各60例,非利尿剂组采用依那普利治疗,利尿剂组采用依那普利联合双氢克尿塞治疗,对比两组临床效果.结果:利尿剂组治疗总有效率为90.0%,非利尿剂组为75.0%,两组差异具有统计学意义(P<0.05);两组治疗前电解质K+变化情况无明显差异,治疗后利尿剂组电解质K+改变情况好于非利尿剂组,差异具有统计学意义(P<0.05).讨论:利尿剂治疗高血压效果明显,降压效果显著,依从性良好,值得临床推广.     

P2Y1受体介导Aβ25-35所致大鼠星形胶质细胞活化

目的: 观察嘌呤受体P2Y₁在Aβ_25-35所致的大鼠星形胶质细胞活化中所起的作用。方法: 体外分离培养大鼠星形胶质细胞,按空白对照、Aβ_25-35和P2Y₁受体阻断剂MRS2179+Aβ_25-35和MRS2179分组干预后,通过免疫细胞化学、免疫荧光法和Western blotting方法观察GFAP和P2Y₁表达的变化。结果: 各组细胞数量无明显变化。与对照组相比,Aβ_25-35组GFAP荧光强度明显增加;MRS2179+Aβ_25-35和MRS2179组均降低,两组间无明显差异。Western blotting显示GFAP在各组间表达与免疫荧光法有相似趋势;与对照组相比,P2Y₁表达在Aβ_25-35组明显增多(P＜0.05)和MRS2179+Aβ_25-35和MRS2179组无明显变化(P＞0.05)。结论: Aβ_25-35通过P2Y₁受体活化激活星形胶质细胞。     

超选择动脉溶栓治疗80岁以上脑梗死的安全性及疗效评估-两中心研究

目的 探讨80岁以上高龄脑梗死患者超选择动脉溶栓治疗的安全性、可行性及治疗效果.方法 回顾性分析86例超选择动脉溶栓治疗的脑梗死患者的临床资料,根据年龄不同分为高龄组(≥180岁,21例)和普通年龄组(<80岁,65例),并设对照组(同时期≥80岁未行动脉溶栓治疗患者,50例).评估患者动脉溶栓术后血管良好再通率、早期临床改善率,以及各组症状性脑出血发生率、较好转归率及死亡率.结果 接受动脉溶栓治疗的两组患者血管良好再通率、早期临床改善率及症状性脑出血发生率比较差异无统计学意义(P=0.528,P=0.102,P=0.353).高龄组症状性脑出血发生率明显高于对照组,比较差异有统计学意义(P=0.034).高龄组较好转归率为42.9%,低于普通年龄组(50.8%),但高于对照组(16%),差异有统计学意义(P=0.042,P=0.017).高龄组死亡率与对照组比较差异无统计学意义(23.8%vs 28%,P=0.816),但高于普通年龄组,差异有统计学意义(23.8%vs 10.8%,P=0.034).结论 80岁以上高龄脑梗死患者超选择动脉溶栓治疗具有较高的安全性、可行性和临床疗效,高龄不是脑梗死动脉溶栓治疗的禁忌因素.

Abstract：

Objective To evaluate the feasibility, safety and efficacy of intra-arterial thrombolytic therapy on elderly patients (≥ 80 years old) with acute ischemic stroke. Methods The clinical data of 86 patients with acute ischemic stroke, received intra-arterial thrombolytic therapy, were retrospectively analyzed; according to age differences, these patients were divided into advanced age group (≥80 years old, n=21) and common age group (<80 years old, n=65); and control group (≥80 years old, not receiving thrombolytic therapy, n=50) was established. The recanalization rate and early clinical improvement rate, and the incidence, recover rate and death rate of symptomatic intracerebral hemorrhage were evaluated in these patients after treatment. Results No significant differences in the favorite recanalization rate and short-term outcome, and the incidence of symptom intracranial hemorrhage were noted between the advanced age group and common age group (P=0.528, P=0.102,P=0.353). The incidence of symptom intracranial hemorrhage in the advanced age group was obviously higher than that in the control group (P=0.034); the recover rate of symptom ntracranial hemorrhage in the advanced age group (42.9%) was obviously lower than that in the common age group (50.8%), but significantly higher than that in the control group (16%, P=0.042, P=0.017). The mortality of the advanced age group was similar to that of the control group (23.8% versus 28%, P=0.816), but higher than that of common age group (23.8% versus 10.8%, P=0.034). Conclusion Relatively high feasibility, safety and efficacy of intra-arterial thrombolytic therapy are noted in elderly patients (≥80 years old) with acute ischemic stroke, demonstrating that the use of intra-arterial thrombolytic therapy in very elderly patients should not be avoided but pursued advisably.     

海人酸对神经干细胞增殖及分化的影响

背景：神经干细胞对脑组织的修复作用非常有限,约80%新增殖的内源性神经干细胞在6周内死亡,仅0.2%的细胞继续增殖、分化,参与修复。 目的：分析不同剂量海人酸在对神经干细胞增殖及分化的影响。 方法：体外分离并培养新生Wistar大鼠神经干细胞,将神经干细胞分为空白对照组和加入不同浓度梯度的海人酸组,通过免疫组化法和免疫荧光法进行鉴定,MTT比色法测定海人酸对神经干细胞分化的影响,计算分化后神经元和星形胶质细胞比例。 结果与结论：海人酸组贴壁的神经球分化速度较空白对照组快,在同一时间点进行观察,神经细胞的迁移距离较未处理组远。分化5 d后,海人酸组所分化的细胞中,星状细胞较空白对照组多,而神经元样细胞相对较少,培养的细胞具有自我更新和向神经元﹑少突胶质细胞和星形胶质细胞分化的潜能。兴奋性氨基酸海人酸可使部分神经干细胞死亡,但可促进幸存的神经干细胞增殖及分化,并诱导其向星形胶质细胞分化。中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程全文链接：     

天麻素后处理对糖氧剥夺大鼠皮层神经元EphA4表达的影响

目的研究天麻素对糖氧剥夺(oxygen-glucose deprivation,OGD)大鼠皮层神经元损伤的保护性作用及EphA4表达的影响。方法提取新生大鼠大脑皮层神经元体外培养7 d,对4组神经元分别施以60 min的OGD,换回正常培养液培养30 min后分别及给予含终浓度为50、125、250、500μmol/L天麻素的培养液作为后处理措施,培养4 h后换回正常条件培养24 h;采用倒置相差显微镜观察神经元形态学变化,LDH活性测定检测神经元损伤情况,CY3荧光染色检测EphA4表达变化。结果天麻素后处理能降低糖氧剥夺神经元的损伤,降低EphA4表达。结论天麻素对糖氧剥夺神经元损伤有保护作用,该作用与EphA4表达降低有关。