肌萎缩侧索硬化患者轻度认知功能损害

Objective To explore the cognitive status of amyotrophic lateral sclerosis (ALS) patients, and to explore the involved cognitive domains, subtypes and risk factors of mild cognitive impairment in ALS ( ALS-MCI).Methods Twenty-nine cases of ALS and 58 healthy volunteers were included.The severity of the bulbar and spinal functions of the patients was evaluated by the Improved Norris Scale.According to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition-Revised( DSM-Ⅳ-R) criteria of dementia, ALS cases were classified as demented and non-demented.For non-demented ALS cases, the common cognitive batteries evaluating mental state, verbal memory, executive, attentional and visuospatial abilities were performed.Hamilton Anxiety Scale ( HAMA) and Hamilton Depression Scale (HAMD) were evaluated too.They were further classified into ALS-cognitively normal (ALS-CogNL) and ALS-MCI groups according to Petersen criteria of MCI.Risk factors possibly correlated with ALS-MCI were analyzed by comparing the differences in age, age of onset, duration of the disease, sites of onset, symptoms of bulbar and limb function between ALS-CogNL and ALS-MCI groups.Results Among 29 ALS cases, 14 (48.3% ) cases with cognitively normal( ALS-CogNL), 15 cases (51.7% ) with ALS-MCI,and none with dementia were identified.Among 15 ALS-MCI cases, 12 cases with executive dysfunction, 8 cases with memory deficits,9 cases with attention impairment and none with visuospatial impairment were found.ALSMCI cases could be further classified into three subtypes; 1 case with amnestic MCI (aMCI) ,6 cases with single domain non-memory MCI ( sdMCI), and 8 cases with multiple domains slightly impaired MCI (mdMCI).Between ALS-MCI and ALS-CogNL groups, there were significant differences (t = -2.435,- 2.576, both P ＜ 0.05) in education ((8.7 ± 2.8) years vs (11.3 ± 3.0) years) and Improved Norrisscale (bulbar score: (28.4 ± 7.7) scores vs ( 34.0 ± 3.4) scores) , however, no significant differences in sex, age, age of onset, duration,site of onset,HAMA or HAMD scores,and Improved Norris scale( spinal score) were found.Conclusions Cognitive deficits commonly exist in ALS patients.For the involved domains, executive dysfunction is the most common, deficits of attention and memory are also common, and deficit in visuospatial function is not found.The most common subtype of ALS-MCI is mdMCI.Severe bulbar symptoms and lower education may be the risk factors of ALS-MCI.     

产超广谱β-内酰胺酶革兰阴性杆菌的检测和耐药性研究

目的 研究汕头地区革兰阴性杆菌产超广谱β-内酰胺酶(ESBLs)情况及其耐药特性,为临床合理使用抗生素提供依据.方法 收集汕头地区革兰阴性杆菌共1 445株(大肠埃希菌895株和肺炎克雷伯菌550株),采用Vitek-2全自动细菌鉴定和药敏分析仪进行ESBL检测和药敏实验.结果 69.4%大肠埃希菌和33.6%肺炎克雷伯菌产ESBLs.产ESBLs菌株对青霉素类、头孢菌素类和单环类抗生素的耐药率极高;产ESBLs菌株存在多重耐药性,而且对多种抗生素的耐药率明显比不产ESBLs菌株高;产ESBLs菌株和不产ESBLs菌株对亚胺培南均未出现耐药.结论 汕头地区革兰阴性杆菌中ESBLs菌株检出率高;产ESBLs菌株耐药性比不产ESBLs菌株高,且耐药表型多样性;亚胺培南是临床治疗产ESBLs菌株感染的首选药物.     

金属硫蛋白3对快速老化痴呆模型小鼠海马组织学变化的影响

目的研究金属硫蛋白(MT)3对快速老化痴呆模型小鼠(SAMP8)海马结构CA1区神经元组织学变化的影响。方法给小鼠不同浓度MT3及盐水腹腔注射28 d,处死小鼠后应用光镜和电镜观察制备标本海马结构神经元的变化。结果快速老化小鼠对照小鼠(SAMR1)海马CA1区锥体细胞排列较整齐、均匀,胞膜完整,染色质分布均匀,细胞核呈圆形或椭圆形,核仁清楚,细胞器清晰可见。SAMP8组海马CA1区可见锥体细胞稀疏、排列紊乱,大部分神经元肿胀、空化,出现凋亡细胞,很多胞核固缩深染,胶质细胞增多,有较多脂褐素沉积。低、中、高浓度MT3组海马CA1区锥体细胞较空白对照组结构较清晰,排列较整齐均匀。神经元核基质呈轻度空化改变,胞质内都可见线粒体、粗面内质网及脂褐素,胶质细胞减少。高浓度MT3组的超微结构最接近于SAMR1组,但仍处于老化状态。结论 SAMP8海马有组织结构和超微结构的改变。MT3对SAMP8海马锥体细胞有保护的作用。     

不同剂量阿托伐他汀预防动脉粥样硬化性脑梗死疗效分析

目的：观察不同剂量阿托伐他汀预防再发动脉粥样硬化性脑梗死疗效。方法：80例住院脑梗死患者按服用阿托伐他汀剂量分为常规组（20mg）及强化组（40mg）,常规组48名,强化组32名,收集患者基线临床资料,进行神经功能NIHss评分及mRS评分,随访3个月,再次进行神经功能评估及血脂、肝功能指标复测,登记新发卒中事件。结果：2组在年龄、性别、体重指数、高血压病、糖尿病患病率、基线NIHss评分、mRS评分、基线LDL—C、肝功能异常率、以及相关治疗策略未有统计学差异（P〉0．05）。治疗3月随访,常规组与强化组在神经功能评估方面较治疗前有改善,但2组间并无统计学差异（P〉0．05）。LDL—C达标率强化组明显优于常规组（53．1％VS27．1,P=0．018）,新发缺血性卒中事件方面,强化组也呈现优势,但并未有明显统计学差异（0VS9．1％,P=0．099）。在并发症方面,包括颅内出血及肝功能异常方面,2组并未有统计学差异（P〉0．05）。结论：阿托伐他汀40mg相比20mg预防再发动脉粥样硬化性脑梗死疗效可能更好,且未增加肝功能损害或颅内出血风险。     

脑静脉系统血栓形成43例临床分析

目的 探讨腩静脉系统血栓形成(cerebral venous thrombosis,CVT)的病因、临床特征、诊断及治疗.方法 回顾性分析43例CVT患者临床资料,总结CVT的临床特点、影像学特征、诊断、治疗及转归.结果 CVT多见于中青年,多为急性起病,大部分可找到相关病因,最常见的首发症状为头痛,MRI联合MRV能清晰地显示静脉系统形态及阻塞情况,DSA能清楚显示静脉系统血栓的部位及继发于CVT的动静脉瘘.早期诊断及应用抗凝治疗是取得良好预后的关键.结论 CVT的病因多样,临床表现缺乏特异性,MRI联合MRV检查是目前CVT诊断及随访的重要检杳方法 ,对原因不明的颅内高压患者需行相应检查,一旦确诊,应予抗凝治疗.     

汕头地区产超广谱β-内酰胺酶细菌耐药性动态分析

目的：探讨汕头地区革兰阴性杆菌产超广谱β-内酰胺酶（ESBLs）的检出率及耐药性．为指导临床合理使用抗生素提供依据。方法：收集2009年至2011年汕头地区大肠埃希菌1547株和肺炎克雷伯菌837株,采用Vitrk-2全自动分析系统进行ESBLs检测和药敏实验、结果：2009-2011年大肠埃希菌和肺炎克雷伯菌产ESBLs阳性率分别为65．9％、72．9％、71．0％和30．2％、38．4％、33．1％：2010年与2009年产ESBLs菌株分离率比较,差异有统计学意义（P〈0．05）;2009-2011年产ESBLs菌株对多种抗生素具有较高的耐药率;耐药率最低的是碳青霉烯类（亚胺培南和厄他培南）;除碳青霉烯类外,产ESBLs菌株耐药性比较差异无统计学意义（P〉0．05）．产ESBLs菌株对多种抗生素的耐药率明显比不产ESBLs菌株鬲（P〈0．05）结论：汕头地区产ESBLs菌株检出率高;产ESBLs菌株耐药性严重,动态监测对临床     

金属硫蛋白3对快速老化痴呆模型小鼠行为学变化的影响

目的研究金属硫蛋白(MT)3对快速老化痴呆模型小鼠(SAMP8)水迷宫行为学变化的影响。方法给小鼠不同浓度MT3及盐水腹腔注射28 d,进行Morris水迷宫检测。结果与快速老化小鼠对照系(SAMR1)小鼠相比,SAMP8逃避潜伏期明显延长(P<0.01),跨越原平台次数明显减少(P<0.05);3种浓度MT3组当中高浓度MT3组逃避潜伏期最短,跨越原平台次数最多(P<0.05);高浓度MT3组与SAMR1相比,逃避潜伏期仍延长,跨越原平台次数减少(P<0.05)。结论高浓度MT3可以提高SAMP8小鼠的学习能力和记忆能力,其作用效果与浓度有关。     

肌萎缩侧索硬化患者轻度认知功能损害

Objective To explore the cognitive status of amyotrophic lateral sclerosis (ALS) patients, and to explore the involved cognitive domains, subtypes and risk factors of mild cognitive impairment in ALS ( ALS-MCI).Methods Twenty-nine cases of ALS and 58 healthy volunteers were included.The severity of the bulbar and spinal functions of the patients was evaluated by the Improved Norris Scale.According to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition-Revised( DSM-Ⅳ-R) criteria of dementia, ALS cases were classified as demented and non-demented.For non-demented ALS cases, the common cognitive batteries evaluating mental state, verbal memory, executive, attentional and visuospatial abilities were performed.Hamilton Anxiety Scale ( HAMA) and Hamilton Depression Scale (HAMD) were evaluated too.They were further classified into ALS-cognitively normal (ALS-CogNL) and ALS-MCI groups according to Petersen criteria of MCI.Risk factors possibly correlated with ALS-MCI were analyzed by comparing the differences in age, age of onset, duration of the disease, sites of onset, symptoms of bulbar and limb function between ALS-CogNL and ALS-MCI groups.Results Among 29 ALS cases, 14 (48.3% ) cases with cognitively normal( ALS-CogNL), 15 cases (51.7% ) with ALS-MCI,and none with dementia were identified.Among 15 ALS-MCI cases, 12 cases with executive dysfunction, 8 cases with memory deficits,9 cases with attention impairment and none with visuospatial impairment were found.ALSMCI cases could be further classified into three subtypes; 1 case with amnestic MCI (aMCI) ,6 cases with single domain non-memory MCI ( sdMCI), and 8 cases with multiple domains slightly impaired MCI (mdMCI).Between ALS-MCI and ALS-CogNL groups, there were significant differences (t = -2.435,- 2.576, both P ＜ 0.05) in education ((8.7 ± 2.8) years vs (11.3 ± 3.0) years) and Improved Norrisscale (bulbar score: (28.4 ± 7.7) scores vs ( 34.0 ± 3.4) scores) , however, no significant differences in sex, age, age of onset, duration,site of onset,HAMA or HAMD scores,and Improved Norris scale( spinal score) were found.Conclusions Cognitive deficits commonly exist in ALS patients.For the involved domains, executive dysfunction is the most common, deficits of attention and memory are also common, and deficit in visuospatial function is not found.The most common subtype of ALS-MCI is mdMCI.Severe bulbar symptoms and lower education may be the risk factors of ALS-MCI.     

额颞叶变性伴运动神经元病1例报告

额颞叶变性(frontotemporal lobar degeneration,FTLD)是以局限性的额叶、颞叶变性为特征的进行性非阿尔茨海默病痴呆综合征,这组综合征包括额颞叶痴呆(frontotemporal dementia,FTD)、原发性进行性失语和语义性痴呆.运动神经元病(motor neuron disease,MND)是一组病因未明的选择性侵犯脊髓前角细胞、脑干后组运动神经元、皮质锥体细胞及锥体束的慢性进行性变性疾病.     

肌萎缩侧索硬化患者轻度认知功能损害

目的 探讨肌萎缩侧索硬化(ALS)患者认知功能状态、ALS轻度认知功能损害(ALS-MCI)的受累领域和各种亚型及其可能的危险因素.方法 收集ALS患者29例,健康对照者58名,选用改良Norris量表评价ALS患者的延髓功能及肢体功能.根据美国精神病学会精神障碍诊断和统计手册(DSM-Ⅳ-R)痴呆的诊断标准,将ALS患者分为痴呆和非痴呆;对于非痴呆的ALS患者,通过常用的认知功能(包括精神状态、记忆力、执行功能、注意力、视空间功能)量表、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)进行评分,按照Petersen等修订的MCI诊断标准,将其分为认知功能正常(ALS-CogNL)组和ALS-MCI组,分析ALS-MCI受累的领域及其亚型;比较2组在年龄、起病年龄、病程、起病部位、延髓性麻痹症状、肢体运动功能损害等方面的差异,分析ALS患者出现MCI的相关危险因素.结果 29例ALS患者中,认知功能正常14例(48.3%),MCI有15例(51.7%),未发现痴呆患者.15例ALS-MCI患者中,执行功能损害12例,注意力损害9例,记忆力损害8例,未发现视空间功能损害;其中遗忘型(ALS-aMCI)1例,非记忆单一领域损害型(ALS-sdMCI)6例,多领域受损型(ALS-mdMCI)8例.ALS-MCI组与ALS-CogNL组的教育年限[(8.7±2.8)年与(11.3 ±3.0)年]、Norris量表延髓功能评分[(28.4±7.7)分与(34.0±3.4)分]差异有统计学意义(t=-2.435、-2.576,均P＜0.05),性别、年龄、起病年龄、病程、起病部位、HAMA及HAMD评分、Norris量表肢体功能评分差异无统计学意义.结论 ALS患者常出现MCI,其中以执行功能损害最常见,记忆力、注意力亦有损害,未发现视空间功能损害,ALS-mdMCI是最常见的亚型.文化程度低、严重延髓性麻痹症状是ALS患者出现认知功能损害的危险因素.

Abstract：

Objective To explore the cognitive status of amyotrophic lateral sclerosis (ALS) patients, and to explore the involved cognitive domains, subtypes and risk factors of mild cognitive impairment in ALS ( ALS-MCI).Methods Twenty-nine cases of ALS and 58 healthy volunteers were included.The severity of the bulbar and spinal functions of the patients was evaluated by the Improved Norris Scale.According to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition-Revised( DSM-Ⅳ-R) criteria of dementia, ALS cases were classified as demented and non-demented.For non-demented ALS cases, the common cognitive batteries evaluating mental state, verbal memory, executive, attentional and visuospatial abilities were performed.Hamilton Anxiety Scale ( HAMA) and Hamilton Depression Scale (HAMD) were evaluated too.They were further classified into ALS-cognitively normal (ALS-CogNL) and ALS-MCI groups according to Petersen criteria of MCI.Risk factors possibly correlated with ALS-MCI were analyzed by comparing the differences in age, age of onset, duration of the disease, sites of onset, symptoms of bulbar and limb function between ALS-CogNL and ALS-MCI groups.Results Among 29 ALS cases, 14 (48.3% ) cases with cognitively normal( ALS-CogNL), 15 cases (51.7% ) with ALS-MCI,and none with dementia were identified.Among 15 ALS-MCI cases, 12 cases with executive dysfunction, 8 cases with memory deficits,9 cases with attention impairment and none with visuospatial impairment were found.ALSMCI cases could be further classified into three subtypes; 1 case with amnestic MCI (aMCI) ,6 cases with single domain non-memory MCI ( sdMCI), and 8 cases with multiple domains slightly impaired MCI (mdMCI).Between ALS-MCI and ALS-CogNL groups, there were significant differences (t = -2.435,- 2.576, both P ＜ 0.05) in education ((8.7 ± 2.8) years vs (11.3 ± 3.0) years) and Improved Norrisscale (bulbar score: (28.4 ± 7.7) scores vs ( 34.0 ± 3.4) scores) , however, no significant differences in sex, age, age of onset, duration,site of onset,HAMA or HAMD scores,and Improved Norris scale( spinal score) were found.Conclusions Cognitive deficits commonly exist in ALS patients.For the involved domains, executive dysfunction is the most common, deficits of attention and memory are also common, and deficit in visuospatial function is not found.The most common subtype of ALS-MCI is mdMCI.Severe bulbar symptoms and lower education may be the risk factors of ALS-MCI.