目的 探讨脑心通结合抗抑郁药对卒中后抑郁(post-stroke depression,PSD)患者脑血管灌注量、血清神经递质、B淋巴细胞刺激因子(B cell activating factor,BAFF)和增殖诱导配体(a proliferation inducing ligand,APRIL)水平的影响.方法 选取2019年3月-2020年7月海南省安宁医院收治的PSD病人120例为研究对象,按照随机数字表法分成对照组和研究组,各60例.对照组给予基础治疗联合舍曲林,研究组给予基础治疗联合舍曲林和脑心通胶囊.治疗6个月后,比较2组治疗前后焦虑抑郁情况、神经与认知功能、生活质量、脑血管灌注量、血清神经递质和免疫调节指标水平;统计两组患者治疗6个月内不良反应情况.结果 治疗6个月后,2组汉密尔顿抑郁评分和汉密尔顿焦虑评分低于治疗前(t=38.336、28.801,39.615、24.149,P均＜0.001),且研究组低于对照组(t=9.902、7.879,P＜0.001);2组神经功能缺损评分低于治疗前(t=73.234、38.386,P均＜0.001),且研究组低于对照组(t=20.275,P均＜0.001);2组认知功能评分高于治疗前(t=11.428、5.489,P均＜0.001),且研究组高于对照组(t=3.131,P=0.002);2组脑血容量和脑血流量高于治疗前(t=22.463、17.428,17.781、10.470,P均＜0.001),且研究组高于对照组(t=2.901、5.134,P=0.016、＜0.001);2组脑源性神经营养因子、血清5-羟色胺和去甲肾上腺素含量高于治疗前(t=22.815、17.068,24.579、19.283,46.583、37.896,P均＜0.001),且研究组高于对照组(t=2.843、3.815、7.255,P=0.005、＜0.001、＜0.001).研究组B淋巴细胞刺激因子和增殖诱导配体含量水平低于治疗前(t=5.783、4.495,P均＜0.001),且低于对照组(t=2.377、2.059,P=0.019、0.042).2组治疗后世界卫生组织生活质量总评分高于治疗前(t=9.568、8.091,P均＜0.001),且研究组总分高于对照组(t=5.114,P＜0.001).2组均未出现严重药物不良反应(x2=0.120,P=0.729).结论 脑心通胶囊联合抗抑郁药治疗PSD有较显著疗效,可以帮助患者恢复神经功能、提高血清神经递质水平、改善脑血管灌注量,值得临床推广使用.

目的 研究首发精神分裂症穹隆脚MRI影像学特征与阴性和阳性综合征量表(PANSS)阳性症状的相关性.方法 选取98例首发精神分裂症患者作为病例组,另选40例健康受试者作为对照组,比较2组穹隆脚MRI影像学特征,包括穹窿脚下方至大脑中线距离(FMD)、紧贴胼胝体穹窿脚直径(FD1)、穹窿脚中段直径(FD2)、脑室面积(VA),以及其他MRI检测指标(外侧裂宽度、海马厚度、脑岛面长度),采用PANSS对病例组临床症状进行评分,采用Pearson法对上述检测指标与PANSS阳性症状评分做相关性分析.结果 2组左侧FD1值均明显低于右侧,左侧VA值均明显高于右侧,病例组左侧FD2值低于右侧(P<0.05);病例组双侧FD2值明显低于对照组,VA值明显高于对照组(P<0.05);病例组双侧的外侧裂宽度均高于对照组,海马厚度低于对照组(P<0.05);首发精神分裂症患者的FD2值与PANSS阳性症状评分呈负相关(P<0.05);外侧裂宽度与PANSS阳性症状评分呈正相关(P<0.05).结论 首发精神分裂症穹隆脚左右侧不对称,双侧VA与外侧裂宽度均高于正常人,海马厚度低于正常人,其中FD2值与PANSS阳性症状评分呈负相关,外侧裂宽度与PANSS阳性症状评分呈正相关,提示FD2部位的形态、纤维束可能存在异常,对精神分裂症患者的临床影像学研究有重要意义.

目的 探讨棕榈酸帕利哌酮注射液(PP-LAI)联合穴位埋线治疗精神分裂症(SCH)的远期疗效及对血清肌酸磷酸激酶(CPK)、同型半胱氨酸(Hcy)水平的影响.方法 选取SCH患者400例,分为观察组200例和对照组200例,分别予PP-LAI联合穴位埋线治疗、单纯肌注PP-LAI治疗12个月;采用倾向性匹配方法对患者进行1:1匹配,比较阳性与阴性症状量表(PANSS)、认知功能成套测验系统(MCCB)、个人和社会功能量表(PSP)、血清肌酸磷酸激酶(CPK)、同型半胱氨酸(Hcy)水平、精神分裂症患者生活质量量表(SQLS)的差异,评价安全性.结果 倾向性匹配后,所有混杂因素在两组间达到平衡.治疗后观察组治疗总有效率高于对照组(P<0.05).治疗后,两组PANSS总分及各因子分、血清CRK、Hcy水平和SQLS评分均较各自治疗前降低(P<0.05),且观察组低于对照组(P<0.05);两组MCCB、PSP评分均较各自治疗前升高(P<0.05),且观察组高于对照组(P<0.05).结论 PP-LAI联合穴位埋线治疗SCH的远期疗效显著,可下调血清CPK、Hcy水平,有助于缓解SCH症状,提高患者认知功能、社会功能和生活质量.

目的:研究精神分裂症的难治性相关因素.方法:选取200例难治性精神分裂症患者和200例非难治性精神分裂症患者,药物基因检测他们的CYP系列基因CYP1A2、CYP3A4、CYP2D6,对3个基因的快代谢型概率进行比较分析;再将200例难治性精神分裂症患者随机分为合并药物治疗组、单一药物治疗组各100例,分别于治疗的0W、4W进行药物基因检测3个基因快代谢型以及BPRS量表评分疗效进行比较分析.结果:难治性精神分裂症患者CYP1A2、CYP3A4、CYP2D6基因快代谢型概率与非难治性差异具有显著性(P＜0.05);治疗4W后合并药物治疗组CYP1A2、CYP3A4、CYP2D6基因快代谢型概率对比单一药物治疗组差异无显著性(P＞0.05);BPRS量表评分合并药物治疗组疗效显著高于单一药物治疗组(P＜0.05);经过Logistic回归分析,精神分裂症的难治性与CYP系列基因CYP1A2、CYP3A4、CYP2D6快代谢型相关.结论:CYP系列基因CYP1A2、CYP3A4、CYP2D6快代谢型是精神分裂症难治性的相关因素,抗精神病药物合并CYP酶抑制剂治疗能够提高疗效.

目的 探讨舒必利联合重复经颅磁刺激( rTMS)治疗老年抑郁症的疗效及安全性.方法 将90例老年抑郁症患者随机分为研究组和对照组各45例,研究组选用舒必利联合rTMS治疗,对照组单用rTMS治疗,分别于治疗前及治疗后第2、4、6周使用汉密尔顿抑郁量表(HAMD)评定疗效.结果 治疗6 w后,研究组痊愈5例,显著进步10例,进步25例,无效5例,显效率33. 3% ,有效率88. 9% ;对照组痊愈3例,显著进步7例,进步20例,无效15例,显效率22. 2% ,有效率66. 7% .研究组疗效显著高于对照组(P均<0. 05);两组HAMD量表评分比较,研究组在治疗第4、6周时减分率较对照组显著下降(P均<0. 05);两组治疗过程不良反应症状量表(TESS)分值差异无统计学意义(P均>0. 05).结论 舒必利联合rTMS磁治疗老年抑郁症安全有效.

Objective To investigate the relationship between the dopa-mine D2 receptor ( DRD2 ) gene polymorphism and efficacy of paliperi-done extended release tablets.Methods Eighty schizophrenia patients ( the Han nationality ) were included in the study.They were administra-ted with pailperidone extended -release tablets(6-12 mg· d-1 ) for six weeks and assessed with positive and negative symptoms scale ( PANSS) and the other four kinds of scores before and after treatment.They were divided into responsive group ( the reduction rate ≥50%) and unrespon-sive group ( the reduction rate <50%) by the score of PANSS reduction rate.The polymerase chain reaction restriction fragment length polymor-phism ( PCR-RFLP) method was used to determine the relation between DRD2 gene polymorphism and efficacy of paliperidone extended release tablets.Results There were significant differences before and after treatment according to PANSS score and the other four kinds of scores ( P<0.01).The differences of alleles and genotypes frequencies in the responsive group and unresponsive group were not statistically significant ( P>0.05).Conclusion DRD2 gene polymorphism and the efficacy of paliperidone extended -release tablets in Han nationality patients with schizophrenia may be not related .

近年来,大学生的心理健康问题越来越受到重视,大学生入学前都需要完成心理测试,但是大学生精神障碍患者仍有逐步上升的趋势.大学生的心理健康和精神状态是一项复杂的社会心理学问题,其治疗状况也存在着诸多问题.为此,研究者对武汉市3所医院(2所大型综合性医院和1所精神专科医院)1524例高校学生因精神疾病住院治疗的相关资料进行分析,为高校学生精神障碍的预防提供参考.

Objective:To comparatively analyzing the status of hospitalized treatment and curative effect of college students with psychonosema from Hubei and Hainan.Methods 2486 cases of inpatients with psychonosema were randomly sampled from these two provinces.Their data was retrospectively analyzed.Results There had more college students with psychonosema in Hubei than those in Hainan.The main diseases were schizophrenia,emotional psychonosema and severe stress disorder.No significant difference was observed between these two provinces(P>0.05).More male college students with schizophrenia,character and conduct obstacles were observed than female college students(P<0.05),but for diseases of emotional psychonosema,severe stress disorder and organic disorder,it was on the contrary(P<0.05).No significant difference of the proportion of personality disorders and physiological disorders related to psychological factors was observed between male and female college students.As for the curative effect,comprehensive intervention treatment was much better than other treatments.Conclusion There had different morbidity of mental disorder in college students between these two provinces,which kept increasing.It was suggested that comprehensive intervention treatments should be adopted and popularized.

Objective:To analyze the basic conditions and dynamic changes of perinatal birth defects in Hainan,explore the causes and prevention strategies of perinatal birth defects. Methods:The perinatal data of birth defects in a maternal and child health hospital of Hainan from 2005 to 2010 were analyzed statistically. Results:Among 11 483 perinatal infants,286 infants were found with birth defects,the incidence was 24.91 ‰;the perinatal mortality was 3.57 ‰.The top five birth defects were cleft lip and palate,polydactylia,ear deformities,congenital heart disease and neural tube defects;there was a positive correlation between the incidence of birth defects and maternal age,>35 years old was a high risk factor of birth defects;most of the pregnant women who gave birth to neonates with birth defects belonged to the population with low income and low educational level. Conclusion:Enhancing prenatal screening and education and creating a good social and cultural environment of fertility may reduce the incidence of infantile birth defects.

Objective To investigate the status quo sexual behavior of college students in Hainan province and explore the factors related to sexual behavior,and to make recommendations for sexual education.Methods 2 875 college students in Hainan province were selected by random cluster sampling method,and were surveyed with the self-designed questionnaire.Results The incidence of sexual behavior among college students was 21.25% in Hainan province,and it was different in different groups by gender and grades.The male students(31.04%) and high grade(OR=1.487) had higher incidence.The incidence was higher among the students who get sexual information through the erotica,internet,and so on.Loneliness,family-type,smoking,drinking,and video games also have influence to sexual behavior.Conclusions College students' sexual behaviors and personal habits are closely related.We should strengthen sexual health education for college students to promote the healthy development of college students' sexual psychology and personality.

Objective:To understand the social behavior of university students occurred in the status quo.Methods:To investigate the current situation of 1,200 college students who come from 10 universities in Hainan Province in social behavior and sexual psychology by a self-compiled questionnaire of "Survey on sexual behavior of university students".Results:The respective percentage of kissing,sexual touch-ing,sexual intercourse of university students were 49.0%,27.7%,17.1%.Boys and girls in sexual foreplay,sexual intercourse on the significant difference(<0.01);The initiative of sexual behavior occurrence of boys were more significant than girls(<0.01).Conclusions:A part of the university students’moral sense were indifferent that they needed sex education,to ensure that the maintenance of the social and moral behav-ior within the range that allowed to promote their psychological development and the improvement of personality.

目的探讨阿立哌唑对女性精神分裂症患者的疗效及不良反应.方法随机抽取用阿立哌唑治疗40例女性精神分裂症患者,在治疗前和治疗1、2、4、6、8周末进行阳性和阴性症状量表(PANSS),临床疗效总评量表(CGI)评定疗效,副反应量(TESS)评定药物不良反应. 结果阿立哌唑治疗8周末,以PANSS减评率评定疗效,显效率为60.5%,总有效率为83.8%,锥体外系反应和抗胆碱能反应少见,对心脏、体重影响不明显.结论阿立哌唑对女性精神分裂症疗效确切,不良反应少,安全性和耐受性高.

目的探讨十二年来住院精神病人药源性迟发性运动障碍患病率变化特点及其影响因素.方法应用AIMS对1998年4月,1993年7月和2000年12月正在住院病人进行评定,可疑者肌注海饿辛,并收集有关情况.结果 1988年TD患者率为13.5%,1993年为5.5%,2000年为8.1%.1993年TD患病率显著低于1988年,TD患病率的高低与应用抗精神病药物品种及剂量有关联.结论不同年代TD患病率也不同,并且与应用抗精神病药物及剂量有关.