帕金森综合征是指有类似帕金森病表现的多种疾病,其中包括帕金森病(PD)、多系统萎缩(MSA)、进行性核上性麻痹(PSP).PD以震颤、肌强直、动作迟缓、姿势平衡障碍的运动症状和睡眠障碍、嗅觉障碍、自主神经功能障碍、认知和精神障碍等非运动症状为临床特征.MSA以自主神经功能障碍、帕金森病、小脑共济失调和锥体束征的不同组合为主要临床表现.PSP是一种非典型帕金森综合征,早期可出现步态不稳所致跌倒,可见核上性凝视麻痹或迟缓,锥体外系肌强直,伴皮层下认知和精神行为改变.不正常的眼球运动很常见,有时在运动障碍性疾病中也很突出.眼球运动检查包括床边评估和实验室记录眼球错位、不自主眼球运动,包括眼球震颤和扫视侵入、视振荡、诱发性眼球震颤、扫视、平滑跟踪和前庭眼反射.眼动检查已被证明是鉴别帕金森综合征的一个极好的工具.本文综述PD、MSA及PSP的眼动特征,旨在为三者的鉴别诊断提供依据.

血管性认知障碍(vascular cognitive impairment,VCI)是目前第二大导致痴呆的原因,其发病机制目前尚不明确.神经炎症作为其可能最重要的发病机制之一,已成为当前研究的热点及重点.由于脑缺血缺氧所导致慢性脑灌注不足可引起神经胶质细胞活化、血脑屏障通透性改变、神经炎症信号反应通路的激活等一系列的神经炎性反应,同时许多神经炎症介质也积极参与VCI的发生与发展.现就上述神经炎症反应及神经炎症介质在慢性脑灌注不足条件下引起认知障碍的发病机制进行综述.

目的 建立一种眩晕起病的急性后循环缺血性卒中(aPCI)的风险预警模型,分析其诊断价值.方法 将2021年12月至2022年10月共461例以急性眩晕起病的该院神经内科住院患者,按照是否患有aP-CI分为两组,aPCI组(375例,出院诊断为aPCI)和非aPCI组(86例,出院诊断为其他眩晕相关疾病),纳入分析的风险因素包含6个方面、共25项临床资料.通过单因素logistic回归分析得到有统计学意义的风险因素(P<0.05),再将这些风险因素纳入多因素logistic回归分析得出风险预警模型,绘制受试者工作特征(ROC)曲线,评价模型诊断价值.结果(1)通过logistic回归分析得到风险预警模型,吸烟史、饮酒史、糖尿病史、中性粒细胞/淋巴细胞比值(NLR)、国际标准化比值(INR)、共济失调是aPCI发生的风险因素;(2)利用ROC曲线,得到风险预警模型AUC为0.819,灵敏度0.640,特异度0.872,95％CI:0.773～0.866.结论(1)吸烟史、饮酒史、糖尿病史、NLR、共济失调与aPCI的发生呈正相关,INR与aPCI呈负相关.(2)该风险预警模型可帮助临床医生筛选出aPCI的高危患者,具有较高的诊断价值.

急性缺血性卒中是脑组织缺血缺氧而引起神经功能损伤的临床综合征,抗血小板治疗是缺血性卒中预防及治疗的基础,替罗非班作为一种GPⅡb/Ⅲa受体抑制剂的新型抗血小板药物,在心血管疾病应用已经基本成熟,但是在脑血管疾病中的应用仍处于探索阶段,具体用法用量及安全性仍有较多争议,现就替罗非班在急性缺血性卒中治疗中的应用及研究进展进行综述.

血管性痴呆(VD)是一种严重的影响中老年人生活质量的痴呆类型,目前的主要治疗药物多是对症治疗,且有价格昂贵、不良反应多等缺点,因此,寻找有效的治疗药物以改善患者的认知功能成为临床上亟待解决的问题.银杏叶提取物(GBE)作为目前治疗痴呆的常用药物,有效果明显、不良反应少、多靶点共同作用的特点,在临床中应用广泛.针对VD,GBE具有改善脑循环、降低β淀粉样蛋白沉积、减少炎症因子等作用.本文就其在治疗VD的作用机制方面的研究进展进行综述,为GBE的临床应用提供更多依据.

多发性硬化(MS)是一种由免疫系统异常驱动导致的神经退行性疾病,其复杂性和不可预测的临床过程需要敏感和特异性的诊断、预后和治疗监测随访指标.神经丝轻链蛋白(NFL)作为神经元结构蛋白中最重要的组成成分,是轴突损伤的敏感标志物.多项研究表明NFL目前在MS生物标志物中具有重要的潜在价值.本文将对NFL在MS中的研究现状进行综述.

目的:通过观察加味不忘散对阿尔茨海默病(AD)模型大鼠学习记忆能力及海马区NOD样受体热蛋白结构域3(N LRP3)炎症通路中相关分子NLRP3,天冬氨酸蛋白酶-1(Caspase-1)和白细胞介素-1β(IL-1β)表达的影响,探讨其作用机制.方法:通过Morris水迷宫筛选出合格SD大鼠52只,随机均分为假手术组,AD模型组,加味不忘散低剂量组(1.5g.kg-1),加味不忘散高剂量组(3 g·kg-1).采用双侧海马注射β-淀粉样蛋白1-42(Aβ1-42)5μL (2 g·L-1)建立AD模型大鼠.造模后分别予低、高剂量加味不忘散灌胃,每日1次,连续4周.灌胃结束后通过Morris水迷宫法检测大鼠学习记忆能力,判断造模是否成功;通过实时荧光定量聚合酶链式反应(Real-time PCR),蛋白免疫印迹法(Western blot)检测大鼠海马组织中NLRP3,Caspase-1,IL-1β mRNA和蛋白的表达水平.结果:与假手术组比较,AD模型组大鼠学习记忆能力明显下降(P＜0.05);与AD模型组比较,加味不忘散低剂量组大鼠学习记忆能力无改善,NLRP3,Caspase-1,IL-1β mRNA和蛋白的表达水平均无统计学差异,加味不忘散高剂量组大鼠学习记忆能力明显改善,NLRP3,Caspase-1,IL-1β mRNA和蛋白的表达均明显下降(P＜0.05).结论:高剂量加味不忘散可改善大鼠学习记忆能力,其机制可能与下调NLRP3炎症通路中NLRP3及下游Caspase-1,IL-1β的表达,抑制海马组织内的炎症反应有关.

目的:研究中药免煎剂加味不忘散对阿尔茨海默病(AD)模型大鼠海马神经元细胞凋亡及炎症反应的影响,初步探讨其发挥作用可能的机制.方法:SD大鼠按随机数字表法分为假手术组、模型组、低剂量组及高剂量组,分别采用HE染色、TUNEL染色观察海马神经元细胞形态学改变及海马神经元细胞凋亡情况,使用ELISA法测定IL-1β、IL-6、TNF-α含量.结果:HE染色观察结果示,模型组海马神经元细胞形态异常,低、高剂量组海马神经元细胞较模型组均有不同程度的改善;TUNEL染色结果示,模型组较假手术组凋亡细胞数明显增加,低剂量组未见凋亡细胞数减少,而高剂量组凋亡细胞数减少;ELISA结果示,低剂量组海马组织中TNF-α水平较模型组降低,而IL-1β及IL-6水平并未降低,高剂量组海马组织中的IL-1β、IL-6、TNF-α水平降低.结论:加味不忘散可抑制Aβ1-42所致的海马炎症因子释放以及神经元细胞凋亡,提示加味不忘散可能通过抑制炎症反应发挥其神经元保护作用.

Objective To investigate the levels of T helper cell 17 (Th17), Th17-related cytokines in-terleukin 17 (IL-17) and interleukin 23 (IL-23) and regulatory T cell (Treg) in relapsing remitting multiple sclerosis (RRMS). Methods In a case-control study, plasma was collected from RRMS patients (n=20) and healthy subjects as control group (n=20). The percentages of Th17 and Treg cells and the levels of IL-17 and IL-23 were tested. The levels of Th17, Treg, IL-17 and IL-23 of the two groups were compared. Patients were treated with methylprednisolone. The levels of Th17, Treg, IL-17 and IL-23 of multiple sclerosis (MS) patients b efore and after treatment were compared. Expanded disability status scale (EDSS) score and the number of Gd-enhancing lesions were evaluated in the case group. Statistical analysis was made by body mass index (IBM) statistical program for social sciences (SPSS) 17.0 software. Independent sample t test was conducted to compare the measurement data of the case group and the healthy control group, and enumeration data were compared by χ2 test; paired sample t test was performed to compare the data of the case group before and after treatment; Pearson correlation analysis was made forthe variables of the MS group before treatment. Results In the RRMS group, the percentage of Th17 cells in peripheral blood was significantly higher than the control group [(2.10±0.45)％vs (1.09±0.20)％](t=9.130, P<0.01), the levels of Th17-related cytokines IL-17 and IL-23 were remarkably higher than the control group (IL-17:t=19.843, P<0.01;IL-23:t=22.747, P<0.01), and the percentage of Treg cells was significantly lower than the control group [(1.33 ±0.30)％vs (2.52±0.30)％], (t=12.422, P<0.01). The levels of Th17 and IL-17 were positively associated with EDSS score (Th17: r=0.458, P<0.05; IL-17: r=0.480, P<0.05), there was no significant-correlation between the level of IL-23 and EDSS score (r=0.368, P>0.05), and Th17, IL-17 and IL-23 were positively correlated with the number of Gd-enhancing lesions (Th17: r=0.446, P<0.05; IL-17: r=0.544, P<0.05; IL-23: r=0.461, P<0.05). The levels of Th17, IL-17 and IL-23 in the RRMS group after the treatment with methylprednisolone were obviously decreased than before treatment (Th17: t=5.747, P<0.01; IL-17: t=9.967, P<0.01; IL-23: t=14.697, P<0.01), while that of Treg was apparently increased (t=10.050, P<0.01). Compared with the control group, the levels of Th17, IL-17 and IL-23 in the RRMS group after treatment were higher (Th17: t=6.889, P<0.01;IL-17:t=7.185, P<0.01;IL-23:t=13.284, P<0.01), and the percentage of Treg was lower (t=7.622, P<0.01). EDSS score of the RRMS group after treatment was remarkably decreased than before treatment(t=6.190, P<0.01), but the number of Gd-enhanced lesions after treatment was no significantiy changed (t=1.453, P>0.05). Conclusion Th17/Treg expression imbalance and Th17-related cytokines IL-17, IL-23 may participate in the pathological process of MS, and they might be therapeutic target for MS.

With the method of literature, this paper summarizes the therapeutic effects of Ultrasonic physiotherapy which is a common way to treat the soft tissue injuries. On this basis, Ultrasound penetration of drug therapy which combined Ultrasonic physiotherapy with Transdermal drug delivery is further introduced. The paper wants to provide some theoretical basis for the development of new treatment for soft tissue injuries and further research of Ultrasonic physiotherapy.

超声药物透入法作为一种新型经皮给药疗法,具有较高的研究价值和广阔的应用前景.本文在查阅相关文献资料的基础上,对超声波物理作用及促渗机制、制定原则及应用前景进行综述,为超声波药物透入疗法的发展提供一定的理论依据.