获得性免疫缺陷综合征(AIDS)是以全身性严重免疫缺陷为主要特征的致命性传染病,可累及消化、心血管和神经等系统等,亦可引起脑血管壁出现纤维素样坏死、炎性细胞浸润以及管腔内血栓形成等血管炎性改变,导致脑组织出现梗死或出血.其临床症状无明显特异性,且与原发性中枢神经系统血管炎(PACNS)极其相似,极易误诊误治.本文就1例肢体无力查因入院患者,诊断为AIDS相关性脑血管炎病例,详细介绍患者的临床症状和诊疗过程.随着我国艾滋病病毒(HIV)感染人数的逐年增加,AIDS相关性脑梗死的患病率也会逐年增多.相关专业医生应该注意此类疾病可能,避免误诊、误治.

[Objective]To investigate the prognostic value of serum interleukin-18 with NIHSS (National Institutes of Health Stroke Scale) and mRS (modified Rankin scale) in patients with actual cerebral infarction (ACI).[Methods]A total of 100 cases of ACI patients from August 2013 to December 2014 in our hospital were chosen as the subjects of the study.All were diagnosed as ACI by head CT or MRI based on the guidelines of China Ischemic Stroke Treatmentin 2010.According to the score of NIHSS, patients were divided into mild group(NIHSS score<7), moderately severe group (NIHSS score 7~15) and severe group (NIHSS scor >15).At same time period, sixty healthy volunteers were collected as control.Serum interleukin-18 levels were measured within 24hamong all patients in ACI and control group.The relevance and relationship between serum interleukin-18 levels and Alberta CT (ASPECT) scores plus NIHSS scores were analyzed.All patients were followed up on the day of 90 and 180;neurological impairment was assessed by mRS score;the correlation between plasma interleukin-18 levels and prognosis were analyzed.[Results] Patients'serum interleukin-18 levels 24h after hospitalization were significantly higher than that in the healthy control group (P<0.05).The interleukin-18 levels were (526.36±26.82)ng/L,(439.24±26.45)ng/L,and (385±34.26)ng/L,respectively, in severe group, moderate severe group and mild group.The differences among the three groups were statistically significant (P<0.05).Interleukin-18 level in the poor prognosis group was significantly higher than the good prognosis group(P<0.05).Serum interleukin-18 levels were positively correlated betweenwith ASPECT scores and NIHSS scores.Univariate Logistic regression analysis showed that the age, ASPECT score, NIHSS score, and interleukin-18 levels were prognostic factors of ACI patients (P<0.05).Area under the receiver's work curve (ROC) analysis showed that the predictive value of serum interleukin-18 was no significant difference with NIHSS score and ASPECT score in predicting outcomes of ACIpatients.[Conclusion] Plasma interleukin-18 levels were significantly elevated in patients with acute ACI;there is a significant positive correlation between serum interleukin-18 levels within 24 hours with neurologic impairment severity and prognosis in ACI patients.Serum interleukin-18 levels has great value in assessing the severity and prognosis in patients with ACI.

Objective To investigate the disease assessment and prognosis value of serum copeptin level in patients with acute cerebral infarction (ACI). Methods One hundred first diagnosed ACI patients were selected as ACI group. According to the National Institutes of Health stroke score (NIHSS), the ACI patients were divided into mild (NIHSS<7 scores), moderate (NIHSS 7-15 scores) and severe (NIHSS>15 scores). Sixty cases of healthy subjects were selected as control group. The serum copeptin level was measured by double antibody sandwich enzyme linked immunosorbent assay method in control group and ACI group (onset within 24 h). The NIHSS, Alberta stroke program early CT score (ASPECTS) and modified Rankin score (mRS) onset within 24 h and 14 d were evaluated in patients with ACI, and the mRS 90 d and 180 d after ACI were evaluated. The neurological impairment was assessed by mRS 180 d after ACI, mRS ≤ 2 scores was good prognosis, ≥ 3 scores was poor prognosis. The correlation was analyzed. Results Among the 100 patients with ACI, mild was in 52 cases, moderate in 34 cases, and severe in 14 cases; good prognosis was in 79 cases and poor prognosis in 21 cases. The serum copeptin levels within 24 h of ACI in mild, moderate and severe patients of ACI group were significantly higher than that in control group:(4.82 ± 1.25), (6.39 ± 2.21) and (9.28 ± 3.82) pmol/L vs. (1.95 ± 0.28) pmol/L. The serum copeptin level within 24 h of ACI in moderate patients was significantly higher than that in mild patients, in severe patients was significantly higher than that in moderate patients, and there were statistical differences (P<0.05). Within 24 h of ACI , the ASPECTS in moderate and severe patients were significantly lower than that in mild patients:(10.02 ± 2.10) and (6.24 ± 3.05) scores vs. (12.16 ± 0.84) scores, in severe patients was significantly lower than that in moderate patients, and there were statistical differences (P<0.05). The NIHSS in moderate and severe patients were significantly higher than that in mild patients:(10.68 ± 3.14) and (16.20 ± 4.26) scores vs. (4.35 ± 1.52) scores, in severe patients was significantly higher than that in moderate patients, and there were statistical differences (P<0.05). The serum copeptin levels within 24 h of ACI and NIHSS in each time point in good prognosis patients were significantly lower than those in poor prognosis patients:(3.52 ± 1.26) pmol/L vs. (8.68 ± 3.06) pmol/L and (5.68 ± 2.11) scores vs. (15.36 ± 3.25) scores, (4.85 ± 1.86) scores vs. (12.60 ± 3.89) scores, (3.68 ± 1.21) scores vs. (6.35 ± 2.96) scores, (2.16 ± 0.75) scores vs. (5.21 ±1.96) scores, and the ASPECTS within 24 h of ACI was significantly higher than that in poor prognosis patients:(11.38 ± 2.21) scores vs. (7.86 ± 2.49) scores, and there were statistical differences (P<0.05). The single factor Logistic regression analysis results showed that the age, ASPECTS, NIHSS and serum copeptin level were the influencing factors of severity of illness in patients with ACI (OR = 1.21, 5.36, 5.61 and 6.62;95%CI 0.99-1.39, 3.34-9.21, 2.86-7.52 and 1.38-12.64;P=0.04, 0.01, 0.01 and 0.00), and the influencing factors of poor prognosis (OR=1.32, 5.21, 4.86 and 6.82;95%CI 0.84-1.43, 3.52-8.39, 2.62-5.35 and 2.67-11.85;P=0.04, 0.01, 0.01 and 0.00). ROC analysis results showed that the area under curve of NIHSS, serum copeptin level and ASPECTS in predicting poor prognosis in patients with ACI were 0.926, 0.863 and 0.624. In the mild, moderate and severe patients, the serum copeptin level was negative correlated with ASPECTS ( r=-0.682,-0.594 and-0.572;P<0.01), and the serum copeptin level was positively correlated with NIHSS ( r = 0.652, 0.614 and 0.586; P<0.01). Conclusions The serum copeptin level in patients with ACI is significantly elevated. The serum copeptin level is positively correlated with neurologic impairment severity and prognosis in patients with ACI, and it has important significance in evaluating pathogenetic condition and prognosis.

目的 研究急性脑梗死(acute cerebral infarction,ACI)患者神经功能缺损程度与氧化型低密度脂蛋白(oxidized low density lipoprotein,ox-LDL)、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、同型半胱氨酸(Hcy)、颈动脉内膜中层厚度(IMT)的相关性.方法 2013年1月至2014年1月内蒙古自治区人民医院神经内科住院ACI患者146例,依据美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS score)评分,将所有入组病例分为轻型组(NIHSS评分＜7分,82例)、中型组(NIHSS评分7～15分,46例)、重型组(NIHSS评分＞15分,18例).测定各组ox-LDL、hs-CRP、Hcy水平及IMT值,分析其与急性脑梗死严重程度的相关性.结果 Ox-LDL水平重型组显著高于轻、中型组,中型组显著高于轻型组,各组间比较差异均有统计学意义(P＜0.05).hsCRP水平重型组显著高于轻、中型组,差异有统计学意义(P＜0.05),中型组与轻型组比较差异无统计学意义(P＞0.05).Hcy水平重型组显著高于轻、中型组,中型组显著高于轻型组,各组间比较差异均有统计学意义(P＜0.05).重型组IMT值显著高于轻、中型组,中型组显著高于轻型组,各组间比较差异均有统计学意义(P＜0.05).结论 Ox-LDL、Hcy水平随ACI的严重程度加重而升高,提示ox-LDL、Hcy水平与脑梗死严重程度呈正相关,具有较高的敏感性,其在一定程度上可以反映ACI患者神经功能缺损程度.Hs-CRP与ACI的发生密切相关,可作为脑梗死的风险预测因子.IMT值反映动脉血管壁形态变化,可作为AS监测指标.

根据临床神经病学教学特点和实践,从课堂教学方法、多媒体运用、考核方式等方面探索神经病教改的新方法.

目的观察急性脑梗死患者血清白细胞介素-18(interleukin-18,IL-18)、白细胞介素-6(interleukin-6,IL-6)水平变化,探讨炎症因子在脑梗死发病机制中的作用。方法采用ELISA法检测急性脑梗死患者(实验组)的血清IL-18和IL-6水平,并与32例健康对照组比较。结果急性脑梗死患者血清IL-18和IL-6水平为(168.30±27.42)pg/mL与(0.33±0.43)mg/mL,显著高于对照组(P<0.05)。结论急性脑梗死患者血清IL-18和IL-6水平明显升高,提示炎症反应参与了缺血性脑梗死的病理生理过程,早期炎症干预治疗可能有助于减轻脑组织缺血性损害,提高临床疗效。

Objective To observe the effect of glycosides( GCs) on vascular dementia( VD) rats model of learning and memory dysfunction,explore the prevention and cure function of GCs on VD; Methods VD rats model was establishde by bilateral common carotid artery ligation( 2-VO); and divided into VD model group,sham-operation group,GCs low、middle、high dose treatment groups and drug control group. Spatial learning and memory ability of rats was detected by Mories water maze; and NF-κB expression were investigated by Immunohistochemistry; Results( 1) Eescape latency period of VD rats extended obviously compared with the control group( P 0. 01); but the escape latency significantly shortened after treatment;( 2) NF-κB expression in hippocampus is significantly increased compare with the VD group; and decreased after GCs treatment; Conclusion GCs can decrease expression of NF-κB,so as to effectively improve the learning and memory ability of VD model rats.

目的 探讨脑梗死患者血清白介素-18水平变化的临床意义.方法 采用ELISA法检测脑梗死患者(CI组)和健康对照组(NC组)的血清IL-18水平,并进行比较.结果 CI组患者血清IL-18水平显著高于NC组(t=9.029,P＜0.05).结论 急性脑梗死患者血清IL-18水平明显升高,因而对于炎症介质的早期干预治疗,可能有助于梗死后神经功能的修复及临床症状的改善.

Objective:To investigate the clinical effect of Dianxianning pian to patients with epilepsy.Method:In this double-blind,randomized clinical trial,69 patients with generalized tonic-clonic seizures were selected from clinic or department of neurology in Inner Mongolia Hospital from April 2007 to April 2008.They had been made a definite diagnosis by Electroencephalogram and had at least two seizures in previous three months.They were treated with Dianxianning pian or placebo for 3 months,based on previous anti-epileptic drug.We recorded and observed clinical symptoms each month.Data was analyzed and safety evaluation was gived by SPSS 13.0 statistic software at last.Result:46 subjects received Dianxianning pian and 23 received placebo.After 3 months therapy.the seizure frequency of experiment group was significantly decreased compared with control group(P0.01).The severity of seizures total scores were significantly decreased compared with control group(P0.01).Therapeutic effect of seizure frequency and therapeutic effect of symptom had significant difference befween the two groups(P0.01).Safety index such as ECG,blood routine,urine routine,blood biochemical change had no statistically difference between the two groups(P0.05).Conclusion:Add-on Dianxianning pian can raise therapeutic effect in patients with epilepsy of generalized t tonic-clonic seizures.And Dianxianning pian treatmentEpileptic seizures is safe and well tolerated.

Objective To assay zinc and copper ion content in hippocampus of senescence-acceler-ated mouse prone 8(SAMP8) and the influence of metallothionein 3(MT3) on it compared with MT1. Methods Sixty SAMP8 mice were randomly divided into dementia group, three groups of different MT3 concentrations, MT1 group and blank control group with 10 mice in each group. Ten SAMR1 mice were taken as normal control group. In the experimental groups, the adult SAMP8 mice were injected intraperitoneally with MT of different types and concentrations continuously. After 4 weeks, the mice were executed. Atomic absorption speetrophotometer was used to assay zinc and copper ion content in hippocampus and the dose-effect relationship of different MT3 concentrations was observed. Results The zinc ion content in hippocampus of SAMP8 was less than that in SAMR1 group, but there was no difference in the copper ion content. The zinc ion content increased by MT3 injection,and the medium concentration group had the best result,with statistically significant difference. There was no significant difference between the MT1 and MT3 groups. Conclusions The zinc ion content in hippocampus of SAMP8 was decreased. MT3 can transport zinc ion and increase the content of it in hippocampus of SAMP8,but when the content of zinc ion get balanced it does not rise with the increase in MT3 concentration. MT3 can keep the zinc ion content in balance and had no influence on copper ion content.

目的 对50例单一视神经炎患者进行头部MRI检查并跟踪随访观察,部分视神经炎患者存在中枢神经系统(CNS)其他部位病损,证实部分视神经炎可发展为临床确诊的多发性硬化(CDMS).方法 对50例视神经炎行头部MRI检查,采用自旋回波(SE),纵向射频重复时间为30～500ms,横向射频重复时间为80～2000ms,层厚5mm.全部患者进行了1年～10年的随访.结果 38%的视神经炎患者有脑MRI异常.显示视神经异常的5例,脑白质有异常改变的16例,脑MRI正常的31例.其中9例随访中证实发展为CDMs.MRI异常的19例12例发展为cDMs,发展为cDMs的总比例为(21/50)42%.结论 通过脑MRI检查及临床随访,证实部分视神经炎患者可以发展为CDMS.