目的 调查神经内科门诊导致缺血性脑血管疾病患者发生脑血管病的危险因素知晓情况,为脑卒中筛查工作提供依据,探讨降低患者脑血管危险因素的措施.方法 选取我院神经内科的符合纳入条件的门诊患者74例.对全部入选象均接受各项临床指标检测(收缩压、舒张压、TC、TG、HDL C、LDL-C、BMI、血糖、肌酐、尿酸),同时调查受检者对于脑血管危险因素知晓情况.结果 患者对危险因素知晓情况为:高血压知晓率为44.59％,高脂血症知晓率为78.37％,糖尿病知晓率为43.24％,肥胖症知晓率为54.05％,冠心病知晓率为62.16％;在年龄方面,33～44岁的患者对于高脂血症、糖尿病、肥胖、冠心病的知晓率最低,与其他年龄层患者比较差异有统计学意义(P＜0.05).结论 本次调查显示,所有年龄段层患者对脑血管病危险因素知晓度均较低,其中33～44岁的患者对脑血管病危险因素的知晓率最低,提高知晓率,控制危险因素,以减低疾病发生率,对降低脑卒中的发病率具有重要意义,特别是33～44岁的患者,应该加强对这个年龄段人群的关注.

目的 分析急性脑缺血性脑卒中患者并发脑卒中相关性感染危险因素.方法 回顾性分析我院收治的急性缺血性脑卒中患者96例,根据是否发生脑卒中相关性感染分为观察组(42例)和对照组(54例),分析急性脑缺血性脑卒中患者并发脑卒中相关性感染危险因素并制定预防对策.结果 (1)入院时NIHSS、GCS、合并糖尿病、吸烟、留置胃管、留置尿管、人院时白蛋白水平、入院时IL-6水平、机械通气为影响AIS患者并发SAI的相关因素(P＜0.05);(2)入院时NIHSS＞15分、吸烟、留置胃管、入院时IL-6＞11.5mg/L为AIS患者并发SAI的高危因素(P＜0.05).结论 急性缺血性脑卒中患者并发脑卒中相关性感染几率高,影响因素较多,临床应对患者进行综合评估,制定合理治疗措施降低患者各项风险因素或者指标,降低并发脑卒中相关性感染率.

目的 探讨流式细胞术检测脑脊液CD4+T细胞比例在脑梗死后精神病性障碍患者中的诊断价值.方法 选取2018年6月～2021年1月医院收治的172例脑梗死患者作为研究对象,按照有无精神病性障碍分为研究组(有精神病性障碍者,60例)和对照组(无精神病性障碍者112例).比较两组NIHSS评分、血常规、血液生化等常规指标.检测脑脊液S100B蛋白与神经元特异性烯醇化酶(neuron-specific enolase,NSE)含量,应用流式细胞术检测脑脊液CD44+T细胞比例,采用多因素Logistic回归分析相关影响因素,绘制受试者工作特征曲线(ROC曲线)并分析各项指标的诊断价值.结果 两组间NHISS评分、收缩压、舒张压、白细胞、血小板、凝血酶原时间、总胆红素、谷丙转氨酶、天冬氨酸转氨酶、白蛋白和性别、年龄、体重指数、梗死部位等常规指标比较,无统计学差异(P＞0.05).与对照组比较,研究组脑脊液S100B、NSE含量均明显升高,CD4+T细胞比例明显降低(P＜0.05).多因素Logistic回归分析显示脑脊液S100B、NSE、CD4+T细胞比例是导致脑梗死后精神病性障碍发生的重要影响因素(P＜ 0.05);ROC曲线分析显示,脑脊液S100B、NSE、CD4+T细胞比例在诊断脑梗死后精神病性障碍的曲线下面积分别为0.733、0.714、0.814,灵敏度为68.43％、70.39％、74.27％,特异度为83.72％、77.38％、80.31％.结论 表达升高的脑脊液S100B、NSE含量和显著降低的CD4+T细胞比例可能是脑梗死后精神病性障碍的诊断依据.在脑梗死后精神病性障碍患者的临床诊断中,流式细胞术检测脑脊液CD4+T细胞比例具有重要诊断价值.

With the deepening of study on the immune mechanism of sepsis, it is now generally believed that host immune responses to sepsis involve multiple sequential or concurrent processes, including both excessive inflammation and immunosuppression. The main mechanism is immune dysfunction, including abnormalities in innate and adaptive immune responses. Based on the recent study of immune mechanism in sepsis, we explore the changes of the body′s immune response in sepsis from the perspective of innate immunity and adaptive immunity. Key words: Sepsis; Innate immunity; A daptive immunity; Inflammation

目的 分析经颅多普勒超声在急性缺血性脑卒中患者颅内外血管狭窄临床诊断中的应用价值和准确性.方法 选取2014年1月至2018年12月100例医院收治的急性缺血性脑卒中患者,所有患者在入院之后均行常规经颅多普勒超声检查,并将超声检查结果与计算机血管成像检查结果进行对照分析,观察经颅多普勒超声检查的诊断准确率.结果 经颅多普勒超声检查对于颅内外血管狭窄的诊断准确率存在较大的差异,经颅多普勒超声检查对于颅内外血管狭窄的诊断准确率存在较大的差异,对于颅内动脉血管狭窄的敏感性、特异性为96.2％和98.6％;对椎-基底动脉系统血管狭窄的敏感性、特异性为71.1％和94.3％,且经颅多普勒超声检查能够观察到计算机血管成像无法观察到的信息,例如微栓子状况、侧支循环血流状况等.结论 经颅多普勒超声检查在急性缺血性脑卒中患者颅内外血管狭窄临床诊断中具有较好的应用效果,尤其是颅内动脉血管狭窄具有较高的敏感性与特异性,同时能够观察到计算机血管成像无法观察到的血流动力学指标.

Objective To investigate the effect of Salvianolic acid on endoplasmic reticulum stress (ERS) pathway in brain hippocampus of PAP mice. Methods Twenty PAP dual transgenic male mice were selected, they were randomly divided into a PAP mice model group and a Salvianolic acid group, 10 mice in each group; another 10 SPF grade C57BL/6J male mice were selected as a normal control group. In the Salvianolic acid group, 0.9% normal saline solution of Salvianolic lyophilized injection (400 g/L) of dosage 21 mg·kg-1·d-1 was injected intravenously through a tail vein of mice; the PAP mice model and normal control groups were given the same amount of 0.9% normal saline, and the therapeutic course was consecutive 4 weeks in the three groups. At the end of the 4th week, the Morris water maze test was carried out to observe the changes of escape latency, the third quadrant residence time (RTQ), entry angle into water and cross-platform times of mice in each group; amyloid precursor protein (APP) positive cell expression in cerebral hippocampus of mice were detected by immunohistochemistry; Western Blot was used to detect the expression level of PER like endoplasmic reticulum kinase-eukaryon initiation factor 2α-C/EBP homogenous protein (PERK-eIF2α-CHOP) pathway related proteins in hippocampus of mice. Results The escape latency of the PAP mice model group on the 1st to 5th day were significantly longer than those of the normal control group, although a downward trend was observed on the 5th day, it was still significantly longer than that of the model group (seconds: 58.41±2.36 vs. 28.60±10.15); compared with the PAP mice model group, the escape latency of Salvianolic acid group was shorter at each time point, and reached the shortest level on the 5th day (seconds: 31.97±8.36 vs. 58.41±2.36). In the PAP mice model group, the RTQ and the number of crossing platforms were significantly lower than those in the normal control group [RTQ (seconds): 8.27±2.95 vs. 15.97±7.33, numbers of crossing platforms (frequency/90 s): 0.70±0.95 vs. 2.70±0.48]; the entry angle was obviously greater than that of the normal control group [(47.94±4.68)°vs. (32.66±2.55)°, P < 0.05]. Compared with PAP mice model group, in Salvianolic acid group, the RTQ and number of crossing platform were significantly higher [RTQ (seconds): 13.57±1.86 vs. 8.27±2.95, number of crossing platforms (frequency/90 s):1.60±0.97 vs. 0.70±0.47], the entry angle was markedly smaller [(35.46±6.79)°vs. (47.94±4.68)°,P < 0.05]. The positive expression rate of APP and the protein expressions of CHOP, p-eIF2α in PAP mice model group were significantly higher than those in the normal control group [the positive rate of APP: (60.44±6.19)% vs. (21.05±5.87)%, CHOP protein expression (gray value): 3.09±0.07 vs. 1.46±0.09, p-eIF2αprotein expression (gray value): 0.98±0.09 vs. 0.47±0.06, all P < 0.01], the expression of PERK and p-PERK were lower than those in normal control group [PERK (gray value): 0.42±0.06 vs. 0.82±0.11, p-PERK protein expression (gray value): 0.98±0.09 vs. 0.64±0.10, both P < 0.01]; the positive expression rate of APP and protein expressions of CHOP, p-eIF2α in Salvianolic acid group were significantly lower than those in PAP mice model group [positive expression rate of APP: (33.09±10.33)% vs. (60.44±6.19)%, CHOP protein expression (gray value): 1.57±0.12 vs. 3.09±0.07, p-eIF2α protein expression (gray value): 0.80±0.07 vs. 0.98±0.09, all P < 0.01], while PERK and p-PERK expression were significantly higher than those in the model group [PERK (gray value): 0.89±0.12 vs. 0.42±0.06, p-PERK (gray value): 0.78±0.08 vs. 0.98±0.09, both P < 0.01]. Conclusion Salvianolic acid might work through the PERK-eIF2α-CHOP pathway to reduce the retention of APP in the hippocampus tissue of PAP dual-transgenic mice, thereby the learning ability of the mice is improved, and the progression of brain injury delayed.

目的 探讨正规专业的居家照护干预对阿尔茨海默病(AD)患者康复疗效的影响.方法 临床确诊的112例AD患者,随机分为干预组和对照组,每组各56例.对干预组照顾者进行AD疾病知识、专业照护和康复训练培训,并进行定期随访和连续的指导干预,使之能够对干预组患者提供正规专业的居家照护;对照组患者只给予一般的生活照护.分别于干预开始时、干预后6个月及12个月,采用简易智能量表(MMSE)和日常生活量表(ADL)对两组患者进行评定.结果 干预前,两组MMSE和ADL评分比较无统计学差异(P＞0.05).干预后6个月及12个月,干预组MMSE评分均比对照组高,干预后12个月比较具有统计学差异(P＜0.05);干预后6个月及12个月,干预组ADL评分均显著低于对照组(P＜0.05).结论 科学、正规的居家照护干预可以延缓AD患者的病情进展,提高患者的生活质量,此种干预护理模式应该进一步推广.

Objective To evaluate the clinical curative effects of mirtazapine and zoloft on senile patients with depression and the safety of this treatment.Methods Eighty eight senile patients with depression who reached the CCMD-3 diagnostic criteria of depression were randomly divided into mirtazapine group(n=44) and zoloft group(n=44) and received the treatment for 24 weeks.The curative effect was assessed by Hamilton Depression Rating Scale(HAMD),and the side reaction was assessed by Treatment Emergent Symptom Scale(TESS).Results After the treatment for 24 weeks,the effective rates of the mirtazapine and the Zoloft group were76.0% and 72.8%,respectively.There was no significant difference in the curative effects between the two groups(P>0.05).However,for those with severe insomnia,mirtazapine had a better effect.There was no significant difference in the TESS scores between the two groups(P>0.05).Conclusion Mirtazapine and zoloft are both effective and safe antidepressants for senile patients.

<正>目前对急性脑梗死除溶栓治疗之外尚无疗效确切的治疗方法,但因为溶栓治疗有严格的治疗时间窗及禁忌证,在临床应用上受到许多限制,因此寻找一种安全有效治疗急性脑梗死的药物以便最大程度改善患者预后具有重要的临床意义。注射用尤瑞克林(HUK,凯力康,广东天普生化医药股