目的 探讨米氮平联合文拉法辛治疗伴有失眠的老年抑郁症患者的临床效果及对睡眠质量、血清5-羟色胺(5-HT)的影响.方法 选取2016年10月—2018年2月石家庄市第一医院收治的伴有失眠的老年抑郁症患者88例为研究对象,根据治疗方法的不同分为观察组和对照组各44例.对照组患者接受米氮平治疗,观察组患者接受米氮平联合文拉法辛治疗,两组患者均连续治疗8周.治疗结束后观察两组患者的临床疗效、治疗前后汉密尔顿抑郁量表(Hamilton depression rating scale for depression,HAMD)评分、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分及血清5-HT水平,以及治疗期间不良反应发生情况.结果 ①治疗8周后,观察组治疗总有效率为93.18％明显高于对照组的77.27％,差异有统计学意义(χ2=38.210,P<0.001);②两组患者治疗后HAMD和PSQI评分均较治疗前降低,且治疗后观察组HAMD和PSQI评分降低程度明显大于对照组,差异均有统计学意义(P<0.01);③两组患者治疗后血清5-HT水平较治疗前明显升高,且治疗后观察组血清5-HT升高幅度明显大于对照组,差异均有统计学意义(P<0.01);④两组治疗期间不良反应总发生率比较差异无统计学意义(χ2=0.948,P=0.257).结论 米氮平联合文拉法辛治疗在改善伴有失眠的老年抑郁症患者睡眠质量方面效果显著,且能有效减轻患者的抑郁症状,调节神经内分泌功能,应用安全性较好.

目的 观察艾司西酞普兰治疗老年抑郁症的临床效果及安全性.方法 选择2017年10月—2018年5月收治的老年抑郁症患者73例,根据治疗方法分为观察组38例及对照组35例.观察组给予艾司西酞普兰,对照组给予米氮平.2组均治疗6周,观察临床疗效、汉密尔顿抑郁量表(HAMD)评分及药物不良反应.结果 2组治疗后HAMD评分均较治疗前降低(P<0.05),但2组间比较差异无统计学意义(P>0.05).2组总有效率比较差异无统计学意义(P>0.05).观察组不良反应发生率低于对照组(P<0.05).结论 艾司西酞普兰治疗老年抑郁症效果好,且安全性较高.

目的 研究重复经颅磁刺激(repeated transcranial magnetic stimulation,rTMS)联合盐酸舍曲林片治疗老年抑郁症的临床疗效及对患者认知功能的影响.方法 回顾性分析石家庄市第一医院2016年4月—2017年10月收治的84例老年抑郁症患者的临床资料,根据不同的治疗方式将其分为对照组(42例)与观察组(42例),对照组患者给予假刺激结合盐酸舍曲林片治疗,观察组患者给予rTMS结合盐酸舍曲林片治疗,2组均治疗5周,分别采用汉密尔顿抑郁量表(HAMD)对抑郁症进行评分和威斯康星卡片分类测验(WCST)对认知功能进行评估,观察2组治疗中的不良反应发生率和临床疗效情况.结果 治疗前,2组患者HAMD评分比较差异均无统计学意义(P>0.05);治疗后,观察组第1、3、5周末HAMD评分低于对照组(P<0.05).治疗后,观察组患者的总应答数及错误应答数、持续错误应答数均低于治疗前(P<0.05),其正确应答数及完成分类数高于治疗前(P<0.05);对照组治疗后总应答数、错误应答数及持续错误数低于治疗前(P<0.05),其正确应答数高于治疗前(P<0.05),2组患者的WCST评分治疗后比较差异有统计学意义(P<0.05);观察组患者治疗有效率(95.24％)与对照组(90.48％)比较,差异无统计学意义(P>0.05);观察组患者不良反应发生率(11.90％)与对照组(9.52％)比较,差异无统计学意义(P>0.05).结论 rTMS联合盐酸舍曲林片和单纯采用盐酸舍曲林片治疗老年抑郁症临床效果相似,均无明显不良反应,然而前者联合治疗更能有效地改善老年抑郁症患者认知功能.

Objective To investigate the neuroprotective effects of Gastrodia elata extract on SH-SY5Y cell injury induced by H2O2 in vitro,and to explore its molecular biological mechanism.Methods The SH-SY5Y cells were treated by H2O2 in vitro to induce SH-SY5Y cell injury model,then the Gastrodia elata extract was added into the medium at the concentration of 0,0.1,1,10,100μg/ml,respectively.The cell morphological changes were observed by microscopy,and cell proliferation was detected by MTT,moreover,the expression levels of related genes with nerve cells growth including nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) were detected by qPCR method.Results After 24-hour induction by H2O2,the obvious morphological changes were found in SH-SY5Y cells,with cell synapse length being decreased significantly (P ＜ 0.05),and cell proliferation was obviously decreased (P ＜ 0.05),however,after H2O2 cells were treated by Gastrodia data extracts,the cytotoxicity caused by H2O2 was obviously inhibited,moreover,with the increase of Gastrodia elata extract concentration,the cell synapse length and cell proliferation were gradually improved,furthermore,there were significant differences among different concentrations of Gastrodia elata extracts (P ＜ 0.05).In addition the expression levels of NGF and BDNF in SH-SYSY cells with injury induced by H2O2 were significantly decreased (P ＜ 0.05),however,after the cells were treated by different concentrations of Gastrodia elata extract,the expression levels of NGF and BDNF were significantly upregulated (P ＜0.05).Conclusion Gastrodia elata extract has protective effects on SH-SY5Y cells with injury induced by H2O2,and its action mechanism may be correlated with its regulative effects on the expressions of NGF and BDNF.

目的：探讨高同型半胱氨酸（ HCY）血症、叶酸及维生素B12与缺血性脑血管病的关系。方法选择急性缺血性脑血管病患者60例为病例组，与病例组性别、年龄相匹配的来院进行健康体检者（无脑血管史）60例为对照组。采用高效液相色谱法测定2组的血清Hcy水平。同时检测叶酸水平、维生素B12水平。结果病例组血清Hcy指标显著高于对照组（ P ＜0湝．05）；血清叶酸及维生素B12水平与血清Hcy均呈负相关（ r值分别为-0．554、-0．539， P＜0．05）。结论高Hcy血症是缺血性脑血管病发生的独立危险因素；叶酸、VitB12水平的下降在动脉粥样硬化发生的过程中起着重要的作用。

血管性认知功能障碍（ vascular cognitive impair-ment，VCI）是指由脑血管病危险因素（如高血压、糖尿病和高脂血症等）、显性（如脑梗死或脑出血等）或非显性脑血管病（如白质疏松和慢性脑缺血）引起的从轻度认知功能损害（ Mild cognitive impairment，MCI）到痴呆（ Vascular Dementia ， VaD ）的一大类综合症， VCI可单独存在或（和） Alzheimer （ AD）伴随存在，2／3的卒中患者会有一定程度的认知功能损害，1／3可发展为痴呆。严重的影响了患者的生活质量，对社会、家庭均产生了不可估量的危害。因此，改善患者认知功能障碍迫在眉睫，本文收集了轻中度认知功能障碍患者120例，给予治疗组患者口服奥拉西坦，报告如下。

Objective To assess cognitive impairment of patients with obstructive sleep apnea and hypopnea syndrome(OSAHS) by montreal cognitive assessment(MoCA).Methods Eighty two OSAHS patients were divided into three groups according to apnea hypopnea index(AHI) and longest apnea time(LAT),including mild group,moderate and severe groups.The cognitive function was evaluated by MoCA.Results The parameters,including total scores of MoCA,attention,delayed recall in moderate and severe groups were lower than mild or control group(P0.05).The visuospatial skills and orientation in severe groups were significantly lower than those in control group(P0.05).The attention in mild groups were lower than that in control group(P0.05).The total scores of MoCA were positive correlation with Minimal saturation of blood oxygen(P0.01),and were negative correlation with AHI,LAT,and percentage of time spend when oxygen saturation lower than 90%(SLT 90%)(P0.01).Conclusion The risk of MCI increased in OSAHS patients.MoCA could be used to evaluate the cognitive impairment in OSAHS patients.

Objective To analyze the characteristics of magnetic resonance diffusion tensor imaging(DTI) and to explore the values of DTI in patients with acute cerebral infarction.Methods Forty-five patients with acute cerebral infarction were classified in three groups according to the course: hyperacute group(12 h,n=7),acute group(12-24 h,n=18),and subacute group(1-7 d,n=20).Conventional magnetic resonance imaging(MRI) and diffusion weighed imaging(DWI),DTI were performed by the Siemens Tim-avanto 1.5 T using a standard.The values of fractional anisotropy(FA) and apparent diffusion coefficient(ADC) were measured in the infarcted regions,corresponding contralateral regions,and in the infarcted cores and peripheral parts.Results FA values of infarcted core and surround area were 0.318±0.057 vs 0.398±0.055(P0.01) in acute period and 0.305±0.035 vs 0.309±0.029(P0.01) in subacute period;ADC values of infarcted core and surrounding area were(0.291±0.051)×10-3mm2/s vs(0.390±0.050)×10-3mm2/s(P0.01) in hyperacute period and(0.379±0.018)×10-3mm2/s vs(0.479±0.016)×10-3mm2/s(P0.01) in acute period.With the course progressing,FA decreased gradually,FA values of infarcted side and contralateral side were 0.342±0.050 vs 0.461±0.079(P0.01) in acute period and 0.305±0.029 vs 0.480±0.059(P0.01) in subacute period;ADC of infarcted side declined first and then increased,ADC values of infarcted side and contralateral side were(0.344±0.023)×10-3mm2/s vs(0.663±0.033)×10-3mm2/s(P0.01) in hyperacute period and(0.432±0.018)×10-3mm2/s vs(0.678±0.026)×10-3mm2/s(P0.01) in acute period.Conclusion The combination of FA and ADC may assist clinical stage and evaluate the existence of ischemic penumbra more accurately after acute stroke.