目的:探讨血清诱骗受体3(DcR3)、白细胞介素-9(IL-9)水平变化与急性呼吸窘迫综合征(ARDS)患者病情程度的关联性及动态监测指导意义.方法:选取2017年9月—2020年8月我院ARDS患者96例作为观察组,同期急性肺炎(AP)患者96例作为对照Ⅰ组,健康体检者96例作为对照Ⅱ组.对比三组血清DcR3、IL-9水平及观察组不同病情程度患者治疗前、治疗24h后、48h后血清DcR3、IL-9水平,分析血清DcR3、IL-9水平变化与ARDS病情程度的关联性及动态监测的指导意义.结果:经单因素方差分析,三组血清DcR3、IL-9水平对比,差异有统计学意义(P<0.05);两两对比,观察组高于对照Ⅰ组、对照Ⅱ组,对照Ⅰ组高于对照Ⅱ组(P<0.05);96例ARDS患者轻度22例,中度49例,重度25例,整体分析发现,不同病情程度患者之间、同病情程度间、交互作用对比,差异有统计学意义(P<0.05);两两比较,同病情程度间随治疗时间推移,血清DcR3、IL-9水平呈先升高后降低趋势,不同病情程度间病情越重血清DcR3、IL-9水平越高(P<0.05);经Spearman秩相关系数分析,治疗前、治疗24h后血清DcR3、IL-9水平与ARDS病情程度呈正相关(P<0.05);治疗48h后血清DcR3、IL-9水平与ARDS病情程度无相关性(P>0.05).结论:血清DcR3、IL-9水平变化与ARDS患者病情程度具有密切相关性,动态监测可为临床积极调整治疗方案提供参考.

目的 探讨MRI和磁共振质子波谱分析(1H-MRS)对大脑胶质瘤病(GC)的诊断价值.方法 采用3.0T磁共振机给9例GC患者作头颅常规MRI+增强扫描,以及7例患者行1H-MRS检查.检测病变区域和对侧相应区域MRS的N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、肌醇(mI)、乳酸(Lac)、脂质(Lip)峰值,计算NAA、Cho、mI与Cr及Cho与NAA的比值.结果 MRI检查示,病灶均侵犯2个或以上脑叶,位于颞叶9例、额叶6例、胼胝体5例、顶、枕叶和基底节区各4例、岛叶2例、小脑1例.病灶T1WI低或等信号,T2WI高或混杂高信号,占位效应轻.增强扫描,有结节或斑片状强化3例,无强化6例.1H-MRS检查示:与对侧比较,病变区域NAA/Cr降低,Cho/Cr升高,Cho/NAA升高(均P＜0.05);NAA峰降低,Cho峰升高(均P＜0.05);mI/Cr及mI、Lac、Lip峰值的差异无统计学意义.结论 MRI是诊断GC的首选影像学检查方法,MRS是其非常重要的补充.二者结合对GC的诊断有重要的价值.

To investigate the application value of MRI and proton magnetic resonance spectroscopy (H-MRS) in hepatic encephalopathy (HE). Methods MRI and 1 H-MRS examination were applied in 6 HE patients. The peaks of N-acetyl aspartate (NAA) , Creatine (Cr) , Cholines (Cho) , glutamine compounds (Glx) , myo-inositol (ml) in basal nuclei were measured, and the ratio of Cho, ml, NAA and Cr were computered. The results were compared with 5 normal controls. Results MRI was showed that there were high signal on T,WI in bilateral basal nuclei in all the 6 HE patients, including involved internal capsule in 1 case, caudate nucleus in 2 cases, tegmental in 1 case. There were no obvious abnormal signal on T 2WI in 5 cases, but widely high signal on T2WI in 1 case caused by diffuse cerebral edema. 1 H-MRS was showed that the peaks of Cho, ml, ratio of Cho/Cr and ml/Cr in HE group were significantly lower than those in normal control group, the peak of GLx was significantly higher than normal control group, (P < 0. 01 -0.00). There was no statistical significance in NAA/Cr between the two groups. Conclusions MRI shows that high signal on T 1WI in bilateral basal nuclei is the characteristics of HE. 1H-MRS can reflect metabolism changes more aceutately.

目的探讨后循环梗死的临床特点。方法选择后循环梗死219例,根据年龄分为青年组(12例)、中年组(105例)、老年组(102例)。对比分析后循环梗死各年龄组临床症状、体征、梗死部位、责任血管、并发症。结果后循环梗死各年龄组最常见的临床症状为头晕/眩晕,其后依次为行走不稳、言语不清、肢体无力等,3组间比较差异无统计学意义(P>0.05)。各年龄组最常见的临床体征为肢体共济失调,其后依次为肢体瘫痪、延髓性麻痹、脑神经麻痹,3组间比较差异无统计学意义(P>0.05)。各年龄组最常见的梗死部位为桥脑,次为小脑、中脑、延髓、枕叶、丘脑、颞叶内侧,3组间比较差异无统计学意义(P>0.05);老年PCI责任血管发生动脉硬化狭窄、闭塞显著高于中、青年组(P<0.05～0.01);老年PCI肺炎发生率最高,显著高于中、青年组(P<0.01)。结论老年后循环梗死时责任血管更易硬化狭窄、闭塞,同时也更易并发肺炎,应针对性治疗、护理与康复措施。

目的探讨中脑梗死的临床及影像学特点。方法回顾性分析28例中脑梗死患者的临床资料和影像学检查结果。结果中脑梗死患者常见的临床症状为头晕或眩晕、肢体麻木或(和)无力等。常见的临床体征为肢体瘫痪、眼球运动障碍等,MRI显示,最常见的病变部位是中脑腹侧。MRA显示,大多数患者基底动脉狭窄或闭塞。绝大多数患者预后较好。结论头晕或眩晕、肢体瘫痪、眼球运动障碍等是中脑梗死常见的临床表现。MRI是诊断中脑梗死最重要的影像学检查技术。MRA能较准确反映血管病变的部位及程度。

Objective To evaluate the clinical value of proton magnetic resonance spectroscopy(1H-MRS) in clinically isolated syndrome(CIS).Methods MRI and 1H-MRS were performed in 6 patients with CIS and 5 healthy volunteers.NAA,Cr,Cho,and Lac peaks and the ratio of NAA/Cr,NAA/Cho and Cho/Cr were measured in the lesions,NAWM,and normal control group.Results Compared with normal control group,decreased NAA,Cr,Cho,mI peaks were demonstrated among lesions and NAWM in CIS,and increased Lac peaks were demonstrated among them,and Lip peaks were not changed.The ratios of NAA/Cr in lesions and NAWM(respectively:1.50±0.17,1.67±0.15) from CIS patients were significantly decreased than that of control group(1.82±0.08,P0.01).The ratio of NAA/Cho in lesions(1.40±0.28) was also significantly decreased than that of both NAWM(1.79±0.16) and control group(2.10±0.25,P0.001);Cho/Cr in lesions(1.09±0.14) was significantly increased than that in NAWM(0.93±0.02) and that in the control group(0.83±0.11,P0.001).mI/Cr in both lesions and NAWM was not more significant than that in control group.Conclusion 1H-MRS can reflect the metabolic abnormalities within the lesions and can detect the early biochemical changes in NAWM from CIS patients.1H-MRS has an important value in neurologic impairment,evaluation of therapeutic efficacy and prognosis.

<正>延髓梗死因其部位特殊,行头颅CT检查时,由于病变部位受到颅骨伪影干扰,显示的清晰度较差,因此临床上往往不能确诊。近年随着头颅MRI技术的发展和广泛普及,尤其是DWI、ADC的广泛应用,使大量延髓梗死能得到及时正确的诊断。本文对36例延髓梗死的临床表现及影像学特点进行临床分析。

目的观察安乐片治疗抑郁症的疗效。方法选择符合诊断标准的临床患者108例,予安乐片治疗。结果所有患者痊愈60例,显效30例,好转12例,无效6例。结论安乐片治疗抑郁症临床疗效肯定。

目的观察尤瑞克林治疗急性脑干梗死的疗效及安全性。方法将60例急性脑干梗死患者随机分为治疗组和对照组各30例,两组均行阿司匹林治疗;在此基础上,治疗组加用尤瑞克林。治疗前后评定两组神经功能缺损程度(NIHSS)及临床疗效,记录不良反应。结果治疗后两组NHISS评分均有所改善(P均<0.05);与对照组比较,治疗组NHISS评分改善更显著(P<0.01);治疗组总有效率较对照组明显提高(P<0.01)。结论尤瑞克林治疗急性脑干梗死安全有效,值得临床推广应用。

目的探讨脑梗死出血转化(hemorrhagic transformation,HT)的相关危险因素及出血与预后的关系。方法回顾性分析432例脑梗死患者的临床资料。将10 d内复查头颅CT或MRI的患者160例,分为HT组80例,非HT组80例。列入多项危险因素进行单因素分析。卡方检验分析HT组和非HT组的结局,多因素回归分析出血转化的危险因素。结果 2组患者Logistic回归分析显示,差异有统计学意义的有3项因素:大面积脑梗死、溶栓治疗、入院时高血糖。结论溶栓治疗、大面积脑梗死、入院时高血糖是HT的主要危险因素,HT组中发生脑实质血肿预后较差。

椎基底动脉系统供血不足是引起眩晕的主要原因之一,临床较难控制,笔者发现川芎嗪注射液对其往往有着立竿见影的效果,现总结我院1993年7月至2009年7月1 100例椎动脉供血不足性眩晕患者的资料如下.

目的分析以腰痛为首发症状患者6例的临床特点,以提高临床早期确诊率。方法对1996—2008年收治的6例以腰痛为首发症状患者的临床资料回顾性分析,分析其不典型的临床表现,诊断过程和误诊原因。结果6例被误诊,最后确诊为:白血病、主动脉夹层、再生障碍性贫血、肝癌、腰椎结核、肺癌骨转移各1例。结论以腰痛为首发症状患者临床会出现误诊,应提高临床早期确诊率。

典型的脑出血(包括脑室和蛛网膜下腔出血)常有头痛、呕吐、脑膜刺激征、甚至昏迷等临床表现,然而实际工作中,发现许多老年脑出血患者并没有以上高颅压征象,甚至意识清醒,往往被误诊误治,甚至造成生命危险,故其早期诊断至为关键,现将我院1993年7月至2009年11月17例老年人不典型脑出血的资料,以总结规律,避免误诊误治.

现代社会竞争激烈,人们的生活压力很大,头痛抑郁日渐增多,医生处理起来也很棘手,笔者发现丹栀逍遥胶囊治疗神经性头痛有较好疗效,现报告如下,与大家共享.

Objective:To construct a prokaryotic expression vector of TAT-h survivin fusion gene.Methods:The whole mature protein coding sequence of survivin gene was amplified by RT-PCR method applied to human breast carcinomas cell lines B-cap37 cDNA.The fragment was inserted into prokaryotic expression vector pET28a(+) plasmid.The recombinant plasmid was verified by double digestion and DNA sequencing.Results:The length of specific fragment applied by RT-PCR was 62bp,and the recombinant plasmid pET28-TAT-survivin presented two bands:5.3kb and 462bp using respective restriction enzymes HindIII and BamHI.The sequence of survivin gene was comformed by blasting to Genbank.It suggested that survivin gene had been cloned into pET28a vector correctly.Conclusion:The recombinant prokaryotic expression vector pET28-TAT-survivin could be successfully constructed.

Objective To investigate the clinical and imaging characteristics of cerebral venous sinus thrombosis(CVST), as well as to study the causes and treatments of CVST.Methods The clinical and neuroradiological f indings of 14 cases with CVST were analyzed ret rospectively.Results Among the 14 cases, 5 were in perinatal period, 2 were secondary tonephrotic syndrom, 1 secondary to primary thrombothemia, and 1 secondary to accessory sinusitis, 2 secondary to mastoiditis,1 secondary to tympanitis, 2 secondary to craniocerebral trauma.Diverse manifestations were seen in these cases, in which increased intracranial pressure was prominent.CT scan showed encephal edema widely, and MRV examination showed the lesion directly.After treatment by decreasing intracranial pressure, anticoagulation or thrombolysis by Sodium Ozagrel and Low Molecular Heparin, 10 cases recovered, 4 cases were better.Conclusion It is premise of early diagnose to grasp the clinical and imaging characteristics of CVST, thrombolysis and anticoagulation by Sodium Ozagrel and Low Molecular Heparin could make satisfactory effect.

失眠是临床常见的症候群,虽然看似小病,却可影响生活与工作,使人昏昏沉沉,严重的甚至造成抑郁、自杀,因此不可小视.临床中发现全天麻、血府逐瘀口服液治疗顽固性失眠有神奇效果,特总结如下.

目的:研究基底动脉尖综合征(Top of the basilar arterysy ndrome,TOBS)的病因、临床表现和影像学表现,加深对这种疾病的认识。方法:我们对自2005年以来收治的6例TOBS患者的原始资料进行回顾性分析。结果:栓塞可能是TOBS的主要病因之一,高危因素有高血压、糖尿病、心脏病、高血脂等,临床表现多以突然眩晕或意识障碍起病,合并眼球运动障碍及瞳孔异常、运动障碍、偏盲,可伴有行为异常等。CT及MRI提示重要的特征是中脑或丘脑梗死合并其他部位梗死,如枕叶、小脑、颞叶。结论:TOBS的诊断主要依赖临床及影像学表现,早期全面综合治疗可以提高生存率。

目的观察症状相关侧血管狭窄程度、颈动脉斑块与短暂性脑缺血发作(TIA)的相关性,及血管内介入治疗的可能性。方法应用DSA和颈动脉超声、经颅彩色多普勒超声(TCD)联合对62例急性期颈内动脉系统TIA患者进行检查。结果颈内动脉系统TIA患者的血管病变以颅内病变为主,以大脑中动脉病变最常见33例(51.6%),颈内动脉颅外段24例(37.5%),症状相关侧血管病变31例(48.4%),支架置入5例。结论颈内动脉系统TIA患者的病因与颅内外血管病变有关,其发病机制可能主要与血流动力学因素有关,介入治疗在TIA中的治疗价值有待进一步临床研究。

目的 总结新型隐球菌颅内感染的临床特点和临床诊断.方法 对13例确诊的新型隐球菌颅内感染患者的发病规律和临床特点进行总结分析.结果 13例患者中11例(84.6%)为亚急性或慢性起病,12例患者(92.3%)有头痛、发热,7例患者(53.8%)出现呕吐,另外意识障碍、精神异常、发作性抽搐、视力损害也较常见.13例脑脊液涂片均发现隐球菌,其中7例为多次涂片发现,大部分病例确诊前误诊为其他疾病.结论 新型隐球菌颅内感染大多数以亚急性或慢性起病,临床表现、脑脊液常规、生化检查及头颅影像学检查均缺乏特异性.脑脊液或脑组织病原学检查发现隐球菌为诊断的金标准.