目的 对比支架辅助管栓塞与开颅夹闭术治疗大脑中动脉(MCA)宽颈动脉瘤的临床疗效.方法 随机将80例MCA宽颈动脉瘤患者分为A、B两组(A=40,B=40),A组行开颅夹闭术治疗,B组行支架辅助管栓塞术治疗.对比两组术后即刻完全栓塞率、住院时间、预后良好率和并发症发生率.结果 两组术后即刻完全栓塞率和预后良好率组间差异无统计学意义(P>0.05),而B组住院时间和并发症发生率低于A组(P<0.05).结论 支架辅助管栓塞术与开颅夹闭术治疗MCA宽颈动脉瘤临床疗效基本一致,但支架辅助管栓塞术安全性更高,可作为临床首选术式.

目的 分析抗血管内皮生长因子(VEGF)药物玻璃体腔内注射联合23 G玻璃体切除术对增殖性糖尿病视网膜病变(PDR)患者的疗效.方法 选取2017年1月～2019年1月河南省人民医院88例PDR患者(88只眼),根据治疗方案分组,各44例(44只眼).对照组给予23 G玻璃体切除术,实验组给予抗VEGF药物玻璃体腔内注射+23 G玻璃体切除术.观察2组手术时间、电凝止血使用率,对比术前术后最佳矫正视力.结果 实验组电凝止血使用频率较对照组低,手术时间较对照组短(P＜0.05);与对照组比较,术后实验组最佳矫正视力较高(P＜0.05);实验组并发症发生率为4.54％,低于对照组18.18％(P＜0.05).结论 PDR患者采取抗VEGF药物玻璃体腔内注射和23 G玻璃体切除术联合治疗,可减少并发症,缩短手术时间,提高视力.

目的 观察微创定向钻孔软通道血肿穿刺引流术治疗高血压脑出血(HCH)的临床疗效.方法 随机将我院收诊的90例HCH患者均分为A、B两组,A组行传统开颅血肿清除术,B组行微创定向钻孔软通道血肿穿刺引流术.对比术前和术后7d时的NIHSS评分;统计两组术后并发症发生率.结果 B组术后7d时的NIHSS评分低于A组(P<0.05);B组术后并发症发生率(4.44％)低于A组(20.00％),差异有统计学意义(P<0.05).结论 微创定向钻孔软通道血肿穿刺引流术治疗HCH临床疗效优于开颅血肿清除术,可作为临床首选术式.

Objective To explore the relationship of the change in platelet activation with type 2 diabetic retinopathy.Methods This study enrolled 138 cases of hospitalized patients with type 2 diabetes mellitus, they were experience group, the 138 cases of hospitalized patients with type 2 diabetes mellitus were divided into three groups:PDR group(n=48),NPDR group(n=28),NDR group(n=62).In case of inconsistency in the two eyes, the less diseased one is out. This study enrolled 32 cases of healthy persons. Mean platelet volume (MPV), platelets distribution width (PDW), platelet-large cell ratio (P-LCR ), platelet hematocrit (PCT ), and platelet count(PLT ) were measured in the studied groups; SPSS22.0 statistical software was used for statistical processing of the data, and ANOVA was used for single factor analysis. Results MPV in PDR group was higher than that in control group, and the difference was statistically significant(P=0.006); PDW increased in diabetic retinopathy, and the difference was statistically significant (P=0.003), especially in the PDR group;MPV and PDW showed no significant difference between PDR and NPDR groups(P=0.085、 P=0.879,P>0.05);PLT decreased in patients with DR. Conclusion MPV and PDW are related to the occurrence and development of diabetic retinopathy, the decrease of PLT is consistent with the progress of DR, changes in platelet activation are associated with diabetic retinopathy.

目的 观察显微镜开颅夹闭术治疗老年前交通动脉瘤破裂患者的临床效果.方法 选取2014年2月至2015年8月襄城县人民医院收治的36例老年前交通动脉瘤破裂患者,均接受显微镜开颅夹闭术治疗,采用格拉斯哥预后量表(GOS)评估其预后效果,统计并发症发生率.结果 经显微镜开颅夹闭术治疗,36例患者中恢复良好20例(55.56％),轻度残疾9例(25.00％),重度残疾4例(11.11％),植物生存2例(5.56％),死亡1例(2.78％).36例患者术后出现低钠血症4例(11.11％),肺部感染3例(8.33％),尿崩症1例(2.78％),脑积水2例(5.56％),并发症发生率为27.78％(10/36).术后随访1 a,35例患者中恢复良好26例(74.29％);术后随访2 a,35例患者中恢复良好31例(88.57％).结论 显微镜开颅夹闭术治疗老年前交通动脉瘤破裂患者效果显著,术后并发症较少,术后中、远期恢复良好.

目的 研究超早期小骨窗微创脑出血清除术对高血压脑出血患者术后血肿清除率及康复进程的影响.方法 选取2014年7月至2017年1月收治的94例高血压脑出血患者,按治疗方案分为观察组与对照组,各47例.给予观察组超早期小骨窗微创脑出血清除术治疗,给予对照组早期小骨窗微创脑出血清除术治疗.比较两组治疗效果、术后血肿清除情况及住院天数.结果 观察组总有效率高于对照组,术后血肿清除率高于对照组,住院天数低于对照组,差异有统计学意义(P<0.05).结论 高血压脑出血采用超早期小骨窗微创脑出血清除术疗效显著,可提高血肿清除率,缩短住院时间,加快康复进程.

Diabetic retinopathy (DR) is the main complication of type 2 diabetes mellitus (T2DM),and is the main cause of visual impairment and preventable blindness.It is well known that inflammation plays an important role in the pathogenesis of T2DM and DR.Retinol binding protein 4 (RBP4) is a novel adipocyte factor,which can induce the insulin resistance and retinal degeneration indirectly through proinflammatory mechanisms,such as Toll like receptor 4 (TLR4),c-Jun amino terminal kinase (JNK),extracellular signal regulated kinase (ERK),p38 signaling pathway,and nuclear factor kappa B (NF-κB),etc.Also the rise of RBP4 can induce insulin resistance and retinal degeneration directly through inflammatory mechanism.In addition,the serum transthyretin (TTR) might inhibit the inflammation of retinal endothelial cells induced by RBP4.

Objective To analyse the clinical efficacy of treatment of the neovascular glaucoma with different intraocular pressure.Methods A total of 111 eyes of 100 patients with neovascular glaucoma from September 2013 to December 2015 were enrolled.They according to the IOP before treatment were divided into four groups:Group A,18-21 mmHg (1 mmHg =0.133 kPa) in 20 eyes of 19 cases;Group B,22-30 mmHg in 30 eyes of 28 cases;Group C,31-40 mmHg in 31 eyes of 28 cases;Group D,≥41mmHg in 30 eyes of 25 cases.Group A and Group B received the panretinal photocoagulation,Group C received intravitreal ranibizumab injection firstly,then received the panretinal photocoagulation,Group D received intravitreal injection of ranibizumab firstly,then received the trabeculectomy combined with panretinal photocoagulation.At 1 week,1 month and 3 months after treatment the intraocular pressure,corneal edema degree,iris neovascularization subsided and complications were observed.Results After treatment new vessels subsided in Group A was 17 eyes,Group B in 24 eyes,Group C in 26 eyes,and Group D in 22 eyes.In Group A,the difference in IOP between before and after treatment was not significant (P =0.342,0.101,0.591),the difference in IOP after treatment in other groups compared with before treatment was statistically significant (P =0.000).Conclusion Different treatments are used to treat patients with neovascular glaucoma with different intraocular pressure.

目的 探讨miR-195在增生型糖尿病视网膜病变(PDR)发生、发展中的作用及机制.方法 选取PDR患者56例(观察组)、特发性黄斑裂孔患者30例(对照组),均为单侧发病.两组均接受常规玻璃体切割术,观察组术中采集玻璃体及视网膜前增生膜组织,对照组采集玻璃体及内界膜组织.采用实时荧光定量PCR法检测两组玻璃体和膜组织miR-195和高迁移率族蛋白B1(HMGB1)mRNA相对表达量,Western blotting法检测两组膜组织HMGB1蛋白相对表达量,并分析观察组玻璃体、膜组织中miR-195与HMGB1 mRNA相对表达量的关系.结果 观察组玻璃体及膜组织miR-195相对表达量均低于对照组,HMGB1 mRNA相对表达量均高于对照组(P均<0.01).观察组膜组织HMGB1蛋白相对表达量为0.94±0.11,对照组为0.58±0.09,两组比较P<0.05.观察组玻璃体及膜组织中miR-195与HMGB1 mRNA相对表达量均呈负相关(r分别为-0.369、-0.508,P均<0.05).结论 PDR患眼玻璃体及增生膜组织中miR-195表达均降低,其可能通过负性调控HMGB1表达而参与PDR的发生、发展.

Objective To explore the relationship of serum retinol binding protein 4 (RBP4) with type 2 diabetic retinopathy.Methods Clinical case control study.The 83 cases of hospitalized patients with type 2 diabetes mellitus (T2DM) were divided into three groups:PDR group (n =32fundus examination showed proliferative diabetic retinopathy),NPDR group (n =20 fundus examination showed non proliferative diabetic retinopathy),NDR group (n =31 fundus examination showed normal).Their serum RBP4 levels were measured.At the same time,factors that may be closely related to the occurrence and development of DR were detected.And we also measured the amplitude of B wave in full field electroretinogram (F-ERG).Results Serum RBP4 differences among three groups had statistical significance,P ＜0.05;There was significant difference in B wave amplitude among the three groups,P ＜0.05.Simple correlation analysis showed that the serum RBP4 level was negatively correlated with the b wave amplitude of ERG (r =-0.458,P =0.0001).Binary Logistic regression analysis showed that RBP4 was significantly correlated with DR (B =0.105,P =0.019).Conclusions The increase of serum RBP4 level is consistent with the progress of DR.There is a close relationship between serum RBP4 and the damage of retinal bipolar cells.

AIM:To investigate the expression changes and clinical significances of Gas6,SDF-1α and SDF-1β in serum in patients with diabetic retinopathy (DR).METHODS:Totally 113 patients with DR were divided into proliferative group (n=45) and nonproliferative group (n=68).In the same period,49 cases of patients with non-contracted DR diabetes were selected as the diabetic group and 42 cases of healthy subjects were selected.The indexes of blood glucose,blood lipids and hs-CRP were detected.The expressions of Gas6,SDF-1α and SDF-1β genes in serum were detected by using real-time PCR technology.RESULTS:The HOMA-IR,TG and hs-CRP in the diabetic group,nonproliferative group and proliferative group gradually increased,the differences were statistically significant (F=39.672,81.625,99.872,all P<0.05).The LDL-C in the nonproliferative group and proliferative group were higher than the diabetic group and healthy subjects,while the HDL-C were lower than the diabetic group and the healthy subjects,the differences were statistically significant (F=51.974,43.824,all P<0.05).The relative expression levels of Gas6 mRNA in proliferative group,nonproliferative group and diabetic group were higher than the healthy subjects;the relative expression levels of SDF-1α mRNA in proliferative group were higher than the nonproliferative group,diabetic group and healthy subjects.The relative expression levels of SDF-1β mRNA in proliferative group and nonproliferative group were higher than the diabetic group and healthy subjects,and the proliferative group were higher than the nonproliferative group,the differences were statistically significant (F=15.381,21.589,38.942,all P<0.05).Pearson correlation analysis showed that the relative expression levels of Gas6 mRNA in serum in patients with DR were positively correlated with TG,TC and LDL-C (r=0.228,0.241,0.209,all P<0.05),and the relative expression levels of SDF-1α mRNA and SDF-1β mRNA in serum were positively correlated with hs-CRP (r=0.297 and 0.325,all P<0.05).CONCLUSION:The expression levels of Gas6,SDF-1α and SDF-1β genes in serum in patients with DR are elevated.They might be related to abnormal blood lipid metabolism and inflammatory response.

目的：探讨早期显微手术夹闭瘤颈治疗脑动脉瘤破裂出血的疗效。方法选择2011-05—2014-05于我院手术治疗的脑动脉瘤破裂出血患者107例为研究对象,根据手术时机的不同分为2组：破裂出血后72 h 内手术者纳入早期组(57例)、>72 h 进行手术者纳入择期组(50例)。所有患者均接受显微镜手术夹闭瘤颈治疗,比较2组手术时间、术中出血量及住院时间、格拉斯哥预后评分(GOS)及术后并发症情况。结果早期组手术时间、术中出血量及住院时间分别为(3.75±1.49)h、(76.33±20.58)mL、(13.23±4.62)d,与择期组(4.02±1.86)h、(79.43±18.66)mL、(12.58±5.27)d 相比差异无统计学意义(P >0.05)；早期组术后 GOS 评分良好率80.70%,明显高于择期组的62.00%(P <0.05)；2组术后动脉瘤再破裂、感染、脑血管痉挛、脑积水的发生率相当,差异均无统计学意义(P >0.05)。结论对脑动脉瘤破裂出血患者实施早期显微镜手术夹闭瘤颈,可在保障安全性的前提下提升临床疗效,具有实际诊疗价值。

目的：了解腹腔镜辅助与开腹手术胃癌切除术术后复发区域的差异。方法通过回顾性分析2008年6月—2013年6月间接受腹腔镜辅助胃癌根治术(观察组,n=20)及开腹胃癌根治术(对照组,n=18)后复发患者的临床资料。比较两组患者的术后复发区域的差异及与原发肿瘤的关系。结果腹腔镜辅助与开腹手术治疗胃癌术后复发区域无差异(P>0.05)。观察组腹膜后淋巴结复发17例,局部转移6例,肝脏转移2例；对照组腹膜后淋巴结复发15例,局部转移5例,肝脏转移2例。结论腹腔镜胃癌根治术术后复发区域与开腹组无明显差异。

目的 探讨动脉瘤性蛛网膜下腔出血首次CTA假阴性患者的可能原因及处理方法.方法 对2011-03—2015-03收治28例动脉瘤性蛛网膜下腔出血首次CTA假阴性患者的资料进行回顾分析.结果 28例患者均行头颅CT检查明确有蛛网膜下腔出血行16层CTA检查,全部阴性患者均行DSA复查.首次复查阴性患者给予抗血管痉挛药物并在三周后复查DSA,DSA结果首次检查发现动脉瘤26个,其中1例复查DSA检出2个动脉瘤.本组26例动脉瘤中,位于大脑中动脉6例,前交通动脉4例,颈内动脉-后交通动脉7例,眼动脉动脉瘤2例,后循环动脉瘤7例.26例假阴性动脉瘤最大直径<3 mm.其中2例DSA检查仍为阴性,于1~3个月后再复查CTA或DSA,仍为阴性.结论 对于高度怀疑动脉瘤出血的弥漫性蛛网膜下腔出血患者,及时行CTA检查,如CTA为阴性又不能完全排除动脉瘤者,等脑血管痉挛期结束后行DSA,能降低CTA假阴性率.

目的:通过分析前循环动脉瘤的显微手术治疗,探讨手术入路与技巧、避免术中动脉瘤破裂及破裂后处理以及脑血管痉挛的预防和处理.方法:回顾分析2011年3月-2015年6月笔者所在科室收治的48例前循环动脉瘤的显微手术治疗患者的临床资料.结果:手术成功率为100%,大面积脑梗死3例,基底节小面积梗死1例,单肢瘫2例,动眼神经麻痹1例,死亡2例.术后随诊2~12个月,术后恢复良好39例,轻残6例,重残2例,死亡2例.本组近期疗效良好率81.25%(39/48),病死率4.16%(2/48).结论:经翼点入路手术夹闭是治疗前循环颅内动脉瘤的有效方法,避免动脉瘤破裂和正确处理术中破裂出血,积极防治脑血管痉挛是手术成功的关键.

OBJECTIVE To comprehensively evaluate vitrectomy in the treatment of bleb infection-related endoph-thalmitis after glaucoma surgery ,so as to provide reliable clinical data for the treatment of bleb infection-related endophthalmitis after glaucoma surgery .METHODS Totally 30 cases (30 eyes) diagnosed with bleb infection-relat-ed endophthalmitis after glaucoma surgery during Dec .2013 to Oct .2014 were randomly divided into the experi-mental group and the control group ,15 cases in each group .The experimental group underwent vitrectomy and the control group received medication treatment .The two groups were compared for treatment effects and vision . RESULTS The infection rate of postoperative bleb infection-related endophthalmitis was 2 .58% in the experimental group ,lower than 11 .25% in the control group .Vision was improved in 13 eyes (86 .67% ) in the experimental group ,higher than 10 eyes (66 .67% ) in the control group ,with significant differences (P<0 .05) .CONCLUSION Vitrectomy has clinical value in treatment of bleb infection-related endophthalmitis after glaucoma surgery .

Objective To identify the effect of retinal photocoagulation on the degree of adhesion between the retinal surface and the fibrovascular tissuein proliferative diabetic retinopathy(PDR).Methods Pars planavitrectomy was performed for the 73 cases (80 eyes) with PDRin type 2 diabetes.Theseeyes were assigned to the retinal photocoagulationand noretinal photocoagulation groups(40 eyes,respectively).All cases had B-scan examination.The morphologic characteristics of fibrovasculartissueinneovascularization elsewhere(NVE)was identified during the surgery.The differences of adhesiondegree between the prior retinal photocoagulation group and no priorretinal photocoagulation groupwere compared.Results Eighteen eyes (45％) and 29 eyes (72.5％)with adhesionalfibrovascular tissue of ＞ 1PD area was observedin the retinal photocoagulation andnoretinal photocoagulation groups, respectively;there was a significant difference(P ＜0.05) on both groups.Adhesionalfibrovascular tissuewas observedin the supertemporal, Infratemporal,supemasal and intranasal quadrant,respectively;there wasno significant differencein both groups.Nineteen eyes (47.5％) and 24 eyes (60％) with tractional retinal detachment was observedin the retinal photocoagulationand no retinal photocoagulation groups, respectively;there was no significant difference(P ＞0.05) on both groups.Conclusions Retinal photocoagulation on the fibrovascular proliferations in PDR is effective at preventing PDR development, reducingthe degree of fibrovascularadhesionandsimplifyingoperation in difficulty.

Background Retinal vascular recanalization is key to the treatment of retinal vascular occlusive disease.Studies confirmed that urokinase by intravitreal injection inhibits the expression of occludin protein at tight junction complexes among retinal capillary endothelial cells.Objective This study was to observe the effects of urokinase via eye local injection on the outward permeability of blood-retinal barrier by detecting the concentration of intravitreal Evans blue (EB).Methods Sixty healthy Sprague-Dawley (SD) rats were randomly assigned to four groups,and the right eyes of the rats were used as experimental eyes.Urokinase of 4 μl (350 U) and the equal volume of PBS (0.01 mol/L) was intravitreally injected separately in the intravitreal urokinase group and the intravitreal PBS group,and 10 μl urokinase (1000U) and the equal volume of PBS was injected via retrobulbar tissue respectively as the retrobulbar urokinase group and the retrobulbar PBS group.Twenty-four hours after injection of drugs,0.5％ EB 4 μl was intravitreally injected.Four hours later,the rats were sacrificed and the right eyeballs were excised for the extraction and drying.EB was extracted from dried vitreous by formamide.Then,the concentration of EB in formamide was determined by a formamide extraction-ultraviolet spectrophotometry method to calculate the concentration of EB in vitreous.The use and care of experimental animals followed the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission (2011 version).Results The rat vitreous body showed the light blue color in intravitreal urokinase group and the retinal vessels were visible under the microscope,and that in the retrobulbar urokinase group presented blue color.However,in the intravitreal and retrobulbar PBS group,rat vitreous exhibited the deeper blue color and retinas were invisible.Absorbance of EB in formamide was 0.181 ±0.008,0.450±0.017,0.330±0.009 and 0.436±0.012 in the intravitreal urokinase group,intravitreal PBS group,retrobulbar urokinase group and retrobulbar PBS group,respectively.The intravitreal EB concentrations in the intravitreal urokinase group were (0.266±0.014)g/L,which was lower than (0.667±0.026) g/L,(0.496±0.015) g/L and (0.657±0.017) g/L of the intravitreal PBS group,retrobulbar urokinase group and retrobulbar PBS group,showing significant different among the four groups (F =100.406,P＜0.01),and the intravitreal urokinase group showed the lowest value in comparison with other three groups (all at P＜0.01).Conclusions Local application of urokinase around eye can augment the outward permeability of blood-retinal barrier in rats.Intravitreal assay of EB after intravitreal injection is a feasible approach to the determination of outward permeability of blood-retinal barrier.

Posterior vitreous detachment (PVD) in diabetic retinopathy (DR) has played an important role in the development process,and outcome of surgical treatment.Partial PVD can contribute to the worsening of DR.Neovascularization on the retinal surface cannot occur without an appropriate scaffold of collagenous material,complete PVD can eliminate the scaffold,reduce vitreous hemorrhage,increase vitreal oxygen levels,make surgery easier and safer.Intravitreal injection of plasmin and other drugs with little side effects can induce PVD,improve the surgical outcome of DR and reduce surgical complications.

目的 比较单用黄斑局灶/格栅样光凝术、玻璃体内注射雷珠单抗(Ranibizuma)及联合黄斑局灶/格栅样光凝术和玻璃体内注射雷珠单抗治疗糖尿病性黄斑水肿(diabetic macular edema,DME)的有效性及安全性.方法 选取2012年1月至2013年6月南阳市中心医院收治的102例(102眼)DME患者,随机分为单纯黄斑局灶/格栅样光凝术组(A组)、单纯玻璃体内注射泪珠单抗组(B组)和黄斑局灶/格栅样光凝术联合玻璃体内注射雷珠单抗组(C组).分别于术前、术后3个月、6个月、12个月行最佳矫正视力(best corrected visual acuity,BCVA)、裂隙镜、眼压、光学相干断层扫描、眼底荧光血管造影等检查,比较三种处理方式的疗效和安全性.结果 三种治疗方式均能改善DME患者BCVA、黄斑中心凹厚度(central macular thickness,CMT)、视网膜新生血管(retinal neovascularization,RNV)渗漏,但B、C组疗效优于A组(P＜0.05).B、C组患者BCVA改善情况差异无统计学意义(P＞0.05),但C组患者CMT及RNV渗漏改善情况优于B组(P ＜0.000 1),表现出更理想且持久的治疗效果[BCVA:0.250 0±0.094 1;CMT:(-162.40±26.34)μm;RNV渗漏面积:(-19.63±4.87)mm2],且无光凝术及雷珠单抗相关的并发症发生.结论 黄斑局灶/格栅样光凝术联合玻璃体内注射雷珠单抗能迅速减轻DME及新生血管形成,从而提高患者视力,其疗效优于单纯黄斑局灶/格栅样光凝术和联合雷珠单抗.