目的 探讨血清乙酰胆碱酯酶(AChE)和白细胞介素(IL)17水平与单纯疱疹病毒性脑炎(HSE)患者认知功能障碍的相关性.方法 选取2019年3月—2021年3月邯郸市中心医院HSE患者159例(HSE组),根据是否发生认知功能障碍将所有患者分为认知障碍组(69例)和认知正常组(90例),根据简易智能精神状态检查量表(MMSE)评分将认知功能障碍患者分为轻度组(23例,MMSE评分为20～25分)、中度组(30例,MMSE评分为11～19分)和重度组(16例,MMSE评分≤10分).以健康体检者65名作为正常对照组.检测所有研究对象血清AChE、IL-17水平.采用Pearson相关分析评估AChE和IL-17与蒙特利尔认知评估量表(MoCA)评分和MMSE评分的相关性.采用受试者工作特征(ROC)曲线分析AChE和IL-17诊断HSE患者认知功能障碍的效能.结果 HSE组血清AChE、IL-17水平均显著高于正常对照组(P<0.05).认知障碍组血清AChE、IL-17水平均高于认知正常组(P<0.05).重度组血清AChE、IL-17水平高于中度组和轻度组(P<0.05),中度组血清AChE、IL-17水平高于轻度组(P<0.05).认知障碍组血清AChE、IL-17水平与MoCA评分呈负相关(r值分别为-0.311、-0.480,P<0.01),与MMSE评分亦呈负相关(r值分别为-0.349、-0.447,P<0.01).AChE、IL-17单项检测和联合检测诊断HSE患者认知功能障碍的曲线下面积(AUC)分别为0.689、0.724、0.893.结论 HSE患者血清AChE和IL-17水平与认知功能障碍有关,且可用于评估认知功能障碍的严重程度.

Objective To explore the expression of acetylcholinesterase（Ache）, P-selectin, and cyclin-dependent kinase 5（CDK5） in viral encephalitis（VE） and their correlation. Methods A total of 130 patients with viral encephalitis who underwent physical examination, presented to Department of Neurology or treated in our hospital were selected as the research subjects, and included in the research group. The patients were divided into acute phase group（n=85） and recovery phase（n=45） according to severity of their illness. According to the clinical manifestations of patients, they were divided into mild group（n=76） and severe group（n=54）. Sixty healthy people who underwent physical examination in our hospital during the same period were used as the control group. The butyrylthiocholine substrate method was used to detect the level of Ache, the enzyme-linked immunosorbent method was used to detect the level of serum P-selectin, and the CDK5 separation kit was used to detect the level of CDK5. The Ache, P-selectin, and CDK5 levels of patients in the research group and control group, acute phase and recovery phase, and severe and mild groups were observed. The correlation between Ache, P-selectin and CDK5 in patients with VE was analyzed. The ROC curve was used to compare the diagnostic value of detection of Ache, P-selectin, and CDK5 alone or in combination in VE. Results The levels of Ache, P-selectin and CDK5 were significantly higher in the research group than in the control group（P＜0.05）, higher in the acute phase than in the recovery phase（P＜0.05）, and higher in the severe group than in the mild group（P＜0.05）. Ache, P-selectin and CDK5 protein expressions were positively correlated（P＜0.05）. The diagnostic value of combined diagnosis was significantly higher than that of Ache, P-selectin, and CDK5 alone（Z=2.765, 2.563, 2.925, all P＜0.05）. Conclusion Ache, P-selectin and CDK5 are all involved in the pathogenesis of VE patients. They are expressed at different levels at different stages of the onset, and there is a positive correlation between each two indicators. Therefore, they can be used as a basis for diagnosis and treatment of patients with VE.

目的 观察单纯疱疹病毒型脑炎(HSE)患者血清乙酰胆碱酯酶(AchE)、可溶性OX40L(sOX40L)水平及认知功能变化情况,探讨血清AchE、sOX40L水平与认知功能关系.方法 选取2017年3月至2020年12月邯郸市第一医院收治的HSE患者63例作为观察组,同期体检健康者63例作为对照组.比较两组血清AchE、sOX40L水平、认知功能[简易精神状态检查量表(MMSE)评分],分析血清AchE、sOX40L水平与MMSE评分的关系,以及HSE患者认知功能的影响因素.结果 观察组血清AchE、sOX40L水平高于对照组,MMSE评分低于对照组,差异均有统计学意义(P<0.05),随着MMSE评分降低,血清AchE、sOX40L水平呈升高趋势;血清AchE、sOX40L水平与MMSE评分呈负相关(r=-0.675、-0.598,均P<0.001);多元线性逐步回归分析显示,校正白细胞介素6、C反应蛋白水平后,AchE、sOX40L、癫痫发作仍是认知功能损害的影响因素(P<0.05).结论 HSE患者血清AchE、sOX40L水平异常,其血清AchE、sOX40L水平与患者认知功能有关.

目的 观察侧脑室外引流联合对侧脑室Ommaya储液囊埋置术,并结合术后腰大池持续引流治疗重症高血压性脑室出血的临床效果.方法 选择15例重症高血压性脑室出血患者,采用侧脑室穿刺引流联合对侧脑室Ommaya储液囊埋置术,并结合术后腰大池持续外引流治疗(A组),同期收治的13例行常规侧脑室外引流联合对侧脑室Ommaya储液囊埋置术治疗的重症高血压性脑室出血患者为B组,同期收治的14例行常规双侧脑室外引流治疗的重症高血压性脑室出血患者为C组.比较3组患者的脑室血肿清除时间、术后颅内感染率、住院时间.出院后随访6个月,评价3组患者的日常生活活动能力(ADL).结果 A组患者的脑室血肿清除时间、住院时间明显短于B组和C组(均P ＜0.05).随访6个月,治疗组ADL分级优于B组和C组(P＜0.05).结论 侧脑室外引流联合对侧脑室Ommaya储液囊埋置术,并结合术后腰大池持续外引流治疗重症高血压性脑室出血是一种简单安全、可行、有效的治疗方法,可快速清除脑室内血肿,缩短患者住院时间,改善患者的临床预后,值得在基层医院推广应用.

目的 评估非高密度脂蛋白(non-HDL-C)对血管性认知障碍(VCI)的影响.方法 筛选2016年9月至2018年3月邯郸市第一医院神经内科收治的脑梗死患者126例,根据简易精神状态量表(MMSE)得分将其分成单纯梗死组(n=57)和认知障碍组(n=69),比较两组性别、吸烟、饮酒、高脂血症等危险因素的发生频率,研究认知障碍患者的非高密度脂蛋白胆固醇(non-HDL-C)水平与MMSE评分之间的关系.结果 单纯梗死组年龄显著低于认知障碍组(P=0.02).认知障碍组患者的non-HDL-C浓度与MMSE分值呈负相关(P=0.031).结论 non-HDL-C水平可能是VCI患者的潜在临床指标.

Objective To investigate the clinical effect of simple stereotactic puncture on patients with intracerebral hemorrhage and its effect on electrolyte level.Methods The clinical data of 88 patients with cerebral hemorrhage treated in our hospital from August 2016 to October 2018 were collected,who were divided into two groups according to the treatment methods,44 cases in each group.The control group was treated with craniotomy,while the experimental group was treated with simple stereotactic puncture.The perioperative indexes,clinical efficacy,electrolyte level,and complications were compared between the two groups.Results After operation,the levels of serum potassium and sodium in the experimental group were higher than those in the control group,the amount of intraoperative blood loss,operation time,and the incidence of complications in the experimental group were lower than those in the control group,with statistically significant differences between the two groups (P＜0.05).There was no statistically significant difference in the clinical effect between the two groups (P＞0.05).Conclusion Simple stereotactic puncture is effective in the treatment of cerebral hemorrhage,which can maintain electrolyte balance,reduce surgical trauma and the incidence of complications.

目的:对微创穿刺引流联合开颅血肿清除术在治疗高血压脑出血并发脑疝的疗效与预后进行观察与分析.方法:选取我院收治的高血压脑出血并发脑疝患者70例,根据手术方式区分为观察组和对照组,其中观察组采用微创穿刺引流联合开颅血肿清除术进行治疗,对照组采用常规开颅血肿清除术进行治疗,比较两组预后情况与生活质量情况.结果:观察组预后良好率为14.29％,显著优于对照组的5.71％(P<0.05);观察组各项健康生活质量评分均显著优于对照组(P<0.05).结论:在治疗高血压脑出血合并脑疝患者时采用微创穿刺引流与开颅血肿清除术联合治疗的方法临床疗效显著,不仅可以改善预后效果,还可提高患者日常生活质量,值得临床推广应用.

Objective To investigate the significance of early diagnosis and prognosis for severe traumatic cerebral injury combined with cerebral salt wasting and abnormal secretion of antidiuretic hormone syndrome.Method 47 cases of severe traumatic cerebral injury were divided into syndrome of inappropriate antidiuretic hormone secretion (SIADH) group and cerebral salt wasting (CSWS) group according to CSWS, SIADH diagnostic criteria. Laboratory tests were compared between groups. Prognosis and hazards factors were analyzed by Cox proportional analysis. Results ① Atrial natriuretic peptide (ANP), brain Natriuretic Peptide (BNP) of CSWS group reduced after treatment, which had a significant difference compared to the treatment (P<0.05 orP<0.01).②After treatment, GCS score<3 and 5 point in CSWS, SIADH patients were significantly lower than four point group (P<0.05).④Cox proportional hazards model analysis showed that skull fracture, cerebral hematoma, blood osmolality, sodium, hydrocortisone (HC), aldosterone (AL) were hazard factors for CSWS, SIADH. ANP, BNP had obvious relevance with CSWS.Conclusion CSWS, SIADH can be identified by CVP, ADH, ANP and BNP after severe traumatic cerebral injury, which have a major impact on the prognosis.

目的：分析储液囊联合脑室外引流治疗丘脑出血的临床效果，总结其在降低丘脑出血患者颅内感染发生率中的应用价值。方法选取我院收治的60例丘脑出血患者为观察对象，按随机数字表法分为对照组与观察组各30例。对照组仅给予脑室外引流处理，观察组给予储液囊联合穿刺引流联合脑室外引流，统计比较2组治疗效果、颅内感染发生率，记录脑室血肿清除时间，并于术后6个月采取 GOS （格拉斯哥预后评分）量表评估2组术后恢复情况。结果治疗前，2组GCS及Graeb量表评分比较差异无统计学意义（ P＞0.05）；治疗后，观察组 GCS 量表评分提升至（12.33±2.67）分，Graeb量表评分上升至（21.34±3.59）分，与对照组相比差异有统计学意义（ P＜0.05）；观察组GOS评级为5级者7例，4级18例，预后良好25例，有效率为83.33％，明显高于对照组的53.33％，差异有统计学意义（P＜0.05）；观察组脑室血肿清除时间为（7.03±1.02）d ，对照组为（7.33±1.12）d ，差异无统计学意义（P＞0.05）；观察组术后颅内感染发生率为3.33％，交通性脑积水发生率为3.33％，均明显低于对照组（P＜0.05）。结论在常规脑室外引流的基础上联用储液囊反复穿刺引流，可明显降低丘脑出血患者术后颅内感染发生率，改善患者预后，且安全性高，值得推广。

目的:探讨鞍区肿瘤术后合并脑性盐耗综合征(CSwS)的预后相关影响因素.方法:鞍区肿瘤术后患者49例,按照是否发生CSWS分为单纯肿瘤术后组(SS)29例和术后合并CSWS(SC组)20例.随访1年,采用格拉斯哥预后量表(GOS)评价患者预后,Kaplan Meier法进行生存分析,Cox模型分析患者预后危险因素.结果:入院时,SC组血钠、血渗透压低于SS组(P＜0.05),而24h尿钠、24h尿量、血清中心钠素(ANP)、脑钠肽(BNP)、皮质醇(HC)、醛固酮(AL)均高于该组(P＜0.05).随访1年后,SS组无死亡;SC组死亡5例,差异有统计学意义(P＜0.05);GOS4分组BNP、HC、AL含量均低于＜3分组(P＜0.05);5分组ANP、BNP、HC、AL含量均低于＜3分组、4分组(P＜0.05).Cox模型分析显示,鞍区肿瘤手术方式、肿瘤类型、血钠降低程度、中心静脉压(CVP)、ANP、BNP、HC、AL水平为鞍区肿瘤术后影响患者预后的危险因素(P＜0.05或0.01).结论:鞍区肿瘤术后合并CSWS患者ANP、BNP、HC、AL在治疗初期明显增高,肿瘤手术入路方式、肿瘤类型、血钠降低程度、CVP、ANP、BNP、HC和AL含量对患者的预后有着明显的影响.

目的 探讨鞍区肿瘤术后、重度颅脑损伤合并中枢性尿崩症的早期临床诊断意义及预后分析.方法 选取在我院就诊的48例鞍区肿瘤术后或重度颅脑损伤合并中枢性尿崩症患者,按照诊断类型分为短暂性尿崩症组(A组),持续性尿崩症组(B组),三相性尿崩症组(C组),检测患者治疗前后实验室指标,同时分析患者预后情况.结果 ①治疗结束后,A组、C组在血钠、血渗透压、24尿钠及24h尿量均降低,同治疗时比较,差异具有显著性意义(P＜0.05或P＜0.01);治疗后A组、C组血渗透压,24h尿钠均低于B、C组(P＜0.05);②治疗后经GOS评分,B组、C组4分及以下患者所占比例明显高于A组(P＜0.05),而5分者均低于A组(P＜0.05);③患者随访1年,A组患者生存状况良好,与B组死亡3例、C组死亡3例相比较,差异有统计学差异(P＜0.05);④B、C组ADH术后先下降后上升,但未能达到正常水平,A组先升高后下降,后恢复至正常水平.结论 鞍区肿瘤术后、重度颅脑损伤合并CDI患者的预后与血ADH水平、24小时尿量有一定的相关性,不同类型CDI预后生存状况存在一定差异.

目的：观察分析消化道肿瘤术后肠内营养与肠外营养联合治疗的临床效果。方法选取2012年1月-2014年1月的180例消化道肿瘤手术患者，将患者随机分为A、B、C三组，A组55例，B组58例，C组67例。A组患者行肠内营养支持操作，B组行肠外营养支持操作，C组行肠内肠外联合的营养支持操作。对比分析三组患者术后住院时间、肛门排气时间以及相关并发症发生情况。结果 C组患者术后住院时间、肛门排气时间显著优于A、B二组（P＜0．05），而A、B二组患者差异无统计学意义（P＞0．05）；此外，三组患者切口感染、尿路感染、导管相关感染、消化道出血等并发症出现率差异无统计学意义（P＞0．05）。结论消化道肿瘤术后行肠内营养与肠外营养联合治疗是安全有效的，患者术后肠道功能恢复程度显著高于单纯的肠内或场外营养。

目的 探讨脑胶质瘤组织中基质金属蛋白酶-9(MMP-9)、尿激酶型纤溶酶原激活剂(uPA)阳性表达及意义.方法 采用组织芯片技术和免疫组织化学S-P法检测50份脑胶质瘤组织、10份正常脑组织中MMP-9、uPA的阳性表达,并分析两者与患者临床病理特征的关系.结果 MMP-9和uPA在脑胶质瘤组织、正常脑组织中的阳性表达比较差异有统计学意义(P均＜0.05).MMP-9和uPA的阳性表达与脑胶质瘤患者的年龄、性别无明显相关性,但WHO分期Ⅲ、Ⅳ期明显高于Ⅰ、Ⅱ期(P均＜0.05)；在脑胶质瘤组织中MMP-9的阳性表达与uPA的阳性表达呈正相关(r =0.456,P＜0.05).结论 MMP-9、uPA的阳性表达可能与脑胶质瘤的发生和恶性程度有关.

目的 探讨内皮型一氧化氮合酶基因G894T多态性与成人过敏性紫癜易感性的关系.方法 将邯郸市第一医院治疗的98例成人过敏性紫癜患者作为观察组,同时随机选取同一时间进行体检的91例健康成人作为对照组.首先从两组所有人体内提取DNA,然后在PCR扩增仪上完成对内皮型一氧化氮合酶基因进行目的片段的扩增,接着进行酶切.最后观察酶切产物.结果 观察组患者体内G基因明显多于对照组的健康群体(P＜0.05).结论 机体内皮型一氧化氮合酶基因G894T增多会增加成人过敏性紫癜的发生,其易感性与内皮型一氧化氮合酶基因G894T多态性有很大的关系.

目的 探讨脊髓损伤患者心脏节律变异性(HRV)和血浆D-二聚体水平改变的意义.方法 采用回顾性分析的方法,分析本院2005年7月至2007年8月收治的60脊髓损伤患者临床资料,根据脊髓损伤部位的不同,分为颈髓损伤组(31例)、胸髓损伤组(20例)、腰髓损伤组(9例),同时选取35例健康体检者为对照组.结果 颈髓、胸髓组代表交感和迷走神经张力的低频检测结果为(299.28±310.25)ms2、(254.16±221.71)ms2,明显低于对照组的(560.32±320.14)ms2,差异有统计学意义(P<0.01);脊髓各段(颈髓、胸髓、腰髓)损伤患者血浆D-二聚体水平均较对照组显著增高(P<0.05),同时各组脊髓损伤患者血浆D-二聚体水平随着治疗时间的延长,逐渐降低(P<0.05).结论 HRV和血浆D-二聚体水平的联合检测可以作为脊髓损伤部位诊断及损伤程度的参考指标.