目的:探讨伴持续性向地或背地变向性位置性眼震(DCPN)患者的临床特点及区别.方法:回顾性收集我院收治的眩晕患者56例纳入DCPN组,均经眼震视图检查及翻滚试验证实为持续性DCPN患者,并进一步分为背地DCPN亚组40例和向地DCPN亚组16例;收集同时期诊断为常见耳石症的患者66例纳入常见耳石组.记录患者的基本资料(年龄、性别、糖尿病、高血压、高脂血症、吸烟、饮酒、失眠等)以及发病诱因、耳部相关症状(听力下降、耳鸣等)特点;所有患者均完善头颅核磁、血管、眼震电图相关检查,比较常见耳石组与DCPN组及其亚组的临床特点、检查结果及预后等差异.结果:与常见耳石组相比,DCPN组的病程较长(P<0.05);与常见耳石组和背地DCPN亚组相比,向地DCPN亚组的平均年龄更小、女性比例更高、病程更长、听力下降和耳鸣患者的比例更高(均P<0.05).常见耳石组患者首次复位后有84.8％的患者痊愈,1周内均痊愈;背地DCPN亚组首次复位后62.5％的患者痊愈,10 d内均痊愈;向地DCPN亚组首次复位后均无效,结合药物治疗和多次手法复位治疗,1个月后随访均痊愈,病程最长24 d.所有患者在3月后随访均未复发.结论:伴持续性向地/背地DCPN患者临床病程长,背地性DCPN危险因素与常见耳石症相似,提示两疾病的同源性;而向地性DCPN发病年龄偏轻、女性多见、病程更长,其发病机制可能与耳石粘附及内耳病变相关.DCPN患者手法复位的效果比常见耳石患者差,向地性DCPN患者的复位效果更差.

原发性中枢神经系统淋巴瘤(primary central nervous sys-tem lymphoma,PCNSL)是一种少见的高度恶性肿瘤,PCNSL定义为淋巴瘤,累及大脑、软脑膜、眼睛或脊髓,而无中枢神经系统以外的淋巴瘤存在迹象,大多数肿瘤组织学与弥漫大B细胞淋巴瘤相同,且临床表现复杂,疾病进展快,预后差[1],既往研究显示[2]该病在免疫异常(艾滋病、器官移植或免疫抑制剂应用)发病率显著高于正常人群,提示本病与免疫功能低下或缺陷相关.近年来不少临床确诊病例出现在不伴此类疾病的免疫功能正常人群[3],提示其发病机制的复杂,可能存在更多诱因及途径.本文收集了2010年-2016年诊治的4例免疫功能正常患者,对其临床、影像、病理及预后进行随访,以进一步探讨其临床特点,为该疾病的诊治提供参考和依据.

目的:分析进行性核上性麻痹的临床特征、影像学表现及预后.方法:通过观察及随访7例临床诊断进行性核上性麻痹患者,收集其相关临床资料,并随访患者生存情况.结果:7例进行性核上性麻痹患者,发病年龄56～74岁,中位数66岁,4例患者早期出现头晕,2例存在不明原因的焦虑抑郁,其余患者早期以走路不稳伴摔倒,4年内出现典型的垂直性眼肌麻痹,5年左右出现头颅核磁提示中脑被盖部萎缩,中脑前后径变小,呈现该病典型改变,多数患者约6～8年需他人帮助生活,依据最新的临床诊断标准,5例诊断为很可能PSP经典型(PSP-RS),2例为PSP帕金森综合征型(PSP-P).结论:进行性核上性麻痹典型症状多有走路不稳姿势异常伴摔倒,多存在轴性为主姿势异常,多表现为翻身及转身困难,美多巴治疗效果欠佳,多数患者早期有头晕、焦虑、抑郁状态改变,偶有视力改变,可能以视力、精神因素第一时间就诊于眼科或精神科,随着疾病进展,均可出现典型的垂直性眼肌麻痹及典型影像学改变,总体预后不佳.

目的 分析脑梗死复发或初发采用血小板药物单抗或双抗治疗对血小板抑制效果的影响,复发与初发对药物抵抗的影响,评价血栓弹力图对脑梗死复发风险评估以及指导作用的价值.方法 以2014年2月-2016年2月收治的神经内科脑梗死病人作为研究对象,入选174例,初发脑梗死病人72例纳入初发组,复发脑梗死病人102例纳入复发组;单独应用阿司匹林肠溶片治疗92例(初发者42例、复发者50例),采用阿司匹林联合氯吡格雷联合治疗82例(初发者30例,复发者52例).在梗死后10 d~14 d进行血栓弹力图检查,进行对比研究,分析梗死危险因素.结果 单抗治疗复发组与初发组R、K、α、CI、AA抑制率值水平差异无统计学意义(P>0.05),复发组MA值水平低于初发组,差异有统计学意义(P<0.05);复发组发生阿司匹林抵抗发生率44.00%(22/50),高于初发组11.90%(5/42),差异有统计学意义(P<0.05);双抗治疗,复发组与初发组阿司匹林抵抗、氯吡格雷抵抗、完全抵抗发生率差异无统计学意义,双抗治疗复发组R水平低于初发组,差异有统计学意义(P<0.05),双抗治疗复发组与初发组K、α、MA、CI、AA抑制率差异无统计学意义(P>0.05);多因素Logistic回归分析显示阿司匹林抵抗[OR=2.676,95%CI(1.104~6.103),P=0.024]为独立危险因素.结论 脑梗死复发与阿司匹林抵抗有关;血栓弹力图可用于评价抗血小板治疗效果,及早发现阿司匹林抵抗,指导双抗治疗,从而使病人获益,降低复发风险.

Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) is a syndrome constituted by acute dementia, psychiatric symptoms, pyramidal and extrapyramidal symptoms, which can be developed after the original clinical symptoms of carbon monoxide poisoning recovered. Lots of studies have been done to explain the mechanisms of DEACMP, and more and more researches have demonstrated that the immunological mechanism may be involved in or play an important role on the pathogenesis of the process. This article will review the researches of immunological mechanism of DEACMP in recent years and give some prompts to clinical study in the future. doi: 10.3969/j.issn.1672-6731.2014.10.006

脑静脉血栓形成(cerebral venous thrombosis)是导致缺血性卒中的少见病因之一,近年来国内外[1-3]在此方面的研究已经有所进展,但是由于病因的多样性,使其诊断标准仍得不到统一.皮层静脉血栓作为脑静脉血栓形成的分类,临床更为少见,诊断更为困难.笔者收集了2008-2012年诊治的5例皮层静脉血栓患者,对其临床和影像学资料进行总结并随访,以进一步探讨其临床特点,为疾病的早期诊断及治疗提供参考和依据.

Objective To investigate the clinical features of relapsing viral encephalitis.Methods The clinical data of 2 patients with relapsing viral encephalitis was analyzed retrospectively.Results Two cases were one male(71 years old) and one female(35 years old).The clinical manifestation of the 2 patients were epilepsy with repeatedly seizure,disturbance of intelligence or consciousness and aphasia,etc.Imaging detection showed that lesions mostly suffered in cortex,especially in the temporal lobe.EEG revealed wide range of slow-wave-based.After treating with sufficient antiviral medicine and glucocorticoid their symptoms markedly improved,and they were follow-up for 2-4 months without recurrence.Conclusions The clinical manifestation of relapsing viral encephalitis is mainly as temporal lobe symptoms.The mechanism is possibly owing to reactivation of the virus.The efficacy of sufficient and early antiviral treatment is good.

OBJECTIVE: To assess the role of cytotoxin-associated gene-A (CagA) positive strains of Helicobacter pylori (Hp) in ischemic stroke (IS) subtypes.DATA SOURCES: A computer-based online search of PubMed, EMBASE, the Cochrane Collaboration database, the CNKI database and the VIP database, from January 1997 to July 2010, was performed to find relevant studies.DATA SELECTION: Case-control studies relevant to CagA with IS and IS subtypes were selected. Data regarding related factors in the case group and control group were acquired using the same approach. All patients had been diagnosed as exhibiting IS using skull CT or MRI, and were etiologically typed according to the 1993 TOAST diagnosis criteria. Two investigators independently performed the same search and study selection. Meta-analyses were then performed for the selected studies using RevMan 5.0 software (Cochrane Collaboration) after strict screening. Heterogeneity tests, sensitivity analyses and publication bias assessments were then conducted.MAIN OUTCOME MEASURES: Relationship of CagA with IS and IS subtypes.RESULTS: Eight studies were selected, involving data from 879 patients with IS, and 849 healthy controls. Five out of eight of the selected studies were related to large artery atherosclerosis (461 patients with IS and 497 health controls). The results of our meta-analysis revealed a significant association between prior infection with CagA-positive strains and increased risk of IS (odds ratio (OR) = 2.31, 95% confidence interval (CI): 1.89-2.82, P < 0.01). In addition, we found an association between infection with CagA-negative strains and IS (OR = 0.57, 95%CI: 0.47-0.70, P < 0.01). CagA positive and negative strains were found to correlate with large artery atherosclerosis (CagA-positive strains: OR = 2.87, 95%CI: 2.19-3.77, P < 0.01; CagA-negative strains: OR = 0.51, 95%CI: 0.39-0.67, P < 0.01). Because of the diversity of etiological factors in the case-control study, we conducted further analyses after correcting for confounding factors, and the overall effects were recalculated. The results revealed significant relationships between CagA-positive strains and IS (OR = 2.36, 95%CI: 1.84-3.02, P < 0.01), and between CagA-positive strains and large artery atherosclerosis (OR = 3.10, 95%CI: 2.29-4.19, P < 0.01). A heterogeneity test of CagA-positive strains in IS and its subtypes revealed good homogeneity (I-2 = 0%; I-2 = 0%) and we adopted a fixed-effects model to calculate OR. Sensitivity analysis confirmed that the results of the meta-analysis were reliable. However, the funnel plot suggested that the experimental results may be affected by bias, possibly resulting from a lack of published studies reporting negative outcomes in the meta-analysis.CONCLUSION: Infection with CagA-positive strains is a risk factor for IS, especially the large artery atherosclerosis subtype. However, the evidence from case-control studies is weak, and more prospective studies are required to conclusively determine whether infection by CagA-positive strains should be considered a novel risk factor for IS and its subtypes.

Previous studies have demonstrated that Helicobacter pylori infection is associated with coronary atherosclerotic heart disease, but the correlation between Helicobacter pylori infection and ischemic stroke remains unclear. The present study assessed the effects of Helicobacter pylori infection on atherothrombotic stroke. This study included 115 individuals with atherothrombotic stroke, all of whom were patients receiving treatment at the Department of Neurology, Aerospace Central Hospital (Aerospace Clinical Medical College Affiliated to Peking University) in China, from March 2006 to July 2009. In addition, 131 controls without the history of cardiovascular disease, cerebrovascular disease or atherothrombosis were also enrolled in the study. Results show that the Helicobacter pylori-IgG positive rate was greater in the atherothrombotic stroke patients than in the controls, but the difference was not statistically significant (67.8% vs. 61.8%, OR = 1.301, 95%CI: 0.769-2.203, P = 0.327). After correction for potential risk factors for Helicobacter pylori infection and known risk factors for ischemic stroke, no significant difference was detected between them (OR = 1.278, 95%CI: 0.667-2.449, P = 0.459). These results indicate that there is no specific correlation between Helicobacter pylori infection and atherothrombotic stroke. This finding requires further verification in large-sample prospective studies.

幽门螺杆菌(Helicobacter pylori,Hp)与慢性胃炎、消化性溃疡胃黏膜相关淋巴样组织淋巴瘤以及胃腺癌等胃肠疾病密切相关,近年来研究发现Hp亦可导致心脑血管疾病的发生,相应机制可能是通过促血管动脉粥样硬化形成,具体表现在促全身炎性反应、促代谢紊乱等方面,本文即从生物学特征以及致病机制两方面对Hp与动脉粥样硬化的关系作一综述.

Objective To assess the prevalence of Helicobacter pylori(Hp) infection in a case-control study and to analyze the risk role of Hp in patients with atherothrombotic stroke(AT).Methods The seroprevalence of Hp infection was assessed by enzyme-linked immunosorbent assay (ELISA) in 69 AT patients and 108 control subjects without clinical and instrumental evidence of atherosclerosis diseases.Potential risk factors for Hp infection and traditional risk factors for atherosclerosis were recorded in all subjects.The serum specific antibody IgG to Hp was detected by ELISA.Logistic regression was used for multifactor analysis.Results The proportions of males, hypertension,diabetes and familial history of stroke were significantly higher in patients compared with control subjects(P 0.05,P0.01).A trend toward higher prevalence of Hp infection was observed in patients compared with controls,but the difference did not reach statistical signif-icance (68.1%vs 63.9%,P =0.564).This difference remained nonsignificant after adjusting for potential risk factors for Hp infection and known risk factors for ischemic stroke(P = 0.698). Conclusion This case-control study does not provide evidence of any strong association between Hp chronic infection and AT.

Objective To conduct a meta-analysis of case-control studies for assessing association between Helicobacter pylori(Hp) and different types of ischemic stroke(IS) in order to explore whether Hp infection is the risk factor for IS and its subtypes.Methods MEDLINE,EMBASE and Cochrance Collaboration database with the time limit of 1995 to 2009 were searched.Meta-analyses were performed for case-control studies after strict screening.Heterogeneity test,sensitivity analysis and publication bias assessment were also performed.Results Eleven case-control studies were included-of which,9(1575 patients,1720 controls) were related to IS and 7 were related to large artery atherosclerotic stroke(LAA,510 patients,944 controls).The pooled OR was 1.57(95%CI:1.23—1.99).Patients with LAA had higher odds for Hp infection than controls(OR =2.24,95%CI:1.46—3.43) according to the seven studies.Random-effects model was adopted to perform heterogeneity test because of significant study heterogeneity(I~2= 58%, I~2=60%).Sensitivity analysis suggested the results of meta-analysis were reliable.However,the funnel plot suggested that the experimental results may be affected by bias,possibly resulting from lack of published studies reporting negative results in small-size sample.Conclusion Association between Hp and IS is significant and seems higher with LAA.Relation between Hp and IS needs to be further confirmed by future large sample and prospective investigations.

Objective The aim of our study was to investigate the association between helicobacter pylori (Hp) infection and ischemic stroke Subtypes. Methods Total of 123 patients with ischemic stroke were enrolled. Analyses were stratified for etiologic stroke subtypes according to 2007 modified TOAST criteria: 94 patients with atherothrombosis (AT), I4 patients with cardioembolism (CE), 12 patients with small artery disease (SAD). 131 control subjects without clinical and instrumental evidence of atherosclerosis diseases were randomly selected from clinic. All subjects were recorded potential risk factors for Hp infection and traditional risk factors for IS. The serumal specific antibody IgG of Hp was detected by enzyme-linked immunosorbent assay (ELISA). Conditional logistic regression was used. Results Hp-IgG-positive rate of patient group was higher, but the difference was not statistically significant (69.1% vs 61.8%, OR=1.381, P=0.223). This result remained no significant after adjusting for potential risk factors for Hp infection and known risk factors for IS (OR 1.284, 95%CI 0.705-2.338, P=0.413). Subgroup analyses yielded similar results in all etiologic stroke subtypes (univariate analysis: AT: OR 1.455, 95%CI 0.827-2.561, P=0.193; CE: OR 1.111, 95%CI 0.352-3.504, P=0.857; SAD: OR 1.852, 95%CI 0.478-7.167, P=0.366; Multivariate analysis: AT: OR 1.441, 95%CI 0.726-2.861, P=0.297; CE: OR 0.894, 95%CI 0.249-3.211, P=0.864; SAD: OR 1.836, 95%CI 0.396-8.503, P=0.437). Conclusion Our case-control study does not provide evidence of any strong association between Hp chronic infection and IS. There is still need for large case-control and mainly prospective studies to investigate the contribution of Hp infection to IS risk particularly subgroups.

研究发现,幽门螺旋杆菌(Helicobacter pylori,Hp)可能通过促进动脉粥样硬化形成导致心脑血管疾病发生[1-3],Hp细胞毒素相关蛋白A(cytotoxin-associated gene-A,CagA)在其中起至关重要的作用,CagA促动脉粥样硬化发生的机制与全身炎性反应、代谢紊乱等有关.本文就CagA的生物学特征、临床研究进展及其促进动脉粥样硬化形成的可能机制综述如下.

Objective To evaluate the diagnostic efficacy of Helicobacter pylori(Hp) stool antigen test (ImmunoCard STAT HpSA) and serological test (helicobacter pylori rapid test with current infection marker, CIM Hp RT) for Hp current infection in patients with cerebrovascular infarction. Methods Stool and boold samples of 93 patients were taken. The patients were evaluated with ImmunoCard STAT HpSA and CIM Hp RT. HpSA was detected using a lateral flow chromatography technique based on monoclonal antibody and Serology was done elsewhere using CIM Hp RT. The result assessment was taken by masked fashion. Analysis was carried out by paired Chi-square test (Mc Nemar Test) and the consistency of two determinations was evaluated using Kappa statistics. Results The prevalence of Hp current infection in patients with cerebrovascular infarction of ImmunoCard STAT HpSA and CIM Hp RT was 47.3%(44/93) and 52.7%(49/93), respectively. The total coincidence rate was 75.3%(70/93). There was no significant difference between the two determinations(P=0.405). The Kappa value for consistency was 0.507(95%CI 0.333-0.681, P<0.01). Conclusion The two determinations are helpful tools in the detection of Hp current infection in patients with cerebrovascular infarction and show moderate consistency.