目的:研究多模式CT指导下觉醒型缺血性卒中(WUIS)病人阿替普酶静脉溶栓的疗效及安全性.方法:前瞻性纳入神经内科就诊,并在急诊多模式CT指导下给予阿替普酶静脉溶栓的WUIS病人28例(观察组);收集同时期发病时间窗<4.5 h的非WUIS采用阿替普酶静脉溶栓病人30例(对照组).比较2组病人治疗前及治疗后24 h、7 d和14 d的凝血功能[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)]、血小板(PLT)、超敏C反应蛋白(hs-CRP)、美国国立卫生研究院卒中量表(NIHSS)评分、生活能力评分(Barthel)及临床疗效和结局.结果:观察组临床总有效率和临床结局良好率分别为78.57％和75.00％,对照组为83.33％和80.00％,2组差异均无统计学意义(P>0.05);观察组治疗后Fib、PLT和hs-CRP水平低于治疗前(P<0.05～P<0.01),PT和APTT水平高于治疗前(P<0.05～P<0.01);对照组变化趋势与观察组一致,但2组各时间点指标比较差异均无统计学意义(P>0.05);观察组治疗后NIHSS评分逐渐降低,Barthel指数逐渐增加,与治疗前比较差异有统计学意义(P<0.05);对照组变化趋势与观察组一致,但2组各时间点指标比较差异均无统计意义(P>0.05).结论:应用急诊多模式CT可作为WUIS病人静脉溶栓的可靠影像学依据,且有效性和安全性较高.

慢性头晕为临床常见症状，多见于中老年人群，其病因较为复杂，因此常被误诊。如何正确认识慢性头晕的病因，及时、准确诊断，是临床工作的一大挑战。持续性姿势-感知性头晕（PPPD）在头晕或眩晕门诊中占有重要比例，但由于该病病名新颖，故目前临床医生知晓率低，诊断率低。本文结合1例PPPD患者的诊治经过简要介绍该病，希望能引起临床医生的重视。

目的:探讨血清小窝蛋白-1(caveolin-1)与急性缺血性脑卒中(AIS)患者阿替普酶静脉溶栓治疗后出血转化(HT)的关系.方法:选取2020年6月—2021年5月江阴市人民医院卒中病房连续收治的87例AIS行阿替普酶静脉溶栓治疗患者,根据其是否发生HT分为溶栓后HT组(n=13)和溶栓后未HT组(n=74);选取体检健康者40例为对照组.收集各组临床资料,用酶联免疫吸附法(ELISA)检测血清小窝蛋白-1水平.三组数据应用统计学软件SPSS20.0进行分析.结果:溶栓后HT组、未HT组血清小窝蛋白-

目的 探讨眼眶冰试验用于重症肌无力(MG)早期诊断的价值.方法 上睑下垂患者60例分为MG组和非MG组,每组30例.两组均接受眼眶冰试验和闭目休息试验,两组中各有20例再行新斯的明试验.分析3种试验的灵敏度和特异度.结果 MG组眼眶冰试验、闭目休息试验和新斯的明试验诊断MG的灵敏度分别为76.7％、50.0％和80.0％,优于非MG组的10.0％、10.0％和10.0％ (P＜0.05).MG组中眼眶冰试验和新斯的明试验的灵敏度高于闭目休息试验(P＜0.05).MG组眼眶冰试验、闭目休息试验和新斯的明试验的特异度分别为80.0％、93.3％和85.0％,优于非MG组的6.7％、30.0 ％和30.0％(P＜0.05).结论 眼眶冰试验早期诊断MG的灵敏度及特异度较高,不良反应少,值得临床采用.

目的 探讨不同时期肠内营养对急性脑卒中后吞咽障碍患者的综合疗效.方法 将184例急性脑卒中后吞咽障碍患者随机分为入院24 h内鼻饲肠内营养液的观察组(92例)和入院第4天开始鼻饲肠内营养液的对照组(92例).比较治疗前和治疗后免疫功能、营养状况、并发症及鼻饲时间、住院时间、住院费用等.结果 治疗后,观察组患者总淋巴细胞计数(TLC)、IgA、IgG、白蛋白和血红蛋白下降幅度较小,两组比较差异有统计学意义(P<0.05);观察组患者电解质紊乱、消化道溃疡、胃肠道反应及低蛋白血症发生率与对照组比较差异有统计学意义(P<0.05);观察组患者鼻饲时间、住院时间和住院费用较对照组明显缩短或减少,差异有统计学意义(P<0.05).结论 急性脑卒中后吞咽障碍患者早期肠内营养可以更好地改善患者免疫功能和营养状态,减少并发症,同时减少鼻饲时间和住院时间,并降低住院费用.

BACKGROUND:Schizophrenia risk genes are widely investigated, but a systemic analysis of miRNAs contributing to schizophrenia is lacking.METHODS:Schizophrenia-associated genetic loci profiles were derived from a genome-wide association study (GWAS) from the Schizophrenia Working Group of the Psychiatric Genomics Consortium (PGC) dataset. Experimentally confirmed relationships between miRNAs and their target genes were retrieved from a miRTarBase. A competitive gene set association analysis for miRNA-target regulations was conducted by the Multi-marker Analysis of GenoMic Annotation (MAGMA) and further validated by literature-based functional pathway analysis using Pathway Studio. The association between the targets of three miRNAs and schizophrenia was further validated using a GWAS of antipsychotic treatment responses.RESULTS:Three novel schizophrenia-risk miRNAs, namely, miR-208b-3p, miR-208a-3p, and miR-494-5p, and their targetomes converged on calcium voltage-gated channel subunit alpha1 C (CACNA1C) and B-cell lymphoma 2 (BCL2), and these are well-known contributors to schizophrenia. Both miR-208a-3p and miR-208b-3p reduced the expression of the RNA-binding protein Quaking (QKI), whose suppression commonly contributes to demyelination of the neurons and to ischemia/reperfusion injury. On the other hand, both QKI and hsa-miR-494-5p were involved in gliomagenesis.CONCLUSION:Presented results point at an orchestrating role of miRNAs in the pathophysiology of schizophrenia. The sharing of regulatory networks between schizophrenia and other pathologies may explain higher cardiovascular mortality and lower odds of glioma previously reported in psychiatric patients.

目的 研究TLR4介导小胶质细胞自噬在脑出血后炎症反应的作用机制.方法 从C57BL/6J小鼠中提取分离原代小胶质细胞,分组1中,A组:小胶质细胞;B组:小胶质细胞+阴性siRNA转染;应用C组:小胶质细胞+TLR4-siRNA转染.应用Q-PCR和Western Blot检测分组1中TLR4的表达.分组2中,D组:小胶质细胞+等量的对照溶剂(0.9％ NaCl);E组:小胶质细胞+自噬抑制剂(3-MA);F组:小胶质细胞+control-siRNA+ 3-MA;G组:小胶质细胞+TLR4-siRNA+等量的对照溶剂(0.9％ NaCl);H组:小胶质细胞+TLR4-siRNA+3-MA.Western Blot检测LC3-Ⅱ/Ⅰ比值、TLR4、MyD88和核转录因子(NF-κcB)蛋白表达.ELISA检测细胞因子肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)水平.结果 ①A组和B组TLR4mRNA和蛋白表达水平无明显变化(P＞0.05);与B组相比,C组TLR4 mRNA和蛋白表达水平下调(P＜0.05).②D组、E组和F组TLR4、MyD88和NF-κB p65蛋白水平无明显变化(P＞0.05);与D组相比,G组TLR4、MyD88和NF-κB p65蛋白水平下调(P＜0.05);与F组相比,H组TLR4、MyD88和NF-κB p65蛋白水平下调(P＜0.05).E组和F组LC3-Ⅱ/Ⅰ比值、TNF-α、IL-1β、IL-6水平无明显变化(P＞0.05);与F组相比,H组LC3-Ⅱ/Ⅰ比值、TNF-α、IL-1β、IL-6水平下降(P＜0.05);与G组相比,H组LC3-M比值、TNF-α、IL-1β、IL-6水平下降(P＜0.05).结论 TLR4-siRNA可抑制TLR4介导的小胶质细胞自噬,从而减轻自噬引起的脑出血炎症损伤.

Objective To evaluate the effects of lipoprotein related phospholipase A2 on the prognosis of large artery atherosclerosis cerebral infarction. Methods Sixty-two patients with large artery atherosclerosis cerebral infarction were di-agnosed and collected. According to levels of Lp-PLA2,they were divided into low level group ( n =32) and high level group (n=30). At the time of admission,one month and six months,the clinical efficacy and the degree of collateral circu-lation opening were evaluated in the two groups,and the differences between the two groups were compared. Results There was no significant difference in NIHSS score,Barthel Index (BI) score and mRS score between the low level group and the high level group at admission (P>0. 05). NIHSS score and the mRS score of the low level group were lower than those in the high level group after one month (P<0. 05),and there was no significant difference between the two groups regarding the BI scores (P>0. 05). After six months,the NIHSS score and the mRS score of the low level group were lower than those in the high level group (P<0. 01),and the BI score was higher than that in the high level group (P<0. 05). After 1 month (P<0. 05) and 6 months (P<0. 01),the collateral circulation opening rate of lower level group was higher than that in the high level group. The recurrence rate of cerebral infarction in low level group was significantly lower than that in high level group within 6 months (P<0. 05). Conclusion Lp-PLA2 is closely related to the prognosis of large artery ath-erosclerosis cerebral infarction.

Objective To investigate the correlations of high mobility group protein box-1 (HMGB1) level with severity and prognoses of acute cerebral infarction.MethodsBetween April 2018 and October 2018, 300 patients with acute cerebral infarction and 122 healthy control subjects were enrolled. According to National Institute of Health stroke scale (NIHSS) scores, patients with acute cerebral infarction were divided into group A (NIHSS scores<5), group B (5≤NIHSS scores≤15) and group C (NIHSS scores≥16). According to modified Rankin Scale (mRS) scores, patients were divided into good prognosis group (mRS scores≤2) and poor prognosis group (mRS scores>2) after 3 months of follow up. The serum levels of HMGB1, low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) in different groups were detected and compared. Pearson correlation analysis and receiver operating characteristic curve were used to analyze the correlations of serum HMGB1 level with other indicators and evaluate their predictive values in poor prognosis.Results The serum HMGB1 level in the acute cerebral infarction patients was significantly higher than that in the controls ([7.98±3.99]μg/Lvs. [4.61±1.02]μg/L,P<0.05); the serum HMGB1 level in the group C was significantly higher than that in group B ([12.86±1.91]μg/Lvs. [7.30±1.07]μg/L,P<0.05), and that in group B was statistically higher than that in group A ([7.30±1.07]μg/Lvs. [3.78±0.95]μg/L,P<0.05). Serum HMGB1 level was positively correlated with LDL-C level and NIHSS scores (r=0.521,P=0.000;r=0.931,P=0.000), and negatively correlated with HDL-C level (r=-0.114,P=0.001). The serum HMGB1 level in good prognosis group was significantly lower than that in poor prognosis group ([6.52± 3.29]μg/Lvs. [9.88±4.03]μg/L,P<0.05), and the serum HMGB1 level was positively correlated with mRS scores (r=0.160,P=0.000). The area under the curve of HMGB1 predicting poor prognosis of acute cerebral infarction (0.736[95％CI: 0.677-0.795]) was larger than that under the curve of LDL-C predicting poor prognosis of acute cerebral infarction (0.634[95％CI: 0.570-0.698]).ConclusionSerum HMGB1 level in patients with acute cerebral infarction is significantly increased, which is related to severity of disease, and has certain predictive value in prognoses of acute cerebral infarction.

Objective To evaluate the effect of butylphthalide on executive function in patients with mild vascular cognitive impairment (MVCI). Methods A total of 48 MVCI patients were included in this study, all of whom were divided into observation group (n=24) and control group (n=24). On the base of conventional therapy, Butylphthalide (200 mg, tid) was added to the observation group, and Vitamin E (100 mg, tid) was added to control group, with a treatment course of 90 days in each group. Executive function of patients were evaluated by the following tests: trail making test A and B (TMT-A and B), digit span test (including forward and backward), verbal fluency test (VFT) and clock drawing task. Executive function changes of two groups before and after treatment between the two groups were compared to evaluate the effect of butylphthalide on executive function in MVCI patients. Results The baseline cognition and executive function of two groups had no statistical difference. After treatment, the TMT-A [(53.65±0.88) vs (56.22±0.87)] and TMT-B [(174.95±1.99) vs (177.41±1.44)] scores in observation group were significantly lower than that in control group, the digit span forward and backward score [(5.05±1.22) vs (4.59±0.33)] and the VFT score [(13.29±0.88) vs (12.43±1.02)] in observation group were significantly higher than that in control group. There was no statistical difference in CDT between the two groups. Conclusions Butylphthalide can improve the executive function of patients with MVCI.

目的 评估高分辨磁共振影像技术诊断前庭阵发症的敏感性和特异性,进一步分析前庭阵发症血管压迫侧和前庭功能受累侧一致和矛盾特点.方法 连续收集20例前庭阵发症患者和20例良性阵发性位置性眩晕患者,运用磁共振三维稳态进动快速成像序列和三维时间飞跃血管成像序列技术,分析第Ⅷ脑神经和血管压迫情况,所有患者进行详细的前庭功能检查.结果 高分辨磁共振诊断前庭阵发症敏感度100％,特异度70％,血管压迫距离脑干0～10 mm,20例患者中14例(70％)为小脑前下动脉,2例(10％)为小脑后下动脉,2例(10％)为静脉,2例(10％)为椎动脉.5例(25％)前庭神经功能检查无明显异常,9例(45％)表现神经血管压迫侧同前庭神经功能下降或缺失侧一致,6例(30％)神经血管压迫侧同前庭神经功能下降或缺失侧不一致.结论 前庭阵发症患者神经血管压迫侧和前庭功能受累侧存在一致和矛盾,联合详细的前庭神经功能检查和高分辨MR可进一步明确前庭阵发症受累侧.

Objective To explore the role of CD8+ T lymphocyte in the pathogenesis of pneumonia after acute cerebral infarction by laboratory testing combined with clinical evaluation. Methods A total of 60 patients with acute cerebral infarction hospitalized at Department of Neurology of East Hospital Affiliated to Tongji University and Jiangyin People′s Hospital Affiliated to Southeast University from December 2014 to December 2016 were enrolled. Venous blood was collected from patients with cerebral infarction in 48 h of onset, and peripheral blood mononuclear cells were isolated. Cellular CD107a, intracellular IFN-γ and TNF-α were detected. According to whether pneumonia occurred during hospitalization, the 60 cases were divided into a pneumonia group or a non-pneumonia group. The difference in the positive expression of CD107a, IFN-γ and TNF-α was compared among the pneumonia group stimulated with hybrid viral peptides, non-pneumonia group stimulated with hybrid viral peptides, pneumonia group without hybrid viral peptide stimulation and non-pneumonia group without hybrid viral peptide stimulation. Results After stimulation with the hybrid viral peptides, CD107a positive expression rates in CD8+ T lymphocytes (10.6±3.7% vs 15.6±4.3%, t=3.192, P=0.004) and intracellular IFN-γ [(15.3±4.3)% vs (20.0±5.1)%, t=4.127, P<0.001] and TNF-α positive expression rates [(15.1±4.4)% vs (19.3±4.7)%, t=3.621, P<0.001] were significantly lower in the pneumonia group than in the non-pneumonia group. Without stimulation with the hybrid viral peptides, intracellular IFN-γ [(3.0±1.2)% vs (3.6±1.7)%, t=3.734, P<0.001] and TNF-α positive expression rates [(3.3±1.4)% vs (4.1±2.1)%, t=3.189, P=0.004] were significantly lower in the pneumonia group than in the non-pneumonia group. Conclusion The inhibition of cytotoxicity of CD8+ T lymphocytes is an important mechanism involved in the pathogenesis of pneumonia after acute cerebral infarction. Key words: Cerebral infarction; Pneumonia; T lymphocytes

目的 探讨CD8+T淋巴细胞毒性改变在急性脑梗死后肺炎发病中的作用,分析急性脑梗死后肺炎的危险因素.方法 收集200例急性脑梗死病人的临床资料,并依据是否感染肺炎将其分为肺炎组和非肺炎组.先从单因素方面进行分析,筛选出可能导致急性脑梗死后并发肺炎的有关危险因素,然后进行多因素非条件Logistic回归模型的拟合,对相关的混杂因子进行适度调整,最终揭示参与急性脑梗死后并发肺炎的独立危险因素.结果 单因素分析显示:年龄、性别、糖尿病、慢性呼吸系统疾病、贫血、基线空腹血糖、侵入性检查和治疗、质子泵受体阻滞剂、早期康复治疗、意识状况、神经功能缺损程度、日常生活能力、残障程度、吞咽功能与急性脑梗死后并发肺炎显著相关(P＜0.05).多因素Logistic回归分析结果显示,CD8+T淋巴细胞毒性改变、年龄、性别、糖尿病、慢性呼吸系统疾病、贫血、基线空腹血糖、侵入性检查和治疗、质子泵受体阻滞剂、意识状况、神经功能缺损程度、日常生活能力、残障程度、吞咽功能是急性脑梗死后肺炎发生的独立危险因素(P＜0.05),而早期康复治疗是急性脑梗死后并发肺炎的一种保护因素.结论 CD8+T淋巴细胞毒性改变、年龄、性别、糖尿病、慢性呼吸系统疾病、贫血、基线空腹血糖、侵入性检查和治疗、质子泵受体阻滞剂、意识状况、神经功能缺损程度、残障程度、吞咽功能是急性脑梗死后肺炎发生的独立危险因素.

目的 :观察冰试验和疲劳试验在重症肌无力辅助诊断为一致性,进而评估冰试验在重症肌无力的诊断价值.方法 :对患者、实施试验的专科医师双盲,对64例重症肌无力患者一名专科医师进行冰试验,另一名专科医师进行疲劳试验,时间相差24小时后对同一患者进行二种试验的互换交叉,分别记录试验结果 ,借助Kappa一致性性评价分析二试验的一致性.结果:64例重症肌无力患者,冰试验和疲劳试验的一致性κ=0.688.结论 :重症肌无力患者冰试验和疲劳试验具有较高的一致性,可用于重症肌无力的辅助诊断.

目的 探讨血浆脂蛋白相关磷脂酶A2(Lp-PLA2)、脂蛋白(a)[Lp(a)]与大动脉粥样硬化型脑梗死急性期病情进展及头颈部血管狭窄的关系.方法 收集大动脉粥样硬化型脑梗死患者117例,其中非进展性脑梗死(NPCI) 67例,进展性脑梗死(PCI) 50例.依据头颈部CT血管造影(CTA)、磁共振血管造影(MRA)或数字减影血管造影(DSA),将患者分为中度狭窄组48例,重度狭窄组40例,闭塞组29例.检测Lp-PLA2、Lp(a)水平,比较不同组间的差异,分析其与脑梗死进展及头颈部血管狭窄的相关性.结果 PCI组性别、年龄、高血压、冠心病、吸烟、饮酒与NPCI组相比无显著差异(P＞0.05),PCI组糖尿病、低密度脂蛋白胆固醇(LDLC)水平高于NPCI组(P＜0.05),PCI组Lp-PLA2、Lp(a)水平显著高于NPCI组(P＜0.05或P＜0.01);与中度狭窄组相比,重度狭窄组和闭塞组Lp-PLA2、Lp(a)水平均显著增高(P＜0.05或P＜0.01);与重度狭窄组比较,闭塞组Lp-PLA2、Lp(a)水平显著增高(P＜0.05).Spearman相关分析显示,Lp-PLA2、Lp(a)与头颈部血管狭窄程度均呈正相关(P＜0.05或P＜0.01).结论 Lp-PLA2、Lp(a)水平与大动脉粥样硬化型脑梗死进展及头颈部血管狭窄程度密切相关.

Objective To investigate the efficacy and safety of alteplase intravenous thrombolytic therapy within 3 hours after onset of mild ischemic stroke in the elderly. Methods In our hospital from October 2015 to October 2017, 48 elderly patients with acute mild ischemic stroke who were admitted into our hospital consecutively within 3 hours after onset were randomly divided into two groups: 24 patients in the intravenous thrombolysis group and 24 patients in the non-thrombolysis group. The general condition, baseline National Institute of Health Stroke Scale (NHISS) scores, intracranial hemorrhage conversion rates after 24 hours of treatment, modified Rankin Scale (mRS) score after 90 days of treatment, and 90-day mortality were compared between the two groups on admission. Results There were no significant difference in general clinical data and baseline NIHSS score between the intravenous thrombolytic group and the non-thrombolysis group. In the intravenous thrombolytic group and the non-thrombolysis group, the conversion rate of intracranial hemorrhage after 24 hours was 4.17% and 0 (P=1.000). The 90-day mortality of two groups was 4.17% (P=1.000). The ratio of 90-day mRS score of 0-2 in the intravenous thrombolytic group and the non-thrombolysis group was 83.33% and 54.17% (P=0.029). Conclusion Early alteplase intravenous thrombolysis in elderly patients with acute ischemic stroke does not increase the risk of acute intracranial hemorrhage, it can significantly improve the prognosis of elderly patients with mild ischemic stroke, without increasing the mortality.

目的 探讨TLR4介导小胶质细胞自噬在脑出血后炎症反应中的作用及机制.方法 A组(空白对照组):野生型C57BL/6小鼠;B组(自噬抑制剂对照组):野生型C57BL/6小鼠+自噬抑制剂(3-MA);C组(假手术组1):野生型C57BL/6小鼠+假手术+自噬抑制剂(3-MA);D组(造模组1):野生型C57BL/6小鼠+造模+自噬抑制剂(3-MA);E组(假手术组2):野生型C57BL/6小鼠+假手术+TLR4腺病毒抑制+自噬抑制剂(3-MA);F组(造模组2):野生型C57BL/6小鼠+造模+TLR4腺病毒抑制+自噬抑制剂(3-MA);进行脑组织含水量(BWC)和神经功能障碍评分(NDS);Western Blot检测LC3-Ⅱ/Ⅰ比值,TLR4,MyD88和NF-κB蛋白表达水平;ELISA检测细胞因子TNF-α,IL-1β,IL-6水平.结果 与C组比较,E组BWC和NDS下降(P＜0.05);与D组比较,F组BWC和NDS下降(P＜0.05);A,B,C和D组TLR4,MyD88和NF-κB p65蛋白水平无明显变化(P＞0).05);与C组比较,E组TLR4,MyD88,NF-κB p65水平,LC3-Ⅱ/Ⅰ比值下降(P＜0.05);与D组比较,F组TLR4,MyD88,NF-κB p65水平,LC3-Ⅱ/Ⅰ比值下降(P＜0.05);与A组比较,B,C和D组LC3-Ⅱ/Ⅰ比值下降(P＜0.05);与A组比较,B,C和D组TNF-α,IL-1β3,IL-6水平下降(P＜0.05);与C组比较,E组TNF-α,IL-1β,IL-6水平下降(P＜0.05);与D组比较,F组TNF-α,IL-1β,IL-6水平下降(P＜0.05).结论 抑制C57BL/6小鼠的TLR4及自噬可减轻自噬引起的脑出血炎症损伤.

目的:研究分析3％高渗盐水联合20％甘露醇治疗脑出血的临床效果.方法:选取2014年6月至2015年9月来我院治疗的脑出血患者46例,将患者随机分为对照组和观察组,每组23倒,首先对两组患者均采用常规治疗,然后,观察组联合使用3％高渗盐水和20％甘露醇治疗,对照组单纯使用20％甘露醇治疗.观察比较两组的血肿体积变化情况,肾功能变化以及不良反应发生情况.结果:治疗15d、30d后观察组的脑血肿体积明显小于对照组,并且患者副作用未增多.观察组的治疗总有效率为95.7％,显著高于对照组的65.2％.组间比较差异有统计学意义(P＜0.05).结论:观察组患者使用3％高渗盐水联合20％甘露醇治疗脑出血,患者的治疗效果显著,副作用未见增多,因此,联合使用3％的高渗盐水及20％甘露醇治疗脑出血,具有一定的医学价值,值得在临床医学治疗中推广.

Objective To analyze the damage of corticospinal tract in ischemic stroke patients with diffusion tensor tractography (DTT).Methods Thirty-seven ischemic stroke patients who underwent routine MRI scanning and DTT within 3 days after their disease onset.Their bilateral corticospinal tracts were plotted using MRI software.The patients were divided into grade Ⅰ group (n=10),grade Ⅱ group (n=12),and grade Ⅲ group (n=15) according to the severity of their corticospinal tract damage.Their general clinical data and NIHSS score were recrded.The patients were followed up for 6 months,during which the recovery of their motor function was assessed according to the Fugl-Meyer score (FMS) and the risk factors for FMS were analyzed.Results The NIHSS score on admission was significantly higher in grade Ⅲ group than in grade Ⅰ group and grade Ⅱ group (P＜0.05).The recovery of motor function was significantly better and the NIHSS score was significant higher in grade Ⅰ group than in grade Ⅲ group.The FMS was significantly higher in grade Ⅰ,Ⅱ andⅢ groups after 6 months of treatment than on admission (P＜0.01).Multivariate linear regression analysis showed that corticospinal tract damage,white matter lesion and NIHSS score on admission were the independent risk factors for the recovery of motor function(P＜0.01).Conclusion DTT can assess the damage of corticospinal tract in ischemic stroke patients.The damage of corticospinal tract is an important risk factor for the recovery of motor function in ischemic stroke patients.

帕金森病、运动神经元病同属神经系统变性疾病,临床表现明显不一,前者以运动迟缓、静止性震颤、肌强直、姿势障碍为主要特征,后者以损害上、下运动神经元部位不同组合表现,特征为肌无力和萎缩、延髓麻痹及锥体束征.两者极少复合存在,我院近来遇见1例帕金森病、运动神经元病复合存在,临床非常罕见,现报道如下: 1 病例简介 患者,男,76岁,小学文化.6年前患者出现行走困难,步行前倾,渐行走不稳,独自步行困难,并出现双上肢震颤,未行诊治;近1年患者步行不能,双上肢震颤加重,全身无力并四肢肌肉萎缩,卧床、生活不能自理,并伴反应迟钝、进食呛咳、吞咽困难,无胡言乱语,无头昏头痛,无恶心呕吐,无肢体抽搐,有便秘及小便潴留,于2015年1月22日入院.有高血压史,血压控制可,无家族遗传疾病及长期毒物接触史.查体:神清,口齿欠清,反应迟钝,能对答,颅神经阴性,双上肢肌力4级,双下肢肌力3级,四肢肌张力齿轮样增高,双上肢及右下肢有静止性震颤,四肢肌肉萎缩明显,以大小鱼际肌、肢带肌萎缩为甚,双侧感觉对称存在,双侧腱反射+,病理征阴性,双侧指鼻试验、跟膝胫试验不能完成.