目的 探讨丙戊酸钠治疗偏头痛的疗效与CYP2C19基因多态性的关系.方法 选取2019年1月～2021年1月浙江新安国际医院收治的偏头痛患者135例,患者均服用丙戊酸钠治疗,抽取患者外周静脉血分析CYP2C19基因多态性,并记录丙戊酸钠治疗后患者的头痛发作情况,如头痛发作次数、持续时间、头痛程度积分等.结果 CYP2C19基因快代谢型患者的头痛发作次数、持续时间和头痛程度积分高于CYP2C19基因慢代谢型和中间代谢型,差异有统计学意义(P＜0.05);CYP2C19基因慢代谢型和中间代谢型患者的头痛发作次数、持续时间和头痛程度积分差异无统计学意义(P＞0.05).结论 丙戊酸钠用于治疗预防CYP2C19基因快代谢型患者偏头痛,效果欠佳,对于此类患者可以考虑使用其他类型的药物治疗偏头痛.

目的 探究急性缺血性脑卒中(AIS)患者外周血微小RNA(miRNA)-30a(miR-30a)、miR-122、miR-126、miR-221、miR-409水平与病情严重程度和炎症反应的相关性.方法 选择2020年2月至2022年2月浙江新安国际医院收治的90例AIS患者为观察组,以同期在本院健康体检正常者110名作为对照组.检测两组血清miRNA和血清炎症因子水平,分析AIS患者血清miRNA水平与其梗死体积、美国国立卫生研究院卒中量表(NIHSS)评分和血清炎症因子的相关性.结果 与对照组相比,观察组患者血清 miR-30a、miR-122、miR-126、miR-221和CRP、TNF-α、IL-12、IL-35水平显著升高,miR-409水平显著降低,差异均有统计学意义(均P＜0.05).与小体积梗死组相比,大体积梗死组患者血清miR-30a、miR-122、miR-126、miR-221及CRP、TNF-α、IL-12、IL-35水平更高,miR-409水平更低,差异均有统计学意义(均P＜0.05).与轻度卒中组相比,中重度卒中组患者血清miR-30a、miR-122、miR-126、miR-221及CRP、TNF-α、IL-12、IL-35水平更高,miR-409水平更低,差异均有统计学意义(均P＜0.05).Pearson相关性分析表明,AIS患者血清miR-30a、miR-122、miR-126、miR-221水平与梗死体积、NIHSS评分及 CRP、TNF-α、IL-12、IL-35均呈正相关(均P＜0.05);而miR-409水平与梗死体积、NIHSS评分及CRP、TNF-α、IL-12、IL-35水平均呈负相关(均P＜0.05).结论 AIS患者血清miR-30a、miR-122、miR-126、miR-221水平升高,miR-409水平降低.此5种miRNA水平与患者病情严重程度和炎症反应程度相关,对其开展检测将有助于AIS患者病情的评估.

Objective:To investigate the changes in cognitive and behavioral function in patients with cerebral small vessel disease and their correlation with serum homocysteine (Hcy) and cystatin C (CysC) levels.Methods:Ninety-four patients with cerebral small vascular disease who received treatment in Zhejiang Xin'an International Hospital from March 2019 to March 2021 were included in the observation group. An additional 80 healthy controls who concurrently received physical examination were included in the control group. The Mini-Mental State Scale (MMSE) and the Montreal Assessment Scale (MoCA) were used to evaluate cognitive function. The activity of daily living (ADL) was used to evaluate behavioral function. Enzyme-linked immunosorbent assay was used to measure serum Hcy and CysC levels. MMSE score, MoCA score, ADL score, serum Hcy and CysC levels were compared between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the sensitivity and specificity of serum Hcy and CysC levels in the diagnosis of cerebral small vessel disease. Pearson correlation analysis was performed to analyze the correlation between serum Hcy and CysC levels and cognitive behavioral function.Results:MMSE score, MoCA score, and ADL score in the observation group were (21.21 ± 2.87) points, (20.18 ± 3.25) points, and (34.32 ± 5.45) points, which were significantly lower than (28.23 ± 1.02) points, (28.45 ± 0.89) points and (76.35 ± 8.29) points in the control group ( t = 20.78, 22.05, 40.03, all P < 0.05). Serum Hcy and CysC in the observation group were (16.28 ± 2.97) μmol/L and (1.21 ± 0.23) mg/L, which were significantly higher than (8.35 ± 1.76) μmol/L and (0.56 ± 0.12) mg/L in the control group ( t = 20.95, 22.77, both P < 0.05). ROC curve analysis showed that the sensitivity and specificity of serum Hcy in diagnosing cerebral small vessel disease were 85.29% and 53.85%, respectively; the sensitivity and specificity of serum CysC in diagnosing cerebral small vessel disease were 81.54% and 41.38%, respectively. Pearson correlation analysis revealed that serum Hcy level was linearly negatively correlated with MMSE score, MoCA score, and ADL score ( r = -0.79, -0.68, -0.71, all P < 0.05); serum CysC level was linearly negatively correlated with MMSE score, MoCA score, and ADL score ( r = -0.67, -0.75, -0.78, P < 0.05). Conclusion:The cognitive and behavioral function of patients with cerebral small vessel disease are decreased, and serum Hcy and CysC levels are increased. Serum Hcy and CysC levels are closely related to the cognitive and behavioral function of patients with cerebral small vessel disease.

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对老年脑小血管病(CSVD)患者认知功能及血清同型半胱氨酸(Hcy)和胱抑素(Cys)C的影响.方法 选择老年CSVD患者80例,经睡眠呼吸监测证实:伴OSAHS患者40例(研究组),不伴OSAHS患者40例(对照组).采用蒙特利尔认知功能评估(MoCA)量表和简易智力状况检查(MMSE)量表评价患者认知功能;采用日常生活活动能力(ADL)量表评价患者日常生活活动能力;采用焦虑自评量表(SAS)和抑郁自评量表(SDS)分别评价焦虑和抑郁症状;采用酶联免疫吸附试验测定血清Hcy和CysC水平.结果 研究组MoCA量表评分和MMSE量表评分明显低于对照组(P<0.05).研究组ADL评分明显低于对照组(P<0.05).研究组SAS和SDS评分明显高于对照组(P<0.05).研究组血清Hcy和CysC水平明显高于对照组(P<0.05).结论 老年CSVD合并OSAHS患者存在认知功能障碍,日常生活活动能力下降,且存在明显焦虑和抑郁症状,血清Hcy和CysC水平明显上升.

目的 观察丁苯酞注射液联合依达拉奉对老年急性脑梗死(ACI)患者神经功能及血清超敏C-反应蛋白(hs-CRP)、神经元特异性烯醇化酶(NSE)水平的影响.方法 选取2015年1月—2017年12月在浙江新安国际医院治疗的82例ACI患者,按照住院顺序分为联合组和对照组,每组41例.对照组使用依达拉奉治疗;联合组在对照组基础上使用丁苯酞注射液.两组疗程均为2周,比较两组临床疗效、治疗前后神经功能及血清hs-CRP和NSE的变化.结果 联合组患者治疗有效率高于对照组(97.56％VS 87.80％)(P<0.05);两组患者治疗后6、12、24、48及72 h的美国国立卫生研究院卒中量表(NIHSS)评分比较,采用重复测量设计的方差分析:①不同时间点的NIHSS评分有差别(F=13.246,P=0.000);②两组间的NIHSS评分有差别(F=22.331,P=0.000),联合组NIHSS评分较对照组低;③两组NIHSS评分变化趋势有差别(F=16.371,P=0.000).联合组治疗前后血清hs-CRP、NSE水平变化差值高于对照组(P<0.05).结论 在依达拉奉基础上,联合运用丁苯酞注射液治疗ACI的效果更佳,能减轻神经功能损伤,有效控制机体的炎症反应,且不会对患者造成不适,安全性更高,值得临床推广.

Objective To observe the serum high mobility group box protein B1 (HMGB1) and other serum markers in patients of diabetes complicated with cerebral infarction, and to explore the relationships between serum HMGB1 and other serum markers. Methods Sixty patients of diabetes complicated with cerebral infarction were selected as the diabetes complicated with cerebral infarction group, 60 cases of diabetes were selected as diabetic group, 60 cases of healthy subjects were selected as control group. The clinical data and serum levels of HMGB1 and other markers in the patients of the three groups were collected. Results The serum levels of HMGB1, high-sensitivity C-reactive protein (hs-CRP), fasting blood glucose (FBG), glycated hemoglobin (HbA1c), fasting insulin (FINS), insulin resistance index (HOMA-IR), triglycerides (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) in the patients of the diabetes complicated with cerebral infarction group and the diabetic group were higher than those in the control group (P < 0.05); the serum levels of high-density lipoprotein cholesterol (HDL-C) were lower than that in the control group (P < 0.05). The serum levels of HMGB1, hs-CRP, FBG, HbA1c, FINS, HOMA-IR, TG, TC and LDL-C in the patients of the diabetes complicated with cerebral infarction group were higher than those in the diabetic group (P < 0.05); the serum HDL-C level was lower than that in the diabetic group (P < 0.05). In the diabetes complicated with cerebral infarction group, serum HMGB1 was in positive correlations with serum levels of hs-CRP, FBG, HbA1c, FINS, HOMA-IR, TG, TC and LDL-C (P < 0.05), but negatively correlated with serum HDL-C level (P < 0.05). The results of multivariate regression analysis showed that FINS, HOMA-IR, TG, TC and LDL-C were the influencing factors of serum HMGB1 (P < 0.05). Conclusions The level of serum HMGB1 increases in the patients with diabetes complicated with cerebral infarction. The serum HMGB1 is related to the levels of hs-CRP and blood glucose and lipid indexes. The FINS, HOMA-IR, TG, TC and LDL-C are the influencing factors of serum HMGB1.

Sanqi in Chinese herbal medicine is the root and rhi-zoma of Panax notoginseng (Burk.)F.H.Chen. As the effects of strengthening with tonics, promoting blood circulation to re-move blood stasis,relieving swelling and pain and hemostasia,it is widely used as a tonic medicine in the traditional Chinese medicine. The main active constituents of Sanqi are panax noto-ginseng saponins,including ginsenoside Rg1,Rb1 and notogin-senoside R1. Notoginsenoside R1 is one of the unique monomer compositions of panax notoginseng,which is often used as an in-gredient indicator in new drug research and development.In cur-rent years, the scientists have been conducted tremendous fun-damental studies to research the pharmacological activities of no-toginsenoside R1, to reveal its protective effects on the cardio-vascular system,central nervous system as well as to many other aspects. It is hoped that the relevant study about the pharmaco-logical action of notoginsenoside R1 would help its further clini-cal application. This paper mainly reviews the research on the pharmacological mechanism of notoginsenoside R1 in recent years.

Objective To investigate the clinical effect of edaravone combined with ginkgo leaf extract and dipyridamole injection in the treatment of acute cerebral infarction.Methods From January 2016 to September 2017,100 patients with acute cerebral infarction in Xin'an International Hospital were selected.According to digital table method,the patients were divided into observation group and control group,with 50 cases in each group.The observation group was given edaravone combined with ginkgo leaf extract and dipyridamole injection.The control group received ginkgo leaf extract and dipyridamole injection treatment.The patients were treated for 20 days.The clinical effect of the two groups was compared.Results The total effective rate of the observation group was 90.0％,which was significantly higher than 70.0％ in the control group (x2 =16.265,P ＜ 0.05).Before treatment,the whole high blood viscosity,whole low blood viscosity,blood plasma viscosity,hematocrit and fibrinogen between the two groups had no statistically significant differences (t =0.156,1.563,0.156,1.563,1.263,all P ＞ 0.05).After treatment,the indicators in the two groups were declined.The whole high blood viscosity,whole low blood viscosity,blood plasma viscosity,hematocrit and fibrinogen in the observation group were (5.29 ± 1.25) mPa/s,(12.88 ± 3.35) mPa/s,(1.76 ± 0.28) mPa/s,(0.44 ± 0.48) and (3.48 ± 0.57) g/L,respectively,which were significantly better than those in the control group[(5.83 ± 1.54) mPa/s,(14.54 ±4.29) mPa/s,(1.89 ±0.32) mPa/s,(0.47 ±0.65),(3.76±0.89) g/L],the differences were statistically significant between the two groups(t =5.423,6.287,5.112,9.145,5.443,all P ＜ 0.05).Conclusion Edaravone combined with ginkgo leaf extract and dipyridamole injection in the treatment of acute cerebral infarction has good effect,and it is worth to be widely used in the clinical treatment.

目的 探讨注射用丹参多酚酸辅助治疗急性脑梗死患者临床效果,并观察其对神经功能及认知功能的影响.方法 对照组采用常规药物治疗;观察组于对照组治疗基础上辅以注射用丹参多酚酸治疗.分别于治疗前后采用简易精神状态量表(MMSE)及蒙特利尔认知评估(MOCA)评价患者认知功能,采用神经功能量表(NIHSS)评价神经功能.检测两组患者治疗前后氧化应激水平.并比较两组临床疗效及安全性.结果 治疗后,观察组MMSE和MOCA评分高于对照组,NIHSS评分低于对照组(均P＜ 0.05);MDA及SOD水平低于对照组(均P＜0.05);总有效率高于对照组(均P＜ 0.05).两组不良反应症状轻微,未经任何处理症状自行消失.结论 注射用丹参多酚酸辅助治疗急性脑梗死患者疗效显著,有助于减轻氧化应激反应,改善患者认知功能及神经功能,且具有较高安全性.

Objective To evaluate the clinical efficacy of ganglioside combined with edaravone in the treatment patients with acute cerebral infarction,to assess the improvement of neurological function and prognosis.To provide the evidence for the clinical treatment of acute cerebral infarction.Methods 126 patients with acute cerebral infarction were selected.According to the digital table,they were randomly divided into the control and the study group,with 65 cases in each group.The control group was given edaravone based on the conventional treatment,the study group was treated with ganglioside and edaravone.The treatment effect was assessed,and the National Institutes of Health Stroke Scale(NIHSS),Fugl -Meyer motor function score,Barthel Index(BI)to assess the improvement of the situation neurological,physical function and daily life were applied.Results The total effective rate of the study group was 82.54%,which was higher than 71.43% of the control group,the difference was statistically significant(χ2 =9.63, P <0.05).The NIHSS score of the study group after treatment was (24.60 ±5.81 )points,which was lower than (27.74 ±5.93)points of the control group,the difference was statistically significant(t =9.97,P <0.05).The FM and BI scores of the study group after treatment were (78.62 ±8.46)points and (72.89 ±8.03)points,which were higher than (73.58 ±8.09)points and (68.30 ±7.45)points of the control group,the differences were statistically significant(t =10.16,11.42,all P <0.05).Conclusion It has better clinical effect on ganglioside and edaravone for the patients with acute cerebral infarction,which can significantly improve neurological function and limb motor function,and significantly improved prognosis of patients.