目的 探讨肌球蛋白ⅦA基因2个单核苷酸多态性(SNP)位点(rs1052030,rs4945149)的多态性与老年急性一氧化碳中毒(ACMP)后迟发性脑病(DEACMP)的潜在关联.方法 选择2006年11月～2017年12月河南省豫北地区汉族老年ACMP昏迷后抢救成功且已完成90 d以上随访人群.共收集DEACMP患者外周血标本196例,ACMP患者外周血标本347例.其中包含rs1052030位点,DEACMP患者194例(DEACMP1组);ACMP患者344例(ACMP1 组).其中包含 rs4945149位点,DEACMP 患者 192例(DEACMP2组);ACMP 患者340例(ACMP2组).肌球蛋白ⅦA基因多态性采用Sequenom分型技术检测,并分析其与DEACMP遗传易感性.DEACMP患者病情最严重期间应用常识-记忆力-注意力测验量表(IMCT)及日常生活活动能力量表(ADL)评分.结果 DEACMP1组与ACMP1组基因型及等位基因频率比较,差异无统计学意义(P＞0.05).DEACMP2组与ACMP2组基因型及等位基因频率比较,差异无统计学意义(P＞0.05).DEACMP1组CC、TC、TT基因型患者ADL和IMCT评分比较,差异无统计学意义(P＞0.05).DEACMP2组CC、TC、TT基因型患者IMCT和ADL评分比较,差异有统计学意义[(3.12±0.90)分vs(2.37±1.32)分vs(1.71±0.97)分,P=0.000;(55.45±4.86)分 vs(60.48±2.66)分vs(64.81±1.99)分,P=0.001].结论 肌球蛋白 Ⅶ A 基因2个 SNP 位点(rs1052030,rs4945149)与DEACMP发病无遗传关联性.

目的 观察消栓肠溶胶囊对慢性脑缺血患者脑部血流及认知功能的改善作用.方法 选取我院收治的120例慢性脑缺血患者,随机分为对照组(60例)采取常规药物治疗,实验组(60例)在对照组治疗基础上联合消栓肠溶胶囊口服治疗,监测患者脑部血流动力学、血液流变学及脑灌注的情况,并采用蒙特利尔认知评估量表(MoCA)评价患者认知功能的改善情况,同时记录患者不良反应发生情况.结果 治疗后,实验组患者的前分水岭区白质、中动脉区白质、后动脉区白质的平均脑血流量(r-CBF)水平明显高于对照组(均P＜0.05);实验组患者的大脑双侧前动脉(ACA)、双侧中动脉(MCA)、双侧后动脉(PCA)、双侧基地动脉(BA)的平均血流速度(Vm)均值明显高于对照组(均P＜0.05);实验组患者的高切全血粘度(HS)、低切全血粘度(LS)、血浆粘度(PV)、纤维还原蛋白(PV)以及红细胞压积(HCT)明显低于对照组(均P＜0.05);实验组治疗后的命名、注意力、语言、定向力、延迟回忆、抽象、视空间功能的评分及MoCA量表总分明显高于对照组(均P＜0.05);两组患者的不良反应发生率比较无统计学意义(P＞0.05).结论 消栓肠溶胶囊可有效促进脑循环,提高脑血流灌注,改善认知功能,具有一定的临床推广应用价值.

目的 探讨托吡酯与卡马西平单药治疗癫痫部分性发作的疗效和安全性.方法 计算机检索PubMed、Cochrane、Embase、中国知网、万方数据库和中国生物医学文献数据库中,建库—2019年01月31日关于托吡酯与卡马西平单药治疗癫痫部分性发作患者的临床对照试验文章.对其进行文献筛选,数据提取,文献质量及风险偏倚评估,并交叉核对,使用Meta分析专用软件Revman 5.3进行数据分析.结果 初检文献459篇,最终纳入文献12篇,共2348例患者,其中托吡酯组1075例,卡马西平组1273例.其中高质量文献3篇,低质量文献9篇.Meta分析结果显示:托吡酯组完全控制540例,占52.38％(540/1031);卡马西平组完全控制546例,占45.73％(546/1194),两组差异有统计学意义[OR=1.53,95％CI(1.05,2.24),P<0.05].托吡酯组有效204例,占37.02％(204/551);卡马西平组有效326例,占47.52％(326/686),两组差异无统计学意义[OR=0.91,95％CI(0.70,1.19),P>0.05].托吡酯组出现不良反应372例,占39.45％(372/943);卡马西平组出现不良反应466例,占44.72％(466/1042),两组差异有统计学意义[OR=0.75,95％CI(0.56,1.00),P<0.05].结论 托吡酯单药治疗癫痫部分性发作的疗效及安全性优于卡马西平.

目的 探讨急性高血压性脑出血患者术后各期卒中后抑郁(PSD)的发病特点和危险因素,为提高脑出血术后抑郁的诊治提供依据.方法 选择2015年1月至2017年12月新乡医学院第一附属医院神经外科收住的259例急性脑出血行开颅血肿清除术患者作为研究对象,收集患者性别、年龄、职业类型、文化程度、婚姻状况、性格、家庭收入、有无近期负性事件、脑出血部位、脑出血量、有无高血压、烟酒史、有无失语、手术方式、美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力评定量表(ADL)评分、汉密尔顿抑郁量表(HAMD)评分等资料,依据手术后14 d HAMD24项评分结果分为非PSD组和PSD组,在术后14d和3、6、12、18个月各随访1次,共评估5次,观察患者NIHSS评分、HAMD评分等变化情况,统计PSD患病率,评估PSD发生的危险因素.应用SPSS 21.0统计软件对数据进行独立样本t检验、配对t检验和x2检验,多因素相关分析采用逐步logistic回归分析.结果 脑出血术后14d患者PSD的点现患率为66.4％(172例),3个月时点现患率为42.5％(105例),6个月时点现患率为35.0％(84例),12个月时点现患率为33.0％(76例),18个月时点现患率为30.4％(68例),脑出血术后18个月内PSD的患病率为85.3％.PSD组职业类型、性格、失语、脑出血量、手术方式、入院时NIHSS评分、入院时ADL评分与非PSD组比较,差异均有统计学意义(P＜0.05,P＜0.01).多因素logistic回归分析显示,入院时NIHSS评分、性格、职业类型、失语与PSD的发生独立相关(OR值分别为1.610、2.915、2.200和5.651,P＜0.05,P＜0.01).两组患者NIHSS评分、HAMD评分在同一随访时点比较,差异均有统计学意义(P＜0.05).结论 急性脑出血手术后PSD的患病率较高,随着术后康复,PSD的点现患率降低;入院时NIHSS评分、性格、职业类型、失语是首次急性脑出血术后PSD发生的独立危险因素,可通过调控危险因素予以干预.

目的 探讨豫北地区首次急性脑梗死患者卒中后抑郁(PSD)的危险因素.方法 选择2015年1月至2018年9月新乡医学院第二附属医院神经内科收治的首次发病急性脑梗死患者387例为研究对象.收集患者的人口学资料和临床资料,采用单因素分析PSD危险因素,将单因素分析结果 中差异有统计学意义的指标进一步行单因素和多因素logistic回归分析,筛选PSD的独立危险因素.结果 急性脑梗死患者在发病14 d至6个月PSD的患病率为47.0％(182/387).单因素分析结果 显示,患者的职业类型、性格、病灶部位、失语、脑梗死体积、美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力量表(ADL)评分与PSD有关(P<0.05);患者的年龄、性别、婚姻状况、文化程度、家庭收入、近期负性事件,高血压病、糖尿病、吸烟、饮酒、卒中家族史、颈动脉斑块与PSD无关(P>0.05).单因素logistic回归分析结果 显示,病灶部位、入院时NIHSS评分、性格、职业类型、失语是急性脑梗死发生PSD的危险因素(P<0.05);多因素logistic回归分析结果 显示,患者入院时NIHSS评分、性格、病灶部位和失语是急性脑梗死发生PSD的独立危险因素(P<0.05).结论 豫北地区首次急性脑梗死后患者PSD发生率较高,患者入院时NIHSS评分、性格、病灶部位和失语是PSD发生的独立危险因素.

目的 验证急性一氧化碳中毒后迟发性脑病(DEACMP)预测概率方程的可靠程度,评价其对该病的临床预测价值.方法 以2001年1月至2014年12月豫北地区3座城市12家医院符合急性一氧化碳中毒(AGMP)诊断标准的752例住院患者为研究对象,采集患者基本信息并随访至清醒后90 d.应用秦洁等1987年10月至1990年3月从中国人民解放军海军总医院收集的被诊断为ACMP的223例患者随访结果分析中所得出的预测发生DEACMP的概率logistic回归方程,计算ACMP患者发生DEACMP的概率.预测结果与实际DEACMP发病率相比较,分析该方程的符合率及临床预测价值.结果 752例ACMP患者在随访期内实际有127例发生DEACMP,发生率16.9％,预测概率≥50％时,实际发生DEACMP者19例,明显低于理论推测发病数49例(x2=20.27,P＜0.05);预测概率分别≥60.0％、≥80.0％、≥90.0％时,实际发生DEACMP者分别为13、3、2例,明显低于理论推测发病数37、21、8例(x2=19.30、25.07、8.10,P＜0.05).随着预测概率的增加,实际发生DEACMP的比率逐渐降低.预测概率越大,患者发生DEACMP假阴性率越大,灵敏度越低,假阳性率越小,特异度越高,诊断符合率越小.结论 应用DEACMP预测概率方程预测本研究752例ACMP患者发生DEACMP的概率与实际发病情况符合率很低.

Background Previous studies of patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) mainly focused on the symptoms, such as mental retardation, extrapyramidal dysfunction, rather than secondary epilepsy.The investigation of the incidence and clinical features of secondary epilepsy after DEACMP would be beneficial to the aforesaid issues.Objective To analyze the clinical features of DEACMP patients with secondary epilepsy.To compare the clinical manifestations, the therapeutic effects and prognosis between DEACMP patients with and without secondary epilepsy, in order to provide a basis for predicting the prognosis of DEACMP patients with secondary epilepsy.Methods 450&nbsp;DEACMP patients admitted to eight hospitals of the Second Affiliated Hospital of Xinxiang Medical University, the First Affiliated Hospital of Xinxiang Medical University, the Third Affiliated Hospital of Xinxiang Medical University, Xinxiang Center Hospital, the First People′s Hospital of Xinxiang, the Second People′s Hospital of Xinxiang, the 371st Center Hospital of PLA and Henan Honliv Hospital from January 2001 to January 2014 were recruited, and 272 of these patients were eligible for inclusion and exclusion criteria and included in our study. The patients′clinical condition changes, treatment effect and prognosis were recorded through outpatient follow -up and telephone follow -up.Results In the 272 patients, 20 cases ( 7.4%) got secondary epilepsy, and 17 ( 85.0%) of them epileptic seizures occurred within 6 months after DEACMP.There were no statistically significant differences in gender, age, coma duration, latent phase between DEACMP patients with and without secondary epilepsy (P>0.05), but there was statistically significant difference in severity of illness (P<0.05).There was statistically significant difference in treatment effect ( Z =5.098, P <0.01 ) .12 cases of DEACMP patients with secondary epilepsy died during the follow up and the mortality was 60.0%, while 52 cases of DEACMP patients without secondary epilepsy died and the mortality was 20.6%. There was statistically significant difference in mortality between the two groups (χ2=15.95, P<0.01) .Conclusion The DEACMP patients with secondary epilepsy are characteristic of severe condition, poor treatment effect and high mortality.It is important for improving the treatment effect and prognosis of DEACMP patients to prevent the secondary epilepsy, especially epileptic seizure duration.

目的 利用磁共振弥散张量成像(DTI)和神经功能评定量表(FMA)研究急性脑梗死患者康复治疗前后CST类型、部分各向异性(FA)值变化与运动功能恢复及临床预后之间的关系,探讨影响脑梗死患者神经功能恢复的相关因素.方法 40例急性脑梗死患者,随机分为治疗组与康复组.在发病3d内及发病3 m时行3.0T常规磁共振(MRI)和DTI检查,分别测量病灶侧、对侧皮质脊髓束FA值.通过Fugl-Meyer量表(FMA)评分,探讨影响预后的相关因素.结果 3 m后两组患者FMA值评分均较入院时明显增高(P＜0.05),康复组CST Ⅱ型、CST Ⅲ型患者的FMA值较治疗同组有显著提高(P＜0.05).预后以CST Ⅰ型最好,CST Ⅱ型次之,CST Ⅲ型最差.所有患者入院时病灶侧FA值均较健侧减低,FA值CST Ⅰ型＞CST Ⅱ型＞于CST Ⅱ型,P＜0.05.3 m复查病灶侧FA值仍低于健侧,且较入院时各型FA值均有下降.结论 早期康复训练有助于促进患者运动功能恢复.皮质脊髓束受损重、白质纤维断裂者,运动功能恢复较差.但通过康复训练结果仍好于未康复训练者.FA值与神经功能损害呈正相关.

目的 比较5种抗癫痫药(AEDs)单药治疗初诊儿童癫痫患者的2 a单药保留率,为儿童癫痫患者的药物选择提供参考.方法 采用前瞻性登记队列研究方法,选择2002年1月至2012年1月初诊儿童癫痫患者564例,根据患儿首次选用AEDs名称将患儿分为5组,即卡马西平(CBZ)组、丙戊酸(VPA)组、托吡酯(TPM)组、奥卡西平(OXC)组和拉莫三嗪(LTG)组,通过门诊随访患者的停药时间及停药原因,比较其6、12和24个月的单药保留率.结果 6个月单药保留率OXC组患儿为82.98％,LTG组患儿为79.69％,TPM组患儿为68.49％,CBZ组患儿为51.15％,VPA组患儿为46.18％;12个月单药保留率LTG组患儿为76.56％,OXC组患儿为74.47％,TPM组患儿为61.64％,CBZ组患儿为42.75％,VPA组患儿为42.17％;24个月单药保留率LTG组患儿为71.88％,OXC组患儿为61.70％,TPM组患儿为60.27％,CBZ组患儿为41.22％,VPA组患儿为40.56％.6、12、24个月单药保留率LTG组、OXC组、TPM组患儿均明显高于CBZ组和VPA组(P＜0.05),但LTG组、OXC组、TPM组患儿之间单药保留率比较差异无统计学意义(P＞0.05).停药原因上,因依从性差停药患儿占40.79％,因疗效不佳停药患儿占38.63％,这是导致患儿停药的2个主要原因.结论 LTG、OXC和TPM比较适合作为儿童癫痫治疗的首选药物,导致患儿停药的主要原因是药物疗效不佳和依从性差.

Objective To investigate the associated risk factors of the delayed encephalopathy after acute carbon mon-oxide poisoning (DEACMP) .Methods Seven hundred and fifty-two cases of acute carbon monoxide poisoning (ACMP) in-patients admitted to 10 hospitals in northern Henan during 2001 -2014 who met the inclusive and exclusive criteria were re-cruited .The clinical information of each ACMP patient was collected ,and following-up for each patient was more than 90 days .Based on the occurrence of DEACMP ,the patients were divided into ACMP group and DEACMP group .The statistical induction of 26 indicators in each patient ,such as age ,coma duration ,severity of coma ,smoking & drinking ,etc .was con-ducted to analyze the possible risk factors of DEACMP in ACMP patients .Results One hundred and twenty-seven out of 752&nbsp;patients demonstrated DEACMP ,the univariate analysis showed that male ACMP patients were more susceptible to DEACMP than female patients ,and the difference was statistically significant (P<0 .05) .When the coma duration was >12 h ,the inci-dence of DEACMP significantly increased ,and up to 58 .3% once the coma last for >48 h .The patients who had moderate-a-bove coma ,positive pathology ,being widowed ,history of smoking and drinking ,major mental stimulation was more suscepti-ble to DEACMP than those without above issues ,and the differences were all statistically significant (All P<0.05) .The pa-tients whose brain CT showed abnormalities at the acute stage of ACMP ,or who exhibited coexistence of other diseases were more likely to suffer from DEACMP ,the difference was statistically significant (P<0 .05) .Multivariate regression analysis showed that the gender ,history of being widowed ,abnormal brain CT ,the severity of coma ,coma duration were the inde-pendent risk factors of DEACMP .Conclusion There are multiple risk factors for DEACMP ,especially for the ACMP pa-tients who are over 40 years old ,male with a history of being widowed ,abnormal brain CT ,moderate-above coma ,coma du-ration >12 h .Additional care has to be taken for their clinical monitoring to take premorbid preventive treatment as early in-tervention to the disease .

Objective:To explore the value of 24 hours’ambulatory electroencephalogram(AEEG) monitoring the treatment of epilepsy .Methods:187 patients with epilepsy received clinical and electroen‐cephalogram diagnosis formal antiepileptic drugs therapy .Regular subsequent examinations and AEEG or REEG monitoring were also made during the two years of follow‐up to observe the consistent rate of clin‐ical efficacy and EEG results .Results:The consistent rate of AEEG and clinical curative effect was 62 .1%for the first year’s follow‐up ,70 .5% for the second year ,and REEG was 81 .5% for the first year and 85 .9% for the second ,The proportion of normal REEG results during controlled clinical seizures was much higher than that of AEEG while the proportion of no improved REEG results during controlled clin‐ical seizures was much lower than that of AEEG .They were statistically significant(P<0 .01) .Among the inconsistent of AEEG and clinical efficacy ,89 .3% ~ 94 .5% was clinical seizure controlled or im‐proved while AEEG result was not improved .Conclusion:AEEG monitoring can provide an objective basis in the judging of clinical curative effect of epilepsy .Patients with epilepsy should take regular AEEG mo‐nitoring during the antiepileptic drugs therapy .

目的 动态观察腔隙性脑梗死患者认知功能变化与血浆巨噬细胞游走抑制因子(macrophage migration-inhibitory factor,MIF)变化的关系.方法 选择经半年动态观察的腔隙性脑梗死患者68例为病例组,另选健康体检者36例为对照组.使用简易精神状态量表(Mini-Mental State Examination,MMSE)对患者进行发病初期及半年后认知功能评价,同时通过酶联免疫吸附测定(enzyme-linked immunosorbent assay,ELISA)法检测血浆MIF浓度.根据MMSE评分,将病例组患者分为认知正常组、轻度认知功能障碍组及痴呆组,并对各组进行MIF比较.结果 3组病例MIF浓度均高于对照组,与对照组比较差异有统计学意义,轻度认知障碍组、痴呆组分别与认知正常组比较差异有统计学意义,轻度认知障碍组与痴呆组之间比较无统计学意义.6 m时轻度认知功能障碍组MIF浓度下降,与基线期同组比较差异有显著性,余组比较无统计学意义.结论 腔隙性脑梗死可导致不同程度认知障碍,基线期、随访期腔梗组MIF浓度均高于对照组,MIF水平增高与认知损伤程度呈正相关.