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 探讨病毒性脑炎(viral meningitis,VM)患者脑脊液微小核糖核酸21(micro ribonucleic acid-21,miR-21)表达、陷窝蛋白1(Caveolin-1)、半乳糖凝集素9(galectin-9,Gal-9)水平特点,分析miR-21、Caveolin-1、Gal-9与VM复发的关系.方法 选择VM患者(VM组)132例和经检查证实无神经系统损伤的患者(对照组)136例.根据病情将VM患者分为重症组(58例)和轻症组(74例),所有患者出院后随访3个月,根据是否VM复发分为复发组(26例)和无复发组(106例).治疗前后检测血清miR-21表达、Caveolin-1、Gal-9以及炎性因子水平,分析miR-21、Caveolin-1、Gal-9与VM病情、炎性因子以及复发的关系,受试者工作特征曲线(receiver-operating characteristic curve,ROC)分析miR-21、Caveolin-1、Gal-9预测VM复发的价值.结果 VM组miR-21表达、Caveolin-1、Gal-9、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素6(interleukin-6,IL-6)水平高于对照组(P<0.05).重症组VM患者脑脊液miR-21表达、Caveolin-1、Gal-9、TNF-α、IL-6水平高于轻症组(P<0.05).miR-21、Caveolin-1、Gal-9水平均与TNF-α、IL-6呈正相关(P<0.05).治疗前和治疗前后,复发组脑脊液miR-21表达、Caveolin-1、Gal-9、TNF-α、IL-6水平均高于无复发组,复发组和无复发组患者治疗后脑脊液miR-21表达、Caveolin-1、Gal-9、TNF-α、IL-6水平低于治疗前(P<0.05).治疗后高TNF-α、miR-21、Caveolin-1、Gal-9是VM复发的危险因素(P<0.05).联合检测治疗后miR-21、Caveolin-1、Gal-9预测VM复发的AUC为0.858,大于单项指标预测(P<0.05).结论 VM患者脑脊液中miR-21表达、Caveolin-1、Gal-9水平明显增加,治疗后高表达miR-21、高水平Caveolin-1、Gal-9与VM病情严重程度以及复发密切相关.

目的:探究新生儿呼吸衰竭行nHFV(无创高频通气)治疗的临床疗效.方法:将199例呼吸衰竭新生儿作为研究对象,以随机法分两组,甲组行SIMV(鼻塞式同步间歇指令通气)治疗,乙组行nHFV治疗,对比两组上机时间、住院时间、住院费用、并发症发生情况以及治疗前后血气指标变化情况.结果:与甲组比较,乙组上机时间、住院时间更短,住院费用更少(P<0.05);与甲组比较,乙组治疗后PaCO2、FiO2更低,PaO2更高(P<0.05);与甲组(29.29％)比较,乙组(3.00％)并发症发生率更低(P<0.05).结论:新生儿呼吸衰竭行nHFV治疗可缩短住院时间,减少住院费用,改善血气状况,降低并发症发生率.

目的 探究无创高频振荡通气对新生儿呼吸衰竭外周血Clara细胞蛋白16(CC16)与Ⅱ型肺泡表面抗原6(KL-6)表达的影响.方法 选取2015年1月—2017年12月于邯郸市第一医院就诊的208例呼吸衰竭新生儿作为研究对象,依照随机数字表法将患儿分成观察组和对照组.观察组采用无创高频振荡通气治疗,对照组采用同步间歇指令通气治疗,比较两组的临床疗效,并检测两组患儿机械通气后0、24和72 h血气指标、治疗前后血清CC16及KL-6的变化和并发症的发生情况.结果 观察组总有效率高于对照组(P<0.05),观察组临床疗效优于对照组(P<0.05).观察组机械通气后的氧合指数、呼吸指数、吸入气氧浓度(FiO2)和动脉血二氧化碳分压(PaCO2)低于对照组(P<0.05),而动脉血氧分压(PaO2)、PaO2/FiO2高于对照组(P<0.05).观察组与对照组治疗后72 h血清CC16和KL-6均低于治疗前(P<0.05).观察组治疗后72 h的CC16与KL-6低于对照组(P<0.05).观察组机械通气时间、住院时间低于对照组(P<0.05).观察组呼吸机相关性肺炎、并发症总发病率低于对照组(P<0.05).结论 无创高频振荡通气治疗新生儿呼吸衰竭的疗效更佳,能够显著改善患儿血气指标,减轻炎症反应,降低患儿CC16、KL-6水平.

Objective To explore the clinical efficacy of high frequency oscillatory ventilation and synchronized intermittent mandatory ventilation in the treatment of neonatal respiratory failure, and the influence on the levels of CC16 and KL-6 in neonates. Methods One hundred and thirty cases of neonates with respiratory failure were randomly divided into observation group (n=65, 12 cases of premature infants, 53 cases of full-term infants) and control group (n=65, 12 cases of premature infants, 53 cases of full-term infants). The observation group was treated with high frequency oscillatory ventilation, the control group was treated with synchronized intermittent mandatory ventilation, The clinical efficacy of two groups of preterm infants and full-term infants were compared, and the 0h, 24h and 72h blood gas indexes of two groups were detected, and the changes of serum CC16 and KL-6 before and after treatment and the occurrence of adverse reactions were observed. Results The overall clinical effective rate was 90. 8％ (59/65) in the observation group, which was significantly higher than that in the control group (80. 0％, 52/65). The effective rate of the two groups of full-term infants was better than that of premature infants (P<0. 05). The oral feeding time, ventilator use time and hospitalization time of the observation group were significantly shorter than the control group (P<0. 05). After mechanical ventilation, the OI, RI and PaCO2 of the two groups showed a gradual decline trend. The PaO2 and PaO2/FiO2 of the two groups showed a gradual increase, but the decrease and increase of the observation group were larger. The two groups were between the groups and the time. There were significant differences in the interaction between the groups and between the groups (P<0. 05). The serum levels of CC16 and KL-6 in the two groups were significantly lower than those before treatment (P<0. 05). The levels of CC16 and KL-6 in the observation group were significantly lower than those in the control group after treatment (P<0. 05). The incidence of adverse reactions such as pulmonary hemorrhage, ventilator-associated pneumonia, and lower respiratory tract infection in the observation group were significantly lower than that in the control group (P<0. 05). Conclusion Noninvasive high frequency oscillatory ventilation in the treatment of neonatal with respiratory failure can significantly improve the blood gas index, reduce inflammation, reduce the level of KL-6 and CC16, improve the lung injury and with less adverse reaction.

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.

血管性认知障碍(VCI)作为继阿尔茨海默病后最常见的认知障碍,导致家庭与社会负担日益加重.其危险因素包括年龄、高血压、血脂代谢异常、糖尿病、同型半胱氨酸升高等.而脂蛋白为血浆中常见的生化指标,其与动脉粥样硬化所致的VCI密切相关.不同的脂蛋白组分对VCI产生不同的影响.其中,低密度脂蛋白、载脂蛋白B与高密度脂蛋白对VCI的发生发展起独特作用.因此,早期发现及干预VCI的可控制性危险因素对VCI的预防和治疗具有重要意义.

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 观察三七总皂苷对小量至中量高血压性脑出血病人血肿、神经功能缺损评分及高敏C反应蛋白(hs-CRP)表达的影响.方法 将58例小量至中量高血压性脑出血病人,随机分为对照组和治疗组.对照组给予常规治疗,治疗组在发病24 h后常规治疗基础上给予三七总皂苷治疗,分别于发病24 h、第7天、第14天应用CT测量脑血肿,美国国立卫生研究院卒中量表(NIHSS)进行神经功能缺损评分,检测高敏C反应蛋白水平.结果 治疗组在第7天血肿未增加,NIHSS评分未恶化.第14天治疗组血肿吸收,高敏C反应蛋白水平降低及NIHSS评分均优于对照组(P<0.05).结论 早期应用三七总皂苷治疗小量至中量高血压性脑出血,安能有效促进血肿吸收及降低hs-CRP水平.

目的 观察早期持续血液净化对有机磷中毒患者血清肿瘤坏死因子α(tumor necrosis faetor-α,TNF-α)、白细胞介素8(interleukin-8,IL-8)及白细胞介素18(interleukin-18,IL-18)水平影响.方法 选择2013年1月-2015年10月在邯郸市第一医院就诊的84例有机磷中毒,随机将其分为观察组44例和对照组40例,在常规治疗基础上,观察组接受早期持续血液净化联合血液灌流治疗,对照组接受早期血液灌流治疗,观察比较两组临床疗效指标、血清炎性因子及并发症发生率、存活率情况.结果 观察组阿托品用量明显少于对照组,胆碱酯酶活性恢复时间、昏迷持续时间、住院总时间均明显短于对照组,差异均有统计学意义(P＜0.05).治疗后1d两组血清TNF-α、IL-8及IL-18水平均较治疗前明显升高,治疗后3、5d两组血清TNF-α、IL-8及IL-18水平均较治疗前明显降低,差异均有统计学意义(P＜0.05).治疗后1、3、5d,观察组血清TNF-α、IL-8及IL-18水平均明显低于对照组,差异均有统计学意义(P＜0.05).治疗后1周观察组低氧血症、呼吸衰竭、肝损伤及肾损伤等并发症发生率均明显低于对照组,发病后30 d观察组存活率明显高于对照组,差异均有统计学意义(P＜0.05).结论 有机磷中毒患者早期应用持续血液净化可促进体内胆碱酯酶恢复活性,减少药物用量,缓解机体炎症状态,从而降低并发症发生率,提高生存率.

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 观察超敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)在急性脑梗死(ACI)患者血清中的水平,并探讨其与颈动脉狭窄(CAS)的相关性.方法 132例ACI合并CAS患者,根据颈动脉狭窄程度分为,轻度狭窄组(n=47例)、中度狭窄组(n=44例)和重度狭窄组(n=41例);根据临床神经功能缺损程度评分标准分为轻型(n=40例)、中型(n=45例)和重型(n=47例);根据脑梗死病灶面积分为腔隙性梗死组(n=42例)、小面积梗死组(n=46例)和大面积梗死组(n=44例);根据斑块性质分为分为软斑组(n=43例)、硬斑组(n=43例)和其他类型组(n=46例).比较各组血清hs-CRP、Hcy表达水平.结果 各狭窄组ACI患者血清hs-CRP、Hcy表达水平均明显高于对照组(P＜0.05),且随着颈动脉狭窄程度加重,血清hs-CRP、Hcy表达水平显著性升高(P＜0.05);不同病情程度组ACI患者血清hs-CRP、Hcy表达水平均明显高于对照组(P＜0.05),且随着病情程度加重,血清hs-CRP、Hcy表达水平显著性升高(P＜0.05);不同病灶面积组ACI患者血清hs-CRP、Hcy表达水平均明显高于对照组(P＜0.05),且随着病灶面积增大,血清hs-CRP、Hcy表达水平显著性升高(P＜0.05);不同斑块性质组ACI患者血清hs-CRP、Hcy表达水平均明显高于对照组(P＜0.05),且随着斑块性质逐渐加重,血清hs-CRP、Hcy表达水平均明显升高(P＜0.05).结论 血清Hcy、hs-CRP表达水平随CAS程度、病情程度、病灶面积及斑块性质加重而升高,可作为判断ACI患者病情严重程度的实验室指标.

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.

Objective Toevaluatea modified Ziehl-Neelsen(Z-N) stain in the diagnosis of tuberculous meningitis. Methods Cerebrospinal fluid specimens from 35 patients were stained by using the modified Ziehl-Neelsen staining. Re-sults The positive rate was 94.29% in 35 patients with tuberculous meningitisand the intracellular acid-fast bacilli was detected in 53.40%of all specimens. One case was stained positive in 15 patients with non-tuberculous meningitis. Con-clusion The modified Ziehl-Neelsen stain not only significantly improves the detection rates of tuberculous meningitisbut alsois able to identify intracellular M.tuberculosisin cerebrospinal fluidspecimen.Thus, the modified Z-N stain can be a convenient tool for diagnosing tuberculous meningitis.

目的 对患有2型糖尿病(T2DM)并发白内障的老年患者进行早期干预,探讨其在入院时直接进入临床路径的可行性.方法 对医院门诊筛查出的30例患有2型糖尿病并发白内障的患者(门诊处理组,n=30),按照门诊早期干预临床路径的要求,控制血糖至正常范围,然后收入住院并按照白内障临床路径实施标准化处理.对照同期30例住院后术前检查发现患有2型糖尿病,经降糖治疗控制症状后行超声乳化白内障摘除联合人工晶体植入术患者(住院处理组,n =30).比较两组之间术前等待时间、平均住院天数、住院费用和患者满意度的差别.结果 门诊处理组术前等待时间、平均住院天数、平均住院费用普遍低于住院处理组(P＜0.05),患者满意度明显高于住院处理组(P＜0.01).结论 尽早发现并发白内障的2型糖尿病患者,按照糖尿病治疗原则对其实施入院前干预,待血糖控制后进入临床路径,可减少患者术前等待时间,缩短住院天数,节约住院费用,提高患者及其家属的满意度.

目的:探讨线粒体凋亡途径在高糖刺激的小鼠足细胞凋亡中的可能作用.方法:高糖刺激小鼠足细胞(PC)48、72h,应用流式细胞术、TUNEL染色检测凋亡程度,流式细胞术检测线粒体跨膜电位(△ψm)改变,Western blot检测caspase-3,cytochrome C蛋白表达变化.结果:高糖刺激组较对照组细胞凋亡数、cytochrome C、caspase-3蛋白明显升高,△ψm明显下降.结论:线粒体功能障碍可能在高糖刺激诱导足细胞凋亡机制中发挥一定作用.

<正>临床资料例1患者男性,54岁,既往有高血压病史7年,无规律服用降压药,体型偏胖。主因左膝关节外伤2h于2010年12月26日入院。2010年12月30日行关节镜胫骨髁间嵴骨折复位固定术,手术采用连续硬膜外麻醉,应用空气止血带手术。手术顺利,进行约20min,术毕松止血带后,患者突然出现心慌,胸

Endoplasmic reticulum(ER) is a highly dynamic organelle responsible for multiple cellular functions.However,various conditions can disturb the functions of the ER and result in ER stress(ERS).Several signaling pathways are initiated to cope with ERS,which are designated as the unfolded protein response(UPR),which enhancing cell survival by the adverse effects of ERS dealting with in a timely and efficient manner.Though moderate ER stress could alleviate the damage caused by stress,prolonge or severe stress response,lead to apoptosis and may thus be an important factor in the pathogenesis of many diseases.Accumulative evidence has demonstrated that apoptosis initiated by the ERS was involved in the pathogenesis of diabetes and complication of diabetes mellitus.