Objective To explore the clinical effect of traditional Chinese acupuncture rehabilitation therapy on stroke patients with limb dysfunction. Methods 84 stroke patients with limb dysfunction were randomly divided into two groups. The control group was given routine rehabilitation therapy, and the observation group was given traditional Chinese acupuncture rehabilitation therapy on this basis. The neurological function（NIHSS score）, limb motor function（upper and lower limb motor function scores） and ability of daily living（ADL score） of the two groups were compared. Results After treatment, the NIHSS score of the observation group was lower than that of the control group, and the limb motor function and ADL scores were higher than those of the control group（P ＜0.05）. Conclusions Traditional Chinese acupuncture rehabilitation therapy has better application effect on stroke patients with limb dysfunction, which has positive effect in improving patients’ neurological function, limb motor function and quality of life.

The objective of this research is to study the effect of obstructive sleep apnea-hypopnea syndrome on cognitive function of stroke. Based on linear regression equation and Montreal Cognitive Assessment Scale, the degree of cognitive impairment in OSAHS patients was evaluated and the influencing factors of OSAHS-induced cognitive impairment and the correlation between the degree of OSAHS and cognitive impairment were explored. The results are as follows: about 68% of OSAHS patients have cognitive dysfunction, and the incidence of cognitive dysfunction is positively correlated with OSAHS; cognitive impairment of OSAHS patients was associated with age, obesity, years of schooling, and intermittent nocturnal hypoxia or hypoventilation; the severity of cognitive dysfunction of OSAHS patients was positively correlated with age and obesity but negatively correlated with education level; Logistic regression analysis results showed that there were three factors that were finally entered into the regression equation, namely, LSaO2, BMI, and AHI, and the Logistic regression equation obtained was as follows: LogistP = -0.109X 1 + 0.785X 2 + 1.228X 3. This study helps clinical workers to detect and intervene the impaired cognitive ability of patients with OSAHS early, so as to reduce the incidence and mortality of related complications and improve the quality of life of patients.

目的 探讨间歇低氧大鼠淋巴细胞促进脑血管内皮细胞内质网应激凋亡作用及机制.方法 取SD雄性大鼠30只,分为正常对照组、间歇低氧组、抗低氧组,每组各10只;抗低氧组、间歇低氧组建立间歇低氧大鼠模型,并分别于间歇低氧前半小时腹腔注射100 mg/kg超氧阴离子清除剂和等量生理盐水,1次/d,然后间歇低氧干预8 h/d;正常对照组维持常氧量,干预6周;各组干预后分离淋巴细胞,测定CD4+、CD8+T细胞凋亡率;取对数期内皮细胞RBE4,与各组分离淋巴细胞共培养,命名为正常对照RBE4组、间歇低氧RBE4组、抗低氧RBE4组;4 h后测定培养基上清液中超氧化物歧化酶(Superoxide dismutase,SOD)及丙二醛(Malonaldehyde,MDA)水平、内皮细胞凋亡率、内皮细胞中C增强子结合蛋白同源蛋白(Cenhancer binding protein homologous protein,CHOP)、葡萄糖调节蛋白78(Glucose regulatory protein 78,GRP78)、半胱氨酸天冬氨酸蛋白水解酶-3(Cysteine containing aspartate-specific proteases-3,Caspase-3)mRNA及蛋白水平.结果 与正常对照组比较,间歇低氧组、抗低氧组CD4+、CD8+T细胞凋亡率降低,且间歇低氧组低于抗低氧组(P<0.05);与正常对照RBE4组比较,间歇低氧RBE4组、抗低氧RBE4组上清液中SOD水平降低、MDA水平增高、RBE4凋亡率增高、CHOP,Caspase-3 mRNA及蛋白水平升高、GRP78 mRNA及蛋白水平降低(P均<0.05);与抗低氧RBE4组比较,间歇低氧组SOD水平降低、MDA水平增高、RBE4凋亡率增高、CHOP,Caspase-3 mRNA及蛋白水平升高、GRP78 mRNA及蛋白水平降低(P均<0.05).结论 间歇低氧大鼠淋巴细胞促进脑血管内皮细胞凋亡可能通过激发内质网应激而发挥作用.

目的 探讨奥卡西平联合普瑞巴林对难治性癫痫患者T淋巴细胞和血清干扰素 γ(IFN-γ)、白细胞介素-2(IL-2)水平的影响.方法 选取难治性癫痫患者60例,随机数字表法分为观察组与对照组,各30例.对照组采用奥卡西平治疗,观察组在对照组基础上联合普瑞巴林治疗,比较2组疗效及相关指标.结果 观察组总有效率93.33％,高于对照组76.67％,差异有统计学意义(P<0.05).治疗前,2组CD3+、CD4+、CD8+、CD4+CD25+水平比较,差异无统计学意义(P>0.05);治疗后,观察组CD3+、CD4+、CD8+、CD4+CD25+水平分别为(71.52±2.06)％、(45.73±3.41)％、(30.15±2.47)％及(9.52±1.36)％,高于对照组(64.73±1.48)％、(37.74±2.63)％、(24.49±1.82)％及(6.41±0.82)％,差异均有统计学意义(P<0.05).治疗前,2组血清IL-2、IFN-γ水平比较,差异无统计学意义(P>0.05);治疗后,观察组血清IL-2、IFN-γ水平分别为(327.94±54.36)g·L-1,(14.17±0.68)pg·L-1,低于对照组(453.19±74.38)g·L-1、(26.52±1.24)pg·L-1,差异有统计学意义(P<0.05).结论 奥卡西平联合普瑞巴林治疗难治性癫痫效果较好,能够明显改善患者的免疫功能以及机体炎症活动状态.

目的 探讨视频脑电图在儿童重症昏迷并发非惊厥性癫痫持续状态的应用价值.方法 回顾性分析郑州大学附属郑州儿童医院重症监护病房2017年3月-2020年7月收治的29例重症昏迷合并非惊厥性癫痫持续状态的患儿的临床资料,行长程VEEG监测并分析结果.结果 在29例患儿中,治疗后好转17例,死亡9例,遗留有抽搐3例;其中:0 ～3岁18例,死亡7例;3～6岁8例,死亡1例,遗留抽搐2例;大于6岁3例,死亡1例,遗留抽搐1例.VEEG结果:背景活动为弥漫性慢波和或局限性慢波的27例,周期性放电1例,低电压1例;间歇期有癫痫样放电的15例.29例均记录到NCSE,发作频率从数次到百余十次不等.结论 对持续昏迷或昏迷原因不明的患儿进行视频脑电图监测,对及早诊治NCSE具有重要意义.

目的 探讨阻塞型睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)对急性缺血性卒中患者脑血管反应性(cerebrovascular reactivity,CVR)的影响.方法 前瞻性连续入组2017年10月-2020年8月住院治疗的急性缺血性卒中患者,入院2周内完善多导睡眠监测,根据是否合并OSAHS及呼吸暂停低通气指数(apnea hypopnea index,AHI)将患者分为非OSAHS组、轻度OSAHS组(AHI 5～15次/小时)和中重度OSAHS组(AHI>15次/小时).在完成多导睡眠监测后24?h内对患者进行TCD检查,检测CVR指标包括平静呼吸时、屏气后大脑中动脉的平均血流速度(Vm),计算屏气指数(breath holding index,BHI).比较三组间CVR指标的差异,并在中重度OSAHS组中分析CVR指标与入院时和发病3个月时NIHSS评分的相关性.结果 共纳入228例急性缺血性卒中患者,男性140例(61.4％),其中非OSAHS组49例,轻度OSAHS组42例,中重度OSAHS组137例.中重度OSAHS组BMI、高血压比例、3个月时NIHSS评分均高于非OSAHS组,差异有统计学意义.中重度OSAHS组平静呼吸时Vm低于非OSAHS组(57.4±10.6?cm/s?vs?62.1±12.2 cm/s,P=0.010)和轻度OSAHS组(57.4±10.6?cm/s?vs?59.6±11.2?cm/s,P=0.007),BHI低于非OSAHS组(1.4％±0.6％?vs?1.7％±0.7％,P=0.002)和轻度OSAHS组(1.4％±0.6％?vs?1.5％±0.6％,P=0.001).中重度OSAHS组发病3个月时NIHSS评分与平静呼吸时Vm(r=-0.696,P<0.001)和BHI(r=-0.832,P<0.001)呈负相关.结论 伴中重度OSAHS的急性缺血性卒中患者CVR明显下降,而且CVR的下降可能与急性缺血性卒中患者的预后不良有关.

目的:研究小GTP结合蛋白(Rho)/Rho相关卷曲螺旋形成蛋白激酶(ROCK)信号通路在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)大鼠急性缺血性卒中发生中的作用,为OSAHS后急性缺血性卒中病变的防治提供参考.方法:50只SD大鼠随机分为假手术组、OSAHS组、卒中组、OSAHS后卒中组和Rho抑制剂组(C3转移酶5μg·kg-1·d-1腹腔注射),每组10只.采用慢性间歇性低氧建立OSAHS模型,线栓法阻断大脑中动脉建立急性脑卒中模型.观察各组大鼠建模后的一般情况和脑皮质区组织病理形态表现,计算脑梗死体积.比较各组大鼠呼吸频率和神经功能损伤评分,采用实时荧光定量PCR(RT-qPCR)法和Western blotting法检测各组大鼠脑组织中肌球蛋白轻链(MLC)、Rho和ROCK mRNA及蛋白表达水平.结果:与假手术组比较,其他各组大鼠均有精神状态不佳和脑皮层结构损伤等改变,其中OSAHS后卒中组大鼠变化最严重,Rho抑制剂组变化较轻.与假手术组比较,OSAHS组大鼠呼吸频率增加(P<0.05);与OSAHS组比较,卒中组大鼠呼吸频率降低(P<0.05);与卒中组比较,OSAHS后卒中组大鼠呼吸频率和Longa评分增加(P<0.05),Rho抑制剂组大鼠Longa评分降低(P<0.05);与OSAHS后卒中组比较,Rho抑制剂组大鼠呼吸频率与和Longa评分均降低(P<0.05).与假手术组比较,OSAHS组大鼠逃避潜伏期延长(P<0.05),穿越平台次数减少(P<0.05);与OSAHS组比较,卒中组大鼠逃避潜伏期延长(P<0.05),穿越平台次数减少(P<0.05);与卒中组比较,OSAHS后卒中组大鼠逃避潜伏期延长(P<0.05),穿越平台次数减少(P<0.05);与OSAHS后卒中组比较,Rho抑制剂组大鼠逃避潜伏期缩短(P<0.05),穿越平台次数增加(P<0.05).与卒中组比较,OSAHS后卒中组大鼠脑梗死体积增大(P<0.05);与OSAHS后卒中组比较,Rho抑制剂组大鼠脑梗死体积缩小(P<0.05).与假手术组比较,OSAHS组大鼠脑组织中Rho和ROCK mRNA和蛋白表达水平及p-MLC/MLC比值升高(P<0.05);与OSAHS组比较,卒中组大鼠脑组织中Rho和ROCK mRNA及蛋白表达水平及其p-MLC/MLC比值升高(P<0.05);与卒中组比较,OSAHS后卒中组大鼠脑组织中Rho和ROCK mRNA及蛋白相表达水平及其p-MLC/MLC比值升高(P<0.05);与OSAHS后卒中组比较,Rho抑制剂组大鼠脑组织中Rho和ROCK mRNA及蛋白表达水平及其p-MLC/MLC比值降低(P<0.05).结论:OSAHS的间歇性缺氧状态可损伤神经功能,Rho/ROCK信号通路可能在OSAHS大鼠急性缺血性卒中发生中起一定作用.

目的 研究急性缺血性卒中患者阻塞性睡眠呼吸暂停低通气综合征的严重程度与炎性因子的关系.方法 收集2018年1月至2020年1月期间郑州市第三人民医院神经内科住院的91例急性缺血性卒中患者的病例资料,所有患者入院2周后完善多导睡眠仪检查,根据呼吸暂停低通气指数(apnea hypopnea index,AHI)将患者分为轻度OSAHS组(AHI为5～15次/h),中重度OSAHS组(AHI≥15次/小时)和非OSAHS组.并比较三组患者之间的IL-6、PAI-1、Lp-PLA2水平的变化.结果 共纳入急性缺血性卒中患者91例,其中OSAHS组58例(64％),非OSAHS组33例(36％),两组患者一般资料比较,性别、年龄、BMI、糖尿病患病率、心房纤颤患病率、低密度脂蛋白、血糖差异无统计学意义(P＞0.05),两组患者的IL-6、PAI-1、Lp-PLA2比较差异有统计学意义(P＜0.05).其中,轻度OSAHS组18例(19.8％),中重度OSAHS组40例(44.0％),非OSAHS组33例(36.3％),三组患者的IL-6、PAI-1、Lp-PLA2比较差异有统计学意义(P＜0.05),中重度OSAHS组患者IL-6、PAI-1、Lp-PLA2水平与轻度OSAHS组差异有统计学意义(P值分别为0.002、0.010、0.001,P＜0.05),中重度OSAHS组患者IL-6、PAI-1、Lp-PLA2水平与非OSAHS组差异有统计学意义(P值分别为0.009、0.011、0.004,P＜0.05),且中重度OSAHS组IL-6、PAI-1、Lp-PLA2水平高于轻度OSAHS组与非OSAHS组,轻度OSAHS组IL-6、PAI-1、Lp-PLA2水平与非OSAHS组差异无统计学意义(P值分别为0.078、0.061、0.092,P＞0.05).结论 伴中重度OSAHS的AIS患者的IL-6、PAI-1、Lp-PLA2水平明显高于伴轻度OSAHS和不伴OSAHS的患者,而伴轻度OSAHS的AIS患者的IL-6、PAI-1、Lp-PLA2水平与不伴OSAHS的患者相比没有差异.

目的 探讨脂蛋白相关磷脂酶A2(Lp-PLA2)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者伴缺血性脑血管病(ICVD)的预测作用.方法 回顾性分析93例OSAHS患者的临床资料,根据其是否患有ICVD,分为OSAHS伴ICVD组(38例)和OSAHS不伴ICVD组(55例).比较2组人口统计学资料、血管危险因素、Lp-PLA2水平的差异,并通过二元logistic回归分析和受试者工作特征曲线(ROC)分析Lp-PLA2对OSAHS患者伴ICVD的预测作用.结果 (1)与OSAHS不伴ICVD组相比,OSAHS伴ICVD组的年龄较大,呼吸暂停-低通气指数(AHI)、氧饱和度指数(ODI)及Lp-PLA2水平较高,高血压病的患病率较高(P<0.05).(2)logistic回归分析发现年龄越小、AHI越低是OSAHS患者合并ICVD的保护因素,Lp-PLA2升高是OSAHS患者伴ICVD的危险因素.(3)Lp-PLA2预测OSAHS患者伴ICVD的ROC曲线下面积为0.805(95％CI:0.710～0.880,P<0.001),Lp-PLA2最佳预测值为257.39 ng/mL(敏感度86.8％,特异度67.3％).结论 Lp-PLA2与OSAHS患者ICVD的发生有关,升高的Lp-PLA2水平可能对OSAHS患者伴ICVD具有一定的预测价值.

Objective: To study the MRI and CT characteristics of different periods of acute ischemic stroke and evaluate its diagnostic value by using semi-automatic mention segmentation method. Methods: CT, conventional MRI and DWI were performed in 64 patients with acute ischemic stroke. The average ADC value and average relative ADC (rADC) value of infarct lesions were measured and statistically analyzed. Results: There were no significant differences in CT, conventional MRI, and DWI signal characteristics between 1 and 7 days after the onset of acute ischemic stroke. The average ADC value and the average rADC value decreased, but the average rADC in the infarct area increased with time. The rADC value was statistically significant with the onset of 1d, 2d, 3d, and 4d (P < 0.05), but not statistically significant with the onset of 5d and 6d (P > 0.05). Conclusion: In the image processing method of semi-automatic segmentation method, the characteristics of CT, conventional MRI, and DWI signals combined with the evolution of rADC values over time can help to judge the pathophysiological changes of acute ischemic stroke, which is ischemic. Stroke staging and treatment guidance are provided.

目的 探讨抗接触蛋白相关蛋白-2(CASPR2)抗体相关自身免疫性脑炎的临床特征及治疗.方法 选取2017年3月至2020年12月在郑州市第三人民医院和河南中医药大学第一附属医院确诊的5例抗CASPR2抗体相关自身免疫性脑炎患者临床资料进行回顾性分析.结果 5例患者中男3例,1例患者发病前有发热病史,2例表现为精神行为异常、2例患者以癫痫为首发症状、1例患者表现为记忆力下降,合并神经疼痛基础上存在失眠者1例、合并小脑症状同时存在失眠者1例,合并自主神经功能障碍者2例.5例患者血清抗CASPR2抗体均为阳性,1例患者脑脊液抗CASPR2抗体呈阳性,所有患者均接受免疫治疗,治疗有效.结论 抗CASPR2抗体相关自身免疫性脑炎可累及中枢神经系统、外周神经系统、自主神经系统等多系统从而引起多变临床综合征,免疫治疗有效.

静息性脑梗死(silent brain infarction,SBI)又称无症状性脑梗死,因无临床表现,临床医师对其重视程度不够.近年来,随着头颅MRI的普及和广泛应用,很多老年人在行头颅影像学检查时,可发现脑部有陈旧性脑梗死灶,但这些患者并无典型的肢体麻木、无力、言语不利等神经功能缺损的症状或体征,这种脑梗死灶称为“无症状”或“静息性”或“隐匿性”脑梗死.此类患者既往无脑梗死史,而头颅MRI检查时,可见排除其他非血管因素的新发的或者陈旧的脑梗死病灶.SBI病灶在头颅MRI上的信号与脑梗死的病灶相符,主要通过MRI弥散加权成像(b=1000)的高低信号进行判断是否是新发的病灶.临床医师极易对SBI患者漏诊或者过度诊治,为加强临床医师对SBI的认识,本综述结合国内外相关文献,对SBI的最新研究进展进行详细阐述.

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与急性缺血性脑卒中预后的关系.方法 连续收集2018年1月～2020年1月郑州市第三人民医院及郑州市第二人民医院神经内科收治的急性缺血性脑卒中患者91例,根据呼吸暂停低通气指数(AHI)分为单纯脑梗死组33例(AHI<5/h),轻度OSAHS组18例(AHI 5～14/h)及中重度OSAHS组40例(AHI≥15/h).对比3组一般资料、血管危险因素、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数及改良的Rankin量表(mRS)评分的差异.随访脑卒中发病后3个月,3组Barthel指数及mRS评分的差异.结果 3组性别、年龄、BMI、颈围、糖尿病、冠心病、高脂血症、心房颤动和NIHSS评分比较,差异无统计学意义(P>0.05).单纯脑梗死组、轻度OSAHS组和中重度OSAHS组高血压患病率比较,差异有统计学意义(48.5％ vs 61.1％ vs 77.5％,P=0.036).3组入院当天Barthel指数及mRS评分比较,差异无统计学意义(P>0.05);3组发病后3个月Barthel指数和mRS评分比较,差异有统计学意义(P<0.01).中重度OSAHS组发病后3个月Barthel指数明显低于单纯脑梗死组[(77.0±7.1)分vs(85.3±7.2)分,P<0.05],mRS评分明显高于单纯脑梗死组[(2.2±0.8)分vs(1.3±0.8)分,P<0.05].结论 中重度OSAHS与急性缺血性脑卒中预后不良结局有关.

目的 探讨急性缺血性卒中患者阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)与相关血液生化标志物的关系.方法 纳入2018年1月-2019年12月郑州市第三人民医院及郑州市第二人民医院收治的急性缺血性卒中患者,根据多导睡眠图检测结果分为缺血性卒中伴OSAHS组和单纯缺血性卒中组,对比两组间一般资料、hs-CRP、D-二聚体(D-dimer,D-D)及纤维蛋白原降解产物(fibrinogen degradation products,FDP)的差异.根据OSAHS严重程度,分为轻度OSAHS组,中度OSAHS组,重度OSAHS组,并比较3组患者hs-CRP、D-D及FDP的差异.结果 共纳入98例患者,其中缺血性卒中伴OSAHS组59例,单纯缺血性卒中组39例;缺血性卒中伴OSAHS组中轻度OSAHS 19例,中度OSAHS 16例,重度OSAHS 24例.缺血性卒中伴OSAHS组的BMI (26.33±4.16 kg/m2 vs 23.93±3.83 kg/m2,P=0.048)、hs-CRP (11.95±3.11 mg/Lvs6.13±1.69mg/L,P＜0.001)、D-D[0.78 (0.38～1.21) mg/Lvs 0.25 (0.14～0.30) mg/L,P＜0.001]、FDP(3.36±1.39 μg/mL vs2.30±0.88 μg/mL,P=0.005)均高于单纯缺血性卒中组.轻度OSAHS组(7.92±2.15 mg/L,P＜0.001)和中度OSAHS组(11.47±2.54 mg/L,P=0.005) hs-CRP水平均低于重度OSAHS组(15.31±3.16 mg/L),轻度OSAHS组hs-CRP水平低于中度OSAHS组(P=0.012).轻度OSAHS组D-D水平低于重度OSAHS组[0.42 (0.23～0.98) mg/Lvs0.98 (0.93～1.85) mg/L,P=0.023],轻度OSAHS组FDP水平低于重度OSAHS组(2.74±0.93 μg/mL vs4.19±1.55 μg/mL,P=0.012).结论 与不伴OSAHS的急性缺血性卒中患者相比,伴有OSAHS的急性缺血性卒中患者血清hs-CRP、D-D、FDP水平更高.

Objective To investigate the relationship between serum lipoprotein-related phospholipase A2 (Lp-PLA2) and high-sensitivity C-reactive protein (hs-CRP) levels and carotid atherosclerotic plaque in patients with cerebral infarction. Methods 243 patients diagnosed with cerebral infarction in the Third People’s Hospital of Zhengzhou from January 2017 to March 2018 were selected as cerebral infarction group, and 120 subjects without cerebral infarction through physical examination in this hospital during the same period were selected as control group. Serum Lp-PLA2 and hs-CRP levels were detected in the two groups. According to the results of carotid artery ultrasound examination, the patients with cerebral infarction were divided into non-plaque group, stable plaque group and vulnerable plaque group. Results (1) Serum Lp-PLA2 level [(180.04±35.02) ng/mL vs (152.13±39.67) ng/mL, P=0.014] and hs-CRP level [(10.02±0.47) mg/L vs (2.64±0.33) mg/L, P=0.017] in cerebral infarction group were higher than those in control group. (2) Serum Lp-PLA2 level in the stable plaque group [(162.96±11.34) ng/mL vs (143.67±12.35) ng/mL, P=0.013] and vulnerable plaque group [(197.79±32.56) ng/mL vs (143.67±12.35) ng/mL, P=0.004] were both signiflcantly higher than that in the non-plaque group. Serum Lp-PLA2 level in vulnerable plaque group (P=0.007) was higher than that in stable plaque group. (3) Serum hs-CRP level in vulnerable plaque group were higher than that in stable plaque group [(12.86±1.67) mg/L vs (10.82±0.53) mg/L, P=0.029] and non-plaque group [(12.86±1.67)mg/L vs (9.54±0.47) mg/L, P=0.037] . Conclusions The serum Lp-PLA2 and hs-CRP level probably predicted the development and instability of carotid artery plaques in patients with cerebral infarction.