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中华神经科杂志

中华神经科杂志

北大核心

CSCD

CSTPCD

Chinese Journal of Neurology
1955年3月，中国科协主管，中华医学会主办。本刊是神经科专业学术期刊，2003—2009年连续5年荣获“百种中国杰出学术期刊”称号，2005年荣获国家新闻出版总署颁发的国家期刊奖“第三届国家期刊奖百种重点期刊”。本刊在1576种中国科技论文统计源期刊中，综合排名均列“神经精神医学类”期刊首位。目前我刊已被全国神经病学界公认为反映我国神经病科学研究和临床进展的最高级学术刊物。
  • 发文量：5549
  • 被引量：7890
  • H指数：3
  • 开始收录时间：1994(1)
  • CNKI综合因子：1.6
  • 维普期刊影响因子： 3.24
  • 万方期刊影响因子：1.33
  • 创刊时间：1955
  • 国内刊号/CN：11-3694/R
    国际刊号/ISSN：1006-7876
  • 发行周期：月刊
    邮发代号：82-703
  • 主管单位：中国科学技术协会
    主办单位：中华医学会
中华神经科杂志-联系信息
  • 主编：-
  • 电话：010-51322237
  • 邮箱：cjn@cmaph.org
  • 地址：北京市西城区东河沿街69号
  • 邮编：100052
中华神经科杂志-获奖情况
  • • 1996年中国科协第二届优秀期刊二等奖
  • • 中华医学会85周年优秀期刊二等奖
  • • 2002年中国科协第三届优秀科技期刊二等奖
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中华神经科杂志 >2021年第12期

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  • 摘要：Objective Temporal lobe epilepsy (TLE) patients often have language impairment.The present study is to examine the effective connectivity within the language network in TLE patients by analyzing functional magnetic resonance imaging (fMRI) while performing a silent verb generation task.Methods Thirty-two TLE patients and thirty-two healthy controls were recruited in the study.The fMRI was recorded while the subjects performing verb-generation task.The brain imaging data were analyzed using MATLAB-SPM8 mapping program.The correlation of the connectivities within the language network was analyzed by means of Granger causality.Results Compared to the controls,the activated areas in TLE patients are mainly located in right posterior cingulate gyrus and right precuneus.Granger causality mapping implied a possible correlation between left precuneus and left insular,left insular and left posterior cingulate gyrus,and between left medial frontal gyrus and right insular.Conclusion Granger causality analysis suggests insular,posterior cingulate gyrus may involve in the effective reorganization of language network in TLE patients,which provides the neuroimaging marker for plasticity of brain.%目的 利用默念产词任务研究颞叶癫痫患者与健康对照语言网络的差异性,从而揭示颞叶癫痫患者涉及语言功能区域的核心节点.方法 共纳入32例颞叶癫痫患者和32名性别和年龄相匹配的健康对照.所有受试者在默念产词任务下扫描功能磁共振数据.利用MATLAB平台SPM8软件对数据进行处理.采用条件Granger因果检验方法研究颞叶癫痫患者语言网络节点之间的因果关系.结果 与健康对照相比,颞叶癫痫患者产词任务时激活增强区域包括右侧后扣带回和右侧楔前回,未发现激活降低的区域.条件Granger因果检验分析发现,患者组在左侧楔前回到左侧岛叶,左侧岛叶到左侧后扣带回以及左侧额中回到右侧岛叶的单向条件Granger因果连接增加.结论 岛叶、后扣带回均参与了颞叶癫痫患者语言网络,可能为语言网络重组以及大脑可塑性提供了影像学证据.
  • 摘要：目的 总结Danon病患者的临床表现、实验检查结果和骨骼肌的组织病理学特点.方法 对7例Danon病患者的临床及实验室检查结果进行总结分析.结果 1例未行基因检测,余6例患者溶酶体膜相关蛋白2(lysosomal-associated membrane protein 2)基因均为移码突变.7例患者均为男性,就诊年龄为13～20岁,平均16岁.临床以心脏受累为主,肌力可正常或轻度无力,智力受损常见,2例患者有斜视.患者肌酸激酶升高明显(7/7),超声心动检查提示左室肥厚(5/7)、左室扩张(1/7)、左室肥厚合并左室扩张(1/7).心电图检查提示预激综合征(5/7).肌电图未见异常(2/2).对7例患者均行肌肉活组织检查,可见肌纤维内出现自噬性空泡,dystrophy和spectfin等免疫组织化学染色可见膜阳性空泡和颗粒.3例患者心肌活组织检查可见部分空泡化肌纤维.结论 Danon病多表现为青少年男性起病的肥厚性心肌病,伴肌酸激酶升高,骨骼肌无力和智力低下不突出,往往被忽视而误诊为单纯性肥厚性心肌病.心力衰竭是影响预后的因素.肌肉病理改变与心肌类似,以出现多发膜性自噬空泡为特征,对疾病诊断有较高的提示意义.%Objective To summarize the clinical,laboratory and the muscle histopathology features of patients with Danon disease.Method The clinical documents and laboratory data of 7 patients with Danon disease were analyzed retrospectively.Results Genetic testing was performed in 6 patients and lysosomal-associated membrane protein 2 frame-shift mutations were found.Patients were all male and the age at diagnosis ranged from 13 to 20 years with an average of 16 years.Among the 7 patients,cardiomyopathy was the main clinical manifestation,myopathy was mild or subclinical and mental retardation was common.Besides,2 patients had strabismus.Serum creatine kinase was elevated in all the patients.Echocardiography revealed hypertrophic cardiomyopathy in 5 patients,dilated cardiomyopathy in 1 patient and hypertrophic cardiomyopathy combined with dilated cardiomyopathy in 1 patient.Electrocardiogram revealed pre-excitation syndrome in 5 patients.Electromyogram showed neither myogenic nor neurogenic changes in 2 patients.Autophagic vacuoles in muscle fibers were the character of muscle pathology,and some cytoplasmic vacuoles and granules were positive in dystrophin and spectrin immumohistochemical staining.Endomyocardial biopsy of 3 patients showed extensive vacuoles within some cardiac muscle fibres.Conclusions Danon disease often affects male adolescents,presenting with hypertrophic cardiomyopathy and elevated serum creatine kinase concentration,and myopathy and mental retardation are often mild and can be clinically silent sometimes,which are usually neglected and misdiagnosed as hypertrophic cardiomyopathy.What is more,heart failure is an important predictor of prognosis.Both skeletal and cardiac muscle pathology is characterized by cytoplasmic autophagic vacuoles,even when weakness is not obvious in skeletal muscles.Therefore,skeletal muscle pathology is very important to diagnosis of the disease.
  • 摘要：Objective To investigate the correlation between prestroke comorbidity and long-term outcomes in patients with acute cerebral infarction.Methods Consecutive acute ischemic stroke patients who were hospitalized were prospectively recruited from August 2010 to November 2012.Six hundred and forty-four patients were enrolled,the baseline data including Charlson Comorbidity Index (CCI),National Institute of Health Stroke Scale (NIHSS) score,type of Oxfordshire Community Stroke Project (OCSP:total anterior circulation infarct,partial anterior circulation infarct,posterior circulation infarct and lacunar infarct) were recorded.And recovery was assessed by modified Rankin Scale (mRS) 90 days after stroke by telephone interview (mRS score ≤ 2 reflected good prognosis,and mRS score ＞ 2 reflected unfavorable prognosis).Because CCI included specific comorbidity,we considered CCI,CCI without specific comorbidity and specific comorbidity as variable respectively.After screening the risk factors affecting prognosis using univariate analysis,the relationship between comorbidity and prognosis was estimated using multinomial logistic regression model.Results CCI was an independent predictor of good prognosis and unfavorable prognosis (OR =3.446,95％ CI 1.662-7.417; P =0.001).Congestive heart failure and diabetes were each independent predictor of good prognosis and unfavorable prognosis also (diabetes:OR =2.584,95％ CI 1.709-3.906,P =0.000; congestive heart failure:OR =6.229,95％ CI 1.705-22.755,P =0.006).Conclusions After acute ischemic stroke,the patients with the higher CCI score,diabetes and congestive heart failure are more likely to achieve unfavorable outcome.CCI,diabetes and congestive heart failure can each be used as a sensitive index to evaluate the 90 d prognosis of patients.Trial registration Clinical Research Center of China (CHiCTR-OCH-14004228)%目的 探讨急性脑梗死患者发病前共存病与长期预后的关系.方法 前瞻性收集2010年8月至2012年11月在济南军区总医院神经内科住院的急性脑梗死患者644例,记录其年龄、性别、Charlson共存病指数(Charlson Comorbidity Index,CCI)、美国国立卫生研究院卒中量表(NIHSS)评分等基线资料.在发病后第90天通过电话随访,采用改良Rankin量表(mRS)对其预后进行评价(mRS评分≤2分为预后良好,mRS评分＞2分为预后较差).由于CCI包含特异性共存病,所以将CCI、去除特异性共存病的CCI、特异性共存病等分别作为影响患者3个月预后的危险因素,单因素分析并筛选影响患者3个月预后的危险因素后,再采用多元Logistic回归模型分析CCI、特异性共存病是否为患者mRS评分的独立预测因子.结果 CCI(0R=3.446,95％ CI1.662～7.417;P=0.001)是评价急性脑梗死患者预后的独立预测因子.同时,心力衰竭(OR=6.229,95％ CI1.705 ～ 22.755;P =0.006)、糖尿病(OR=2.584,95％ CI1.709 ～ 3.906;P=0.000)等特异性共存病也是评价患者预后的独立预测因子.结论 发病前CCI得分越高、伴有糖尿病或心力衰竭的急性脑梗死患者预后差的可能性越大.CCI及急性脑梗死患者的特异性共存病如糖尿病、心力衰竭可作为评价患者3个月预后的敏感指标.
  • 摘要：@@
  • 摘要：Objective To analyze the efficacy of seizure control by anti-epileptic drugs (AEDs) in patients with epilepsy with febrile seizure plus (EFS +),and explore the proper medication choice in early stage of EFS + and its relation with voltage-gated sodium channel α1-subunit (SCN1A) gene mutations.Methods In 202 patients with EFS +,the data of detected voltage-gated SCN1A gene mutations and their treatment history by AEDs were retrospectively reviewed.The comparative analysis of efficacy of seizure control was performed in each AED administrated and further compared between EFS + patients with or without SCN1A gene mutations.Results Nine AEDs were administered in more than 10 cases,including valproate (VPA),topiramete (TPM),clonazepam (CNZ),phenobarbital (PB),levetiracetam (LEV),lamotrigine (LTG),carbamazepine (CBZ),oxcarbazepine (OXC) and phenytoin (PHT).Combined therapy was predominant (166/202,82.2％).Compared with other AEDs,the improvement rates were the highest in VPA (169/187,90.4％),TPM (111/120,92.5％) and CNZ (69/78,88.5％ ;P =0.000),and were lowest in PHT and LTG (0 and 8.9％ (4/45); P ＜ 0.01).The improvement rate (58.1％ (25/43) and 44.7％ (21/47)) and no change rate (39.5％ (17/43) and 48.9％ (23/47)) of PB and LEV were approximately intermediate,without statistically significant difference between them but with statistically significant difference with others (P ＜ 0.01).The aggravation rats of LTG and CBZ were the highest (57.8％ (26/45) and 36.7％ (18/49)) followed by OXC and PHT(33.3％ (15/45) and 26.9％ (7/26)).All of them showed statistically significant difference compared with others (P ＜ 0.01).The aggravation rate of LTG in patients with SCN1A mutations (13/16,81.3％) was significantly higher than those without SCN1A mutations (13/29,44.8％),and there was statistically significant difference between them (x2 =5.607,P =0.018); similarly,the aggravation rates of CBZ,OXC and PHT showed an increased tendency,but no significant difference compared with other AEDs.Conclusions VPA,TPM and CNZ are relatively recommended AEDs choices in patients with EFS + in early stage.The study suggests avoiding using the AEDs with sodium channel blocking in EFS +,especially in the patients with SCN1A mutations.The efficacy of LEV and PB in EFS + is uncertain.%目的 分析抗癫痫药物(AEDs)对热性惊厥相关癫痫(EFS+)患者发作控制的效果,探讨EFS+患者早期适宜的药物选择及与电压依赖性钠通道α1亚基(SCN1A)基因突变的关系.方法 回顾性分析2007年1月至2013年6月收集的202例进行SCN1A基因检测的EFS+患者的AEDs治疗数据,比较不同AEDs对EFS+患者发作控制的效果,并在EFS+有或无SCN1A基因突变患者中做进一步比较.结果 EFS+患者使用大于10例的AEDs共9种,分别为丙戊酸、托吡酯、氯硝安定、苯巴比妥、左乙拉西坦、拉莫三嗪、卡马西平、奥卡西平和苯妥英钠,其中使用比例最高的前3位为丙戊酸、托吡酯、氯硝安定.AEDs联合治疗占多数(166/202,82.2％).与其他AEDs相比,丙戊酸(169/187,90.4％)、托吡酯(111/120,92.5％)和氯硝安定(69/78,88.5％)的对发作改善的疗效均较好,差异有统计学意义(P =0.000);苯妥英钠和拉莫三嗪[0和8.9％ (4/45)]效果最差(P＜0.01).苯巴比妥和左乙拉西坦的发作改善率[58.1％ (25/43)、44.7％ (21/47)]和无变化率[39.5％(17/43)、48.9％ (23/47)]疗效居中并接近,与其他AEDs比较差异有统计学意义(P＜0.01).拉莫三嗪和卡马西平明显加重发作[57.8％(26/45)、36.7％ (18/49)]最高,苯妥英钠和奥卡西平次之[33.3％(15/45)和26.9％ (7/26)],与其他AEDs比较差异均有统计学意义(P＜0.01).拉莫三嗪加重SCN1A突变患者发作的效果(13/16,81.3％)较无突变患者(13/29,44.8％)显著,差异有统计学意义(x2=5.607,P=0.018);卡马西平、奥卡西平和苯妥英钠也可加重SCN1A基因突变患者的发作,但较无突变患者差异无统计学意义.结论 丙戊酸、托吡酯和氯硝安定是EFS+患者早期治疗的较好药物选择;尽量避免在EFS+尤其存在SCN1A突变的患者中使用有钠通道阻滞作用的AEDs.左乙拉西坦和苯巴比妥在EFS+中的疗效尚不确切.
  • 摘要：目的 总结经基因诊断确诊的特殊多巴反应性肌张力障碍(dopa responsive dystonia,DRD)患者的临床特点,结合文献探讨DRD患者左旋多巴药物治疗有效性及女性患者孕期用药安全性.方法 分析2例DRD患者症状、治疗药物及疗效,检测患者三磷酸鸟苷环化水解酶Ⅰ(GCH1)基因与酪氨酸羟化酶(TH)基因.结果 病例1为青年男性患者,临床主要表现为书写痉挛及下肢僵硬,症状有晨轻暮重,但是小剂量多巴丝肼不能完全控制书写痉挛症状,多巴丝肼加量后,书写痉挛症状仍偶有发作.病例2为青年女性患者,主要临床表现为步态异常,服用左旋多巴及安坦可完全控制症状.该患者在孕期自行服用左旋多巴及安坦,孕38周时产一健康女婴.直接测序检测患者的GCH1与TH基因全长外显子,病例1患者携带GCH1基因突变c.230C＞ G(p.S77C),该突变为新的致病性突变.病例2患者携带GCH1基因c.628delC(p.His210Thrfs*5)突变,该突变在前期研究已被报道.2例患者均未检测出TH基因突变.结论 大多数DRD患者对左旋多巴疗效良好,但书写痉挛症状对左旋多巴反应欠佳.前期文献回顾均提示DRD患者孕期使用左旋多巴单药治疗无不良事件发生.%Objective To investigate the efficiency of levodopa in dopa responsive dystonia (DRD) patients and drugs safety in pregnancy cases confirmed by genetic detection.Methods The clinical characteristics of two patients were analyzed.Direct sequences were performed in guanosine triphosphate (GTP) cyclohydrolase Ⅰ (GCH1) gene and tyrosine hydroxylase (TH) gene mutation screening.Results Case 1 was a young man exhibiting writer's cramp and dystonia of lower legs with marked diurnal fluctuation.Writer's cramp could not be relieved by treatment of low dose levodopa/benserazide.After increasing dose,the symptom of writer's cramp appeared occasionally.Case 2 was a young woman who experienced gait disorder.The symptom disappeared completely by levodopa treatment.She used levodopa and benzhexol during pregnancy.By 38 gestational weeks,she gave birth to a healthy baby.Sequence analysis of GCH1 gene in case 1 revealed a mutation (c.230C ＞ G p.S77C) that is a novel pathogenic mutation.The confirmed mutation c.628delC (p.His210Thrfs* 5) found in case 2 had been reported previously.No mutations in TH gene were detected in two patients.Condnsions Most of DRD patients have dramatic response to levodopa,but patients exhibited writer' s cramp may respond to levodopa incompletely.The previous reports indicate that no adverse events have been reported in DRD pregnant women with the monotherapy of levodopa.
  • 摘要：@@
  • 摘要：Objeetive To follow up the patients with Parkinson's disease (PD) who underwent subthalamic nucleus (STN) deep brain stimulation (DBS) therapy,and to compare the changes of cognitive function before and after this functional surgery.Methods The authors set up a series of clinical tests including unified Parkinson's disease rating scale (UPDRS) Ⅱ & Ⅲ,Hoehn & Yahr stage (H-Y stage),mini mental state examination (MMSE),Wechsler memory scale (WMS),serial reaction time task (SRTT),degraded picture naming (DPN),verbal fluency (VF),clock drawing test (CDT) to measure the performance of both clinical characteristics and cognitions 1 week before and 12 months after STN-DBS operation in 20 PD patients,matched with 20 healthy adults who just assessed by the neuropsychological tests.Results Activity of daily life (UPDRS Ⅱ),motor manifestations (UPDRS Ⅲ) and disease condition (H-Y stage) were all significantly improved whether they were "on period" or "off period" (P ＜ 0.01).In the test of WMS,the memory quotient (MQ) scores of PD patients (88.10 ± 16.70) were significantly lower (t =-3.187,P ＜0.01) than the control group (100.90 ± 6.45).By SRTT test,the mean average response time (Tavg) of the control group,pre-operation and post-operation groups was (1.09 ± 0.32) s,(1.58 ± 0.83) s and (1.62 ± 0.83) s,respectively.As to the comparison of the blocks,no changes were found within each group of PD (pro-F =0.329,P =0.964 ; post-F =0.377,P =0.945),by contrast,it had been proved to be statistically significant in the control group (F =2.316,P ＜0.05).The mean error rates of the control group,pre-operation and post-operation groups were 4.84％ ± 4.27％,9.76％ ± 1.52％ and 13.41％ ± 1.11％ respectively,and the control group was not different from pre-operation group (t =1.388,P =0.173) while significantly different compared with post-operation group (t =3.225,P ＜0.01).As for MMSE and DPN results,no significant benefits were obtained in the control,pre-operation and post-operation groups.In regard to VF,there was a statistically significant difference between control group and pre-operation group (Z =-2.927,P ＜ 0.01),and it was significantly worse after surgery (Z =-2.469,P =0.014).As for CDT,significant benefits were obtained in both preoperation (Z =-2.762,P ＜ 0.01) and post-operation groups (Z =-2.165,P =0.03) compared with control group.Conelusions To some extent,STN-DBS can affect the cognition of PD patients,such as lowing VF,improving visual-spatial function and attention,a decreasing trend of implicit memory and executive function.Explicit memory is partly dissociated with implicit memory.文章序号>=10.3760/cma.j.issn.1006-7876.2014.09.005%目的 随访经丘脑底核脑深部电刺激(DBS)临床治疗的帕金森病患者,观察丘脑底核DBS术对其认知功能的影响.方法 应用统一帕金森病评定量表第二、三部分(UPDRSⅡ,Ⅲ),改良Hoehn-Yahr (H-Y)分级,系列神经心理学量表简易智能量表(MMSE)、韦氏记忆量表(WMS)、Nissen软件(SRTT)、残图命名、词语流畅性(VF)和画钟测验等方法,分别于丘脑底核DBS术前1周及术后12个月对20例帕金森病患者的临床特征和认知功能进行评估.以20名与之匹配的健康人作为健康对照.结果 帕金森病患者DBS术后无论“开期”还是“关期”日常生活能力(UPDRSⅡ)、运动功能(UPDRSⅢ)、病情(H-Y分级)较术前均有显著的改善(P＜0.01).术前帕金森病患者记忆商为88.10±16.70,明显低于对照组(100.90±6.45;t=-3.187,P＜0.01).帕金森病患者DBS手术前后的记忆商及各项分测验比较差异均无统计学意义.SRTT测试获得的平均反应时(Tavg)对照组、术前帕金森病组及术后帕金森病组分别为(1.09±0.32)、(1.58 ±0.83)、(1.62±0.83)s,术前帕金森病组较对照组延长(t =2.432,P＜0.05);对3个组组内各小节间比较发现,帕金森病患者手术前后各节Tavg差异均无统计学意义;对错误率比较,对照组、术前帕金森病组及术后帕金森病组的总错误率分别为4.84％±4.27％、9.76％±1.52％和13.41％±1.11％.MMSE和残图命名测验结果显示,对照组、术前帕金森病组和术后帕金森病组3组间差异均无统计学意义;对于VF测验结果,对照组和术前帕金森病组比较差异有统计学意义(Z=-2.927,P＜0.01),术后VF较术前下降差异有统计学意义(Z=-2.469,P=0.014);对于画钟测验结果,对照组和术前帕金森病组比较差异有统计学意义(Z=-2.762,P＜0.01),术后较术前有所提升(Z=-2.165,P=0.03).结论 丘脑底核DBS术在一定程度上可以引起帕金森病患者认知功能的改变:VF下降,视空间功能和注意力改善,可能内隐记忆和执行功能下降等.
  • 摘要：Objective This study assesses the influence of rizatriptan on calcitonin gene-related peptide (CGRP),proenkephalin (PENK) and cholecystokinin (CCK) mRNA expressions in the trigeminal ganglia of a rat migraine model and investigates the possible mechanisms by which triptans treat migraine.Methods A total of 24 rats were randomly divided into four groups:normal control group (A),migraine model group(B),rizatriptan control group (C) and rizatriptan treatment group(D).Groups C and D were intragastrically perfused with rizatriptan,1 mg/kg per day.After 7 days,nitroglycerin was subcutaneously injected into the buttocks of the groups B and D to induce migraine.Two hours after nitroglycerin injection,the trigeminal ganglia was isolated.CGRP,PENK and CCK mRNA expressions in the trigeminal ganglia were determined using SYBR Green Ⅰ real-time quantitative PCR.Results The copy number of CGRP mRNA (× 107) in 200 ng total RNA of each group was 0.05 ±0.01,1.30 ±0.52,0.23 ±0.12,0.43 ±0.33 ; The copy number of PENK mRNA (× 103) in 200 ng total RNA of each group was 3.30 ± 1.65,0.34 ±0.14,3.91 ± 2.44,0.71 ± 0.13.The copy number of CGRP mRNA in the trigeminal ganglia of group B was significantly higher than that of group A (q =7.854,P ＜ 0.05) ; CGRP mRNA expressions were significantly lower in the trigeminal ganglia of rats in group D compared with group B (q =5.458,P ＜0.05).Compared with group A,PENK mRNA expressions in the trigeminal ganglia of rats were significantly lower in group B (q =4.478,P ＜ 0.05).PENK mRNA expressions were significantly higher in trigeminal ganglia of rats in group C compared with group D (q =4.838,P ＜ 0.05).CCK mRNA expression in trigeminal ganglia of rats was similar among groups.Conelusions Rizatriptan can decrease the expressions of CGRP in the trigeminal ganglia of the migraine rats and exhibits neurogenic inflammation triggered by CGRP.PENK expressions decrease in the trigeminal ganglia of the migraine rats,weaken the analgesic effects of enkephalin.%目的 观察利扎曲普坦对偏头痛大鼠三叉神经节降钙素基因相关肽(CGRP)、脑啡肽原和缩胆囊肽基因表达的影响,探讨曲普坦类药物对偏头痛发作时三叉神经节功能的干预作用.方法 将24只健康Wistar大鼠按随机区组法分为4组:A组:对照组,B组:偏头痛组,C组:利扎曲普坦对照组,D组:利扎曲普坦治疗组.利扎曲普坦给药组(C、D组)大鼠给予利扎曲普坦1mg·kg-1·d-1灌胃,A组和B组大鼠给予生理盐水2 ml/d灌胃.上述处理7d后,B、D组大鼠制备硝酸甘油型偏头痛动物模型,造模2h留取三叉神经节标本,用实时定量PCR检测其CGRP、脑啡肽原和缩胆囊肽mRNA表达.结果 A、B、C、D各组大鼠三叉神经节每200纳克总RNA中CGRP mRNA拷贝数(×10 7)分别为:0.05±0.01、1.30±0.52、0.23 ±0.12、0.43 ±0.33;脑啡肽原mRNA拷贝数(×103)分别为:3.30±1.65、0.34±0.14、3.91±2.44、0.71±0.13.B组大鼠三叉神经节CGRP mRNA拷贝数明显高于A组(q =7.854,P＜0.05),D组大鼠三叉神经节CGRP mRNA拷贝数明显低于B组(q =5.458,P＜0.05);B组大鼠三叉神经节脑啡肽原mRNA拷贝数明显低于A组(q =4.478,P＜0.05);D组大鼠三叉神经节脑啡肽原mRNA拷贝数明显低于C组(q=4.838,P＜0.05);各组大鼠三叉神经节缩胆囊肽mRNA表达差异无统计学意义.结论 利扎曲普坦可以抑制偏头痛发作时三叉神经节CGRP的过度表达,进而减弱三叉神经血管系统的激活,发挥治疗偏头痛的作用;偏头痛发作时三叉神经节脑啡肽原的基因表达明显减少,使得偏头痛发作时三叉神经节内脑啡肽减少,减弱脑啡肽的镇痛效应,利于头痛的持续.
  • 摘要：癫痫持续状态（status epilepticus。SE）是高病死率和高致残率的神经科常见急危重症。据国外文献报道病死率为3％-33％。中国西南部地区SE的病死率为15．8％。早期规范的药物治疗和系统全面的生命支持，能防止因惊厥时间过长导致的不可逆性脑损伤和重要脏器功能损伤，成为改变SE不良预后的关键。
  • 摘要：Objective To investigate the role of the neuropsychological tests and functional imaging in differentiation between multiple system atrophy parkinsonism-predominant (MSA-P) and multiple system atrophy predominant cerebellar ataxia (MSA-C) or idiopathic Parkinson' s disease (PD).Methods We collected three groups of patients including MSA-P (n =8),MSA-C (n =13),idiopathic PD (n =13),and control group (n =13) between December 2012 and November 2013 in General Hospital of People's Liberation Army.We then compared the scores of neuropsychological assessment and parameters obtained from diffusion tensor imaging (DTI) examination among the four groups.Results (1) MSA-P group had longer time-consuming of trail-making test((103.7 ± 25.9) s) and lower graphic symbol test scores (20.9 ±6.1) than that of the MSA-P group ((80.9 ± 29.1) s ; 28.1 ± 7.4) and PD group ((72.0 ± 19.6) s ;29.0 ± 9.4 ; all P ＜ 0.05).(2) Mean diffusivity (MD) in both putamen (8.01 ± 0.76,7.91 ± 0.74) and the left substantia nigra (8.31 ± 0.43),thalamus (8.30 ± 0.69),external capsule (8.12 ± 0.32) of MSA-P group was significantly different from that of MSA-C group (7.27 ± 0.42,7.34 ± 0.3 1,7.58 ±0.81,7.81 ±0.34,7.70 ±0.44) and PD group (7.35 ±0.43,7.45 ±0.43,7.66 ±0.45,7.72 ±0.40,7.56 ± 0.37) ; Significantly higher MD in both middle cerebellar peduncle (8.54 ± 0.74,8.28 ± 0.71),medulla oblongata (8.32 ± 0.61) was demonstrated in MSA-C group than that of MSA-P group (8.54 ±0.74,8.28 ±0.71,8.32 ±0.61),PD group (7.25 ±0.70,7.30 ±0.66,7.65 ±0.50) and control group (6.94±0.39,7.08 ±0.32,7.44 ±0.41; all P＜0.01).(3) Fractional anisotropy (FA) in the left external capsule (0.45 ± 0.35) and right thalamus (0.28 ± 0.27),occipital lobe (0.47 ± 0.87) in MSA-P group was significantly different from that in MSA-C group (0.48 ± 0.36,0.23 ± 0.24,0.49 ± 0.49 ; P ＜0.05) ; FA in the left occipital lobe (0.46 ± 0.10) in PD group was significantly different from that in MSAP group (0.56 ± 0.82 ; P ＜ 0.01).Conclusion Trail-making test,graphic symbol test and DTI can be used to differentiate MSA-P type from MSA-C type or PD.%目的 探讨神经心理学测验及功能成像在多系统萎缩帕金森综合征为主(MSA-P)型与多系统萎缩小脑性共济失调为主(MSA-C)型及原发性帕金森病鉴别中的作用.方法 收集2012年12月至2013年11月在解放军总医院神经内科门诊或住院的MSA-P型患者8例,MSA-C型患者13例,帕金森病患者13例.选择性别、年龄、受教育程度及生活环境相似的健康老年人13名,行神经心理学量表评估及弥散张量成像(DTI)检查,对获得的分值及参数进行比较.结果 (1)MSA-P组患者的连线测验耗时[(103.7±25.9)s]及图形-符号转换测验分值[(20.9±6.1)分]与MSA-C组[(80.9±29.1)s;(28.1 ±7.4)分]及帕金森病组[(72.1±19.6) s;(29.0±9.4)分]差异均存在统计学意义(均P ＜0.05).(2)MSA-P型患者的平均弥散率(MD)在双侧壳核(8.01 ±0.76、7.91±0.74),左侧黑质(8.31±0.43)、丘脑(8.30±0.69)、外囊(8.12±0.32)均与MSA-C型(7.27±0.42、7.34±0.31、7.58±0.81、7.81 ±0.34、7.70±0.44)、帕金森病患者(7.35±0.43、7.45±0.43、7.66±0.45、7.72±0.40、7.56±0.37)存在明显差异;MSA-C型患者的MD值在双侧桥臂(8.54±0.74、8.28±0.71)、延髓(8.32±0.61)均明显高于MSA-P型(8.54±0.74、8.28±0.71、8.32±0.61)、帕金森病患者(7.25±0.70、7.30±0.66、7.65±0.50)及对照组(6.94±0.39、7.08±0.32、7.44±0.41),差异有统计学意义(均P＜0.01).(3)MSA-P型患者的部分各向异性(FA)值在左侧外囊(0.45±0.35)及右侧丘脑(0.28±0.27)、枕叶(0.47±0.87)与MSA-C型患者(0.48±0.36、0.23±0.24、0.49 ±0.49)差异存在统计学意义(P＜ 0.05);FA值在左侧枕叶(0.46±0.10)与帕金森病患者(0.56±0.82)差异存在统计学意义(P＜0.01).结论 连线测验、图形-符号转换测验和弥散张量成像对临床鉴别MSA-P型与MSA-C型及帕金森病有一定辅助意义.
  • 摘要：目的 比较额颞叶痴呆(FTD)与阿尔茨海默病(AD)患者认知功能和神经精神行为的差异以及与痴呆严重程度的关系.方法 选择符合入组条件的FTD患者38例、AD患者46例,分别采用蒙特利尔认知评估量表(MoCA)和简易精神状态检查(MMSE)量表评价认知功能;神经精神量表(NPI)和额叶行为量表(FBI)评价神经精神行为;汉密尔顿抑郁量表21项版本(HAMD-21)评价情绪状态;以及临床痴呆评定量表(CDR)划分痴呆严重程度.结果 与AD患者相比,FTD患者年龄(岁)较小(70.13 ±8.36与66.46±7.04;t =2.124,P=0.037),发病年龄(岁)较旱(68.58±8.51与64.43±6.82;t=2.396,P=0.019),MoCA评分(分)低于AD患者[12.50 (8.00,16.25)与17.00(10.75,21.00);Z=-2.428,P=0.015],而NPI、FBI、FBI-A、FBI-B及HAMD-21分值(分)高于AD患者[NPI:15.00(7.00,25.50)与9.50(4.00,17.75),Z=-2.251,P=0.024;FBI:21.00(13.00,27.00)与16.00(10.75,23.00),Z=-2.159,P =0.031; FBI-A:13.00(8.00,16.00)与9.00 (6.00,12.00),Z=-2.159,P=0.041; FBI-B:9.00 (7.00,14.00)与7.00(3.00,11.00),Z=-2.051,P=0.040;HAMD-21:7.00(2.75,14.00)与5.00(3.00,8.00),Z=-2.061,P=0.039];亚项分析显示:FTD患者在执行功能(Z=-2.140,P=0.032)、语言(Z=-3.357,P=0.001)、抽象能力(Z=-2.498,P=0.012)和延迟回忆(Z=-4.317,P=0.000)等认知方面差于AD患者,AD患者的记忆力(Z=-1.999,P=0.046)和定向力(Z=-2.941,P=0.003)较FTD患者损害明显;FTD患者在激越(Z=-3.255,P=0.001)、脱抑制(Z=-3.093,P=0.002)和易激惹(Z=-2.214,P=0.027)等神经精神行为障碍较AD患者严重;NPI(r =0.279,P=0.010)、FBI(r=0.353,P=0.001)、FBI-A(r =0.386,P=0.000)和FBI-B(r=0.273,P=0.012)与CDR评分呈正相关,MoCA评分与CDR评分呈负相关(r=-0.760,P=0.000);两组患者的MoCA和NPI各亚项分值随着痴呆程度加重发生相应变化.结论 FTD和AD患者在认知功能和精神行为症状方面存在差异,FTD患者执行功能、语言、抽象能力和延迟回忆较差,而AD患者记忆力、定向力较差.随着病情的发展,FTD患者逐渐出现定向力障碍,AD患者的认知功能障碍几乎波及各个领域.FTD患者激越、脱抑制、易激惹行为多见,AD患者病程晚期出现抑郁.临床工作中对痴呆患者的认知功能和精神行为症状的动态观察有助于FTD和AD的鉴别.%Objective The purpose of this study was to investigate the differences of cognitive impairment and neuropsychiatric behavior disturbances between Alzheimer's disease (AD) and frontotemporal dementia (FTD) patients,as well as their relationships with dementia severity.Methods A total of 38 FTD patients and 46 AD patients were recruited in this study.The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to evaluate the degree of cognitive impairments.The Neuropsychiatric Inventory Brief Questionnaire Form (NPI) and Frontal Behavioral Inventory (FBI) were used to measure behavioral disturbances.The 21-items Hamilton Depression Rating Scale (HAMD-21) was used to evaluate the mental or emotional state of patients.Clinical dementia rating scale (CDR) was used to divide the dementia severity.Results FTD patients were younger ((70.13 ± 8.36) years vs (66.46 ± 7.04) years,t =2.124,P =0.037),earlier at age of onset ((68.58 ± 8.51) years vs (64.43 ± 6.82) years,t =2.396,P =0.019),with lower MoCA scores (12.50 (8.00,16.25) vs 17.00(10.75,21.00),Z=-2.428,P=0.015),higher NPI (15.00(7.00,25.50)vs 9.50(4.00,17.75),Z=-2.251,P=0.024),FBI (21.00(13.00,27.00)vs 16.00(10.75,23.00),Z=-2.159,P=0.031),FBI-A (13.00 (8.00,16.00)vs 9.00(6.00,12.00) Z=-2.159,P=0.041),FBI-B (9.00(7.00,14.00) vs 7.00(3.00,11.00),Z=-2.051,P=0.040) and HAMD-21 scores (7.00(2.75,14.00) vs 5.00 (3.00,8.00),Z =-2.061,P =0.039).A detail analysis of different cognitive domains showed the executive functions (Z =-2.140,P =0.032),language (Z =-3.357,P =0.001),abstraction (Z =-2.498,P =0.012) and delayed recall (Z =-4.317,P =0.000) of the MoCA scale were lower in FTD patients than that in AD patients,while AD patients had lower scores in memory (Z =-1.999,P =0.046) and orientation (Z =-2.941,P =0.003) of the MMSE scale.Within the subscale scores of the NPI,the agitation (Z =-3.255,P =0.001),disinhibition (Z =-3.093,P =0.002) and irritability (Z =-2.214,P =0.027) scores were higher in FTD patients than in AD patients.The total scores of NPI (r=0.279,P=0.010),FBI (r =0.353,P=0.001),FBI-A (r=0.386,P=0.000) and FBI-B (r =0.273,P =0.012) were positively correlated with the CDR scores,whereas MoCA scores were negatively correlated with the CDR scores (r =-0.760,P =0.000).The subscale scores on MoCA and NPI areas changed corresponding with dementia severity in both groups.Conclusions The cognitive function,behavioral and psychological symptoms between FTD and AD patients are different.FTD patients have poorer executive function,language,abstraction and delayed recall ability,whereas AD patients perform worse in memory and orientation.With the progression of the disease,FTD patients gradually emerged disorientation,while the cognitive impairment in AD patients almost affected all the areas.FTD patients are more likely to have agitation,disinhibition and irritability behavior,and AD patients are more likely to have depression in the late stage.Dynamic evaluation of the cognitive function,behavioral and psychological symptoms in clinical practice can help to distinguish FTD and AD.
  • 摘要：目的 分析前庭阵发症神经血管压迫的MRI表现特点,并对血管压迫部位和程度在发病中的影响进行探讨.方法 收集28例前庭阵发症(vestibular paroxysmia,VP)患者,以28例其他眩晕病患者作为对照组,经三维-磁共振血管成像技术扫描,对两组患者前庭蜗神经周围有无神经血管交互压迫(neurovascular cross-compression,NVCC)、NVCC类型、责任血管来源及血管压迫部位至脑干的距离进行回顾性分析.结果 VP组NVCC阳性率(27/28,96.4％)显著高于对照组(13/28,46.4％,x2=17.15,P＜0.01).VP组中最常见NVCC类型为血管襻形式压迫(15/35,42.9％),最常见的责任血管为小脑前下动脉(25/35,71.4％),VP组与对照组NVCC分型、责任血管来源差异均无统计学意义.血管严重压迫前庭蜗神经致其变形和(或)移位在VP组为12.5％ (7/56),对照组为0,差异有统计学意义(P =0.013).NVCC距脑干距离VP组为(8.57 ±5.08) mm,对照组为(8.93±4.64) mm,两组差异无统计学意义,但VP组中单侧NVCC距脑干的距离全部小于15 mm,对照组中为7/10,差异有统计学意义(P=0.033).结论 VP患者NVCC的发生率较高,责任血管多为小脑前下动脉,以血管襻形式压迫前庭蜗神经多见,NVCC多发生在前庭蜗神经的中枢髓鞘部;血管压迫部位及程度与VP发病可能相关.%Objective To analyze the MRI characteristics of vestibulocochlea neurovascular compression in patients with vestibular paroxysmia (VP) and to investigate the effect of the compression,its site and degree,on the occurrence of VP.Methods Twenty-eight cases of VP (VP group) and 28 cases of vertiginous patients other than VP (control group) were retrospectively reviewed.Three dimensional magnetic resonance angiography (3D-MRA) was performed and the data were used for neurovascular crosscompression (NVCC) analysis.The frequency and type of NVCC,the origin of the offending vessel and the distance between compression site and brainstem were compared between the two groups.Results The frequency of NVCC was 96.4％ (27/28) in VP group,with a significant difference compared with control group (13/28,46.4％ ;x2 =17.15,P ＜0.01).The most common NVCC type was vascular loop compression at vestibulocochlear nerve (15/35,42.9％).Anterior inferior cerebellar artery was the most common offending vessel (25/35,71.4％) in VP group.There were no significant differences between the two groups in the type of NVCC or the origin of the offending vessel.The frequency on the distortion and (or) displacement of vestibulocochlear nerve which was severely compressed by vessel in VP group (7/56,12.5％) was significantly higher than that in control group (0; P =0.013).The distance between compression site and brainstem was (8.57 ± 5.08) mm in VP group,and (8.93 ± 4.64) mm in control group,showing no significant difference.The ratio that the distance was less than 15 mm between compression site and brainstem in unilateral NVCC of VP group (100％) was significantly higher than unilateral NVCC of control group (7/10,P =0.033).Conclusions The VP patients have higher NVCC incidence and the most common NVCC type is vascular loop compression at vestibulocochlear nerve which is mainly caused by anterior inferior cerebellar artery.NVCC in VP patients mostly occurs in the central myelin portion of vestibulocochlear nerve.The site and degree of neurovascular compression may relate to the occurrence of VP.
  • 摘要：Objective To investigate the neuropsychological and functional neuroimaging features in patients with cerebellar infarction (CI).Methods We analyzed 59 CI patients (27 left CI,32 right CI) and 26 healthy control subjects who received standard and experimental cognitive testing and neuroimaging study.We compared the cognitive manifestations between the groups with Student' s t test.Results Patients with CI(left/right) achieved significantly lower scores in auditory verbal learning test (AVLT) of memory test (12.27 ± 1.37 vs 9.33 ± 1.90/10.25 ±2.20,t =6.46,4.26,P ＜0.05),Associative Learning of Clinical Memory Scale (22.77 ± 3.07 vs 18.67 ± 1.98/16.84 ± 3.55,t =5.74,6.69,P ＜ 0.05),symbol digit modalities test (SDMT) of visuospatial test(42.54 ±6.32 vs 20.85 ±9.57/34.84 ± 16.10,t =9.68,2.47,P ＜ 0.05),and errors responses (RE) of Wisconsin card sorting test for executive function (16.77 ± 2.64vs 52.22 ± 16.29/54.47 ± 16.27,t =11.15,12.89,P ＜ 0.05).Patients with left CI had significantly lower scores in correct responses percentage (RCP; 58.71 ± 10.93 vs 78.43 ± 5.26,t =-8.41,P ＜ 0.05)and significantly higher scores in the trials to compete first category (RF; 23.59 ± 9.79 vs 14.12 ± 3.75,t =4.68,P ＜ 0.05).Those finding suggests left CI would cause impairment on abstract conceptualization and concept formation; The patients with right CI had significantly lower scores in total memory quotient (86.69 ± 7.56 vs 112.02 ± 9.70,t =-11.17,P ＜ 0.05),higher scores in perseverative responses (RP ;44.59 ± 17.50 vs 8.23 ± 3.46,t =11.47,P ＜ 0.05) and nonperseverative responses errors percentage (nRPE; 44.00 ±20.67 vs 10.58 ± 2.35,t =9.07,P ＜ 0.05).It means right CI would cause serious deficits on memory,cognitive shift and attention.The fibers between cerebellum and frontal,parietal lobe were reduced in CI patients,compared with healthy control.Conclusions These results suggest that cerebellum participated in the formation of part of cognitive function by connection with cerebrum.After CI,that the fibers contacted with the prefrontal and parietal reduced is the possible mechanisms for cognitive impairment.%目的 探讨小脑梗死患者的神经心理学和功能影像学的特点.方法 对59例小脑梗死患者(左侧小脑梗死患者27例,右侧小脑梗死患者32例)和26名健康对照者进行神经心理学和功能影像学评估,采用独立样本t检验方法分析认知功能改变及其与功能影像学改变的关系.结果 (1)与健康对照组相比,小脑梗死患者(左侧/右侧)在记忆、视空间能力和执行功能有关测验中得分(分)较低,其中记忆测试中的听觉词汇学习测试[12.27±1.37与9.33±1.90(左侧)/10.25±2.20(右侧);t =6.46、4.26]、临床记忆量表中的联想学习[22.77±3.07与18.67±1.98(左侧)/16.84±3.55(右侧),t=5.74、6.69]、视空间测试中的符号数字模式测试[42.54±6.32与20.85±9.57(左侧)/34.84±16.10(右侧),t=9.68、2.47]、执行功能测试中的威斯康星卡片分类测试子项目错误应答数[16.77±2.64与52.22±16.29(左侧)/54.47±16.27(右侧),t=11.15、12.89]得分均低于健康对照组,差异均具有统计学意义(均P ＜0.05).(2)左侧小脑梗死患者与健康对照组相比,正确应答百分比分值(分)较低(58.71±10.93与78.43±5.26,t=-8.41),差异具有统计学意义(P＜0.05),完成第一个分类所需应答数分值(分)较高(23.59 ±9.79与14.12±3.75,=4.68),差异具有统计学意义(P＜0.05),提示抽象概括能力和概念形成能力受损;右侧小脑梗死患者与对照组相比,总记忆商分值(分)较低(86.69±7.56与112.02±9.70,t=-11.17),差异有统计学意义(P＜0.05),持续性应答数分值(分)较高(44.59±17.50与8.23±3.46,t=11.47),差异有统计学意义(P＜0.05),非持续性错误分值(分)较高(44.00±20.67与10.58±2.35,t =9.07),差异有统计学意义(P＜0.05),提示记忆力、认知转换和注意力受损.(3)与健康对照组比较,小脑梗死患者的小脑与前额叶和顶叶的纤维联系减少.结论 小脑通过与大脑的连接,参与了部分认知功能(如记忆、视空间和执行功能等)形成的过程.小脑梗死后其与前额叶和顶叶纤维的联系减少是认知功能损伤的可能机制.
  • 摘要：Objective To investigate the predictors of early neurological deterioration (END) as well as the correlation between white matter hyperintensities (WMH) and END in patients with acute ischemic stroke.Methods Consecutive patients diagnosed as acute lacunar infarction and admitted to Jinling Hospital between 4.5 and 24.0 hours after symptom onset were prospectively recruited in the study.END was defined as an increase of National Institutes of Health Stroke Scale (NIHSS) score ≥2 points in the first 72 hours after admission.Besides,all patients received magnetic resonance imaging within 24 hours after admission.The WMH were graded according to the Fazekas rating scale.Results A total of 223patients were finally enrolled.Of them,70(31.4％)patients suffered END in the initial 72 hours after admission.Multivariable analysis indicated that systolic blood pressure (OR =1.02,95％ CI 1.00-1.04,P =0.049),baseline NIHSS score (OR =1.32,95％ CI 1.15-1.52,P ＜ 0.01) and fasting plasma glucose on admission (OR =1.14,95％ CI 1.01-1.29,P =0.034) were independent predictors for END.However,for periventricular WMH,compared to Fazekas grade 0,no statistically significant correlation existed between END and WMH grade 1,grade 2 and grade 3.For WMH in centrum semiovale,similarly,END did not correlate with WMH grade 1,grade 2 and grade 3.Likewise,in the post-hoc subgroup analysis of patients with different age,sex and different territory,END did not significantly correlate with WMH neither in periventricular nor in centrum semiovale.Conclusions Systolic blood pressure,baseline NIHSS score and the fasting plasma glucose on admission were independent predictors for END in patients with acute lacunar infarction.However,WMH located neither in periventricular spaces nor in centrum semiovale was related to END.%目的 探讨急性腔隙性脑梗死患者早期神经功能恶化(END)的相关因素及其与脑白质病变(WMH)的联系.方法 前瞻性纳入2009年3月至2012年3月发病,且在发病4.5～24.0 h内收治于南京军区南京总医院神经内科的急性腔隙性脑梗死患者.END定义为入院72 h内任一时刻复评美国国立卫生研究院卒中量表(NIHSS)评分较入院时增加2分或2分以上.另外,所有患者入院后完成头颅磁共振检查,探讨不同位置WMH分级与END的联系.结果 共入组患者223例,其中70例(31.4％)在入院72 h内发生END.多因素分析提示入院收缩压(OR=1.02,95％ CI1.00～ 1.04,P=0.049),基线NIHSS评分(OR=1.32,95％ CI 1.15 ～ 1.52,P＜0.01)以及入院血糖(OR=1.14,95％ CI 1.01 ～1.29,P=0.034)是END的独立预测因素.以Fazekas 0级为参照,侧脑室旁WMH 1级、2级、3级与END均不存在有统计学意义的联系.半卵圆中心WMH 1级、2级、3级同样与END无有统计学意义的联系.在不同年龄段、不同性别、不同动脉系统供血区病灶的亚组分析中,WMH侧脑室旁及半卵圆中心分级与END均未发现有统计学意义的联系.结论 在急性腔隙性梗死患者中,基线NIHSS评分及入院收缩压、入院血糖是END的独立预测因素.不同区域的WMH分级在患者总体及不同年龄、性别、动脉供血区的亚组患者中与END均无联系.但本文为单中心研究,样本代表性可能不足.
  • 摘要：目的 探讨磁共振液体衰减反转恢复序列血管高信号(FVH)与静脉溶栓预后的关系.方法 回顾性分析浙江大学医学院附属第二医院神经内科2009年5月至2013年12月连续收集的缺血性卒中静脉溶栓患者的临床和影像资料.选取前循环梗死的病例,评估大脑中动脉远端供血区域FVH的情况,并分析其与溶栓后再灌注以及临床预后的关系.结果 共纳入93例患者,55例(59.1％)存在FVH,较FVH阴性者基线美国国立卫生院神经功能缺损评分(NIHSS;分)更高(11.8±6.0与7.2 ±4.5,t =-4.82,P＜0.01),弥散加权成像所显示的病灶更大(中位数分别为5.5 ml与2.0 ml,Z=-3.030,P=0.002)、灌注成像低灌注区更大(中位数分别为42.0 ml与3.0 ml,Z=-6.104,P=0.005),差异均有统计学意义.其中FVH阳性的独立影响因素为近端大血管闭塞(OR =48.874,95％ CI 11.6～205.9,P＜0.01)和高脂血症病史(OR =0.264,95％CI 0.07～0.90,P=0.048).FVH阳性是3个月预后不良的独立危险因素(OR =4.143,95％CI 1.440～11.919,P=0.008),但FVH伴早期再灌注则能明显改善3个月预后(OR=8.500,95％CI1.964～36.790,P=0.004).结论 FVH的存在与近端大血管闭塞有关,且影响静脉溶栓远期预后.早期再灌注可改善FVH阳性者的溶栓预后.%Objective To explore the prognostic effect of fluid-attenuated inversion recovery imaging vascular hyperintensity (FVH)on intravenous thrombolysis of acute ischemic stroke.Methods We retrospectively reviewed the clinical and imaging data of intravenous thrombolytic patients with acute anterior circulation infarction admitted from May 2009 to December 2013.The presence of FVH was evaluated,and its associations with reperfusion and clinical outcome after thrombolysis were assessed.Results Ninety-three patients were analyzed.FVH was detectable in 55 (59.1％) cases.Patients with FVH had higher NIHSS scores (11.8 ± 6.0 vs 7.2 ± 4.5,P ＜ 0.01),larger initial DWI lesions (5.5 ml vs 2.0 ml,Z =-3.030,P=0.002) and perfusion lesions (42.0 ml vs 3.0 ml,Z=-6.104,P =0.005),compared with those without FVH.The history of hyperlipidemia (OR =0.264,95％ CI 0.07-0.90,P =0.048) and proximal large vessel occlusion(OR =48.874,95％ CI 11.6-205.924,P ＜ 0.01) were independently associated with the presence of FVH.The presence of FVH independently predicted the poor neurological outcome at 3 months (OR =4.143,95 ％ CI 1.440-11.919,P =0.008).However,early reperfusion was associated with favorable outcome in patients with FVH after intravenous thrombolysis (OR =8.500,95％ CI 1.964-36.790,P =0.004).Conclusions The presence of FVH is associated with proximal large vessel occlusion,which predicts poor outcome in patients with intravenous thrombolysis.However,early reperfusion among patients with FVH can improve the outcome.

    中华神经科杂志的期刊信息

    • 曾用名：中华神经精神科杂志
    • 创刊时间：1955
    • 地区：CN
    • 语言：中文
    • 热门主题：中华医学会
    • 学科分类： 神经病学与精神病学;

      Medicine:Neurology (clinical);Neuroscience:Neurology;

    中华神经科杂志的获奖情况

    • • 1996年中国科协第二届优秀期刊二等奖
    • • 中华医学会85周年优秀期刊二等奖
    • • 2002年中国科协第三届优秀科技期刊二等奖

    中华神经科杂志的收录情况

    • • 北大核心期刊（2000版）
    • • 北大核心期刊（2004版）
    • • 北大核心期刊（2008版）
    • • 北大核心期刊（2011版）
    • • 北大核心期刊（2014版）
    • • 北大核心期刊（2017版）
    • • 化学文摘（网络版）
    • • 中国科学引文数据库（2011-2012）
    • • 中国科学引文数据库（2013-2014）
    • • 中国科学引文数据库（2015-2016）
    • • 中国科学引文数据库（2017-2018）
    • • 中国科学引文数据库（2019-2020）
    • • 医学文摘
    • • 哥白尼索引
    • • 日本科学技术振兴机构数据库
    • • 文摘与引文数据库
    • • 中国科技核心期刊

    中华神经科杂志的投稿信息

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    • 期刊栏目：述评；专论；论著；讲座；综述；临床病理讨论；研究快讯

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