急性脑梗死患者血清血管内皮生长因子的测定

目的　探讨急性脑梗死与血管内皮生长因子 (VEGF)的关系。方法　对 3 0例急性脑梗死患者和 40例健康人血清血管内皮生长因子含量进行测定。患者采血时间为病后第 2天或第 3、4天 ,取均数与对照组比较。结果　 3 0例急性脑梗死患者血清 VEGF含量为 (2 95 .0 4± 3 5 .73 ) pg/ ml,对照组为 (13 7.71± 11.5 3 ) pg/ m l,两组比较差异显著。结论　急性脑梗死患者血清 VEGF升高 ,提示 VEGF是脑梗死急性期的自我保护机制之一。     

血管构筑因子Leptin/VEGF和TGF-β对BAVM血管异常生成的影响

目的探讨血管构筑因子瘦素(Leptin)、血管内皮生长因子(VEGF)和转化生长因子-β(TGF-β)对脑动静脉畸血管异常生成的影响。方法分组:对照组(外伤脑叶部分切除切包含血管)、脑动静脉畸形未出血组、脑动静脉畸形出血组。应用实时定量多聚酶联反应(real time-PCR)、Western blot印迹法检测3组Leptin、VEGF以及TGF-β的mRNA和蛋白的表达差异。结果对照组、未出血组和出血组组间比较Leptin、VEGF以及TGF-βmRNA及蛋白表达差异,出血组和未出血组与对照组比较差异有显著性,具有统计学意义(P<0.01),出血组与未出血组比较差异显著(P<0.01)。结论Leptin、VEGF以及TGF-β的mRNA和蛋白在BAVM的畸形血管团中表达上调,出血组更为显著。在分子生物学水平上研究对BAVM血管生成异常的影响,为指导脑AVM的临床诊疗提供了策略。     

脊髓动静脉性血管病变的诊断与治疗(附99例报告)

目的探讨脊髓动静脉性血管病变(SCAVLs)的诊断与治疗。方法自1990年8月至2006年8月,我们收治99例SCAVLs,并回顾性分析他们的影像学改变、治疗方法与结果。结果99例脊髓动静脉性血管病变中,行手术治疗65例,介入治疗34例。手术治疗病例中,脊髓动静脉畸形(SAVM)31例、硬脊膜动静脉瘘(SDAVF)26例和髓周动静脉瘘(PMAVF)8例,各型SCAVLs病例术后获好转者分别为19例、17例和4例。结论脊髓MRI和DSA是正确诊断本病的关键。对SDAVF和Ⅰ型PMAVF宜首选手术治疗,对SAVM应尽可能采用手术切除(或术前辅以栓塞治疗)畸形灶,对Ⅱ型或Ⅲ型PMAVF宜取介入治疗或介入与手术联合治疗。治疗时,应针对动静脉短路进行根治性治疗,即手术和/或栓塞来闭塞瘘口和去除畸形灶。     

中枢神经系统血管畸形性疾病中VEGF的表达

中枢神经系统常见的血管畸形性疾病有：动静脉畸形(AVM)、硬脑膜动静脉瘘(DAVF)、海绵状血管瘤(CM)。对于这些疾病的确切病因和发病过程尚有未知点。最近有一些国外学对血管内皮细胞生长因子(VEGF)在这些疾病中的表达进行了研究，并认为VEGF在其发展过程中有相当的作用，现综述如下。     

体外培养人脑动静脉畸形血管内皮细胞中VEGF表达增加

目的探讨体外培养的人脑动静脉畸形血管内皮细胞和正常脑血管内皮细胞中血管内皮细胞生长因子(VEGF)表达水平的差异。方法采用组织块贴壁法对人脑动静脉畸形血管内皮细胞进行培养和形态学观察;免疫组化检测CD31和vWF抗原验证内皮细胞;采用RT-PCR和Western blot技术检测脑动静脉畸形血管内皮细胞VEGF mRNA和蛋白表达,并与和正常脑血管内皮细胞进行比较。结果体外培养的内皮细胞CD31和vWF染色阳性率达95%以上。人脑动静脉畸形血管内皮细胞中VEGF mRNA和蛋白表达均显著升高(P0.05)。结论体外培养的人脑动静脉畸形内皮细胞中VEGF的高表达,提示血管生成在脑动静脉畸形的发病机制中起重要作用。     

VEGF对实验性脊髓空洞前状态的血-脊髓屏障功能的调节作用

目的:通过建立兔脊髓空洞症模型,观察脊髓空洞前状态中血脊髓屏障功能变化和脊髓水肿程度,以及脊髓组织中VEGF蛋白、mRNA表达水平,并探讨VEGF表达在脊髓空洞前状态形成和发展中的作用。方法:应用干湿法测定脊髓空洞前状态中脊髓含水量,Evansblue法测定血脊髓屏障功能,应用免疫组织化学和RT-PCR测定脊髓组织中VEGF蛋白和mRNA的表达含量。结果:Kaolin组于术后第1天VEGFmRNA(0.31±0.02)表达有明显升高,第3天(0.44±0.03)、7天(0.66±0.02)、14天(0.56±0.01)呈强阳性表达,第21天(0.35±0.04)表达明显减弱;VEGF蛋白表达也呈现相同的变化趋势。同时Kaolin组动物在术后2周内出现脊髓水肿且随时间延长逐渐加重;组织中Evansblue含量在术后第3天有开始增高(2.79±0.42μg/ml),第7天达到高峰(3.53±0.45μg/ml),持续到第14天(3.45±0.35μg/ml),第21天有好转(3.36±0.27μg/ml)但仍高于正常。统计学分析结果显示VEGF高表达和脊髓空洞前状态中血脊髓屏障功能变化和脊髓水肿程度存在明显正相关。结论:在脊髓空洞前状态中,VEGF高表达对脊髓组织中血脊髓屏障功能和结构的破坏存在重要影响,在脊髓水肿和空洞形成、发展中起着重要作用。     

脑动静脉畸形栓塞治疗后的组织病理及免疫组化研究

目的研究脑动静脉畸形(CAVM)栓塞治疗后的组织病理变化。方法分析11例栓塞治疗后再行手术切除CAVM的病例资料,应用增殖细胞核抗原(PCNA)、α-平滑肌肌动蛋白(α-SMA)、骨桥蛋白(OPN)、血管内皮生长因子(VEGF)等抗体进行免疫组化研究。结果栓塞后,CAVM血管腔内出现不同程度的血管炎性反应,部分被栓塞的血管腔内可见再通。栓塞治疗后的新生内膜中OPN及α-SMA呈阳性染色;畸形血管团周围组织中发现异常微血管,其内皮细胞PCNA阳性染色率高,且VEGF呈阳性染色。畸形血管周围组织中的血管内皮细胞增殖指数(19.6%±8.4%)高于对照组(10.1%±6.2%),差异有统计学意义(P<0.05)。结论栓塞材料引起血管呈不同程度的炎性反应,适度的血管反应有助于管腔闭塞;栓塞治疗后畸形血管周边有微血管增生现象。     

奥氮平对精神分裂症患者血清血管内皮生长因子 水平的影响及其与临床疗效的关系

目的 探讨奥氮平对首发精神分裂症患者血清血管内皮生长因子（VEGF）水平的影响 及其与临床疗效的关系。方法 纳入40 例首发精神分裂症患者（患者组）,经4 周单一奥氮平治疗,采 用阳性与阴性症状量表（PANSS）评估疗效。用酶联免疫吸附法测定患者治疗前后和40 名健康者（对 照组）血清VEGF 的水平。结果 患者组服药前血清VEGF 水平［（331.8±80.1）pg/ml］显著低于对照组 ［（506.1±211.5）pg/ml］,服药后血清VEGF 水平［（475.7±128.5）pg/ml］较治疗前明显上升,差异有统计 学意义（t=6.489,P＜ 0.05）,而与对照组比较差异无统计学意义（P＞ 0.05）;患者组服药后PANSS 评分低 于服药前（P＜ 0.05）,并且PANSS 总分减分率与血清VEGF变化呈正相关（r=0.439,P=0.005）。结论 血 清VEGF水平适合作为精神分裂症的生物标志物,有效的抗精神病治疗能提高血清VEGF水平,血清 VEGF 变化可能是评价抗精神病药物疗效的相关指标。     

脑动静脉畸形破裂出血病人中Ang1、Ang2、VEGF、LP的表达和意义

目的研究血管生成素1(angiopoietin 1,Ang1)、血管生成素2(angiopoietin 2,Ang2)、血管内皮生长因子(vascular-endothelial growth factor,VEGF)及瘦素(leptin,LP)在脑动静脉畸形(AVM)破裂出血病人中的表达和意义。方法收集手术切除的AVM标本28例,将14例有近期破裂出血史的病人作为AVM出血组,14例无明显破裂出血史的病人作为AVM未出血组,采用免疫组织化学法检测2组标本Ang1、Ang2、VEGF及LP的表达,并进行统计分析。结果免疫组织化学法显示:Ang1、Ang2、VEGF及LP在2组血管内皮细胞中均有阳性表达;与AVM未出血组比较,AVM出血组的血管内皮细胞中Ang2、VEGF、LP表达显著增强(均P<0.01),而Ang1的表达较弱(P>0.05)。结论 Angl、Ang2、VEGF及LP在AVM的畸形血管中存在特异性表达,尤其是Ang2、VEGF及LP可能与AVM的进展及破裂出血有密切关系。     

脊髓血管畸形(附70例分析)

目的探讨脊髓血管畸形的临床特征、诊断及治疗方法.方法回顾性分析70例经MRI、DSA和(或)手术病理证实的脊髓血管畸形病例,其中髓内血管畸形38例,髓周动静脉瘘21例,硬脊膜动静脉瘘11例.结果单纯性栓塞治疗24例,先栓塞后手术5例,单纯手术治疗39例,保守治疗2例.随访56例,痊愈12例,好转29例,无变化11例,恶化4例.结论MRI与DSA结合是诊断脊髓血管畸形的最好手段.针对不同病变特点和影像特征,选择恰当的治疗方法是成功的关键.     

皮质下缺血性脑血管病MRI与血管性痴呆的相关性研究

目的:探索皮质下缺血性脑血管病MRI表现与血管性痴呆之间的关系。方法:对比分析了皮质下多发梗死28例痴呆患者和33例非痴呆患者的MRI表现,采用Logistic回归分析皮质下缺血性血管性痴呆的影像学相关高危因素。结果:痴呆组中顶叶皮质下、内囊膝部和丘脑的梗死发生率,顶叶皮质下、侧脑室体旁前部、内囊膝部和丘脑平均梗死数目,4级LA的出现率以及所有脑萎缩指标均明显大于对照组(P<0.05)。但Logistic回归后,只有平均脑沟宽度、侧脑室指数和丘脑梗死的数目进入了方程。结论:皮质下缺血性血管性痴呆可能与脑萎缩的程度和丘脑梗死的数目密切相关。     

Immunohistochemical detection of vascular endothelial growth factor (VEGF) in the vasculature of oligodendrogliomas

C. Christov, H. Adle-Biassette, C. Le Guerinel, S. Natchev and R. K. Gherardi (1998) Neuropathology and Applied Neurobiology 24, 29–35 Immunohistochemical detection of vascular endothelial growth factor (VEGF) in the vasculature of oligodendrogliomas Vascular endothelial growth factor (VEGF) appears to be implicated in tumour angiogenesis. In the present study immunohistochemical expression of VEGF was evaluated in 34 oligodendrogliomas (13 grade II, 21 grade III [WHO]). VEGF immunoreactivity was found in 31 of 34 cases. Expression of VEGF was observed in endothelial cells and some vascular smooth muscle cells, but not in neoplastic oligodendrocytes. Vessel counts, percentages of VEGF-positive vessels and vessels with vascular endothelial proliferation were assessed. The degree of VEGF labelling and vascular-endothelial proliferation in each vessel were evaluated using a 3 degree intensity score. Expression of VEGF was higher in grade III than in grade II oligodendrogliomas as assessed by percentage of VEGF positive vessels (55.8 ± 29.2% vs 17.0 ± 19.0% [P < 0.001]) and by VEGF immunostaining intensity (1.90 ± 0.60 vs 0.90 ± 0.40 [P < 0.001]). VEGF expression did not correlate with vessel density. Intensity of VEGF expression correlated positively with that of vascular-endothelial proliferation in grade III tumours (r=+0.47 [P < 0.05]). The percentage of VEGF positive vessels showed some degree of positive correlation with the percentage of vessels showing vascular-endothelial proliferation (r=+408 [P < 0.10]). Within individual grade III tumours 67.5 ± 29.6% of all vessels with vascular-endothelial proliferation were VEGF-positive and 31.0 ± 20.5% of all VEGF-positive vessels showed no evidence of vascular-endothelial proliferation. We conclude that (i) expression of VEGF is observed in the vasculature of oligodendrogliomas; (ii) marked expression of VEGF is observed in grade III oligodendrogliomas; (iii) VEGF may be one of the interrelated causative stimuli acting in concert to induce vascular-endothelial proliferation.     

小脑血管畸形显微手术治疗的临床分析

目的探讨小脑血管畸形的临床特点及手术治疗方法与疗效。方法回顾性分析72例小脑血管畸形病人的临床资料．采用乙状窦后入路或枕下后正中入路进行手术。结果72例病人均手术全切病灶。术后病理结果：动静脉畸形（AVM）67例,海绵状血管瘤（CM）3例,静脉畸形（VM）2例。术后GOS评分：5分64例,4分4例,3分1例,2分1例,1分2例。随访4个月～13年,恢复良好64例,轻残4例,重残1例,植物生存状态1例,死亡2例。无复发病例。术前GCS评分≥8分的AVM病人,其术后GOS评分较GCS评分〈8分者高（P〈0．05）。结论小脑血管畸形应尽早行手术切除治疗,术中采用合适的手术入路、适当的手术技巧,可取得良好的手术效果。AVM病人术前GCS评分≥8分的病人恢复好,〈8分病人恢复较差。     

纤维蛋白对大鼠脑血管内皮细胞血管内皮生长因子表达的影响

目的观察纤维蛋白对大鼠脑血管内皮细胞血管内皮生长因子(VEGF)转录及蛋白水平表达的影响。方法大鼠脑血管内皮细胞分离后培养,加入不同浓度的纤维蛋白,通过Real-time PCR检测VEGF转录水平,应用酶联免疫方法(ELISA)定量检测培养基和细胞裂解液中的VEGF水平。结果纤维蛋白可以特异性诱导大鼠脑血管内皮细胞表达VEGF;加入不同浓度的纤维蛋白(0.03mg/ml、0.1mg/ml、0.3mg/ml和1.0mg/ml),24h后,1.0mg/ml纤维蛋白组的培养基VEGF水平显著增高(P<0.001);1.0mg/ml纤维蛋白与大鼠脑血管内皮细胞分别培养0、2、4、8、24、48h,VEGF浓度在共培养2h已经升高,8h时显著升高,在24h时仍然保持在显著升高表达水平(P<0.005),48h有所下降;Real-time PCR结果提示,大鼠脑血管内皮细胞中VEGF mRNA的上调呈现出剂量和时间依赖性增加。结论纤维蛋白可以上调大鼠血管内皮细胞中的VEGF。     

The effect of vascular disease on late onset Parkinson''s disease

The clinical severity of late onset Parkinson's disease (PD) varies from patient to patient and it is further complicated by the increasing prevalence of accompanying disorders in the elderly. We set out to study the impact of ischemic heart disease, minor stroke, hypertension and diabetes mellitus in a group of late onset PD patients (age >or=70 years). Consecutive late onset PD patients seen in the Department of Neurology, Medical School of Patras, Greece were included in this study. We used very strict criteria to eliminate the possibility of including patients with vascular parkinsonism. Comparisons were made between groups of patients suffering with idiopathic Parkinson's disease (IPD) and the above-mentioned diseases. One hundred and sixty-seven consecutive late onset PD patients were included in this study. The most common accompanying disorders in our group were hypertension in 31 (18%) of the patients and minor stroke in 20 (12%). The Hoen and Yahr score in late onset IPD patients who suffered from minor stroke, ischemic heart disease or diabetes mellitus was significantly higher when compared with patients without the above disorders. The results clearly suggest that the presence of vascular disease on an IPD patient may aggravate PD severity. In clinical grounds, these findings can be proved significant since early and aggressive prevention of vascular disease and treatment of vascular risk may contribute in controlling symptom severity in PD.     

Study on epidemiology of cognitive dysfunction after stroke in the population over the age of 45 in Inner Mongolia

Objective: To analyze the prevalence of different degrees vascular cognitive impairment (VCI) in stroke and the characteristics of demography distribution in Inner Mongolia. In order to provide reference data and theoretical guidance for the prevention and treatment of VCI after stroke in the area.

Methods: Stratified multi-stage random sampling was used to extract six regions of Inner Mongolia as the first sampling cluster; and then the corresponding banners (counties) were selected randomly as the secondary sampling cluster; according to the number of patient required to investigation, the corresponding number of communities was randomly selected from the secondary sampling cluster. According to the diagnostic criteria of ‘Guidelines for the diagnosis and treatment of vascular cognitive impairment’ and National Institute of Neurological Disorders and Stroke convened an International Workshop with support from the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN), we screened all stroke patients aged 45 or older from each community, a total of 444 patients participated in the questionnaire and various scale assessments.

Results: The prevalence of VCI, vascular cognitive impairment no dementia and vascular dementia was 80.41%, 34.46% and 45.95% respectively. The prevalence of VCI in stroke was significantly different in different nationality, age and education level (P < 0.05), and there was no significant difference in gender, occupation, marital status and family structure (P > 0.05).

Conclusion: The prevalence of VCI after stroke was higher in Inner Mongolia, and VCI had a relatively high morbidity in old age people and person with less education in Chinese Han population.     

Pregnancy causes diminished myogenic tone and outward hypotrophic remodeling of the cerebral vein of Galen

Pregnancy increases the risk of several complications associated with the cerebral veins, including thrombosis and hemorrhage. In contrast to the cerebral arteries and arterioles, few studies have focused on the effect of pregnancy on the cerebral venous side. Here, we investigated for the first time the effect of pregnancy on the function and structure of the cerebral vein of Galen in rats. Our major finding was that cerebral veins from late-pregnant (LP, n=11) rats had larger lumen diameters and thinner walls than veins from nonpregnant (NP, n=13) rats, indicating that pregnancy caused outward hypotrophic remodeling of the vein of Galen. Moreover, veins from NP animals had a small amount of myogenic tone at 10 mm Hg (3.9±1.0%) that was diminished in veins during pregnancy (0.8±0.3% P<0.01). However, endothelium-dependent and -independent vasodilation of the veins was unchanged during pregnancy. Using immunohistochemistry, we show that the vein of Galen receives perivascular innervation, and that serotonergic innervation of cerebral veins is significantly higher in veins from LP animals. Outward hypotrophic remodeling and diminished tone of cerebral veins during pregnancy may contribute to the development of venous pathology through elevated wall tension and wall stress, and possibly by promoting venous blood stasis.     

定量脑电图在血管性认知障碍中的应用

血管性认知障碍（vascular cognitive impairment, VCI）是指由脑血管病危险因素引起，包含从轻度认知障碍到痴呆的一大类综合征，其临床表现形式多样，早期具有隐匿性。临床广泛应用神经心理学量表（如蒙特利尔认知评估量表、简易精神状态检查量表等）作为评估VCI的证据，但存在特异性及敏感性较低、主观性偏差等局限。定量脑电图（quantitative electroencephalography, QEEG）是近年来应用于临床的一种新技术，以其无创、可量化、实时监控的特点被研究者所重视。越来越多的证据表明，QEEG特异性量化指标对VCI的早期诊断有所帮助。目前，常用的QEEG量化指标主要包括相对功率值、慢波化比率、成对衍生脑对称指数、EEG相干系数、Lemple-Ziv复杂度、P300等。轻度认知障碍是VCI的早期阶段，轻度认知障碍患者QEEG特异性改变主要以慢波功率和θ波与β波比值升高、P300潜伏期延长及波幅减低等为主要特点。脑小血管病是VCI常见的亚型之一，临床症状隐匿且进程缓慢，常容易被患者及医务人员忽视。其相关电生理研究报道相对较少，目前认为EEG背景变化的同时出现大量异常尖波可提示脑小血管病认知障碍加重。卒中后认知障碍是由卒中事件触发的VCI。有研究发现，δ波、θ波、β波、δ波与α波比值R和δ波与θ波比值均对识别卒中后认知障碍有一定的意义。此外，应用QEEG技术还可准确地将VCI与其他认知障碍（如路易体痴呆、阿尔茨海默病等）进行鉴别，也可用于药物或其他干预措施对VCI患者治疗前后的疗效评价。因此，QEEG分析技术作为新的一种补充或替代性手段，为追踪VCI的进展轨迹、鉴别各种认知障碍和协助制定治疗方案提供了全新的方向和思路。     

Vascular compression from goiter as an unusual cause of cerebrovascular accident

The unusual case of a patient with goiter and left faciobrachiocrural paresis due to right temporoparietal infarction is reported. Cerebral angioscintigram and arteriography showed a brachiocephalic and right subclavian stenosis secondary to compression by an extended thyroid nodule.

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Sommario Viene descritto un caso di emiparesi faciobrachiocrurale secondaria ad un evento ischemico a carico della regione temporoparietale destra in una paziente portatrice di gozzo retrosternale. Lo studio angioscintigrafico ed angiografico hanno messo in evidenza una stenosi del tronco brachiocefalico e della succlavia di destra dovuta a compressione da parte della neoformazione tiroidea.