喹硫平与舒必利对精神分裂症患者血清泌乳素水平的影响

目的评价喹硫平与舒必利对精神分裂症患者血清泌乳素水平的影响。方法将90例精神分裂症患者随机分为喹硫平组和舒必利组,每组45例,分别口服喹硫平与舒必利治疗,观察4周。抽取同期30名健康体检者设为对照组。于治疗前及治疗第1周、2周、3周、4周末采用阳性与阴性症状量表评定临床疗效,同时采用放射免疫法检测血清泌乳素水平;对照组于人组时检测血清泌乳素。结果治疗后两组阳性与阴性症状量表总分均较治疗前有显著下降（P〈0．05或0．01）;喹硫平组治疗第1周、2周、3周末PANSS总分均较舒必利组下降显著（P〈0．05或0．01）。舒必利组男女患者治疗后血清泌乳素水平均呈持续性升高,治疗第3周、4周末均显著高于奎硫平组和对照组（P〈0．05或0．01）;喹硫平组男女患者治疗前后血清泌乳素水平均无显著变化,且与对照组无显著性差异（P〉0．05）。结论喹硫平治疗精神分裂症疗效显著,较舒必利起效更快,且对血清泌乳素水平无明显影响;而舒必利治疗可引起血清泌乳素水平升高。     

喹硫平与舒必利治疗对精神分裂症患者体质量、血糖及血脂代谢的影响

目的 探讨精神分裂症患者使用喹硫平与舒必利治疗,对患者体质量、血糖及血脂代谢的影响。方法 将90例首发精神分裂症患者按随机数字表法分为2组,每组45例。观察组予以喹硫平组治疗,对照组予以舒必利治疗,均以8周为1个疗程。对2组患者治疗前后的体质量、血糖及血脂水平的变化进行比较。结果 对照组治疗后体质量、空腹血糖、三酰甘油及总胆固醇与治疗前比较均明显升高（均P＜0.05）;观察组治疗后体质量、空腹血糖、三酰甘油及总胆固醇水平与治疗前比较差异均无统计学意义（均P＞0.05）。观察组有4例体质量增加（8.8%,体质量增加≥7%者2例）;对照组有8例体质量增加（17.6%,体质量增加≥7%者6例）,2组体质量比较差异有统计学意义（P＞0.05）。结论 喹硫平用于精神分裂症患者的治疗不会对患者的体质量、血糖及脂代谢产生过多的影响,是理想的治疗药物。     

喹硫平与舒必利对首发精神分裂症患者血糖及血脂代谢的影响

目的研究喹硫平与舒必利对首发精神分裂症患者糖脂代谢的影响.方法 2005年2月至2009年2月入上海市精神卫生中心予喹硫平或舒必利治疗的首发精神分裂症患者167例,分析喹硫平与舒必利治疗8周前后的空腹血糖(FBS)、胆固醇(TC)、甘油三酯(TG)浓度变化.结果 (1)喹硫平治疗后,FBS略有下降,但差异无统计学意义(t=-1.731,P=0.085);舒必利治疗组FBS前后变化不明显(t=1.561,JP=0.120);两组男女间均无差异.(2)喹硫平治疗组TC及TG前后变化不明显,差异均无统计学意义(t=1.647,P=0.102;t=0.552,P=0.582),且男女间无差异.舒必利组治疗后TG明显升高(t=2.355,P=0.024),且女性TG升高的程度显著大于男性患者(t=2.201,P=0.029).(3)舒必利对TC及TG的影响程度均大于喹硫平(t=2.631,P=0.009;t=2.430,P=0.016).结论 喹硫平对首发精神分裂症患者血糖及血脂代谢的影响不大;舒必利使血TG水平升高,且对女性影响大.舒必利对TC及TG的影响均大于喹硫平.     

奎硫平对慢性精神分裂症患者生活质量的影响

目的:探讨奎硫平对慢性精神分裂症患者生活质量的影响。方法:对44例慢性精神分裂症患者随机分为奎硫平组(22例)和舒必利组(22例)治疗6个月。采用阳性症状与阴性症状量表(PA N SS)评定精神症状,副反应量表(TE SS)评定药物不良反应,世界卫生组织生活质量量表(W H O·Q O L-100)和社会功能缺陷筛选量表(SD SS)评定生活质量。结果:治疗6个月后,奎硫平组患者PA N SS所有项目的改善均明显优于舒必利组;奎硫平组患者生活质量总评、生理领域、心理领域、独立性领域、社会关系领域和环境领域的改善明显优于舒必利组;SD SS评分奎硫平组明显低于舒必利组;奎硫平组不良反应少于舒必利组。结论:奎硫平改善慢性精神分裂症患者的生活质量优于舒必利,有利于患者重返社会。     

阿立哌唑与舒必利联合治疗精神分裂症对比分析

目的 探讨阿立哌唑联合舒必利治疗精神分裂症的疗效和安全性.方法 将80例精神分裂症患者随机分为阿立哌唑联合舒必利组和舒必利组各40例,共治疗8周,在治疗前及治疗后1、2、4、6、8周末分别采用PANSS、TESS进行评定.结果 两组治疗前后PANSS评分均明显降低,阿立哌唑组在第2、4、6、8周PANSS评分少于舒必利组.结论 阿立哌唑联合舒必利组能更快地改善精神症状,不良反应未见增高.     

精神分裂症患者脑脊液单胺类神经递质检测与疗效的相关性研究

目的　探讨精神分裂症患者脑脊液 (CSF)内多巴胺 (DA)、高香草酸 (HVA)含量的变化及其临床意义。方法　 86例首发精神分裂症 ,用利培酮治疗 6个月 ,于治疗前及治疗后第 6个月末采用高效液相色谱 -电化学 (HPLC -ECD)法检测CSF中的DA及HVA含量 ,并与 32名健康人进行对照 ,患者组同时用PANSS量表评定其临床疗效。结果　患者组治疗前CSF中DA和HVA含量分别为 (3.2 3± 0 .36 ) / μmol/L和 (1.99± 0 .4 9) μmol/L ,显著高于对照组 (2 .4 4± 0 .32 ) μmol/L和 (1.4 1± 0 .37)βmol/L ,(P均 <0 .0 1) ;治疗后第 6个月末 ,分别为 (2 .4 9± 0 .35 ) μmol/L和 (1.4 2± 0 .2 8) μmol/L。其前后降低值与PANSS量表总分的减分差值里显著正相关。结论　精神分裂症患者CSF内DA和HVA含量显著增高 ,利培酮对精神分裂症的疗效与DA和HVA含量的变化密切相关 ,同时进一步验证了精神分裂症患者中枢神经系统DA功能亢进的假说     

氯氮平与舒必利对精神分裂症患者体重影响的对比观察

为探讨氯氮平与舒必利对精神分裂症患者体重影响的差别,将540名患者随机分为两组,分别服用氯氮平或舒必利,并对两组治疗前、治疗两个月及治疗一年测量体重并进行统计学分析。结果,两组患者体重在治疗两个月均不同程度的增加,且两组间无差异性;长期服药则舒必利组继续增加,氯氮平组基本不变。提示:两药对精神分裂症患者体重影响早期基本一致,而后期则舒必利影响较大。     

立体定向手术对难治性精神分裂症患者血浆高香草酸含量的影响

目的探讨立体定向术对难治性精神分裂症患者中枢多巴胺代谢产物血浆高香草酸(pHVA)的影响。方法立体定向术治疗难治性精神分裂症患者48例,以阳性和阴性症状量表(PANSS)评定手术疗效。荧光分光光度法测定手术前后患者pHVA。结果难治性精神病患者手术治疗前,其pHVA含量〔(1.39±0.30)μmol/L〕与对照组含量〔(1.28±0.53)μmol/L〕的差异无显著性(P>0.05),而手术治疗后pHVA含量〔(0.61±0.13)μmol/L〕明显低于治疗前(P<0.01)。手术前患者组pHVA含量与PANSS阳性症状评分〔(18.6±4.4)分〕呈正相关(r=0.42,P<0.01)。治疗前后pHVA含量差值〔(0.79±0.33)μmol/L〕与PANSS阳性症状评分减分值〔(10.4±5.5)分〕呈正相关(r=0.69,P<0.01)。结论立体定向手术可显著降低难治性精神分裂症患者pHVA,基础pHVA含量及治疗前后pHVA水平的变化与临床立体定向手术疗效有明显的相关性。     

氯氮平、舒必利及氯氮平合并舒必利治疗精神分裂症阴性症状的对照分析

作者对93例以阴性症状为主要临床相的精神分裂症患者分别应用氯氮平、舒必利及氯氮平合并舒必利治疗，并就其疗效与治疗前后SANS量表分进行分析。结果发现，三者疗效相近，治疗后SANS虽表分氯氮平组与舒必利组无明显差异，合并用药组治疗后SANS量表分明显低于氯氮平组和舒必利组，特别是情感平淡、思维贫乏两个症状分改善明显。     

喹硫平与舒必利治疗以阴性症状为主的精神分裂症对照研究

目的：探讨喹硫平与舒必利治疗以阴性症状为主的精神分裂症患者的临床疗效及安全性。方法将106例以阴性症状为主的精神分裂症患者随机分为两组,分别口服喹硫平、舒必利治疗,比较两组的临床疗效及不良反应。结果喹硫平组总有效率为88．7％,舒必利组为62．3％,喹硫平组显著高于舒必利组（ P＜0．01）。喹硫平组副反应量表的行为、神经系统、植物神经系统不良反应评分均显著低于舒必利组（P＜0．01）。结论喹硫平治疗以阴性症状为主的精神分裂症临床疗效显著优于舒必利,能有效改善患者的阴性症状,安全性高,值得在临床推广应用。     

奥扎格雷钠对急性脑梗死患者血浆溶血磷脂酸及酸性磷脂的影响

目的观察奥扎格雷钠治疗急性脑梗死的疗效及对血浆溶血磷脂酸(LPA)和酸性磷脂(AP)的影响。方法 72例该病患者随机分为治疗组和对照组,两组均常规应用阿司匹林抗血小板聚集、营养脑细胞、脱水降颅压等对症支持处理,治疗组加用奥扎格雷钠治疗。比较两组治疗前后疗效、神经功能缺损评分及血浆LPA、AP水平。结果治疗组总有效率显著高于对照组(P<0.05)。两组治疗后血浆神经功能缺损评分、LPA、AP较前均显著下降(P<0.05),且治疗后治疗组神经功能缺损评分、LPA、AP均显著低于对照组(P<0.05)。结论奥扎格雷钠治疗急性脑梗死疗效确切,可降低血浆LPA和AP水平。     

抑郁症患者抗抑郁治疗前后细胞免疫及单胺类神经递质代谢产物的变化特征

背景近期的研究表明细胞因子不但是免疫调节因子,而且具有广泛的中枢调节作用,对神经递质的合成和代谢产生影响.抑郁症的发病机制有着多种假说,但目前研究结果尚不一致.目的探讨抑郁症患者抗抑郁剂治疗前后的细胞免疫及单胺类神经递质代谢产物的改变.设计以诊断为依据的病例对照研究.地点、对象和方法采用酶联免疫吸附法和高效液相电化学检测法,对南京医科大学脑科医院就诊的40例抑郁症患者在治疗前和抗抑郁药治疗4周后的血浆细胞因子白介素2(IL-2)和IL-6以及单胺代谢产物5-羟吲哚乙酸(5-hydroxyindoleacetic acid,5-HIAA)、3-甲基-4-羟-苯乙二醇(3-methoxy-4-hydroxyphenylglycol,MHPG)和高香草酸的水平进行测定,并以20例健康人作为对照组.主要观察指标抑郁症患者治疗前后与对照组血浆IL-2,IL-6,5-HIAA,MHPG和高香草酸水平的比较;抑郁症患者治疗前后血浆IL-2,IL-6与5-HIAA,MHPG,高香草酸的相关性.结果抑郁症组治疗前血浆IL-2,IL-6水平[(4.11±0.53),(41.08±4.85)μg/L]明显高于正常对照组[(3.24±0.53),(35.8l±4.32)μg/L](P＜0.01),经过4周抗抑郁剂治疗后,随着病情显著好转IL-2,IL-6水平较治疗前显著降低(P＜0.01);抑郁症组治疗前血浆5-HIAA,MHPG,高香草酸浓度显著低于正常对照组(P＜0.05),治疗后5-HIAA,MHPG明显高于治疗前(P＜0.05);治疗前后血浆5-HIAA的差值与治疗前后IL-2,IL-6的差值均呈显著的负相关(r=-0.42,-0.36,P＜0.05).结论抑郁症患者可能伴有免疫激活和炎症反应;抑郁症患者存在中枢5-羟色胺和去甲肾上腺素功能低下;IL-2,IL-6可影响中枢的5-羟色胺活动.     

Clinical and biochemical effects during treatment of depression with nortriptyline: the role of 10-hydroxynortriptyline

Plasma concentrations of nortriptyline (NT) and its major metabolite 10-hydroxy-NT (10-OH-NT) were measured in 30 patients with depression, treated with NT for 3 weeks. Nine patients who recovered completely had plasma concentrations of NT and 10-OH-NT ranging from 358 to 728 nmol/L and from 428 to 688 nmol/L, respectively. Of the 21 patients who did not recover completely, only four had plasma concentrations within the window limited by these two plasma concentration ranges. A correlation was found between the degree of amelioration and the plasma concentration of NT (rs = 0.469; P less than 0.01). Lumbar punctures were performed in 26 patients before and after 3 weeks of NT treatment. During treatment there was a 30.9% mean decrease in the noradrenaline metabolite 4-hydroxy-3-methoxyphenylglycol (HMPG) in cerebrospinal fluid (CSF). We could not evaluate the extent to which this decrease was caused by NT or 10-OH-NT, respectively, because both are strong inhibitors of noradrenaline uptake. The ratio between the concentration of NT and 10-OH-NT in CSF correlated to the reduction of HMPG in CSF (r = 0.397; P less than 0.05) and to the amelioration of depression (rs = 0.623; P less than 0.001). This might indicate that NT and 10-OH-NT interact on the noradrenaline system in a nonadditive way. During treatment there was a 15.2% decrease in CSF concentration of the serotonin metabolite 5-hydroxyindoleacetic acid. The reduction was significantly correlated to the CSF concentration of NT but not to that of 10-OH-NT. This is in accordance with the fact that NT is a more potent inhibitor of serotonin uptake than is 10-OH-NT. The dopamine metabolite homovanillic acid in CSF decreased significantly by 10.0%. The biochemical data indicate that noradrenergic, serotoninergic, and dopaminergic systems are affected by NT treatment and that 10-OH-NT might be more selective on noradrenergic neurons than the parent drug.     

Lysosomal enzymes, amino acids and acid metabolites of amines in Huntington's chorea

The activity of acid phosphatase in cerebrospinal fluid (CSF) from 7 Huntington's chorea patients tended to he higher than in 7 controls. The activity of arylsulphatase in CSF was the same in the two groups. In the Huntington's group, but not in the control group, the activity of acid phosphatase in CSF was positively correlated with age. No correlation was found between the CSF and serum levels of acid phosphatase and arylsulphatase. The concentrations of tyrosine, tryptophan, homovanillic acid and 5-hydroxyindolylacetic acid in CSF from the Huntington's chorea patients were not significantly different from control values. The concentration of tryptophan, but not of tyrosine, was significantly reduced in plasma from fasted Huntington's chorea patients.     

The neurochemistry of Parkinson's disease: effect of L-dopa therapy.

Post-mortem brain material from control and Parkinson's disease patients was examined to elucidate further the neurochemistry of this disease and to determine the mechanism of action of L-dopa as a therapeutic agent. The activities of L-aromatic amino acid decarboxylase (dopa D), tyrosine hydroxylase, monoamine oxidase and catechol-O-methyl transferase were examined; in addition the tissue levels of dopa, 3-O-methyldopa, dopamine (DA) and homovanillic acid (HVA) were determined. In the non-dopa-treated Parkinsonian patients, the greatest decreases were detected for striatal DA and dopa D, with homovanillic acid and tyrosine hydroxylase levels showing a lesser change. The activities of monoamine oxidase and catechol-O-methyl transferase in the striatal nuclei were not different from the controls. The putamen was consistently the most severely affected region. Dopa and 3-O-methyldopa were detectable in all brain areas only in those patients treated with L-dopa shortly before death. The mean concentrations of DA in the striatum of these patients were 1) 9 to 15 times higher than those in non-dopa-treated patients, 2) related to the time before death of the last dose of L-dopa and 3) greater in the striatum of patients clinically classified as "good responders" as compared to "poor responders." Although L-dopa therapy increased homovanillic acid levels in all brain areas, a preferential increase was observed in the striatum. It was concluded that L-dopa's principal therapeutic effects in Parkinson's disease are consistent with its transformation to DA in the striatum.     

The effect of vitamin C in high doses on plasma and biliary lipid composition in patients with cholesterol gallstones: prolongation of the nucleation time

Vitamin C deficiency in guinea pigs leads to cholesterol supersaturation of bile and formation of cholesterol gallstones. It has been suggested that there may also exist an association between vitamin C and cholesterol gallstones in man, but such a relationship has not been studied in gallstone patients. In order to study the possible effects of vitamin C on gallstone disease in humans, plasma lipid levels, hepatic cholesterol metabolism, biliary lipid composition, cholesterol saturation and nucleation time of gallbladder bile were analysed in 16 consecutive gallstone patients, who were planned for laparoscopic cholecystectomy and were treated with vitamin C (500 mg, four times a day) for 2 weeks before surgery. The plasma concentration of vitamin C increased by 42% in the treatment group. The concentrations of plasma lipids did not differ before and after vitamin C treatment; nor did the plasma levels of lathosterol and 7α-hydroxy-4-cholesten-3-one, reflecting cholesterol and bile acid synthesis respectively. The relative concentrations of cholesterol, bile acids and cholesterol concentration of bile did not differ significantly between the two groups, but the relative concentration of phospholipids was slightly higher in the treated group. The bile acid composition was changed; the percentage of cholic acid being lower and those of deoxycholic acid, ursodeoxycholic acid and lithocholic acid higher in the vitamin C-treated patients compared with the untreated group. The nucleation time was significantly longer in the treatment group (7 days) compared with the untreated group (2 days). Our findings indicate that vitamin C supplementation may also influence the conditions for cholesterol gallstone formation in humans.     

单用玻璃酸钠注射与联合外用奇正消痛贴膏治疗髌骨关节炎的临床疗效

目的比较单用玻璃酸钠注射与联合外用奇正消痛贴膏外用治疗髌骨关节炎的临床疗效。方法选取2006年8月至2010年10月确诊为髌骨关节炎患者88例,随机分为治疗组(膝关节内玻璃酸钠注射联合奇正消痛贴膏外用)与对照组(单纯膝关节内玻璃酸钠注射),两组各44例。分别观察两组治疗前与治疗后1个月行膝关节评分(HSS评分)。结果治疗后两组HSS评分均分别较治疗前明显增加(P<0.05),且治疗组高于对照组(P<0.01)。结论膝关节内玻璃酸钠注射联合奇正消痛贴膏外用治疗髌骨关节炎的临床疗效优于单纯膝关节内玻璃酸钠注射治疗。     

体外膜肺氧合治疗ARDS期间氧代谢变化与预后的关系

目的探讨体外膜肺氧合（ECMO）治疗重症急性呼吸窘迫综合征（ARDS）期间的氧代谢、乳酸水平的变化与预后的关系。方法回顾性分析17例机械通气效果不佳、应用体外膜肺氧合治疗的急性呼吸窘迫综合征患者,以应用ECMO后30d为观察终点,分为存活组和死亡组,统计分析治疗前后两组患者的氧代谢、血乳酸水平变化,分析各项指标与预后的关系。结果应用体外膜肺氧合后,患者氧代谢情况明显改善,10例患者治愈,7例死亡。两组患者应用ECMO后氧供、氧耗均明显增加,存活组患者的氧摄取率基本维持在正常水平,乳酸水平呈下降趋势。死亡组患者的氧摄取率明显提高,乳酸水平未见明显下降。结论体外膜肺氧合治疗重症急性呼吸窘迫综合征,氧摄取率维持在正常水平、乳酸水平逐渐下降提示预后良好。     

Difficulties in establishing reference intervals for special fluids: the example of 5-hydroxyindoleacetic acid and homovanillic acid in cerebrospinal fluid.

Biochemical measurements in "special fluids" are complicated with the problem of reference intervals. Reference intervals are difficult to establish for these types of samples since they are usually only collected in patients with clinical suspicion of disease. Determination of neurotransmitter metabolites in cerebrospinal fluid illustrates this difficulty. This paper will review the factors and circumstances that have been identified or are suspected to modify the concentration of 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) in cerebrospinal fluid. In addition to obvious parameters such as age-related variation that can affect the concentration of 5-HIAA and HVA in cerebrospinal fluid, a variety of other factors can explain the wide range of "control" group sizes reported in the literature. Reference intervals must take into account the purpose of cerebrospinal fluid examinations, whether they be prospective studies to explore physio-pathologic relationships or for diagnostic purposes. In the latter case, certain neurological disorders cannot be excluded if a single measured value is within the reference interval.     

The secretion of ibuprofen metabolites interferes with the capillary chromatography of urinary homovanillic acid and 4-hydroxy-3-methoxymandelic acid in neuroblastoma diagnosis.

Neuroblastoma is the most common extracranial solid tumor in children. Abnormal secretion of catecholamines in tissues and body fluids allows for the differential diagnosis of neuroblastoma from other neoplasms and its distinction from non-neoplastic inflammatory diseases. This is achieved by assaying homovanillic acid and 4-hydroxy-3-methoxymandelic acid, the catabolites of catecholamine metabolism. In the course of an evaluation of children with suspected neuroblastoma, homovanillic acid and 4-hydroxy-3-methoxymandelic acid were analyzed in urine samples by capillary gas chromatography with flame ionization detection after extraction and derivatization of these compounds as trimethylsilyl derivatives. In three urine samples a significant increase in biogenic amines was observed, but these results were not confirmed by thin-layer chromatography. Patient history revealed that these children had been treated with ibuprofen, an analgesic and anti-inflammatory drug. To verify how ibuprofen or its metabolites may have interfered with capillary gas chromatography with flame ionization detection, we analyzed the same samples by capillary gas chromatography-mass spectrometry. In urine samples from patients on the drug, the presence of a peak identified as the trimethylsilyl ester of hydroxyibuprofen, which had the same retention time as 4-hydroxy-3-methoxymandelic acid, was found to interfere with the capillary gas chromatography with flame ionization detection analysis of the metabolite. This interference must be taken into account during the laboratory diagnosis of neuroblastoma.