血清维生素D水平与多发性硬化的临床相关性研究

目的评估MS患者与健康对照体内血清维生素D3水平,以及影响MS患者预后神经功能缺损的相关因素。方法 86例缓解复发型多发性硬化(RRMS)患者和86例健康对照组随机纳入研究,评估并统计两组性别、年龄、维生素D3水平,记录患者组家族史、发病时间、病程、随诊期间复发情况。在入组时以及6 m后对患者组进行EDSS评分。结果患者组与健康对照组血清维生素D水平分别为14.70±12.49和20.90±13.00(P=0.002),具有显著统计学差异。患者组复发患者与未复发患者血清维生素D水平分别为9.77±7.86和16.83±13.54(P=0.003),具有显著统计学差异。EDSS评分与血清维生素D水平无明显相关性(r=-0.101,P=0.353)。EDSS评分与年龄(r=0.701,P<0.001)、病程(r=0.752,P<0.001)存在显著正相关关系。结论 MS患者血清维生素D水平显著低于健康对照组,同时与复发相关,但血清维生素D水平与患者预后神经功能缺损未显示相关关系。研究提示MS患者年龄越大、病程越长,患者预后越差。     

43例脑卒中后抑郁状态相关因素分析

目的 探讨脑卒中后抑郁状态发生的相关因素.方法 观察127例脑卒中住院患者抑郁发生情况,将并发抑郁组与未并发抑郁组就年龄、性别、居住情况、神经功能缺损程度评分、卒中类型以及卒中部位等因素进行比较,分析抑郁发生率与病程的关系、抑郁严重程度与神经功能缺损程度评分的关系.结果 2组性别、年龄、卒中类型差异无统计学意义;神经功能缺损程度评分、病变部位、独居丧偶者所占比例差异有统计学意义.结论 脑卒中后抑郁状态的发生与脑损害部位、病情严重程度、病程及家庭社会关系等多因素有关,提示对于具有抑郁高发因素的脑卒中患者应及早干预.     

多发性硬化患者生活质量调查

目的观察多发性硬化(multiple sclerosis,MS)患者扩展残疾状况评分量表(expanded disability status scale,EDSS)评分、病程、年龄及性别与生活质量的关系,初步探讨影响MS患者生活质量的因素。方法对35例MS患者进行EDSS评分,填写MS专用生活质量(MSQOL-54)量表,分别对MS患者的EDSS评分、病程、年龄与MSQOL-54量表评分的相关性进行分析。结果 MS患者EDSS评分与生活质量呈负相关(r=-0.395,P=0.019),但为非线性关系;在MSQOL-54的14个领域中,身体健康状况、因身体问题引起的角色受限、活力、健康的自我感觉、社会功能及总体生活质量与EDSS评分具有相关性;EDSS评分与生活质量评分的"健康变化情况"及"性生活的满意度"无相关性(P=0.108,P=0.1 39);病程、年龄、性别与生活质量均无相关性(P0.05);EDSS评分与病程也无相关性(P=0.925)。结论 EDSS评分在MS早期较晚期更能预测患者生活质量,可作为早期MS患者生活质量的一个预测因子,从而指导临床医生早期关注患者生活质量并进行必要干预。     

多发性硬化认知障碍评估及其影响因素分析

目的了解多发性硬化(MS)患者认知功能障碍的特点及其相关因素分析。方法对41例MS患者及41例健康对照组进行蒙特利尔认知评估量表(MoCA)智能测试和常规头颅磁共振(MRI)检查,对41例MS患者进行扩展功能障碍状态量表(EDSS)检查。结果 MS组MoCA得分较对照组明显降低,差异具有统计学意义(P0.01);MoCA评分降低的项目主要以视空间与执行功能、延迟记忆、命名、语言为著,而注意力、抽象能力、计算力及定向力未见明显受损;MoCA评分除与受教育程度、MS分型具有相关性(Pearson相关系数分别为0.576、0.366,P值分别为0.000、0.019)外,与性别、年龄、病程、EDSS评分及常规头颅MRI病灶等级等临床资料均无相关性(P0.05)。结论 MS患者存在认知功能障碍,以视空间与执行功能、命名、延迟记忆、语言为著,注意、计算、抽象、定向能力未见明显受损;MS患者认知功能障碍与患者性别、年龄、病程、神经功能缺损程度、常规头颅MRI所示病灶等级无相关;躯体功能障碍越严重,视空间与执行功能得分越低,即操作智商得分越低。     

卒中后抑郁及其治疗对神经功能康复的影响

目的　观察卒中后抑郁(PSD)的发生率和相关因素;探讨百优解抗抑郁治疗对卒中后抑郁患者神经功能康复的影响。方法　选取急性脑卒中患者132例(脑梗死78例,脑出血54 例),分别在病程2周、1月、3月、6月、12月行PSD诊断、神经功能缺损评分(SSS)、日常生活能力评分(ADL)、汉密尔顿抑郁量表( HAMD)评分,同时完成Zung’s 抑郁自评量表( SDS)和焦虑自评量表( SAS)。结果　(1)脑卒中患者中约44.70%出现抑郁症状;(2)卒中类型和性别与PSD发生率无相关性(P>0.05);(3)PSD的发生率和严重程度与神经功能缺损和日常生活能力下降程度有关。(4)PSD与病变部位、病灶大小、病灶半球利性均无相关性(P >0.05);(5)百优解能明显改善病程3、6 月时神经功能缺损,病程12月时不仅抑郁症状减轻,日常生活能力改善,神经功能缺损减轻尤为显著。结论　卒中后抑郁是急性脑血管病患者常见的长期并发症,并可影响患者神经功能康复的速度和程度。抗抑郁治疗能在抑郁症状明显改善的同时,促进患者神经功能和日常生活能力的恢复。     

干扰素β-1b对多发性硬化患者生活质量影响的1年随访

目的观察干扰素β-1b(IFNβ-1b)治疗复发缓解型多发性硬化(MS)患者的疗效并进行生活质量评估,进一步探索生活质量的相关因素。方法选择接受IFNB-1b治疗的MS患者13例,并于治疗后第1个月、3个月、6个月、9个月、12个月对患者进行随访,评估包括扩展的功能缺损状况(EDSS)评分、多发性硬化患者生活质量量表(MSQOL-54)及汉密尔顿焦虑抑郁量表(HAMA、HAMD)评分。结果经IFNB1b治疗的MS患者在第1、3、6、9、12个月随访时生活质量、EDSS、HAMA、HAMD评分与治疗前比较均无明显变化(P0.05)。治疗前生活质量中躯体功能、性功能及对性生活满意度与EDSS评分呈负相关(P值均0.05);情绪致角色受限、疼痛与病程呈正相关(P值均0.05);躯体功能、情绪状况、社会功能、性功能及对性生活满意度与HAMA评分呈负相关(P值均0.05);认知、应激与HAMD评分均呈负相关(P值均0.05)。躯体致角色受限、精力、健康认知、总体生活质量及健康变化与病程、EDSS、HAMA、HAMD各项无相关性,年龄与MSQOL-54无关(P值均0.05)。结论 IFNB-1b短期内可能对MS患者生活质量无明显影响,生活质量与患者的EDSS评分、焦虑抑郁症状相关。     

多发性硬化与抑郁、焦虑的相关性研究

目的 探讨多发性硬化(multiple sclerosis,MS)与抑郁、焦虑情感障碍的关系.方法 采用汉密尔顿抑郁量表(Hamilton depression,HAMD)、汉密尔顿焦虑量表(Hamilton Anxiety,HAMA)、扩展的残疾状况评分(Expanded disability status scale,EDSS)量表对86例多发性硬化患者、85例健康对照者进行评分,了解MS伴发抑郁焦虑,同时应用多元回归分析方法对抑郁焦虑障碍的相关因素进行分析.结果 MS患者抑郁障碍发生率为52.3%(45例),焦虑障碍发生率为32.6%(28例),抑郁伴发焦虑26.7%(13例),均较对照组明显升高(P<0.01).病情活动期、EDSS评分高者抑郁发生率亦高,女性患者抑郁发生率高.结论 MS患者抑郁焦虑发生率较高,早期识别及干预可以明显提高患者的生活质量.     

肿瘤坏死因子β水平与多发性硬化临床表现的相关性

目的 探讨肿瘤坏死因子(TNF)β水平与多发性硬化(MS)临床表现的相关性.方法 应用双抗体夹心酶联免疫法测定58例MS患者(MS组)血清TNFβ水平;并与患者不同亚型、病期、神经功能缺损程度的扩展病残状态评分(EDSS)、病程、发病次数、发病年龄等临床情况进行相关性分析.结果 (1)MS组急性期TNFβ水平较缓解期和正常对照组显著升高(P<0.05～0.01);MS缓解期与正常对照组间差异无统计学意义.(2)MS西方型急性期TNFβ水平较缓解期显著升高(P<0.01);MS亚洲型急性期与缓解期差异无统计学意义.(3)两亚型急性期、缓解期TNFβ水平与其EDSS、病程、发病次数及发病年龄均无相关性.结论 (1)TNFβ水平与MS急性期存在相关,MS西方型急性期、缓解期变化更显著.(2)TNFβ水平与EDSS、病程、发病次数及发病年龄可能不相关.     

多发性硬化SF-36的影响因素分析

目的探讨多发性硬化(MS)"健康调查简易量表"(SF-36)的影响因素。方法对比分析MS不同间歇期、发作期、Zung抑郁自评量表(SDS)评分指数、焦虑自评量表(SAS)评分、扩充神经功能残疾量表(EDSS)评分及病程等SF-36各维度,如生理功能(PF)、情感职能(RE)、社会功能(SF)、精神健康(MH)、生理职能(RP)、精力(VT)、躯体疼痛(BP)、总体健康(GH)等参数,提出MS者SF-36的影响因素。结果 MS患者间歇期越缩短、发作期及病程越延长、SDS及SAS和EDSS评分越高,SF-36各维度评分越降低(P0.05或P0.01)。结论间歇期、发作期、SDS评分指数、SAS及EDSS评分、病程等直接影响MS患者的生活质量。     

脑梗死后抑郁症的发生率及相关因素分析

目的 探讨脑梗死后抑郁症（PSD）的发生率及相关因素。方法采用汉密尔顿抑郁量表对450例脑梗死进行分析观察,统计分析抑郁与性别、神经功能缺损程度以及其他因素的相关性。结果PSD发生率为32．2％,PSD发生与年龄、长期疾病困扰、脑梗死后病程、急性期神经功能缺损程度及病灶大小、数量、部位等因素有关。结论脑梗死后抑郁与脑损伤的生物效应有关,且受多种因素影响。     

Cross-cultural adaptation and validation of multiple sclerosis quality of life questionnaire (MSQOL-54) in a Turkish multiple sclerosis sample

OBJECTIVE: Multiple sclerosis (MS) is a chronic progressive disease with multiple neurological impairments. The disease can also dramatically affect the health-related quality of life of patients. The objective of this study was to investigate the validation of the translated and cross-culturally adapted MSQOL-54 in 183 Turkish MS patients. METHODS: 183 adults classified as having definite MS patients were enrolled into the study. Patients were classified into four severity groups according to the expanded disability status scale (EDSS); group I (EDSS 0-4), group II (EDSS 4.5-5.5), group III (EDSS 6-6.5) and group IV (EDSS 7-8). MSQOL-54 questionnaire were translated and culturally adapted into Turkish. Associations between age, gender, disease duration, EDSS score, marital status, education and health insurance and the MSQOL-54 physical and mental health composite scores were determined. RESULTS: The mean age of the 183 patients (138 female and 45 male) was 39+/-10 years. The questionnaire was well accepted but small cultural adaptations were required. EDSS scores showed significant associations with the MSQOL-54 physical and mental health composite scores. From the different EDSS groups only, the group I (EDSS 0-4) score was significantly associated with the physical health composite as well as the disease duration showed significant correlation with the physical and mental composite scores. None of the other EDSS groups and the other parameters showed correlation with physical health composite or mental health composite. CONCLUSION: Assessment of quality of life of MS patients in addition to disease severity and disability level is important, because it provides unique information that is important to patients and to clinicians. A translation of an existing MS-targeted HRQOL measure from US English into Turkish was easily administered and well accepted in a Turkish MS sample.     

女性紧张性头痛及经期偏头痛影响因素的比较

目的比较女性紧张性头痛(TTH)及经期偏头痛(MM)的影响因素。方法收集104例女性TTH患者(TTH组)及91例MM患者(MM组)的临床资料。采用视觉模拟评分法(VAS)和头痛影响测评量表-6(HIT-6)对其头痛程度、生活质量进行评估,并采用汉密尔顿焦虑(HAMA)、抑郁量表(HAMD)对患者情绪障碍进行测定。结果 TTH组与经期相关19例,累积发病率18.3%;MM组与经期相关59例,累积发病率64.8%。与TTH组比较,MM组发病年龄显著降低,病程、家族史,焦虑、抑郁、重度疼痛、HIT-6(Ⅳ级)、共病的比率,以及HAMA、HAMD评分均显著升高(P0.05~0.01),而文化程度、吸烟、饮酒、职业差异无统计学意义(均P0.05)。无先兆的月经相关性偏头痛(MRM)、无先兆的单纯月经性偏头痛(PMM)及非月经性无先兆偏头痛患者发病年龄、家族史、VAS及HIT-6评分差异有统计学意义(P0.05~0.01)。结论与女性TTH比较,MM发病年龄更轻、病程更长,也更易合并焦虑、抑郁。在不同类型MM中,PMM发病年龄更早,有家族史的比率更高;而MRM的重度疼痛率及HIT-6评分最高。     

Fatigue in multiple sclerosis: relationship with disease duration, physical disability, disease pattern, age and sex

To evaluate the relationship between disease duration, disability, disease pattern, age and sex with fatigue in MS patients. One hundred and seventy-three clinically definite MS patients and 87 age-matched healthy controls enrolled in this cross sectional study. Demographic data (sex, age), duration of the disease and disease pattern extracted from patient’s files and Kurtzke Expanded Disability Status Scale (EDSS) were recorded for each patient by an expert neurologist. Participants were asked to answer the validated and reliable Persian version of beck depression inventory (BDI) and FSS (fatigue severity score) questionnaires. Mean FSS and BDI scores were significantly different between patients and controls (p < 0.001). Patients with longer disease duration, higher EDSS and progressive type of disease had significantly higher FSS and BDI scores. Although men had higher EDSS, FSS and BDI scores were similar in both sex groups. FSS was significantly correlated with age, disease duration, BDI and EDSS. The analysis of covariance revealed that there is no difference in the covariance-adjusted means for fatigue among two disease groups (relapsing remitting and secondary progressive) except for EDSS. MS patients with longer disease duration, higher EDSS and progressive type of disease suffer from fatigue more than cases with lower EDSS, duration of disease and relapsing type of the disease.     

Fatigue and its association with sleep disorders,depressive symptoms and anxiety in patients with multiple sclerosis

Background and purposeThe aetiopathogenesis of fatigue in multiple sclerosis (MS) is not clear. It could be associated with structural changes of the central nervous system, but also with mood and sleep disorders. The purpose of the study was to evaluate frequency of fatigue and its association with sleep and mood disorders in MS patients.Material and methodsThe examined group consisted of 122 MS patients (mean age 37.7 ± 10.8 years). The following questionnaires were used: Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), Montgomery-Asberg Depression Rating Scale (MADRS), and Hospital Anxiety and Depression Scale (HADS).ResultsFatigue was present in 75 MS patients (61.5%). Excessive daytime sleepiness was observed in 25 (20.5%), insomnia in 73 patients (59.8%). According to MADRS, depressive symptoms were present in 33 (27%), according to HADS in 15 people (12.3%). Anxiety was present in 32 patients (26.2%). We observed an association between fatigue (FSS) and sleep disorders (ESS, AIS) and also between fatigue and either depression (MADRS, HADS-D) or anxiety (HADS-A). The FSS score was not associated with age, sex, disease course and duration, Expanded Disability Status Stage (EDSS), treatment or level of education in MS patients. In inactive professionally people we noted significantly higher FSS scores (44.8 ± 13.8) in comparison with active individuals (37.2 ± 14.9; p = 0.0053).ConclusionsFatigue is a very common symptom in MS, sometimes associated with sleep disorders, depressive symptoms or anxiety. The treatable causes of fatigue in MS such as sleep and mood disturbances should be identified and treated.     

Multiple sclerosis and depression: influence of interferon beta therapy

BACKGROUND AND OBJECTIVES: Depression is frequently part of the clinical picture of multiple sclerosis (MS). Major depression affects one in two patients with MS during the course of their lifetime. Our objectives were to determine first, whether interferon beta-1a (IFNbeta-1a) treatment increases the risk or level of depression and, secondly, whether depression status and depression evolution are related to the clinical characteristics of the disease. PATIENTS AND METHODS: We investigated 106 consecutive patients with relapsing remitting MS treated with IFNbeta-1a (Avonex). Patients with evidence of severe depression were excluded. The depression status, scored on the Beck Depression Inventory (BDI-II) (stratified as minimum, mild, moderate or severe level), and disability, scored on the Expanded Disability Status Scale (EDSS), were evaluated before and after 12 months of IFNbeta-1a treatment. RESULTS: At baseline, 85% of patients had a minimum or a mild depression status and after 12 months of treatment most of them (83%) retained their baseline status. Beck scores before and after treatment were not significantly different (P = 0.63). There was no correlation between age, gender, duration of illness or EDSS score and Beck score at baseline (P = 0.696). Patients with disability progression after one year of IFNbeta-1a treatment had a significantly higher Beck score at baseline than patients without disability progression (P = 0.003). CONCLUSION: IFNbeta-1a (Avonex) does not seem to significantly influence the depression status of MS patients even in those with disability progression.     

多发性硬化患者抑郁焦虑障碍与生活质量的关系

目的　探讨多发性硬化 ( multiple sclerosis,MS)患者中抑郁焦虑情感障碍发生率及抑郁焦虑与患者生活质量评定的关系。方法　采用汉密尔顿抑郁量表 ( HAMD)、汉密尔顿焦虑量表 ( HAMA)及 Spitzer生活质量指数 ( Spitzer quality of life index,QLI)量表 ,对 5 8例 MS患者及 5 0名健康人进行调查评分 ,并记录扩展的残疾状况评分 ( EDSS)和病程时间。应用多重回归统计方法对上述各项进行相关分析。结果　 MS患者抑郁情绪发生率为 48.3 % ( 2 8/5 8) ,焦虑情绪发生率为 3 2 .7% ( 1 9/5 8) ,抑郁合并焦虑发生率为 2 9.3 % ( 1 7/5 8) ,均较对照组明显升高 ( P <0 .0 1 ) ;生活质量较对照组明显减低 ( P <0 .0 1 )。抑郁焦虑情绪与生活质量有显著相关性 ,其中抑郁情绪为生活质量减低的重要预示因素。结论　MS患者中抑郁焦虑情感障碍发生率较高 ,抑郁焦虑情绪对生活质量评价有显著影响。     

Central nervous system involvement in Turkish children with primary hemophagocytic lymphohistiocytosis

This report mainly presents the clinical and laboratory findings in a group of 15 primary hemophagocytic lymphohistiocytosis patients with central nervous system involvement (group 1) and compares some of the findings with those of 13 hemophagocytic lymphohistiocytosis patients without central nervous system involvement (group 2). Statistical analysis showed that age and sodium level at diagnosis were significantly higher while alanine aminotransferase and bilirubin levels were significantly lower in group 1 than group 2 (P < .05). There were no statistically significant differences between the 2 groups in the other clinical, laboratory, and overall survival parameters. Three patients in group 1 initially had central nervous system involvement in the absence of systemic findings, which led to the initial misdiagnosis of these patients as central nervous system disorders other than hemophagocytic lymphohistiocytosis.     

Depression in multiple sclerosis

Introduction

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. Prevalence of depression in MS is significant. Existence of mood disorders alters the patients’ life quality.

Objective

To determine the prevalence of depression in MS and establish the relationship between the severity of the disease, the onset of depression and their correlation with neuroimaging.

Methods

Fifty patients with MS aged 20 to 50 years followed at the Neurology Department of Charles-Nicolle Hospital from 2008 to 2012 participated in this study. The evaluation included a neuropsychological assessment, physical examination with EDSS and MRI.

Results

Association between MS and depression is common and known. In our study, prevalence of depression was 65%. Coexistence of other psychiatric disorders was found in around 10% of patients. Mood disorder was inaugural in some cases and delayed in others. This suggests that depression in MS may be linked to the disease or a result of a functional disability process. Occurrence of depression was not directly related to disease severity in all cases studied.

Conclusion

Depression is a possible manifestation of MS. This mood disorder is due to the demyelinating brain damage or to a genetic susceptibility. However, a fortuitous association cannot be excluded.     

米氮平与氟西汀治疗老年抑郁症对照研究

目的:比较米氮平和氟西汀对老年抑郁症的疗效和不良反应. 方法:将60例老年抑郁症患者随机分为米氮平组和氟西汀组,分别给予米氮平和氟西汀治疗,疗程6周.采用汉密尔顿抑郁量表(HAMD)及副反应量表(TESS)评定疗效和不良反应. 结果:米氮平组和氟西汀组显效率分别为83.3%和76.7%,二者疗效相仿.HAMD评分米氮平组治疗1周即显著下降,氟西汀组治疗4周时显著下降.米氮平组嗜睡较多,而氟西汀组口干、失眠、兴奋或激越等发生率较高. 结论:米氮平是一种安全、有效的抗抑郁药物,能用于老年抑郁症患者.