急性脑梗死患者血清同型半胱氨酸与胱抑素C水平相关性分析

目的探讨急性脑梗死患者血清同型半胱氨酸(homocysteine,Hcy)、胱抑素C(cystatin C,Cys-C)水平的变化及临床意义。方法对136例急性脑梗死患者进行血清Hcy和胱抑素C检测,并与40例正常健康人作比较。结果急性脑梗死尤其复发组患者血清Hcy与胱抑素C水平显著高于正常对照组(P<0.01),血清Hcy水平与胱抑素C水平呈明显正相关(r=0.594,P<0.01)。结论急性脑梗死患者血清Hcy与胱抑素C水平密切相关。     

血胱抑素C、同型半胱氨酸与急性脑梗死相关性

目的探讨血胱抑素C(Cys C)、同型半胱氨酸(Hcy)与急性脑梗死(ACI)发病的关系。方法采用胶体金颗粒免疫比浊法和酶循环法分别测定120例ACI患者和120例健康者血清中Cys C和Hcy的含量。用SPSS17.0软件进行统计学分析。结果病例组血清Cys C水平为(1.16±0.21)mg·L~(-1),Hcy水平(15.83±3.15)umol·L~(-1),显著高于对照组血清Cys C水平(0.97±0.18)mg·L~(-1),Hcy水平(13.55±2.22)umol·L~(-1)。病例组高血胱抑素C(HCys C)检出率为85.83%,高同型半胱氨酸(Hhcy)检出率为88.33%,显著高于对照组血清HCys C检出率12.50%,Hhcy检出率10.83%,差异有统计学意义(P<0.01)。结论 HCys C及Hhcy与ACI发病直接相关,检测Cys C和Hcy会对理解ACI的潜在发病机制有帮助。     

老年抑郁患者同型半胱氨酸、血清胱抑素C和血尿酸水平及与认知功能的相关性分析

目的观察抑郁发作老年患者血清同型半胱氨酸(Hcy)、血清胱抑素C(Cys-C)、血尿酸(UA)水平及与认知功能的相关性。方法随机选取符合国际疾病分类第十版(ICD-10)的首次抑郁发作的老年患者60例入研究组,招募与研究组相匹配的40例健康志愿者入对照组。测定基线期两组血清Hcy、Cys-C、和UA水平,采用24项汉密顿抑郁量表(HAMD-24)评估抑郁的严重程度,同时采用简易智力状况检查量表(MMSE)及蒙特利尔认知评估量表(Mo CA)评估认知功能。比较两组血清Hcy、Cys-C和UA水平及认知功能的差异,并分析研究组血清Hcy、Cys-C和UA水平与MMSE、Mo CA和HAMD-24总分的相关性。结果基线期研究组血清Hcy、Cys-C水平均高于对照组(t=12.732、4.135,P均0.01),UA水平与对照组比较差异无统计学意义(t=-0.265,P=0.791),MMSE、Mo CA总分低于对照组(t=-5.643、-9.548;P均0.01)。研究组Hcy、Cys-C水平分别与MMSE、Mo CA评分总分呈负相关(r=-0.690、-0.501、-0.301、-0.355,P均0.05),与HAMD-24总分呈正相关(r=0.367、0.390,P均0.01);UA水平与MMSE、Mo CA和HAMD-24总分无相关性(P均 0.05)。结论抑郁发作老年患者存在认知功能障碍;血清Hcy和Cys-C水平与认知功能损害可能相关。     

血清胱抑素C、基质金属蛋白酶-9及同型半胱氨酸与脑梗死关系的研究

目的研究血清胱抑素C(Cys C)、基质金属蛋白酶-9(MMP-9)及同型半胱氨酸(Hcy)与脑梗死的关系。方法选择我院2014年1月至2015年6月入院的80例脑梗死患者作为脑梗死组,选择同期在我院接受体检的30例健康人群作为对照组。比较两组患者的血清Cys C、MMP-9和Hcy水平以及比较脑梗死患者不同病灶大小、预后的血清Cys C、MMP-9、Hcy水平。结果脑梗死组患者的血清Cys C、MMP-9、Hcy水平明显高于对照组(P0.05);恢复期脑梗死组患者的血清Cys C、MMP-9水平低于急性期(P0.05);脑梗死患者恢复期和急性期的Hcy水平相近(P0.05)。脑梗死组患者的血清Cys C、MMP-9水平随梗死灶的增大而升高(P0.05);Hcy水平相近(P0.05)。预后良好组患者的Cys C、MMP-9水平明显低于预后不良组(P0.05);两组患者的Hcy水平相近(P0.05)。多元Logistic回归分析显示血清Cys C(OR=2.724,95%CI=1.318~5.630)、MMP-9(OR=1.936,95%CI=1.362~2.752)和Hcy(OR=4.915,95%CI=1.372~17.607)水平均是脑梗死的危险因素。结论 Cys C、MMP-9和Hcy水平的增高与脑梗死的发生密切相关,Cys C和MMP-9水平还能预测脑梗死患者的预后,具有重要的临床价值。     

血清同型半胱氨酸、纤维蛋白原、胱抑素C水平与急性脑梗死患者NIHSS评分的相关性分析

目的 探讨入院时血清同型半胱氨酸（homocysteine,Hcy）、纤维蛋白原（fibrinogen,FIB）和胱抑素C（cystatin-C,Cys-C）水平与急性脑梗死患者NIHSS评分的关系。方法 回顾性纳入2014年1月-2018年11月于任丘康济新图医院神经内科住院的急性脑梗死患者,依据入院时NIHSS评分分为轻型组（NIHSS评分＜7分）、中型组（7分≤NIHSS评分＜15分）、重型组（NIHSS评分≥15分）。比较三组间血清Hcy、FI B、Cys-C水平差异,进一步用Spearman相关分析评估血清Hcy、FI B、Cys-C水平与NIHSS评分的关系。结果 共纳入4468例患者,中位年龄65.00（65.00～72.00）岁,男性2765例（61.88%）。轻型组3943例（88.25%）,中型组441例（9.87%）,重型组84例（1.88%）。三组间血清Hcy（P＜0.001）、FI B（P＜0.001）、Cys-C（P =0.035）水平比较,整体差异有统计学意义;进一步两两比较发现,轻型组血清Hcy、FI B和Cys-C水平均低于中型组和重型组。Spearman相关分析发现,血清Hcy（r =0.770,P＜0.001）、FI B（r =0.440,P =0.003）、Cys-C（r =0.580,P＜0.001）水平与急性脑梗死患者NIHSS评分呈正相关。结论 急性脑梗死患者血清Hcy、FI B、Cys-C水平与NIHSS评分呈正相关。     

血浆同型半胱氨酸的水平与帕金森病之间的关系

目的 观察血浆同型半胱氨酸的水平与帕金森病之间的关系。方法 检测正常老年人、脑梗死及帕金森病患者的血浆同型半胱氨酸和血脂水平。结果 脑梗死组和帕金森病组的患者血浆同型半胱氨酸的水平明显高于正常老年组（P〈0．01），脑梗死组血浆同型半胱氨酸的水平高于帕金森病组，但无显著性差异（P〉0．05）。帕金森组甘油三脂和低密度脂蛋白检测显著高于正常老年组，但低于脑梗死组。结论 高同型半胱氨酸血症可能是帕金森病的危险因素。     

血清同型半胱氨酸水平与帕金森病的关系

目的探讨帕金森病(PD)患者伴发高同型半胱氨酸血症(HHcy)情况及美多巴对其血清同型半胱氨酸(Hcy)水平的影响。方法选择2006-06-01-2009-12-31入住作者医院的PD患者53例,按入院前是否服用美多巴治疗分为非美多巴组和美多巴组,两组患者入院后均予美多巴口服治疗;另选择31名同期健康体检者为对照。采用荧光偏振免疫分析法(FPIA)检测血清Hcy水平,微粒子酶免分析法(MEIA)检测血清叶酸(FA)及维生素B12(VitB12)水平。收集患者初次就诊及初次复诊时的血清Hcy、FA、VitB12水平资料至2010-01-30,并进行分析比较。结果 (1)初次就诊时非美多巴组和美多巴组PD患者血清Hcy水平〔分别(17.28±6.79)、(18.50±6.56)μmol/L〕均高于健康对照组〔(13.49±3.21)μmol/L〕(均P<0.01),HHcy的比例〔分别为50%(14/28)和76%(19/25)〕亦高于健康对照组〔29%(9/31)〕(均P<0.01),而血清FA、VitB12的水平无统计学差异(均P>0.05)。HHcy患者的血清Hcy水平与FA、VitB12水平无相关性(分别r=0.118,P=0.455;r=0.001,P=0.995)。(2)非美多巴组患者复诊时血清Hcy水平〔(15.84±3.33)μmol/L〕较治疗前〔(12.92±3.15)μmol/L〕升高(P<0.05),血清FA、VitB12水平同治疗前比较无统计学差异(P>0.05)。美多巴组患者服用美多巴治疗后血清Hcy、FA、VitB12水平同初次就诊时比较均无统计学差异(均P>0.05)。结论服用美多巴可能使PD患者血清Hcy水平升高,但可能不是PD患者伴有HHcy的惟一原因。     

帕金森病患者血清CysC、Hcy水平及其对伴发脑白质病变的评估作用

目的 探讨帕金森病患者血清胱抑素C(CysC)、同型半胱氨酸(Hcy)水平及其对伴发脑白质病变的评估作用.方法 回顾性分析2017年12月至2019年12月该院收治的124例帕金森病患者(研究组)和115例在该院进行体检的健康志愿者(对照组)的资料.结果 研究组血清CysC、Hcy水平分别为(1.37±0.25)mg/L、(0.89±0.14)μmol/L,均高于对照组的(20.54±3.21)mg/L、(14.89±2.18)μmol/L,差异有统计学意义(P＜0.05).研究组患者中有35例伴发脑白质病变,发生率为28.23％;研究组中伴发脑白质病变者的血清 CysC、Hcy 水平分别为(1.58±0.29)mg/L、(23.32±3.58)μmol/L,高于无伴发脑白质病变者的(1.29±0.22)mg/L、(19.45±3.12)μmol/L,差异有统计学意义(P＜0.05).年龄、帕金森病病程、高血压病、糖尿病、血清CysC、Hcy均是研究组伴发脑白质病变的危险因素(P＜0.05).血清CysC、Hcy水平评估伴发脑白质病变的Cut-off值分别为1.25 mg/L、21.02 μmol/L,二者联合评估帕金森病伴发脑白质病变的灵敏度、AUC分别为100.00％、0.953,均高于单独指标评估(P＜0.05).结论 帕金森病患者血清CysC、Hcy水平偏高,伴发脑白质病变的风险高;血清CysC、Hcy与年龄、帕金森病病程、高血压病、糖尿病等均是其影响因素;血清CysC、Hcy水平联合评估帕金森病伴发脑白质病变的效能高.     

急性期脑梗死患者血清胱抑素C水平与TOAST分型的关系

目的观察不同病因类型脑梗死患者急性期血清胱抑素C水平,探讨其与TOAST分型的关系。方法测定在我院神经内科住院的发病48h内的201例脑梗死患者血清胱抑素C水平,按TOAST分型将脑梗死患者分为心源性脑梗死(CE)组、大动脉粥样硬化性脑梗死(LAA)组、小动脉闭塞性脑梗死(SAO)组、其他病因明确性脑梗死(OC)组、不明病因性脑梗死(UND)组,并进行统计学分析。结果 LAA组胱抑素C水平明显高于对照组,其余各组胱抑素C水平与对照组差异无统计学意义。结论胱抑素C水平增高可能是LAA及SAO组脑梗死的危险因素,且胱抑素C水平对TOAST分型的提示具有一定的临床意义。     

无症状脑梗死患者胱抑素C、同型半胱氨酸和血脂的相关性分析

目的分析无症状脑梗死患者血清胱抑素C、同型半胱氨酸（Hcy）、血脂等危险因素,探讨其以上指标与无症状脑梗死的相关性。方法选取84例经头颅磁共振（MR）诊断为无症状脑梗死（SCI）患者为实验组及57例头颅MR正常患者为对照组,观察临床危险因素及相关实验室检验指标,进行统计学分析。结果无症状脑梗死血胱抑素C（Cystic C）、同型半胱氨酸（Hcy）、血脂指标中低密度脂蛋白（LDL）、脂蛋白a[Lp（a）]水平均高于对照组,两组间的差异均具有统计学意义（P〈0．05）。结论胱抑素C、同型半胱氨酸、血脂指标中LDL、Lp（a）的升高均是无症状脑梗死发病的的危险因素。     

Serum homocysteine and physical exercise in patients with Parkinson's disease

Background: Hyperhomocysteinemia is a major risk factor for cerebral and peripheral vascular diseases, as well as cortical and hippocampal injury, including an increased risk of dementia and cognitive impairment. Elevated serum homocysteine (Hcy) concentrations are common in patients with Parkinson's disease (PD) who have been treated with levodopa; however, physical exercises can help reduce Hcy concentrations. The aim of the present study was to compare serum Hcy levels in patients with PD who partook in regular physical exercises, sedentary PD patients, and healthy controls. Methods: Sixty individuals were enrolled in the present study across three groups: (i) 17 patients who did not partake of any type of exercise; (ii) 24 PD patients who exercised regularly; and (iii) 19 healthy individuals who did not exercise regularly. All participants were evaluated by Hoehn and Yahr scale, the Unified Parkinson’s Disease Rating Scale (UPDRS) and Schwab and England scale (measure daily functionality). The serum levels of Hcy were analyzed by blood samples collected of each participant. An analysis of variance and a Tukey’s post hoc test were applied to compare and to verify differences between groups. Pearson’s correlation and stepwise multiple regression analyses were used to consider the association between several variables. Results: Mean plasma Hcy concentrations in individuals who exercised regularly were similar to those in the healthy controls and significantly lower than those in the group that did not exercise at all (P= 0.000). In addition, patients who did not exercise were receiving significantly higher doses of levodopa than those patients who exercised regularly (P= 0.001). A positive relationship between levodopa dose and Hcy concentrations (R²= 0.27; P= 0.03) was observed in patients who did not exercise, but not in those patients who exercised regularly (R²= 0.023; P= 0.15). Conclusions: The results of the present study suggest that, even with regular levodopa therapy, Hcy concentrations in PD patients who exercise regularly are significantly lower than in patients who do not exercise and are similar Hcy concentrations in healthy controls.     

Rapid-eye-movement sleep disorders in Parkinson's disease

During the past 10 years, there has been an increasing interest in the study of rapid-eye-movement (REM) sleep in neurodegenerative diseases and more particulary in Parkinson's disease (PD). This interest is justified by the strong association observed between these diseases and REM sleep behavior disorder (RBD). In the first section of this paper, a critical review of the literature on the presence of REM sleep disorders in PD is presented. Studies that show an association between PD and RBD are reviewed. Studies that report the presence of other REM sleep disorders in PD (short latency, abnormal length and/or proportion of REM sleep, increasing occurrence of hallucinations) are then discussed. Limitations of the criteria proposed by Rechtschaffen et Kales (1968) for the quantification of REM sleep are also presented. Some authors believe that dopaminergic (DA) agents used in the treatment of PD (levodopa, bromocriptine, pergolide, pramipexole and selegiline) could be a responsable factor for the occurence of REM sleep disorders observed in this disease. The literature concerning the impact of these DA agents on human REM sleep is therefore critically reviewed. It is concluded that DA agents cannot explain on their own the presence of REM sleep disorders in PD. Other causes, among which the disturbance of some neurochemical systems linked to the neuropathological process of the disease, must be considered in order to explain these REM sleep disorders. In the second section of this paper, we present the different pathophysiological hypotheses proposed to explain REM sleep disorders in PD, such as a dysfunction of the cholinergic, noradrenergic, serotonergic, dopaminergic or GABAergic neurons. Emphasis is placed on the role of cholinergic neurons of the pedunculopontine and laterodorsal tegmental nuclei, structures shown to be particularly impaired in PD. Neurophysiological, neuroanatomical and neuropharmacological studies demonstrate that these neurons are strongly implicated in the different REM sleep parameters (muscular atonia, electroencephalographic desynchronisation, ponto-geniculo-occipital spikes). Finally, future research directions are proposed.     

Sleep disorders and sleep effect in Parkinson's disease

It has been suggested that sleep may have a positive effect on morning motor symptoms in Parkinson's disease (PD). We examined this possibility and also looked at common sleep disorders in PD. Seventy-eight PD patients and 43 normal elderly subjects answered a questionnaire. Of the PD patients, 43.6% reported improved motor symptoms in the morning, 37.2% worse, and 19.2% unchanged compared to the rest of the day. No difference was found between morning-better and -worse groups with respect to age, duration or stage of PD; antiparkinsonian medications utilized, and predominant motor symptoms. However, the morning-same group had a shorter duration of PD and less severe disease and required fewer dopaminergic medications. Sleep disorders were seen with equal frequency in the morning-better and -worse groups. Our results suggest that sleep does not have a direct effect on morning motor function. Alterations in morning motor symptomatology probably represent a manifestation of motor fluctuations. Sleep fragmentation and spontaneous daytime dozing occurred much more frequently in PD patients than controls. In addition, nocturnal vocalizations and daytime hallucinations occurred only in the PD group.     

帕金森病患者睡眠障碍的临床分析

目的探讨帕金森病(PD)患者睡眠障碍的临床特征、睡眠质量评价,并分析其相关影响因素。方法采用匹兹堡睡眠质量指数量表(PSQI)、爱泼沃斯嗜睡量表(ESS)、简明精神状态量表(MMSE)、UPDRS-Ⅲ分量表、Hoehn-Yahr(H-Y)分级、综合医院焦虑/抑郁情绪测定表(HAD)及自制的睡眠情况及用药调查表分别对170例PD患者的睡眠状况、疾病严重程度、认知状况、抑郁程度、病程、多巴胺能药物应用等情况进行评定和计算。结果在170例PD患者中有141例睡眠质量差,发生率为82.9%。其中入睡困难102例(60.0%),睡眠破碎96例(56.5%),白天过度嗜睡59例(34.7%),睡眠运动障碍81例(47.7%)。多因素逐步线性回归分析显示PSQI总分与UPDRS-Ⅲ评分、H-Y分级、HAD评分、MMSE评分、左旋多巴日平均剂量及年龄相关,而与性别和病程长短无关;ESS仅与UPDRS-Ⅲ评分、左旋多巴日平均剂量相关。结论PD患者总体睡眠质量差,睡眠障碍的发生率高,主要表现为入睡困难、睡眠破碎、睡眠运动障碍、白天过度嗜睡等。PD患者睡眠障碍状况受病情严重程度、认知状态、抑郁、年龄、多巴胺能药物应用等因素影响,而与性别、PD病程长短无关。     

Daytime sleepiness and other sleep disorders in Parkinson's disease.

BACKGROUND: PD is associated with a variety of sleep problems. The dopamine agonists (DA) pramipexole and ropinirole were recently implicated in causing "sleep attacks" and motor vehicle accidents. METHODS: In order to determine the overall rate of subjective sleep problems in PD and to determine if any factors, including specific medications, correlate with sleep pathology, the authors surveyed consecutive patients with PD seen over a 3-month period in a Movement Disorders Clinic. The authors collected demographic and medication data, and the patients completed the Epworth Sleepiness Scale (ESS), questions assessing the presence of restless legs syndrome (RLS), a modified National Sleep Foundation sleep survey, and specific questions regarding falling asleep while driving. RESULTS: A total of 320 patients completed the questionnaire. The authors eliminated 17, six for incomplete data and 11 for having a primary diagnosis other than PD. The mean age of the remaining 303 patients was 67.1 +/- 10.7 years, and the mean duration of PD was 9.1 +/- 5.7 years. The ESS scores averaged 11.1 +/- 5.9, and in 50.2% of patients the score was abnormally high (>10). Stepwise regression analysis found that sleepiness correlated with longer duration of PD (p < 0.001), more advanced PD (p < 0.004), male sex (p < 0.001), and the use of any DA (p < 0.003). The soporific effects of the three most common DA (pramipexole, ropinirole, and pergolide) were similar. Falling asleep while driving was reported by 63/279 (22.6%) of current drivers and correlated with higher ESS scores (p < 0.05). Other sleep disorders, including RLS, were also frequently reported. CONCLUSION: Daytime sleepiness is common in PD and correlates with more advanced and longer duration of PD, and male sex. The DA were also independently associated with daytime sleepiness, but in this group, no single DA was more culpable than the others.