新生儿缺氧缺血性脑病与肾功能损害的关系

目的探讨新生儿缺氧缺血性脑病（HIE）与肾功能损害的关系。方法对70例HIE新生儿50例正常新生儿作血尿素氮（BUN）与肌酐（Cr）检测，并进行分析观察。结果70例HIE惠儿中BUN〉7．14mmol／L32例，血Cr〉88．4μmol／L47例。HIE组BUN、Cr显著高于正常对照组（P〈0．01），重度HIE组BUN、Cr显著高于中度组（P〈0．05），中度组HIE显著高于轻度组HIE组（P〈0．05）。结论新生儿窒息缺氧套导致脑损伤和肾功能损害。血BUN、Cr可作为判断肾功能受损的指标。本组结果显示，HIE惠儿常伴有肾功能损害，HIE程度越重，血BUN、Cr值越高，指示HIE程度与肾功能受损相关。因此治疗HIE惠儿时应检测肾功能，以便早期发现肾损害并及时进行治疗。     

安理申治疗轻中度血管性痴呆的有效性及安全性分析

目的评价安理申治疗轻、中度血管性痴呆（VD）患者的有效性及安全性。方法对86例轻、中度VD患者（简易精神状态检查表（MMSE）得分10-24分]随机分为两组,治疗组和对照组,进行12周临床试验。以MMSE为主要评价指标,日常生活能力量表（ADL）和临床痴呆程度量表（CDR）为次要评价指标。结果结果表明,5mg／d安理申治疗12周时,安理申组较安慰组MMSE、ADL、CDR分数显著改善（依次P〈0．01、〈0．05、〈0．01）。自身对照研究结果显示,5mg／d安理申治疗12周时,治疗后较治疗前MMSE、CDR、ADL分数分别改善3．5、0．6、7．0分（依次P〈0．01、〈0．05、〈0．01）。安理申治疗4周时MMSE分数已有提高（P〈0．05）。结论安理申可显著改善轻中度VD病人的认知功能、痴呆程度和日常生活自理能力,且安全性和耐受性良好,是VD治疗的有效药物之一。     

急性脑梗死患者血浆脑利钠肽变化及左心室功能的研究

目的 通过血浆N端脑利钠肽前体（NT-proBNP）测定及超声心动图检查,观察急性脑梗死患者血浆N端脑利钠肽（NT-proBNP）的变化及与心脏左心室功能（LVF）的关系,为防治急性脑梗死所致心脏损害提供依据。方法选择发病48h内经临床和颅脑CT检查确诊的急性脑梗死患者25例作为研究对象,所有患者既往无心脏病史,并除外心功能不全、心律失常等心脏并发症。选择性别和年龄相当的25例正常人作为对照组。以上2组均行超声心动图检查,同时抽血检测血浆NT-proBNP,对结果进行分析。结果（1）急性脑梗死组血浆NT-proBNP浓度高于正常对照组,二者比较差异有统计学意义（P〈0．01）。（2）急性脑梗死组心脏每搏输出量（SV）、心输出量（CO）明显低于正常对照组（39.4-13vs54±12,P〈0．01;3．10±1．49vs3．89±1．34,P=0．020）。（3）急性脑梗死组左室射血分数（LVEF）明显低于正常对照组（45±15VS66±10,P〈0．01）。（4）急性脑梗死组E峰最大速度／A峰最大速度（E／A）与正常对照组比较差异有统计学意义（0．98±0．30vs1．46±0．21,P〈0．01）。结论急性脑梗死发病后血浆NT-proBNP浓度升高;急性脑梗死可引起左心室收缩及舒张功能下降,可能主要与急性脑梗死本身的病理生理机制有关。     

躯体化障碍与以躯体症状为主诉的抑郁症个性、躯体主诉、生活质量比较

目的探讨躯体化障碍与以躯体症状为主诉的抑郁症患者个性、躯体主诉、生活质量差异。方法对30例躯体化障碍和30例以躯体症状为主诉的抑郁症患者分别采用自编躯体症状主诉频数表,艾森克人格问卷（EPQ）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、健康状况调查问卷（SF-36）等进行评定,对影响生活质量的某些因素进行多元回归分析。结果两组躯体主诉无显著性差异（P〉0．0．5）;躯体化障碍组E分显著低于抑郁症组,N分显著高于抑郁症组（P〈0．05）;两组HAMD总分无差异（P〉0．05）,躯体化障碍组焦虑／躯体化及认知障碍因子分显著高于抑郁症（P〈0．05）,躯体化障碍的HAMA总分及躯体性焦虑分显著高于抑郁症组（P〈0．05）;躯体化障碍组生理机能、生理职能、躯体疼痛分量表评分均显著低于抑郁症组（P〈0．05）;多元回归分析结果,影响两组患者生活质量的主要因素依次为HAMD总分、HAMA总分、EPQ精神质因子、病程。结论躯体化障碍与以躯体症状为主诉的抑郁症患者在个性、HAMA总分、躯体焦虑因子分、生活质量方面有差异,两者的个性、疾病严重程度、病程为影响生活质量的重要因素。     

轻度认知障碍患者的经颅多普勒屏气试验临床研究

目的应用经颅多普勒（TCD）进行屏气试验检测,观察轻度认知障碍（MCI）患者的脑血管反应性（CVR）特点。方法180例受试者编入正常对照组、MCI组及阿尔茨海默病（Alzheimerdis—ease,AD）,分析屏气指数（BHI）与认知功能及脑血流动力学指标的关系。结果MCI组与正常组及AD组比较,BHI结果有统计学意义（P〈0．01）;BHI与视觉ERP的P300潜伏期的相关性最强（r=0．411,P〈0．001）;MCI组不同CVR状态下,各组受试者脑动脉硬化及血管狭窄检出率有差异,事件相关电位（ERP）和TCD常规检测指标比较有统计学意义（P〈0．05）。结论BHI的改变与MCI患者的认知功能损害密切相关,CVR检测有助于MCI的病因诊断。     

VEGF表达对大鼠坐骨神经嵌压性损害的神经保护作用

目的 探讨血管内皮细胞生长因子（VEGF）的表达对周围神经嵌压症病理损伤和神经功能损害的保护作用。方法 将80只SD大鼠按体重随机分层分组制作坐骨神经嵌压性损害的动物模型，取嵌压后第12小时、72小时、7天与第4周的大鼠坐骨神经，分别采用免疫组化与病理学、电生理学的方法检测VEGF水平与病理变化、神经传导速度、脊髓神经元计数等，并将各项检测结果进行对比，运用正常对照组、模型组、前列地尔组和盐酸丁咯地尔组采用SAS统计软件9．1．3进行方差分析统计处理。结果 （1）嵌压大鼠坐骨神经后，除正常对照组外12h起各组背根神经节细胞VEGF表达开始增加，72h达到高峰后开始下降，一周时接近正常水平。正常对照组只轻度表达。与正常对照组比较，其余各组各时段背根神经节细胞VEGF表达水平均显著增加（P〈0．05），前列地尔组和盐酸丁咯地尔组较模型组为优（P〈0．05）、表达的数量增加、持续时间延长。（2）嵌压大鼠坐骨神经4周后，正常对照组正常，其余各组病理变化、脊髓神经元计数均明显较正常对照组差（P〈0．01）；而前列地尔组和盐酸丁咯地尔组第4周时上述诸项结果虽较正常对照组差（P〈0．05），但均较模型组为优（P〈0．05）。（3）嵌压大鼠坐骨神经4周时，正常对照组正常，其余各组大鼠坐骨神经传导速度均明显较正常对照组差（P〈0．01）；而前列地尔组和盐酸丁咯地尔组第4周时上述诸项结果虽较正常对照组差（P〈0．05），但均较模型组为优（P〈0．05）。（4）VEGF表达增加组之病理改变减轻、神经功能恢复增加。结论对于周围神经嵌压性损害，VEGF表达的增加可减轻周围神经病理损害、提高神经传导速度、促进周围神经损伤的修复。     

地震中亲人丧失对胎儿、婴幼儿成年后睡眠质量的远期影响

目的探讨地震中亲人丧失对胎儿、婴幼儿人群成年后睡眠质量的远期影响。方法研究对象为胎儿或婴幼儿阶段经历了1976年7月28日唐山大地震,此后一直居住在唐山的330人,在地震发生40年后采集一般人口学资料和地震中亲人丧失情况,进行匹兹堡睡眠量表、社会支持量表、儿童期创伤问卷的评定。结果完成评估的309人中低睡眠质量检出率为12．6％（39／309）,地震中有亲人丧失组人群低睡眠质量检出率高于无亲人丧失组,差异有统计学意5％（17．6％比8．1％,χ2=6．199,P=0．013）。睡眠正常组与低睡眠质量组人群的儿童期情感虐待、社会支持利用度差异有统计学意义（Z=12．087,-2．551;P〈0．05）。非条件Loostic回归分析显示,地震中丧失亲人是低睡眠质量的危险因素（OR=2．293,95％CI=1．115～4．714）。结论地震中亲人丧失是胎儿、婴幼儿成年后低睡眠质量的危险因素。     

醛糖还原酶抑制剂对实验性糖尿病周围神经病大鼠内源性NGF水平及生理功能的影响

目的探讨神经生长因子（NGF）在糖尿病周围神经病（DNP）发病中的作用以及醛糖还原酶抑制剂（ARI）改善生理功能和NGF水平的作用机制。方法采用链脲佐菌素（STZ）制成大鼠DNP模型后给予ARI治疗,检测大鼠治疗前后摇尾阈值、神经电生理和血清及坐骨神经NGF水平,并与DNP模型组和健康对照组相比较。结果与健康对照组比较,DNP模型大鼠摇尾阈值升高（（49．56±0．32）℃vs．（47．60±1．37）℃,P〈0．053,运动神经传导速度（MNCV）和感觉神经传导速度（SNCV）均下降[（32．82±2．96）m／s％（52．76±6.52）m／s,P〈0．05;（39．22±8．15）m／s vs （45．33±8．21）m／s,P〈0．053,血清和坐骨神经中NGF水平下降[分别为（154．82±136．18）pg／mL vs （313．71±156．99）pg／mL,P〈0．05;（457．40±187．59）pg／mL％（688．93±167．85）pg／mL,P〈0．053。经ARI治疗后大鼠摇尾阈值显著低于DNP模型组（P〈0．05）,SNCV、血清及坐骨神经中NGF水平均显著高于DNP模型组（P〈0．05）,同时经ARI治疗后其摇尾阈值较治疗前显著降低,SNCV、MNCV较治疗前显著增高（P〈0．05）。结论NGF表达或运输水平下降在DNP发病中具有作用。ARI可促进NGF的表达并改善热痛觉和神经传导速度。     

肝豆状核变性患者流体智力的神经心理学研究

目的：通过神经心理学测验评估肝豆状核变性（HLD）患者的流体智力变化特点，探讨HLD患者流体智力变化的发生机制。方法：选取102例HLD患者为研究对象，根据颅脑影像学有无异常分为CT／MRI阳性组（70例）和CT／MRI阴性组（32例X另选正常对照组30例。记录瑞文标准推理测验（R＇SPM）总分和分项结果。结果：3组间比较在R’SPM总分、知觉辨别、系列关系及抽象推理上差异有显著统计学意义（P〈0．01）；在R’SPM比较推理上差异有统计学意义（P〈0．05）。与对照组比较，CT／MRI阳性组在R’SPM总分、知觉辨别、系列关系及抽象推理上差异有显著统计学意义（P〈0．01），在R’SPM类同比较、比较推理上差异有统计学意义（P〈0．05）；与CT／MRI阴性组比较，CT／MRI阳性组在R’SPM系列关系上差异有显著统计学意义（P〈0．叭），在总分、知觉辨别、抽象推理上差异有统计学意义（P〈0．05）。CT／MRI阳性组R’SPM与病程呈负相关（P〈0．05，P〈0．01）。结论：CT／MRI异常HLD患者存在流体智力缺陷；基底神经节器质性破坏及大脑广泛性萎缩可能是HLD患者流体智力缺陷的重要机制之一。     

血纤溶活性变化对颈动脉粥样硬化和急性脑梗死患者的影响和分析

目的：研究血纤溶活性变化对颈动脉粥样硬化患者和急性脑梗死患者的影响。方法：67例急性脑梗死患者（ACI组）和62名健康体检老年人（对照组），均行彩色多普勒超声诊断仪超声观察颈动脉有无斑块；同时测定血浆组织型纤溶酶原激活物（t-PA）和纤溶酶原激活物抑制物-1（PAI-1）的活性。结果：对照组中有颈动脉斑块者与无颈动脉斑块者相比，血浆t-PA降低，PAI-1升高，P／t值升高（P〈0．05）；观察组颈动脉斑块发生率明显高于对照组（P〈0．05）；观察组患者急性期血浆t-PA、PAI-1升高，P／t值减少（P〈0．05）。结论：颈动脉硬化时，机体纤溶活性处于减低状态；急性脑梗死发生时，纤溶活性处于相对亢进状态。     

Panic disorder, trait anxiety, and alcohol use in pregnant and nonpregnant women

OBJECTIVE: The present study examined differences in rates of panic disorder and trait anxiety in pregnant and nonpregnant women receiving care at an urban obstetrics and gynecology clinic. The study further examined correlates and differences in alcohol use among these women. In addition, the study assessed whether panic disorder and trait anxiety influence alcohol use and whether pregnancy status moderates these associations. METHODS: The sample consisted of 412 pregnant and 139 nonpregnant women receiving care at Virginia Commonwealth University (VCU) Health Systems' obstetrics and gynecology clinics for the first time. Participants completed a questionnaire packet, including instruments about emotional and psychologic functioning (eg, panic disorder, anxiety), health-related behaviors (eg, alcohol use), and demographic information. RESULTS: Pregnant women were less likely than nonpregnant women to have panic disorder. There were no differences in trait anxiety levels between pregnant and nonpregnant women. After controlling for demographics, panic disorder and trait anxiety were significant predictors of greater alcohol use in pregnant and nonpregnant women. An interaction revealed that pregnant and nonpregnant women with low trait anxiety had similar levels of alcohol use; however, nonpregnant women with high trait anxiety consumed significantly more alcohol than pregnant women with high trait anxiety. CONCLUSIONS: Current study findings support the need to examine panic disorder and trait anxiety as potential risk factors for alcohol use among pregnant and nonpregnant women in the community. Findings have important implications for assessment and treatment of panic, anxiety, and alcohol use.     

孕产妇焦虑、抑郁的发生和神经递质关系的初步研究

目的　研究正常妇女与孕产妇临产前后的心理状态、孕产妇临产前后焦虑、抑郁的发生和体内神经递质水平的关系。方法　对孕产妇临产入院 3天 (一般在产前 3天内 )、追踪至产后 4天用焦虑自评量表 (SAS)、抑郁自评量表 (SDS)进行测评 ,阳性者用汉密顿焦虑、抑郁量表 (HAMA、HAMD)评定分折。对部分孕产妇及随机抽查育龄妇女 2 0例为对照组进行神经递质测定及分折。结果　本调查193例孕产妇中产前焦虑发生率为 38.34%、抑郁发生率 12 .4 4 %、产后分别为 14 .36 %、5 .85 % ,经比较有明显差异 (P <0 .0 1、P <0 .0 5 )、神经递质测定显示产前、产后 5 羟色胺、(5 HT)、肾上腺素 (NE)多巴胺(DA) (P <0 .0 1)存在非常显著的差异。情绪稳定组与紊乱组也存在差异 (P <0 .0 5 )。结论　在孕产妇人群中提供简便有效的筛查自评、评定量表 ,能客观正确地筛查出焦虑、抑郁发生。神经递质测定为孕产妇焦虑、抑郁监测中提供客观的生物学指标 ,作为临床参考依据。     

新冠肺炎疫情下非高风险地区孕妇焦虑状况调查

目的探讨新冠肺炎(COVID-19)疫情期间非高风险地区孕妇的焦虑状况,为孕期保健心理干预提供参考。方法2020年1月27日-2月6日,采用新型冠状病毒肺炎相关知识调查表及广泛性焦虑量表(GAD-7),调查疫情期间绵阳地区孕妇及非孕妇女的焦虑状况,以GAD-7评分≥5分视为存在焦虑症状。采用DPS 7.05对数据进行统计分析,以单因素试验完全随机设计进行方差分析,以LSD最小差数法进行多重比较。结果孕妇GAD-7评分高于非孕妇女,差异具有统计学意义[(11.76±0.79)分vs.(7.04±1.14)分,P<0.01]。孕妇组中,有并发症者GAD-7评分高于无并发症者[(12.48±1.16)分vs.(6.32±1.09)分,P<0.01];初产妇GAD-7评分高于经产妇[(10.15±1.15)分vs.(8.72±0.97)分,P<0.05];21~30岁、31~40岁和41~50岁的孕妇GAD-7评分差异均具有统计学意义[(11.88±1.39)分vs.(8.80±0.84)分vs.(4.35±0.81)分,P<0.01]。结论新冠肺炎疫情期间,非高风险地区孕妇比非孕妇女焦虑症状更严重,其中有并发症的孕妇、初产妇焦虑状况更为突出。     

High antenatal maternal anxiety is related to impulsivity during performance on cognitive tasks in 14- and 15-year-olds

This study prospectively investigated the influence of antenatal maternal anxiety, measured with the State Trait Anxiety Inventory at 12-22, 23-31 and 32-40 postmenstrual weeks of pregnancy, on cognitive functioning in 57 adolescents (mean age 15 years). ANCOVAs showed effects of State anxiety at 12-22 weeks, after controlling for influences of State anxiety in later pregnancy and postnatal maternal Trait anxiety. Adolescents of high anxious pregnant women reacted impulsively in the Encoding task; they responded faster but made more errors than adolescents of low anxious women. They also scored lower on two administered WISC-R subtests. In the Stop task no differences in inhibiting ongoing responses were found between adolescents of high and low anxious pregnant women. We suspect that high maternal anxiety in the first half of pregnancy may negatively affect brain development of the fetus, reflected by impulsivity and lower WISC-R scores at 14-15 years.     

Safety and feasibility of repetitive transcranial magnetic stimulation in the treatment of anxious depression in pregnancy: a case report

BACKGROUND: The proper treatment of mood disorders occurring during pregnancy is a major therapeutic problem since no antidepressant medications have been established as safe for the developing fetus. Several double-blind placebo-controlled studies have explored the efficacy of repetitive transcranial magnetic stimulation (rTMS) in depression. CASE: We report the case of a 36-year-old woman in her second trimester of pregnancy, whose depression (DSM-IV) and anxiety were successfully treated with rTMS. Further studies of rTMS in depressed pregnant women appear warranted.     

高危孕妇焦虑抑郁症状发生率及相关危险因素

背景：高危孕妇与普通孕妇相比在妊娠期会出现更多的并发症,高危因素作为一种应激因素更易诱发孕妇产生焦虑、抑郁等负面情绪症状。目前国内外对高危孕妇焦虑、抑郁症状的研究相对较少。
　　目标：调查产科高危妊娠孕妇焦虑、抑郁症状发生率及其相关危险因素。
　　方法：对197例孕中期（16-20周）的高危孕妇在妊娠最后4月每月进行综合性医院焦虑/抑郁量表（HAD）评估和风险因素调查。产后3-7天、42天及3月进行爱丁堡产后抑郁量表（EPDS）评估和风险因素调查。
　　结果：入组时高危孕妇HAD焦虑均分：3.69(2.76),抑郁均分：3.42(2.53)。焦虑症状14例(7.18%),抑郁症状10例(5.13%)。多因素分析显示,怀孕有无保胎（OR：8.162,95%CI：1.213-54.914）和乙肝阳性（OR：8.912,95%CI：1.052-75.498）与焦虑症状相关。尿糖阳性（OR：30.529,95%CI：1.312-710.610）和既往出血史（OR：7.122,95%CI：1.015-49.984）与抑郁症状相关。孕期影响高危孕妇焦虑、抑郁症状的因素有：近3月孕妇健康状况、担心胎儿健康、夫妻关系、婆媳关系等。
　　结论：高危妊娠孕妇焦虑、抑郁症状较常见。近3月孕妇健康状况、婆媳关系、夫妻关系、担心胎儿健康是高危孕妇孕期焦虑、抑郁症状的风险因素。     

孕妇妇女对孩子的想象

目的:评估产前焦虑和抑郁的危险因素,特别是孕期和产后早期的孕产妇对胎儿和她自己的父母之间的母婴关系.方法:研究采用在孕期进行量化访谈,通过半定式孕期访谈来评估孕妇对胎儿的心理预期和孕妇自己的母婴依附关系归类.孕期访谈可得到有关孕妇与胎儿、孕妇和她生活中重要人物之间关系的有价值的信息.我们对斯德哥尔摩的孕20周的初产妇进行了调查,询问其有关怀孕的经历、以及他们的家庭、伴侣、和未出生的孩子之间的关系.研究的孕妇均属于有较高压力、童年逆境、有否精神疾病家族史的高危人群.这些女性更易罹患围产期焦虑和抑郁.结果:孕期访谈为了解孕产妇的心理构成提供了有价值的信息.她们心理状态和心理反应的量化可以用来衡量预测其母亲养育能力的质量.访谈中出现的反移情和移情有助于更深入地理解孕期女性的压抑、攻击性、悲伤、自恋、防卫等潜在动力学机制.结论:探究评估母孕期的心理构成以及她与未出生孩子之间的关系有助于进行专业的早期干预.早期干预措施应针对特定的高危人群,可有助预防对其孩子可能产生的不良效应.     

孕期心理干预对产后情绪的影响

目的探讨孕期对孕妇及家属给予心理干预对产后抑郁、焦虑情绪的影响。方法对270名孕妇和268名孕妇家属分别进行心理干预,对照组269名孕妇接受一般教育,干预组及对照组在孕期填写一般情况调查表及SDS、SAS量表,产后1周、1个月、6个月填写SDS、SAS量表。结果干预组产后抑郁焦虑发生率较对照组明显降低(P<0.05)。结论孕期加强对孕妇及家属的心理教育有利于稳定情绪,降低产后抑郁、焦虑的发生。     

Anxiety in a socially high-risk sample of pregnant women in Canada

OBJECTIVE: To determine if an anxiety dimension in the Edinburgh Postnatal Depression Scale (EPDS) could be identified in a sample of pregnant women with high social risk factors. METHOD: Four hundred women attending prenatal outreach programs, most of whom were single, low-income, and Aboriginal, participated in a study of feelings in pregnancy. The primary outcome measure was the EPDS. Data were also collected on sociodemographic, obstetrical-biological, psychological, and behavioural variables. RESULTS: Factor analysis of the EPDS revealed 3 factors: anxiety, depression, and self-harm. The anxiety factor accounted for the greatest variance in the overall EPDS score. Comparisons of different groups of women revealed significantly more anxiety in the women aged under 19 years, compared with those over 25 years (P < 0.01). Linear regression analysis showed anxiety was associated with age, stressors (that is, pregnancy, health of the baby, birth of the baby, money, and other), history of depression, and fluctuating moods. CONCLUSIONS: Anxiety symptoms were predominant in the emotional distress identified by the EPDS in this sample of socially high-risk pregnant women. Younger women appear to experience the highest levels of anxiety. Anxiety in pregnancy in socially high-risk women should not be normalized.     

Maternal insomnia during the COVID-19 pandemic: associations with depression and anxiety

Background

The COVID-19 outbreak has made people more prone to depression, anxiety and insomnia, and females are at a high risk of developing these conditions. As a special group, pregnant and lying-in women must pay close attention to their physical and mental health, as both have consequences for the mother and the fetus. However, knowledge regarding the status of depression, anxiety and insomnia among these women is limited.

Aim

This study aimed to examine insomnia and psychological factors among pregnant and lying-in women during the COVID-19 pandemic and provide theoretical support for intervention research.

Methods

In total, 2235 pregnant and lying-in women from 12 provinces in China were surveyed; their average age was 30.25 years (SD = 3.99, range = 19–47 years).

Participants and setting

The participants completed electronic questionnaires designed to collect demographic information and assess levels of depression, anxiety and insomnia.

Results

The prevalence of insomnia in the sample was 18.9%. Depression and anxiety were significant predictors of insomnia. Participants in high-risk areas, those with a disease history, those with economic losses due to the outbreak, and those in the postpartum period had significantly higher insomnia scores.

Discussion

The incidence of insomnia among pregnant and lying-in women is not serious in the context of the epidemic, which may be related to the sociocultural background and current epidemic situation in China.

Conclusion

Depression and anxiety are more indicative of insomnia than demographic variables.