偏头痛慢性转化的临床危险因素分析

目的比较慢性偏头痛(CM)与发作性偏头痛(EM)的病史特征、临床特点等,探究偏头痛慢性转化的危险因素,为其防治提供依据和策略。方法共纳入在中南大学湘雅医院神经内科就诊的CM患者72例及EM患者109例进行回顾性分析。采集患者基本信息,先进行单因素分析,筛选有统计学意义的指标进行相关分析和非条件性多因素logistic回归分析。结果单因素分析发现两组的BMI(P=0.000)、病程(P=0.000)、基线头痛发作频率(P=0.000)、基线头痛持续时间(P=0.037)、匹兹堡睡眠质量指数量表(PSQI,P=0.000)、焦虑自评量表(SAS,P=0.000)及抑郁自评量表(SDS,P=0.001)差异有统计学意义。logistic回归分析显示BMI(OR=1.468,95%CI:1.148～1.876)、病程(OR=1.102,95%CI:1.022～1.188)、基线头痛发作频率(OR=1.461,95%CI:1.247～1.711)、睡眠质量(OR=1.494,95%CI:1.198～1.864)、焦虑状态(OR=1.201,95%CI:1.048～1.376)是偏头痛慢性转化的危险因素。结论控制体重、减少头痛发作频率、缩短病程、改善心境状态与睡眠质量,有可能延缓偏头痛的慢性进展。     

偏头痛慢性转化的临床危险因素分析

目的 比较慢性偏头痛（CM）与发作性偏头痛（EM）的病史特征、临床特点等,探究偏头痛慢性转化的危险因素,为其防治提供依据和策略。方法 共纳入在中南大学湘雅医院神经内科就诊的CM患者72例及EM患者109例进行回顾性分析。采集患者基本信息,先进行单因素分析,筛选有统计学意义的指标进行相关分析和非条件性多因素logistic回归分析。结果 单因素分析发现两组的BMI（P=0.000）、病程（P=0.000）、基线头痛发作频率（P=0.000）、基线头痛持续时间（P=0.037）、匹兹堡睡眠质量指数量表（PSQI,P=0.000）、焦虑自评量表（SAS,P=0.000）及抑郁自评量表（SDS,P=0.001）差异有统计学意义。logistic回归分析显示BMI（OR=1.468,95%CI：1.148~1.876）、病程（OR=1.102,95%CI：1.022~1.188）、基线头痛发作频率（OR=1.461,95%CI：1.247~1.711）、睡眠质量（OR=1.494,95%CI：1.198~1.864）、焦虑状态（OR=1.201,95%CI：1.048~1.376）是偏头痛慢性转化的危险因素。结论 控制体重、减少头痛发作频率、缩短病程、改善心境状态与睡眠质量,有可能延缓偏头痛的慢性进展。     

偏头痛危险因素分析(37808例—对照调查报告)

本文按1:1配对法对37808例患者进行了危险因素对照分析。发现技术人员、机关干部和教师等脑力劳动职业者患病率高于其他职业。刺激因素(情绪紧张、闷热气候、生气、劳累等)、睡眠障碍、多数酿造酒、多食肥肉、家族史、喜食甜和盐渍咸菜及肌紧张性头痛均为偏头痛的危险因素。情绪紧张是农村女性患者的主要发病危险因素。     

慢性偏头痛的研究进展

慢性偏头痛(CM)是偏头痛的常见致残性并发症。每年,约2.5%的发作性偏头痛(EM)发展为CM,即偏头痛慢性化。CM较EM患者社会经济状况更加恶化,生活质量下降,头痛相关负担加重。CM的发病机制可能与皮质正常抑制能力减弱、脑干疼痛系统调制障碍和三叉神经血管系统的致敏有关。其治疗包括去除危险因素、药物治疗和枕神经刺激。本文就CM的诊断、患病率、疾病负担、发病机制和治疗的研究进展进行综述。     

偏头痛伴发脑微出血的相关危险因素分析

目的分析偏头痛患者伴发脑微出血(CMBs)的临床特点及影响因素。方法连续收集178例临床确诊的偏头痛患者,根据头颅MRI有无CMBs表现分为两组,收集患者一般资料,头痛特点并进行比较。结果 (1)178例偏头痛患者中CMBs患者56例,偏头痛合并CMBs发生率为31.5%,其中单发病灶17例(30.4%),多发病灶39例(69.6%),单纯脑叶病灶31例(55.4%);(2)与无CMBs的偏头痛患者比较,合并CMBs的偏头痛患者更容易合并高血压(P=0.028),头痛病程长(P=0.002)、头痛发作频率高(P=0.001)且容易伴发先兆(P=0.036);(3)多因素Logistic回归分析显示,在校正年龄、性别及其他危险因素后,头痛病程(OR=1.166,95%CI:1.044~1.303,P=0.007)、头痛发作频率(OR=1.353,95%CI:1.116~1.640,P=0.002)和先兆偏头痛(OR=10.080,95%CI:1.630~62.329,P=0.013)与偏头痛发生CMBs相关。结论偏头痛病程长、发作频率高及伴有先兆是偏头痛发生CMBs的危险因素。     

慢性硬膜下血肿患者院内死亡的危险因素分析

目的 调查北京协和医院慢性硬膜下血肿患者的院内病死率以及院内死亡的危险因素。方法 对2000年1月1日-2017年6月1日在北京协和医院住院治疗的慢性硬膜下血肿患者进行回顾性研究,收集患者的年龄、性别、合并症和治疗方式等资料,统计院内病死率以及对各因素进行院内病死率单因素分析,对于P<0.15的因素再采用二元logistic回归分析,评估院内死亡的危险因素。结果(1)调查共433例患者,院内死亡30例,院内病死率为6.9%; 死亡病例平均年龄(72.00±15.04)岁,男女比例为1.3:1;(2)年龄(>50岁)(P<0.05, OR=8.118,95%CI=1.548～42.574)、合并血液系统疾病(P<0.001,OR=11.387,95%CI=3.870～3.501)、合并肺部感染(P<0.001,OR=8.581,95%CI=2.859～25.757)和手术治疗(P<0.05,OR=0.354,95%CI=0.136～0.921)与慢性硬膜下血肿患者院内死亡相关。结论 年龄(>50岁)、合并血液系统疾病以及合并肺部感染为慢性硬膜下血肿患者院内死亡的危险因素; 手术治疗是保护性因素; 性别和免疫系统疾病不是慢性硬膜下血肿患者发生院内死亡的危险因素。     

高血压性脑出血术后慢性意识障碍的危险因素分析

目的 探讨高血压性脑出血（HICH）术后发生慢性意识障碍（pDoC）的危险因素。方法 回顾性分析2017年12月至2021年7月手术治疗的163例HICH的临床资料。术后昏迷时间>28 d诊断为pDoC。结果 163例中,57例发生pDoC,发生率为35.0%。多因素logistic回归分析显示,高龄（OR=1.092,95%CI:1.044~1.142,P<0.001）、入院GCS评分低（OR=0.671,95%CI:0.488~0.922,P=0.014）、术前脑疝（OR=3.058,95%CI:1.122~8.337,P=0.029）、慢性脑积水（OR=4.694,95%CI:1.584~13.906,P=0.005）是HICH术后发生pDoC的独立危险因素（P<0.05）。ROC曲线分析结果显示,年龄≥70岁、入院GCS评分≤6分、术前脑疝、慢性脑积水联合预测术后发生pDoC的效果良好,AUC=0.871（95% CI 0.809~0.918;P<0.001）,特异度=92.45%,灵敏度=73.68%。结论 高年龄、入院GCS评分低、术前存在脑疝、慢性脑积水的HICH病人术后发生pDoC的风险明显增加,临床应采取相应干预措施,以改善病人预后。     

动脉瘤性蛛网膜下腔出血并发慢性脑积水的危险因素研究

目的 探讨动脉瘤性蛛网膜下腔出血(aSAH)并发慢性脑积水的危险因素。方法 选取2013年1月～2016年1月于本院接受治疗的210例aSAH患者,其中并发慢性脑积水者30例,设为观察组,其余180例未并发脑积水者设为对照组; 分析可能影响患者形成慢性脑积水的相关因素,并通过多因素回归分析确定危险因素。结果 2组性别、饮酒史、吸烟史、多发动脉瘤比较无显著差异(P>0.05); 观察组的年龄大于对照组,观察组有高血压病史者占76.7%,首诊CT显示脑室扩大者占43.3%,出血破入脑室者占66.7%,Hunt-Hess分级评分为(2.59±0.66)分,均高于对照组(P<0.05); 预后分级低于对照组(P<0.05),出血次数较对照组多(P<0.05); 多因素Logistic回归分析显示,aSAH并发慢性脑积水的危险因素有高龄、多次出血、高血压病史、出血破入脑室与发病后Hunt-Hess分级高。结论 aSAH出血并发慢性脑积水具有多项危险因素,临床上应注意高危患者的治疗与护理,改善其预后与生存质量。     

慢性硬膜下血肿术后死亡的危险因素分析

目的探讨慢性硬膜下血肿钻孔引流术后发生死亡的危险因素,以降低患者术后死亡率。方法回顾性分析我院2003年1月1日至2012年12月31日在神经外科住院接受慢性硬膜下血肿钻孔引流术患者338例,其中男196例,女142例,年龄42~90岁,平均年龄(69.83±7.715)岁。收集所有患者术前、术中、术后临床资料,建立数据库,进行单因素及Logistic多因素分析影响慢性硬膜下血肿钻孔引流术术后死亡的危险因素。结果术后死亡14例(4.14%),9例患者死于肺部感染,1例患者死于脑实质出血,1例死于大面积脑栓塞,1例死于急性心肌梗死,1例死于急性肾功能衰竭,1例死于急性肺栓塞。单因素分析结果:死亡患者年龄(P=0.000)、采用全身麻醉手术比例(P=0.003)、既往慢性阻塞性肺病(COPD)发病率(P=0.001)高于生存组;术前Glasgow评分(P=0.000)低于生存组。Logistic回归多因素分析结果:患者高龄(P=0.002;比值比(OR)=1.311;95%可信区间(CI)=1.104-1.557)、Glasgow评分低(P=0.000;OR=0.172;95%CI=0.077-0.380)、既往COPD病史(P=0.020;OR=14.333;95%CI=1.529-134.325)是慢性硬膜下血肿(CSDH)术后死亡的危险因素。结论高龄、Glasgow评分低、既往COPD病史是CSDH术后死亡的危险因素。     

偏头痛并发焦虑抑郁等精神心理症状的相关因素分析

目的探讨偏头痛并发焦虑、抑郁等精神心理症状的相关危险因素。方法选择我院2010-03—2013-05收治的180例偏头痛患者作为研究对象,对伴焦虑、抑郁等精神心理症状患者进行相关危险因素分析。结果观察组偏头痛伴随焦虑、抑郁和睡眠障碍的发生率分别为42.2%、60.5%,均明显高于对照组(P0.05)。长期慢性发作、头痛程度重、持续时间长、发作频率高、睡眠质量差、生活满意度差等均为偏头痛伴焦虑抑郁患者的相关危险因素,且伴焦、抑郁、睡眠障碍患者的MIDAS分值均明显高于无精神心理症状患者,差异有统计学意义(P0.05)。结论偏头痛患者多伴较高的焦虑、抑郁以及睡眠障碍等,相关危险因素较多,对其生活质量有较大影响。临床医生应考虑患者伴随的相关精神心理状况,及时予以心理疏导,改善患者的睡眠质量,促进患者预后。     

Chronicity Reconsidered: Improving Person-Environment Fit Through a Consumer-Run Service

In the past, the term chronic referred to people who had serious mental illness and who typically received long-term care in a state mental hospital. Although this term recently has fallen out of favor, we resurrect the term here, not to revive a demeaning euphemism, but rather to redefine it as the result of a poor person-environment fit between the complex and challenging needs of those with serious psychiatric disorders and a community-based service system that often is ill-equipped to treat them. Previous research indicates that recurrent acute hospitalizations and an inability to establish or maintain tenure in the community may be due to a disconnection from community-based services and supports, social isolation, and demoralization. One promising approach to addressing these issues is that of peer support. To illustrate the potential utility of peer support in improving person-environment fit and decreasing the chronicity of the subsample of people who continue to have difficulty in establishing viable footholds in the community, we describe a peer support-based program, the Welcome Basket, developed, staffed, and managed entirely by mental health consumers. Preliminary analyses that evaluate Welcome Basket's effectiveness are included, and we discuss the implications of these data for future research and program development in this area.     

国人Creutzfeldt-Jakob病的可能危险因素

目的 研究国人Creutzfeldt—Jakob病(CJD)的可能危险因素。方法 对30例已确诊的CJD进行地域、职业、颅脑外伤与手术、角膜手术、脑深部电极检查、输血及血液制品、生长激素注射、饮食习惯、遗传以及家族息神经系统其他变性疾病等10项回顾性研究。结果 (1)国内未发现硬膜、角膜移植、生长激素注射、脑深部电极检查所致的CJD；(2)未发现此病与职业相关以及接触牛、羊肉较多的人易患CJD；(3)未发现CJD有高发区；(4)白内障手术、颅脑外伤及开颅手术、遗传及家族中有患神经系统其他变性疾病者，可能为国人CJD的危险因素。结论 国人CJD的可能危险因素，既不同于西方，也有别于日本，充分认识这些事实，对减少医源性传播有积极意义。     

Risk Factors for Suicide Attempts Among Alcohol Dependent Patients

Suicidal behavior is a common and important problem among alcohol dependent patients. The study was designed to examine risk factors for attempting suicide in 499 alcohol dependent patients. Those who had attempted suicide (N = 198) were more likely to be female, report a family history of suicidal behavior, report more childhood trauma, report greater levels of aggressive behavior, began heavy drinking earlier, and were more likely to have received antidepressant medication. Logistic regression analysis showed that gender, family history, and childhood sexual abuse history made significant and independent contributions to the risk of a suicide attempt. Thus, developmental, personality, family history, social, and comorbidity risk factors may differentiate alcohol dependent patients who have attempted suicide from those who have not.     

Chronicity of Challenging Behaviours in People with Severe Intellectual Disabilities and/or Autism: A Total Population Sample

The skills, social impairments and challenging behaviours of a total population of 166 children, with severe intellectual disabilities and/or autism, were assessed through interview with the main carers, when the children were under 15 years old (time 1). Twelve years later, 141 of these individuals were re-assessed, using the same measures (time 2). “Abnormal” behaviours tended to reduce with age and were associated with poorer language skills and poorer quality of social interaction. Individuals with most abnormal behaviours at time 1, tended to have most at time 2. Abnormal behaviour at time 2 was predicted by the presence of abnormal behaviour at time 1, poor expressive language at time 1, poor quality of social interaction at time 1 and a diagnosis of autism/autistic continuum at time 1.     

Migraine pain location in adult patients from eastern India

Background:

Sparse literature documenting the location of pain at the onset of migraine attacks and during established headaches is available.

Objectives:

A prospective study (2003–05) on 800 adult migraine patients (International Classifications of Headache Disorders (ICHD), 2:1.1, 1.2.1 and 1.6.1) was conducted to document (a) sites of onset of pain and (b) location of pain during established attacks (in >50% occasions) through semistructured interviews.

Results: Demography:

N = 800; M:F = 144:656 (1:4.56); age, 16–42 years (mean, 26 years); duration of migraine, 1–18 years (mean, 6.8 years). 87% of the subjects were ethnic Bengalis from the eastern Indian state of West Bengal, Calcutta being the capital city.

Migraine types:

(on the basis of >50% headache spells): N = 800; 1.1:668 (83.5%); 1.2.1:18 (2.25%); 1.6.1:114 (14.25%).

Location of pain at onset:

Unilateral onset was present in 41.38% of the patients; of these, 53.17% had eye pain; 8.16%, frontal pain and 38.67%, temporal pain. In 32.25% of the patients, bilateral/central location of pain, mostly bitemporal or at vertex was noted. Cervico-occipital pain onset was noted in 26.43% patients (predominantly occipital, 14.68%; predominantly cervical, 11.75%).

Location of established headaches:

In 47.4% of the patients, with unilateral ocular or temporal onset, pain remained at the same site. Pain became hemicranial in 32.9%. In most patients, unilateral frontal onset pain (55.5%) became bilateral or holocranial. Most bilateral ocular (69.4%) and temporal onset (69.7%) pains remained at the same location. However, most bifrontal (55.6%) and vertex onset (56.9%) pains subsequently became holocranial. Most occipital pains at onset became holocranial (45.3%), but cervical pains subsequently became either hemicranial (38.3%) or holocranial (36.2%).

Conclusions:

This study documents location of pain at the onset and during established headaches in migraine patients largely from a specific ethnic group. Migraine with aura appears to be rare among ethnic Bengalis in eastern India. More than half had onset pain bilaterally/centrally and in the cervico-occipital regions. Only 40.5% experienced only unilateral pain. Cervico-occipital migraine pain appears to be common in ethnic Bengalis.