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中华神经医学杂志
南方医科大学珠江医院
中华神经医学杂志

南方医科大学珠江医院

徐如祥

月刊

1671-8925

journal@126.com

020-61643273

510282

广州市工业大道中253号珠江医院

中华神经医学杂志/Journal Chinese Journal of NeuromedicineCSCD北大核心CSTPCD
查看更多>>中华医学会主办。本刊主要刊载神经医学的新理论、新进展、新技术、新业务等，内容涵盖神经外科、神经内科以及神经生物等基础神经科学领域。本刊设置的主要栏目有基础研究、临床研究、专家论坛、国际动态、短篇论著、经验交流、病例报告、综述等，目前已成为展示和共享我国神经科学领域学术成就和科研成果的重要载体和平台。杂志迄今已被美国《化学文摘（CA）》、俄罗斯《文摘杂志（AJ）》、《中文核心期刊要目总览》、《中国科技论文统计源期刊（中国科技核心期刊）》、《中国科学引文数据库》等国内外数据库和检索机构收录。
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    1页
    查看更多>>摘要：时序更替，华章日新。在这辞旧迎新的美好时刻，《中华神经医学杂志》编辑部谨向长期以来支持、关心我刊的各级领导、编委、审稿专家及读者作者朋友们致以衷心的感谢和诚挚的问候！
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    骨髓干细胞来源外泌体通过促进海马能量代谢和微血管新生改善小鼠抑郁样行为

    胡维佳蔡黎黎朱小兰罗一烽...
    2-9页
    查看更多>>摘要：目的 观察骨髓间充质干细胞来源外泌体（BMSC-Exo）对抑郁症模型小鼠的海马微血管、能量代谢及其行为学的改善作用。 方法 （1）分离培养小鼠骨髓间充质干细胞，提取BMSC-Exo。采用透射电镜观察BMSC-Exo的形态，采用Zetaview分析仪测定BMSC-Exo的粒径分布范围，采用Western blotting实验检测BMSC-Exo中CD9和CD63的表达。（2）取2只小鼠，采用慢性不可预见性温和应激（CUMS）建立抑郁症模型后于海马分别注射磷酸盐缓冲液（PBS）、DiR标记的BMSC-Exo，24 h后采用活体成像系统检测小鼠体内摄取BMSC-Exo情况。（3）将36只小鼠按随机数字表法分为对照组、模型组和BMSC-Exo组，每组12只。后2组小鼠采用CUMS建立抑郁症模型。造模后BMSC-Exo组小鼠海马注射1 μL BMSC-Exo，对照组小鼠注射等量PBS。采用强迫游泳实验（FST）、悬尾实验（TST）及开放旷场实验（OFT）检测小鼠的行为学。采用碱性磷酸酶染色检测小鼠海马微血管数量及长度。采用微正电子发射断层显像/X线计算机体层成像（mPET/CT）检测小鼠海马的能量代谢情况。采用Western blotting实验检测小鼠海马葡萄糖转运蛋白1（GLUT1）的表达。 结果 （1）BMSC-Exo呈典型的盘状囊泡样结构，粒径为（100。5±1。4） nm。Western blotting实验结果证实BMSC-Exo表达CD9、CD63。（2）活体成像检测结果显示注射PBS后小鼠的脑和肝脏未见明显荧光，注射BMSC-Exo后小鼠的脑和肝脏呈现显著局部荧光。（3）与对照组比较，模型组和BMSC-Exo组小鼠FST、TST的静止时间较长，OFT的中央区域运动路程、中央区域运动时间较短，差异均有统计学意义（P<0。05）；与模型组比较，BMSC-Exo组小鼠FST、TST的静止时间较短，OFT的中央区域运动路程、中央区域运动时间较长，差异均有统计学意义（P<0。05）。与对照组比较，模型组和BMSC-Exo组小鼠海马标准摄取值（SUV）、微血管长度及微血管数量、海马GLUT1的表达较低，差异均有统计学意义（P<0。05）；与模型组比较，BMSC-Exo组小鼠海马SUV值、微血管长度及微血管数量、GLUT1的表达较高，差异均有统计学意义（P<0。05）。3组小鼠海马微血管长度与SUV值呈正相关关系（r=0。540，P<0。001），海马微血管数量与SUV值呈正相关关系（r=0。600，P<0。001）。 结论 BMSC-Exo可促进抑郁症模型小鼠海马微血管新生，提高海马葡萄糖代谢，从而改善抑郁样行为。 Objective To investigate the effect of bone mesenchymal stem cells derived exosomes (BMSC-Exo) on improving hippocampal microangiogenesis， energy metabolism， and behaviors in depression mouse models。 Methods (1) Mouse bone marrow mesenchymal stem cells were isolated and cultured to extract BMSC-Exo BMSC-Exo morphology was observed by transmission electron microscopy， BMSC-Exo particle diameter ranges were determined by Zetaview analyzer， and expressions of CD9 and CD63 in BMSC-Exo were detected by Western blotting。 (2) Depression models were established in 2 mice by chronic unforeseeable mild stress (CUMS) 24 h after stereotaxic injection of phosphate buffer solution (PBS) or DiR labeled BMSC-Exo， BMSC-Exo uptake was detected by in vivo imaging system。 (3) Thirty-six mice were randomly divided into control group， model group and BMSC-Exo group (n=12) CUMS was used to establish depression models in the latter 2 groups brain stereotaxic injection of 1 μL BMSC-Exo was given to mice in the BMSC-Exo group after modeling， and same amount of PBS was given to the control group behaviors were observed by forced swimming test (FST)， tail suspension test (TST) and open field test (OFT) hippocampal microvascular length and number were detected by alkaline phosphatase staining energy metabolism in the hippocampus was detected by micro positron emission tomography/computed tomography (mPET/CT) glucose transporter 1 (GLUT1) expression in the hippocampus was detected by Western blotting。 Results (1) BMSC-Exo had a typical disk-like vesicle-like structure with particle size of (100。5±1。4) nm Western blotting confirmed that CD9 and CD63 expressed in BMSC-Exo。 (2) In vivo imaging showed no fluorescence in the brain and liver after PBS injection， but obvious local fluorescence after BMSC-Exo injection。 (3) Compared with the control group， the model group and BMSC-Exo group had significantly longer rest time in FST and TST and shorter movement distance and time in the central region of OFT (P<0。05) compared with the model group， BMSC-Exo group had significantly shorter rest time in FST and TST and longer movement distance and time in the central region of OFT (P<0。05)。 Compared with the control group， the model group and BMSC-Exo group had significantly decreased standard uptake value (SUV) of regions of interest， microvascular length and number， and GLUT1 expression in the hippocampus (P<0。05) compared with the model group， the BMSC-Exo group had significantly higher SUV， microvascular length and number， and GLUT1 expression in the hippocampus (P<0。05)。 Positive correlations were noted between hippocampal microvascular length and SUV and between microvascular number and SUV in the 3 groups (r=0。540， P<0。001 r=0。600， P<0。001)。 Conclusion BMSC-Exo could promote microangiogenesis energy metabolism in the hippocampus to improve depression-like behaviors in depression mouse models。

    抑郁症微血管葡萄糖代谢外泌体

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    低剂量氯胺酮通过小胶质细胞NF-κB/iNOS通路减轻小鼠颅脑创伤后的微循环障碍

    张国栋何锋李远超赵岗...
    10-17页
    查看更多>>摘要：目的 探讨低剂量氯胺酮对颅脑创伤（TBI）小鼠神经炎症和微循环的影响。 方法 采用随机数字表法将60只成年雄性C57BL/6小鼠分成假手术组、TBI组、假手术+氯胺酮组和TBI+氯胺酮组，每组15只；后2组小鼠采用控制性皮质撞击法（CCI）建立开放性TBI模型。假手术+氯胺酮组和TBI+氯胺酮组于造模后30 min腹腔注射氯胺酮30 mg/kg，1次/d，连续3 d。假手术组和TBI组分别于相同时间点经腹腔注射等量生理盐水。每组取6只小鼠分别于造模前、造模后即刻、造模后30 min、造模后1 d及造模后3 d利用激光散斑对比血流成像（LSCI）技术测量脑皮层血流量。另取6只小鼠于造模后第3天经心脏灌注取材行免疫组织化学染色和免疫荧光双标染色，检测小胶质细胞标志物离子钙接头蛋白抗体-1（Iba-1）及核因子（NF）-κB p65核转位情况。剩余每组3只小鼠于造模后第3天处死后制成组织原浆，通过Western blotting实验检测皮质脑组织NF-κB p65、p-NF-κB p65、p-IκB及诱导型一氧化氮合酶（iNOS）蛋白水平，通过ELISA法检测皮层脑组织肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、iNOS、氧自由基（ROS）、氮自由基（RNS）表达水平。 结果 LSCI检测结果显示，造模后3 d，与TBI组比较，TBI+氯胺酮组小鼠脑局部微循环相对血流量明显增加，差异有统计学意义（P<0。05）。免疫组织化学染色结果显示，与假手术组及假手术+氯胺酮组比较，TBI组、TBI+氯胺酮组小鼠脑皮质区域内Iba-1阳性细胞数明显增加，差异有统计学意义（P<0。05）；与TBI组比较，TBI+氯胺酮组小鼠Iba-1阳性细胞数明显下降，差异有统计学意义（P<0。05）。ELISA法检测结果显示，与假手术组及假手术+氯胺酮组比较，TBI组、TBI+氯胺酮组小鼠损伤皮质脑组织中炎性因子TNF-α、IL-1β和IL-6、iNOS及自由基ROS和RNS表达水平均明显升高，差异有统计学意义（P<0。05）；与TBI组比较，TBI+氯胺酮组小鼠损伤皮质脑组织中炎性因子TNF-α、IL-1β、IL-6、iNOS及自由基ROS和RNS表达水平均明显下降，差异均有统计学意义（P<0。05）。免疫荧光双染结果显示，与TBI组比较，TBI+氯胺酮组小鼠NF-κB p65核转位明显受到抑制。Western blotting实验结果显示，与假手术组及假手术+氯胺酮组比较，TBI组和TBI+氯胺酮组小鼠损伤皮质脑组织中iNOS、NF-κB p65、p-NF-κB p65、p-IκB蛋白表达水平均明显升高，差异均有统计学意义（P<0。05）；与TBI组比较，TBI+氯胺酮组小鼠损伤皮质脑组织中iNOS、NF-κB p65、p-NF-κB p65、p-IκB蛋白表达水平均明显降低，差异均有统计学意义（P<0。05）。 结论 低剂量氯胺酮可减轻开放性TBI后神经炎症，改善脑微循环血流，其作用机制可能与抑制小胶质细胞NF-κB/iNOS通路有关。 Objective To investigate the effect of low-dose ketamine on neuroinflammation and microcirculation in mice with traumatic brain injury (TBI)。 Methods Sixty adult male C57BL/6 mice， weighing 22-28 g， were randomly divided into sham-operated group， TBI group， Sham+ketamine group， and TBI+ketamine group (n=15)。 A controlled cortical impingement (CCI) method was used to establish TBI models in the later 2 groups。 Sham+ketamine group and TBI+ketamine group were intraperitoneally injected with 30 mg/kg ketamine once daily for 3 d at 30 min after TBI sham-operated group and TBI group were intraperitoneally injected same amount of saline at the same time points。 Cerebral cortical blood flow in 6 mice from each group was measured by laser speckle contrast imaging (LSCI) before， immediately after， 30 min after， 1 d after and 3 d after modeling， respectively。 Three d after modeling， immunohistochemical staining and immunofluorescent double label staining were used to detect the nuclear translocation of microglia markers， ionized calcin-antibody-1 (Iba-1) and nuclear factor (NF)-κB p65 in damaged cortical brain tissues in 6 mice from each group。 The remaining 3 mice in each group were sacrificed and tissue plasma was extracted 3 d after modeling levels of NF-κB p65， phosphorylated (p)-NF-κB p65， p-IκB and inducible nitric oxide synthase (iNOS) in cortical brain tissues were detected by Western blotting。 Expressions of tumor necrosis factor-α (TNF-α)， interleukin-1-β (IL-1β) and interleukin-6 (IL-6)， iNOS， reactive oxygen species (ROS) and reactive nitrogen species (RNS) in cortical brain tissues were detected by ELISA。 Results LSCI indicated that， 3 d after modeling， relative blood flow in local cerebral microcirculation of TBI+ketamine group was significantly increased compared with that of TBI group (P<0。05)。 Immunohistochemical staining indicated that compared with the sham-operated group and Sham+ketamine group， the TBI group and TBI+ketamine group had significantly increased number of Iba-1 positive cells in the cerebral cortex (P<0。05) compared with the TBI group， the TBI+ketamine group had significantly decreased number of Iba-1 positive cells (P<0。05)。 ELISA indicated that compared with the sham-operated group and Sham+ketamine group， the TBI group and TBI+ketamine group had significantly increased expressions of TNF-α， IL-1β， IL-6， iNOS， ROS and RNS in damaged cortical brain tissues (P<0。05) compared with the TBI group， the TBI+ ketamine group had significantly decreased expressions of TNF-α， IL-1β， IL-6， iNOS， ROS and RNS in damaged cortical brain tissues (P<0。05)。 Immunofluorescent double label staining indicated obviously inhibited NF-κB p65 nuclear translocation in TBI+ketamine group when it was compared with TBI group。 Western blotting indicated that compared with the sham-operated group and Sham+ketamine group， the TBI+ketamine group had significantly increased iNOS， NF-κB p65， p-NF-κB p65 and P-IκB protein expressions in damaged cortical brain tissues (P<0。05) compared with the TBI group， the TBI+ketamine group had significantly decreased protein expressions of iNOS， NF-κB p65， p-NF-κB p65 and p-IκB in damaged cortical brain tissues (P<0。05)。 Conclusion Low-dose ketamine reduces neuroinflammation and improves cerebral microcirculatory blood flow after open TBI， whose mechanism may be related to inhibition of microglia NF-κB/iNOS pathway。

    颅脑创伤氯胺酮小胶质细胞微循环神经炎症

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    阿尔茨海默病患者脑网络功能连接变化与脑脊液病理标志物之间的相关性

    龚乘丙朱正阳许婧娴宋文婷...
    18-26页
    查看更多>>摘要：目的 探讨阿尔茨海默病（AD）患者脑网络功能连接（FC）变化与脑脊液（CSF）中病理标志物的相关性。 方法 选取南京大学医学院附属鼓楼医院神经内科自2020年1月至2022年12月收治的认知障碍患者39例，其中AD患者23例（AD组）、非AD患者16例（非AD组）。比较2组患者临床资料的差异；采集患者静息态功能磁共振成像（rs-fMRI）数据，采用独立分量分析2组患者脑网络间FC、网络内FC的差异，采用相关性检验分析患者脑网络间FC、网络内FC与CSF中β-淀粉样蛋白1-42（Aβ1-42）、Tau蛋白浓度之间的相关性。 结果 与非AD组相比，AD组患者CSF中Aβ1-42浓度明显较低，差异有统计学意义（P<0。05）。与非AD组比较，AD组患者视觉网络（VN）和后扣带皮层（PCC）之间、左额顶叶网络（lFPN）和前默认网络（aDMN）之间的FC明显较多，lFPN和小脑网络（CEN）之间的FC明显较少，差异均有统计学意义（P<0。05）。与非AD组比较，AD组患者的aDMN、VN和感觉运动网络（SMN）内FC均较低，lFPN内FC明显较高，差异均有统计学意义（P<0。05）。AD组患者SMN内FC和CSF中总Tau蛋白、磷酸化Tau181蛋白浓度均呈正相关关系（P<0。05），VN与PCC之间的FC和CSF中总Tau蛋白浓度呈正相关关系（P<0。05）。AD组患者aDMN、VN内FC和CSF中Aβ1-42浓度均呈正相关关系（P<0。05），FPN内FC和CSF中Aβ1-42浓度呈负相关关系（P<0。05）。 结论 AD患者大脑出现多个脑网络内部和网络之间FC的特征性变化，这些变化与CSF中Tau蛋白和Aβ1-42的浓度相关。 Objective To explore the correlations of brain network functional connectivity (FC) alterations with cerebrospinal fluid (CSF) pathological biomarkers in patients with Alzheimer's disease (AD)。 Methods A total of 39 patients with cognitive impairment， admitted to Department of Neurology， Drum Tower Hospital， Affiliated Hospital of Medical School， Nanjing University from January 2020 to December 2022 were recruited 23 patients were with AD and 16 with non-AD。 Clinical data were compared between the 2 groups。 Resting-state functional MRI (rs-fMRI) data were collected， and FC differences between brain networks and FC differences within brain networks were compared by independent component analysis。 Correlations of FC differences between brain networks and FC differences within brain networks with concentrations of β-amyloid protein 1-42 (Aβ 1-42) and Tau protein in CSF were analyzed。 Results Compared with the non-AD group， AD group had significantly lower Aβ1-42 in CSF (P<0。05)。 Compared with those in the non-AD group， FC alterations between the left frontoparietal network (lFPN) and anterior default mode network (aDMN) and between the visual network (VN) and posterior cingulate cortex (PCC)， as well as FC alterations in lFPN， were significantly increased in AD group (P<0。05)。 Compared with those in the non-AD group， FC alterations between lFPN and cerebellar network (CEN)， and FC alterations in aDMN， sensorimotor network (SMN) and VN were significantly decreased in AD group (P<0。05)。 In AD group， FC in SMN was positively correlated with total Tau and phosphorylated-Tau181 in CSF (P<0。05) FC between VN and PCC was positively correlated with total Tau in CSF (P<0。05)。 CSF Aβ1-42 was positively correlated with FC alterations in aDMN and VN， but negatively correlated with FC in FPN (P<0。05)。 Conclusion In AD patients， characteristic changes in FC within and between multiple brain networks are noted， which are related to changes of Tau protein and Aβ1-42 in CSF。

    阿尔茨海默病静息态功能磁共振成像脑网络功能连接β-淀粉样蛋白Tau蛋白

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    FLAIR信号强度比值对侧支循环不丰富的急性缺血性脑卒中患者发病时间≤4.5 h的预测价值

    姜亮王雅菁陈宇辰彭明洋...
    27-33页
    查看更多>>摘要：目的 探讨液体衰减反转恢复序列（FLAIR）信号强度比值（SIR）对急性缺血性脑卒中患者发病时间≤4。5 h的预测价值。 方法 回顾性选择南京医科大学附属南京医院神经内科自2020年1月至2023年6月收治的180例急性缺血性脑卒中患者，采用低灌注强度比值（HIR）评估患者的侧支循环，将患者分为侧支循环丰富组和侧支循环不丰富组，比较2组患者临床资料和影像学指标的差异。采用单因素和多因素Logistic回归分析明确急性缺血性脑卒中患者发病时间≤4。5 h的影响因素。采用相关性检验分析急性缺血性脑卒中患者SIR与发病时间的相关性。应用受试者工作特征（ROC）曲线分析SIR、弥散加权成像（DWI）-FLAIR不匹配对急性缺血性脑卒中患者发病时间≤4。5 h的预测效能。 结果 180例患者中侧支循环丰富100例，侧支循环不丰富80例。与侧支循环丰富组比较，侧支循环不丰富组患者有高脂血症者占比较多、治疗前DWI梗死体积较大、灌注加权成像（PWI）-DWI不匹配体积较大、SIR较高，差异均有统计学意义（P<0。05）。180例患者中发病时间≤4。5 h 76例，发病时间>4。5 h 104例；单因素Logistic回归分析显示高脂血症、治疗前DWI梗死体积、DWI-FLAIR不匹配、HIR及SIR是急性缺血性脑卒中患者发病时间≤4。5 h的影响因素，差异均有统计学意义（P<0。05）。多因素Logistic回归分析显示高脂血症（OR=6。654，95%CI：5。751~8。824，P<0。001）、HIR（OR=0。724，95%CI：0。521~1。321，P=0。041）及SIR（OR=739。881，95%CI：383。296~14 258。065，P<0。001）是急性缺血性脑卒中患者发病时间≤4。5 h的独立影响因素。相关性检验显示急性缺血性脑卒中患者SIR与发病时间呈正相关关系（r=0。420，P<0。05），侧支循环不丰富组患者SIR与发病时间呈正相关关系（r=0。781，P<0。05）。ROC曲线分析显示SIR预测侧支循环不丰富组患者发病时间≤4。5 h的ROC曲线下面积（AUC）为0。917（95%CI：0。814~1。000，P<0。001），DWI-FLAIR不匹配预测侧支循环不丰富组患者发病时间≤4。5 h的AUC为0。530（95%CI：0。509~0。757，P=0。075），二者预测效能的差异有统计学意义（P<0。05）。 结论 HIR、SIR较低的急性缺血性脑卒中患者发病时间≤4。5 h几率更高，在侧支循环不丰富的患者中SIR可更为准确地预测急性缺血性脑卒中发病时间。 Objective To investigate the predictive value of fluid-attenuated inversion recovery (FLAIR) signal strength ratio (SIR) in onset time≤4。5 h in patients with acute ischemic stroke。 Methods A retrospective analysis was performed 180 acute ischemic stroke patients admitted to Department of Neurology， Nanjing Hospital Affiliated to Nanjing Medical University from January 2020 to June 2023 were chosen。 Hypoperfusion intensity ratio (HIR) was used to evaluate the collateral circulation (poor collateral circulation: HIR≤0。4 good collateral circulation: HIR>0。4) clinical data and imaging indexes between poor collateral circulation and good collateral circulation groups were compared。 Univariate and multivariate Logistic regressions were used to analyze the influencing factors for onset time≤4。5 h in patients with acute ischemic stroke。 Correlation between SIR and onset time was analyzed in patients with acute ischemic stroke。 Role of HIR as agency between SIR and onset time was explored。 Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of SIR and diffusion weighted imaging (DWI)-FLAIR mismatch in onset time≤4。5 h in acute ischemic stroke patients。 Results Of the 180 patients， 100 were into the good collateral circulation group and 80 were into the poor collateral circulation group compared with the good collateral circulation group， the poor collateral circulation group had significantly higher percentage of patients with hyperlipidemia， larger DWI infarction volume before treatment， larger perfusion weighted imaging (PWI)-DWI mismatch volume and higher SIR (P<0。05)。 In these 180 patients， 76 had onset time≤4。5 h and 104 had onset time>4。5 h。 Univariate Logistic regression analysis showed that hyperlipidemia， DWI infarct volume before treatment， DWI-FLAIR mismatch， HIR and SIR were influencing factors for onset time≤4。5 h in acute ischemic stroke patients (P<0。05)。 Multivariate Logistic regression analysis showed that hyperlipidemia (OR=6。654， 95%CI: 5。751-8。824， P<0。001)， HIR (OR=0。724， 95%CI: 0。521-1。321， P=0。041) and SIR (OR=739。881， 95%CI: 383。296-14 258。065， P<0。001) were independent influencing factors for onset time≤4。5 h in acute ischemic stroke patients。 Pearson correlation analysis showed that SIR was positively correlated to onset time in patients with acute ischemic stroke (r=0。420， P<0。05)， and SIR was positively correlated to onset time in patients from poor collateral circulation group (r=0。781， P<0。05)。 ROC curve showed that AUC of SIR in predicting onset time≤4。5 h was 0。917 (95%CI: 0。814-1。000， P<0。001) and that of DWI-FLAIR mismatch in predicting onset time≤4。5 h was 0。530 (95%CI: 0。509-0。757， P=0。075) in poor collateral circulation group， enjoying significant difference in predictive efficacy。 Conclusion Acute ischemic stroke patients with low HIR and SIR have higher odds of onset time≤4。5 h SIR can more accurately predict the onset time in these patients with poor collateral circulation。

    急性缺血性脑卒中液体衰减反转恢复序列信号强度比值发病时间

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    我国西北地区成人颈动脉体瘤的多中心回顾性横断面研究

    谢文宇张洪晨冯元岳哲明...
    34-41页
    查看更多>>摘要：目的 分析我国西北地区成人颈动脉体瘤的流行病学表现及临床特征，为颈动脉体瘤的早期诊断及治疗提供参考依据。 方法 采取多中心、回顾性、非干预性调查方法，选择我国西北地区7所三甲医院（空军军医大学第一附属医院、兰州大学第二附属医院、甘肃省人民医院、解放军联勤保障部队第九四〇医院、青海省人民医院、宁夏医科大学总医院、宁夏回族自治区人民医院）神经外科自2011年1月1日至2023年6月30日收治的成人颈动脉体瘤患者为研究对象。收集患者的病历资料，并根据其常住地平均海拔将患者分为高海拔组（≥1 500 m）与低海拔组（<1 500 m），依据Shamblin分型将患者分为ShamblinⅠ型、Ⅱ型及Ⅲ型组，分别比较不同海拔组、不同Shamblin分型组患者间一般资料及临床特征的差异，同时采用多元有序Logistic回归分析探索颈动脉体瘤进展为ShamblinⅢ型的独立影响因素。 结果 （1）共359例患者纳入研究，其中女性276例、男性83例，年龄（48。80±12。07）岁；高海拔组211例，低海拔组148例；ShamblinⅠ型组165例，Ⅱ型组146例，Ⅲ型组48例。（2）与低海拔组相比，高海拔组患者中女性比例更高，年龄更大，汉族比例更低，ShamblinⅠ型占比更高，肿瘤体积更小，血小板计数更低，红细胞计数、红细胞压积、血红蛋白水平、血小板分布宽度、平均血小板体积、大血小板比率更高，差异均有统计学意义（P<0。05）。（3）与ShamblinⅠ型组相比，ShamblinⅢ型组患者的年龄更低、常住地海拔更低、肿瘤体积更大、发病至确诊时间间隔更长、无意间发现肿瘤而就诊比例更高、术中出血量更多以及血红蛋白水平、红细胞压积、平均红细胞体积、平均血红蛋白浓度明显降低，红细胞分布宽度变异系数、血小板计数明显升高，差异均有统计学意义（P<0。05）；与ShamblinⅡ型组相比，ShamblinⅢ型组患者的年龄更低、肿瘤体积更大、发病至确诊时间间隔更长、术中出血量更多以及血红蛋白水平、红细胞压积、平均红细胞体积明显降低，红细胞分布宽度变异系数、血小板计数明显升高，差异均有统计学意义（P<0。05）。（4）年龄（OR=0。960，95%CI：0。942~0。977，P<0。001）、常住地海拔（OR=0。992，95%CI：0。990~0。999，P=0。020）以及发病至确诊时间间隔（OR=1。009，95%CI：1。005~1。014，P<0。001）是颈动脉体瘤进展为ShamblinⅢ型的独立影响因素。 结论 我国西北地区成人颈动脉体瘤患者中女性多于男性，常住地海拔高者多于海拔低者，ShamblinⅠ型占比最高。常住地海拔高的患者中女性占比较海拔低的患者更高、年龄更大；ShamblinⅢ型患者较Ⅰ、Ⅱ型的年龄最低、常住地海拔最低、发病至确诊时间间隔最长。年龄较小、常住地海拔较低以及发病至确诊时间间隔较长的颈动脉体瘤患者更易进展为ShamblinⅢ型。 Objective To analyze the clinical and epidemiological characteristics of adult carotid body tumors (CBTs) in Northwest China to provide references for early diagnosis and treatment of CBTs。 Methods A multicenter， retrospective， non-intervention epidemiological investigation was conducted on adult CBTs patients who were hospitalized from January 1， 2011 to June 30， 2023 in 7 Class A tertiary hospitals in Northwest China (Departments of Neurosurgery， First Affiliated Hospital of Air Force Medical University， Second Affiliated Hospital of Lanzhou University， People's Hospital of Gansu Province， 940th Hospital of PLA Joint Logistic Support Force， People's Hospital of Qinghai Province， General Hospital of Ningxia Medical University， People's Hospital of Ningxia Hui Autonomous Region)。 Medical records were collected in these patients， and they were divided into 2 groups according to their average altitude residence: high altitude group (≥1 500 m) and low altitude group (<1 500 m) meanwhile， these patients were divided into Shamblin type I， type II and type III groups according to Shamblin classification criteria differences in general data and clinical features among patients from different altitude groups or Shamblin subgroups were compared。 Independent influencing factors for Shamblin type III CBTs were analyzed by multivariate ordered Logistic regression。 Results (1) A total of 359 patients were enrolled in the study， including 276 females and 83 males， aged (48。80±12。07) years 211 patients were into the high altitude group and 148 into the low altitude group 165 patients were into Shamblin type I group， 146 into Shamblin type II group， and 48 into Shamblin type III group。 (2) Compared with those in the low altitude group， patients in the high altitude group had higher proportion of females， older age， lower proportion of Han nationality， higher proportion of Shamblin type I， smaller tumor volume， lower platelet count， higher red blood cell count， hematocrit， hemoglobin level， platelet distribution width and mean platelet volume， and higher large platelet percentage， with significant differences (P<0。05)。 (3) Compared with those in the Shamblin type I group， patients in the Shamblin type III group had younger age， lower resident altitude， larger tumor volume， longer time interval from onset to diagnosis， higher proportion of unintentional tumor discovery， larger volume of intraoperative blood loss， lower hemoglobin level， hematocrit， mean erythrocyte volume， and mean hemoglobin concentration， decreased erythrocyte distribution width variable coefficient， and increased platelet count， with significant differences (P<0。05)。 Compared with those in the Shamblin type II group， patients in Shamblin type III group had younger age， larger tumor volume， longer time interval from onset to diagnosis， larger volume of intraoperative blood loss， lower hemoglobin， hematocrit and mean erythrocyte volume， higher erythrocyte distribution width variable coefficient and platelet count， with significant differences (P<0。05)。 (4) Age (OR=0。960， 95%CI: 0。942-0。977， P<0。001)， residence altitude (OR=0。992， 95%CI: 0。990-0。999， P=0。020) and time interval from onset to diagnosis (OR=1。009， 95%CI: 1。005-1。014， P<0。001) were independent influencing factors for Shamblin type III CBTs。 Conclusions More females than males are noted in patients with adult CBTs in Northwest China， and more CBTs patients live at high altitude， with Shamblin type I enjoying the highest proportion。 More female and old patients lived at high altitude is noted than those lived at low altitude patients with Shamblin type III have the youngest age， lowest altitude， and longest time interval from onset to diagnosis。 CBTs patients with young age， low residence altitude， and long time interval from onset to diagnosis are more likely to develop Shamblin type III。

    颈动脉体瘤临床特征Shamblin分型高原环境

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    重型单侧横窦、乙状窦血栓形成的影像学特征及其血管内介入治疗疗效、安全性分析

    李腾飞田奇史帅龙杨杰...
    42-47页
    查看更多>>摘要：目的 总结重型单侧横窦、乙状窦血栓形成的影像学特征并评估其血管内介入治疗的疗效及安全性。 方法 回顾性收集郑州大学第一附属医院放射介入科自2012年6月至2022年9月收治的37例以颅内高压症状为主要临床表现并行血管内介入治疗的重型单侧横窦、乙状窦血栓形成患者的临床资料，总结其影像学特征，依据患者手术前后闭塞静脉窦内血流复通、压力降低程度及神经症状改善情况评价近期疗效，统计住院期间并发症发生情况，依据术后临床随访及6~12个月的影像学随访结果评价手术安全性和远期疗效。 结果 （1）术前头颅MRI和（或）CT显示患者脑组织不同程度的肿胀，以患侧为著，同时闭塞的横窦、乙状窦内可见混杂信号/密度影，部分患者可同时合并静脉性脑梗死或梗死后脑出血表现；MRV、CTV和DSA显示患侧横窦、乙状窦显影较差或完全闭塞而对侧显影正常，闭塞的静脉窦机械开通后其内可见明显的血栓充盈缺损影。（2）术后所有患者的闭塞静脉窦内血流均得到复通，闭塞段压力梯度差由术前的（16。6±3。3） mmHg降至术后的（2。8±0。8） mmHg。出院前所有患者的临床症状均得到明显改善[改良Rankin量表（mRS）评分0分30例、1分5例、2分1例和3分1例]，2例患者遗留单侧肢体活动障碍（肌力分别为Ⅲ级和Ⅳ级）。所有患者均获得临床随访，随访时间为（9。6±3。0）个月，末次随访时神经功能均较术前有明显改善，且无新发神经系统相关症状（mRS评分0分30例、1分6例、2分1例）。34例患者获得MRV或DSA随访，28例患者的闭塞静脉窦完全再通，6例患者部分再通，均未见明显狭窄或闭塞复发。 结论 重型单侧横窦、乙状窦血栓形成可致局部颅内静脉内血液瘀滞，进而引起"静脉窦区域性压力增高"，表现为单侧脑组织肿胀甚至静脉性脑梗死或梗死后脑出血等影像学改变。早期诊断并积极行血管内介入治疗能显著改善该类患者的预后，且安全性较好。 Objective To summarize the imaging features of severe unilateral transverse sinus and sigmoid sinus thromboses， and evaluate the efficacy and safety of intravascular interventional therapy in them。 Methods Thirty-seven patients with severe unilateral transverse sinus and sigmoid sinus thromboses clinically mainly manifested as intracranial hypertension and accepted endovascular intervention in Department of Interventional Radiology， First Affiliated Hospital of Zhengzhou University from June 2012 to September 2022 were chosen their clinical data were retrospectively analyzed and imaging features were summarized。 Short-term efficacy was evaluated according to blood flow restoration degrees and pressure gradient reduction in the occlusive sinus and modified neurological symptoms before and after endovascular intervention。 Hospitalized complications were observed safety and long-term efficacy were evaluated according to postoperative clinical follow-up and imaging results 6-12 months after endovascular intervention。 Results (1) Preoperative brain MRI and (or) CT showed different degrees of swelling of the brain tissues， with the affected side as the target mixed signals/density shadow could be seen in the blocked transverse sinus and sigmoid sinus venous cerebral infarction or post-infarction cerebral hemorrhage could be combined in some patients。 MRV， CTV and DSA showed poor or completely occluded transverse sinus and sigmoid sinus while normal in the contralateral side obvious thrombus filling-defect was observed in the occluded venous sinus after mechanical thrombolysis。 (2) Occlusive sinus blood flow was restored in all patients after endovascular intervention， and pressure gradient of the occlusive segment decreased from (16。6±3。3) mmHg before to (2。8±0。8) mmHg after endovascular intervention。 Before discharge， clinical symptoms of all patients were significantly improved (modified Rankin scale [mRS] scores of 0 in 30 patients， 1 in 5 patients， 2 in 1 patient and 3 in 1 patient)， and 2 patients had unilateral limb movement disorder (muscle strength grading III and IV， respectively)。 All patients received clinical follow-up for (9。6±3。0) months。 At the last follow-up， neurological function obviously improved compared with that before endovascular intervention， without new neurosystem-related symptoms (mRS scores of 0 in 30 patients， 1 in 6， and 2 in 1 patient)。 In 34 patients received MRV or DSA follow-up， 28 had complete recanalization of occlusive sinus and 6 had partial recanalization， without obvious stenosis or recurrent occlusion。 Conclusions Severe unilateral transverse sinus and sigmoid sinus thrombosis can cause local intracranial venous blood stasis， and then cause "increased regional venous sinus pressure"， which is manifested as unilateral brain tissue swelling and even venous cerebral infarction or post-infarction cerebral hemorrhage。 Early diagnosis and endovascular intervention can obviously improve the prognosis of these patients， enjoying good safety。

    颅内静脉窦血栓形成横窦乙状窦血管内介入治疗影像学特征

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    吡仑帕奈添加治疗≥12岁局灶性癫痫患者的临床观察

    石小莉李丽霞卢燕婷申朗...
    48-54页
    查看更多>>摘要：目的 评估吡仑帕奈添加治疗≥12岁局灶性癫痫患者的有效性、耐受性及安全性。 方法 回顾性选择自2020年7月至2022年12月于广西医科大学第一附属医院神经内科接受吡仑帕奈添加治疗的119例≥12岁青少年及成人局灶性癫痫患者为研究对象，分别采集添加治疗第1~3个月、4~6个月、7~9个月和10~12个月阶段中患者每28天的癫痫发作频率、坚持用药情况及不良反应发生情况等，以评估吡仑帕奈添加治疗的有效性（癫痫发作频率较基线减少≥50%为总有效）、耐受性及安全性，同时依据吡仑帕奈添加治疗第4~6个月（短期）和10~12个月（长期）的有效性结果，将患者分为有效组与无效组，分析影响吡仑帕奈添加治疗短期及长期有效性的相关因素。 结果 吡仑帕奈添加治疗第1~3个月、4~6个月、7~9个月、10~12个月阶段中，患者每28天的癫痫发作频率较基线降低百分比分别为66。7%（24。3%，97。2%）、77。5%（48。6%，100。0%）、94。6%（50。0%，100。0%）、100。0%（70。9%，100。0%），总有效率分别为60。2%（59/98）、75。0%（57/76）、78。9%（45/57）、86。5%（32/37）。吡仑帕奈添加治疗第3、6、9和12个月末时，患者保留率分别为85。2%（98/115）、67。9%（76/112）、54。3%（57/105）、41。1%（37/90）。吡仑帕奈添加治疗期间，共有33例（27。7%）患者出现不良反应，主要症状为头晕，其次为精神症状。吡仑帕奈添加治疗第4~6个月和10~12个月阶段中，有效组与无效组患者间性别、添加吡仑帕奈治疗初始年龄、病程、病因、脑电图检查结果、影像学检查结果、联合抗癫痫发作药物的数量及种类、吡仑帕奈最大服用剂量等方面的差异均无统计学意义（P>0。05）。 结论 吡仑帕奈添加治疗≥12岁青少年及成人局灶性癫痫具有良好的有效性、耐受性及安全性。目前尚未发现影响吡仑帕奈添加治疗有效性的相关因素。 Objective To evaluate the clinical efficacy， tolerability and safety of adjunctive perampanel in focal epilepsy patients≥12 years old。 Methods One hundred and nineteen focal epilepsy patients≥12 years old accepted adjunctive perampanel in Department of Neurology， First Affiliated Hospital of Guangxi Medical University from July 2020 to December 2022 were chosen。 At 1-3 months， 4-6 months， 7-9 months and 10-12 months after adjunctive perampanel， seizure frequency changes every 28 d， medication retention rate and adverse reactions were recorded to evaluate the clinical efficacy (a reduction in seizure frequency≥50% from baseline was defined as overall valid treatment)， tolerability and safety of adjunctive perampanel。 According to efficacy results after adjunctive perampanel of 4-6 months (short-term) and 10-12 months (long-term)， these patients were divided into valid group and invalid group and the influencing factors for short-term and long-term efficacy were analyzed。 Results At 1-3， 4-6， 7-9， 10-12 months after adjunctive perampanel， reduction in seizure frequency every 28 d was 66。7% (24。3%， 97。2%)， 77。5% (48。6%， 100%)， 94。6% (50%， 100%)， 100% (70。9%， 100%)， enjoying overall valid rate of 60。2% (59/98)， 75。0% (7/76)， 78。9% (45/57)， 86。5% (32/37)。 The retention rate at 3， 6， 9 and 12 months after adjunctive perampanel was 85。2% (98/115)， 67。9% (76/112)， 54。3% (57/105)， 41。1% (37/90)。 Adverse reactions were reported in 33 patents (27。7%)， mainly with dizziness and secondly with mental symptoms。 After short-term and long-term adjunctive perampanel， no significant difference was noted in gender， initial age of adjunctive perampanel， course of disease， etiology， EEG results， imaging results， number and type of combined anti-seizure drugs， or maximum dose of pirampanel between the valid group and invalid group (P>0。05)。 Conclusion Perampanel has good efficacy， tolerability and safety in adolescents and adults≥12 years old with focal epilepsy no clear influencing factors for pirampanel valid treatment is found so far。

    局灶性癫痫吡仑帕奈添加治疗有效性耐受性安全性

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    经皮单通道显微减压术治疗退行性腰椎管狭窄症的疗效研究

    魏梁锋薛亮陈业煌吴箭午...
    55-61页
    查看更多>>摘要：目的 探讨经皮单通道显微减压术治疗退行性腰椎管狭窄症（DLSS）的疗效。 方法 回顾性选择解放军联勤保障部队第九〇〇医院神经外科自2018年10月至2023年4月收治的无节段性腰椎失稳影像学表现的117例DLSS患者为研究对象，所有患者均经严格保守治疗无效后改行显微镜与经皮通道系统联合应用下单通道入路腰椎后路椎管和神经根减压术治疗，术后随访6~50个月。分析患者术前1 d、术后1周及末次随访时疼痛视觉模拟量表（VAS）评分、腰椎Oswestry功能障碍指数（ODI）以及腰椎X线、CT、MRI复查情况，并于末次随访时采用改良MacNab标准评价疗效。 结果 117例患者中，实施单侧椎板切开单侧减压56例（47。9%），单侧椎板切开双侧减压61例（52。1%）；实施单节段减压109例（93。2%），双节段减压8例（6。8%）。术中发生硬膜囊撕裂4例（3。5%），即刻予以封堵，术后无脑脊液漏发生。所有患者术中均未发生明显的神经损伤，术后均未发生椎间隙感染或腰椎不稳。所有患者随访18（13，24）个月，末次随访时的VAS评分由术前1 d的（5。96±0。85）分、术后1周的（1。75±0。61）分降至（1。01±0。59）分，腰椎ODI由术前1 d的（63。22±8。33）%、术后1周的（17。66±5。20）%降至（10。64±3。44）%，差异均有统计学意义（P<0。05）。末次随访时，改良MacNab标准为优46例（39。3%）、良66例（56。4%）、可3例（2。6%）、差2例（1。7%），疗效优良率为95。7%。 结论 对于术前无腰柱失稳证据的DLSS患者，经皮通道系统联合显微镜下单通道入路个体化实施单侧或双侧椎管内减压术，在有效减少手术创伤的同时，亦可获得满意的手术效果。 Objective To investigate the efficacy of microscopic decompression in degenerative lumbar spinal stenosis (DLSS) under single percutaneous tubular retractor system。 Methods A retrospective analysis was performed 117 DLSS patients with imaging manifestations as non-segmental lumbar instability， admitted to Department of Neurosurgery， 900th Hospital of PLA Joint Logistics Team from October 2018 to April 2023 were enrolled consecutively。 These patients failed in strict conservative treatment and then changed to posterior lumbar spinal canal and nerve root decompression by microscopy and percutaneous tubular retractor system。 These patients were followed up for 6-50 months。 Pain visual analogue score (VAS) and lumbar Oswestry dysfunction index (ODI) were recorded and results of X-rays， CT and MRI of lumbar spines were analyzed 1 d before and 1 week after decompression and at the last follow-up。 Modified MacNab criteria were used to evaluate the efficacy at the last follow-up。 Results Among the 117 patients， unilateral laminectomy for unilateral decompression was performed in 56 patients (47。9%) and unilateral laminotomy for bilateral decompression in 61 (52。1%)。 Single segment decompression was performed in 109 patients (93。2%) and double segment decompression in 8 (6。8%)。 Dural sac rupture occurred in 4 patients (3。5%)， and immediate occlusion was given no cerebrospinal fluid leakage was noted after decompression。 All patients did not experience obvious nerve damage during decompression or intervertebral infection/lumbar instability after decompression。 After 18 (13， 24) months of follow-up， VAS scores of the patients at the last follow-up decreased from (5。96±0。85) 1 d before decompression and (1。75±0。61) 1 week after decompression to (1。01±0。59)， and lumbar ODI decreased from (63。22±8。33)% 1 d before decompression and (17。66±5。20)% 1 week after decompression to (10。64±3。44)%， with significant differences (P<0。05)。 At the last follow-up， modified MacNab criteria indicated 46 patients (39。3%) as excellent， 66 (56。4%) as good， 3 (2。6%) as fair， and 2 (1。7%) as poor， with an excellent/good therapeutic rate of 95。7%。 Conclusion For surgical treatment of DLSS patients without evidenced preoperative spinal instability， personalized unilateral or bilateral spinal canal decompression under microscope by combiningsingle percutaneous tubular retractor system can effectively reduce surgical trauma and achieve satisfactory surgical results。

    退行性腰椎管狭窄症经皮通道系统显微减压术

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    下肢痛型与腰腿痛型腰椎间盘突出症患者腰大肌的形态学比较

    王辉魏梁锋陈业煌薛亮...
    62-65页
    查看更多>>摘要：目的 基于CT影像学资料比较下肢痛型与腰腿痛型腰椎间盘突出症（LDH）患者腰大肌的形态学差异。 方法 纳入解放军联勤保障部队第九〇〇医院神经外科自2012年1月至2023年2月收治的60例LDH患者进行研究。根据患者临床症状将其分为下肢痛组与腰腿痛组（各30例）。将2组患者腰大肌CT影像进行三维重建，以垂直于腰大肌纵轴的最长横轴所在平面为横截面，计算腰大肌最大横截面积，以腰大肌最大横截面积与L5椎体横截面积之比为腰大肌最大横截面积指数。比较下肢痛组与腰腿痛组患者腰大肌最大横截面积指数差异，并进一步比较下肢痛组与腰腿痛组组内不同疼痛程度[采用视觉模拟量表（VAS）评分评价]、不同疼痛病程患者间腰大肌最大横截面积指数差异。采用Pearson相关性分析检验2组患者腰大肌最大横截面积指数与疼痛程度、疼痛病程的相关性。 结果 下肢痛组患者腰大肌最大横截面积指数明显大于腰腿痛组患者（0。62±0。05 vs。 0。54±0。04），差异有统计学意义（t=7。320，P<0。001）。下肢痛组、腰腿痛组患者中重度疼痛患者腰大肌最大横截面积指数均明显小于中度疼痛患者（0。61±0。05vs。 0。65±0。04；0。53±0。03 vs。 0。58±0。04），差异均有统计学意义（t=2。422，P=0。022；t=3。502，P=0。002）。下肢痛组、腰腿痛组患者中短病程患者腰大肌最大横截面积指数均明显大于长病程患者（0。64±0。05 vs。 0。59±0。04；0。57±0。04 vs。 0。53±0。03），差异均有统计学意义（t=2。570，P=0。016；t=2。941，P=0。007）。Pearson相关性分析结果显示，2组LDH患者腰大肌最大横截面积指数与疼痛程度、疼痛病程均呈负相关关系（P<0。05）。 结论 LDH患者腰大肌的萎缩程度随疼痛程度、疼痛病程的增加而加重。 Objective To compare the morphological differences of psoas major muscles between patients with lumbar disc herniation (LDH) of lower limb pain and lumbocrural pain based on CT imaging data。 Methods Sixty patients with LDH admitted to Department of Neurosurgery， 900th Hospital of PLA Joint Logistic Team from January 2012 to February 2023 were included。 According to clinical symptoms， they were divided into lower limb pain group and lumbocrural pain group (n=30)。 3D CT images of the psoas major muscles in the 2 groups were reconstructed the longest transverse axis perpendicular to the longitudinal axis of the psoas major muscle was chosen as the cross-sectional area， and the maximum psoas major muscle cross-sectional area was calculated maximum psoas major muscle cross-sectional area index (PImax) was defined as ratio of maximum psoas major muscle cross-sectional area and L5 vertebral cross-sectional area。 PImax difference between lower limb pain group and lumbocrural pain group was compared PImax difference among patients with different pain degrees (visual analog scale [VAS] scores) or pain courses was further compared in both lower limb pain group and lumbocrural pain group。 Pearson correlation was used to analyze the correlations of PImax with pain degree and pain course in the 2 groups。 Results PImax in lower limb pain group was significantly larger than that in lumbocrural pain group (0。62±0。05 vs。 0。54±0。04， t=7。320， P<0。001)。 PImax in patients with severe pain from both lower limb pain group and lumbocrural pain group was significantly smaller than that in patients with moderate pain (0。61±0。05 vs。 0。65±0。04， t=2。422， P=0。022 0。53±0。03 vs。 0。58±0。04， t=3。502， P=0。002)。 PImax in patients with short pain course from both lower limb pain group and lumbocrural pain group was significantly larger than that in patients with long pain course (0。64±0。05 vs。 0。59±0。04， t=2。570， P=0。016 0。57±0。04 vs。 0。53±0。03， t=2。941， P=0。007)。 Pearson correlation showed that PImax was negatively correlated with pain degree and pain course in LDH patients from both groups (P<0。05)。 Conclusion Atrophy of psoas major muscles in LDH patients is aggravated with increased pain degree and pain course。

    腰椎间盘突出症腰大肌下肢痛腰腿痛

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