三叉神经痛的临床治疗进展

三叉神经痛是一种常见的面部疼痛性疾病,目前对其病因的认识并不明确。普遍认为压迫可导致三叉神经痛,致病原因包括血管因素和非血管因素,其次创伤也可导致三叉神经痛,常见于口腔外科手术后。三叉神经痛的治疗方法较多,首选药物治疗,包括全身用药和局部用药,药物治疗初期效果明显,但很难治愈三叉神经痛,而且需要长期服药,副作用较大,当药物治疗无效或者患者难以耐受其副作用时,可采用外科疗法进行辅助治疗。三叉神经痛的外科疗法主要包括无创的微血管减压术及有创的射频热凝术、球囊压迫术和甘油毁损术。近年来采用放射外科对三叉神经痛进行治疗,取得了确切效果。此外,还有一些关于其他治疗方法的文献报道,均有一定效果。本文对三叉神经痛病因的认识及临床治疗进展作一回顾性综述。     

家族性支气管哮喘的遗传方式分析

为研究家族性支气管哮喘的遗传方式, 进一步确定在群体中的传递规律,用群体研究法调查邯郸地区有家族史的支气管哮喘家系。采用家系分析法和Smith无偏差校正法, 进行理论值与观察值符合程度的卡方检验分析。72个家族性支气管哮喘的家系, 包括109个核心家系, 其亲属的患病率为0.46。分析结果表明, 有单基因遗传的倾向。用家系法分析, 符合常染色体显性遗传。对D-× dd婚配家系用Smith法分析, χ² = 3.181, P > 0.05, 所得结果支持常染色体显性遗传(Autosomal domiant inheritance, AD), 并提示不同的婚 配类型, 遗传方式可能不同, 存在着遗传异质性, 研究结果可为家族性支气管哮喘的预防、诊断和治疗提供参考依据。     

126例家族性甲状腺机能亢进患者分析

本文分析了126例家族甲状腺机能亢进患者发病情况;一级亲属发病99例（74.4%）;二级亲属26例（19.6%）;(6.0%)。其中一、二级亲属均发病者7例;故各级亲属发病总数为133例;符合一级亲属>二级亲属>三级亲属的发病规律。根据本组资料算得家族性甲亢遗传度为83%。此外;还分析了甲亢发病诱因;有诱因者占84.1%;其中家族、工作纠纷及工作紧张为主要诱因;占63.5%。     

126例家族性甲状腺机能亢进患者分析

本文分析了126例家族甲状腺机能亢进患者发病情况,一级亲属发病99例（74.4%）,二级亲属26例（19.6%）,(6.0%)。其中一、二级亲属均发病者7例,故各级亲属发病总数为133例,符合一级亲属>二级亲属>三级亲属的发病规律。根据本组资料算得家族性甲亢遗传度为83%。此外,还分析了甲亢发病诱因,有诱因者占84.1%,其中家族、工作纠纷及工作紧张为主要诱因,占63.5%。     

婴儿腹痛与家族性偏头痛的相关性研究

目的:研究家族性偏头痛对婴儿腹痛的影响及其相关性。方法:112例婴儿腹痛患儿为腹痛组,97例同期就诊非婴儿腹痛及头痛患儿为对照组,对所有患儿的一、二级及三级亲属进行问卷调查,然后对有偏头痛的亲属用统一的标准进行诊断,最后对两组患儿及其亲属的发病率进行对比分析。结果:20例(17.86%)婴儿腹痛患儿有家族性偏头痛,对照组6例(6.19%)患儿有家族性偏头痛,家族性患偏头痛的患儿比例在两组之间有显著差异(P<0.05);婴儿腹痛患儿的亲属诊断为偏头痛有85例,占本组调查总人数的16.93%,对照组患儿偏头痛亲属共有17例,占调查总人数的2.37%,两组患儿亲属患偏头痛的发病率有显著差异(P<0.05);患儿亲属患偏头痛种类的比较:腹痛组有家族性偏瘫型偏头痛和儿童腹型偏头痛,对照组没有;除散发性偏瘫型偏头痛的在两组的差异有统计学意义(P<0.05),其他种类的偏头痛没有显著差异。结论:有家族性偏头痛史的婴儿腹痛发生率高于正常人,婴儿腹痛与家族性偏头痛的发生率相关,与偏头痛的种类也可能有关。     

肝源性糖尿病治疗体会

在我国各型肝炎、肝硬化的发病率较高,因此由慢性肝病引起的肝源性糖尿病很常见;本病的早期发现及治疗,对改善肝病患者的预后具有重要意义。     

家族性阿尔茨海默病相关研究进展

阿尔茨海默病(Alzheimer’s disease,AD)是老年人中最常见的神经系统退行性疾病,给家庭和社会带来了十分沉重的负担。淀粉样蛋白级联反应假说是AD发病机制的重要学说之一,近年来备受关注。同时家族性老年痴呆(Familial Alzheimer’s Disease,FAD)在AD发病机制的研究中,起着至关重要的作用,其相关的FAD致病基因导致了AD的遗传性。本文将结合Aβ假说、产生过程和FAD的遗传因素进行讨论,浅析FAD的发病原因。     

家族性肥厚型心肌病一家系的调查分析

目的:分析一家族性肥厚型心肌病的特点。方法:对我院就诊的一肥厚型心肌病大家系进行临床调查研究,分析其临床特点,绘制家系图谱。结果:该家系为连续四代遗传,家系成员共35例,患者11例,猝死3例,死亡2例。有1例患者房颤及脑梗塞,2例患者行永久性起搏器植入术,猝死年龄最小3岁,符合肥厚型心肌病高发病率、高猝死率、发病年龄早等特点。结论:家族性肥厚型心肌病详细的家系调查有助于了解疾病全貌,更好地揭示其遗传规律。     

Trigeminal neuralgia: a retrospective study of 188 Thai cases

doi: 10.1111/j.1741‐2358.2011.00530.x Trigeminal neuralgia: a retrospective study of 188 Thai cases Objective: To describe the clinical characteristics and treatment of trigeminal neuralgia (TN) in a group of Thai patients. Materials and methods: Records of 188 patients with TN were reviewed retrospectively for patient demographics, the characteristics of the pain and treatment modalities. Results: Of the 188 patients, 37.2% were men and 62.8% were women. The peak incidence (46.8%) was in the age range of 50–69 years. Pain occurred on the right side of the face more often than on the left (1.8:1). The mandibular division of the trigeminal nerve was the most frequently affected (30.3%), followed by the combined maxillary and mandibular divisions (29.3%) and the maxillary division alone (25%). The majority described their attack as a sharp pain (77.6%), and the most common primary locations were at previous extraction sites (40.5%). The most common triggers were chewing (61.2%) and speaking (47.3%). Carbamazepine was the most common prescribed drug (76.1%) for the initial treatment. Combination drug therapy was introduced when the monotherapy failed to control the pain. Surgical intervention was the alternative choice of treatment in refractory cases. Conclusion: TN affected women more than men, and this disorder occurred most frequently in patients aged 50 years and older. The mandibular division of the trigeminal nerve was most commonly involved.     

消化道出血病因的临床分析

目的:回顾性分析消化道出血的病因构成、相关因素及治疗情况。方法:收集2008年7月至2013年9月因消化道出血在沈阳军区总医院消化内科住院的患者资料,包括患者的一般资料、入院日期、病因、出血部位、生命体征、疾病史。依据消化道出血程度分为轻度组(86例)、中度组(90例)、重度组(132例),分析消化道出血的病因特征。结果:与轻度组比较,重度组上消化道出血患者比例较高,中、重度组Blatchford评分、心率、尿素、血肌酐、凝血酶原时间、INR、血糖明显升高(P0.05);收缩压、舒张压、红细胞、血红蛋白、总蛋白、白蛋白、总胆固醇明显减低(P0.05)。重度组患有食管胃底静脉曲张的比例较高,行内镜下治疗的比例高(P0.05)。结论:根据患者出血程度可初步判断患者消化道出血的部位及病因,为临床诊治提供有价值的参考依据。     

微血管减压与经皮穿刺球囊压迫治疗原发性三叉神经痛的临床观察

目的:对比微血管减压(MVD)和经皮穿刺球囊压迫(PBC)治疗原发性三叉神经痛(PTN)的疗效。方法:选择2010年5月至2013年11月在我院接受治疗的PTN患者124例进行研究,根据数字法随机分成MVD组及PBC组各62例,两组分别行对应手术,随访18个月,对比两组手术相关指标、疗效以及术后并发症。结果:MVD组的手术时间与术中出血量,以及住院时间和住院费用均分别大于PBC组(均P0.05)。MVD组治疗后完全无痛的比例显著高于PBC组,轻度复发的比例显著低于PBC组(均P0.05)。MVD组的麻木及总并发症发生率均分别显著低于PBC组(均P0.05)。结论:MVD术式与PBC术式在治疗PTN时均具有较好的疗效,MVD术后无痛和并发症情况较好,而PBC创伤较小,较适合高龄体弱而无法耐受较大手术者,临床治疗时应合理地选用相关术式。     

咀嚼肌痉挛

咀嚼肌痉挛是一种临床罕见疾病,表现为单侧嚼肌突发阵发性、不自主地抽搐发作。伴或不伴有单侧面萎缩或局部硬皮病,其发病机制至今尚不明确,国内外报道极少,目前为止,仅26例具有肌电图支持的病例报道。文章复习了相关文献,对其病因、发病机制、诊断原则、治疗方法等作了系统综述。     

咀嚼肌痉挛

咀嚼肌痉挛是一种临床罕见疾病,表现为单侧嚼肌突发阵发性、不自主地抽搐发作。伴或不伴有单侧面萎缩或局部硬皮病,其发病机制至今尚不明确,国内外报道极少,目前为止,仅26例具有肌电图支持的病例报道。文章复习了相关文献,对其病因、发病机制、诊断原则、治疗方法等作了系统综述。     

Effect of coenzyme Q10 on mitochondrial respiratory proteins in trigeminal neuralgia

Trigeminal neuralgia (TN) is the neuropathic pain. Mitochondrial dysfunction, increased oxidative stress, and inflammation demonstrated in chronic pain. Carbamazepine (CBZ) is the first-line drug for TN, however, it is still insufficient. Coenzyme Q10 (CoQ10) has been used as the additional supplement for pain therapy. Nonetheless, mitochondrial respiratory proteins, oxidative stress, and inflammation in TN, and the add-on effects of CoQ10 on those defects have never been investigated. CBZ-treated TN-patients, naïve TN-patients, and control subjects were included. CBZ-treated TN-patients were randomised into two subgroups, received either CoQ10 or placebo for 2 months. Pain levels were evaluated, and peripheral blood mononuclear cells were isolated to determine the oxidative stress, mitochondrial oxidative phosphorylation (OXPHOS), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), and cytokines including TNF-α, IL-1β and IL-18 mRNA expression. Pain scales, oxidative stress, and OXPHOS levels were greater in naïve TN-patients than control, whereas the cytokine profiles were unchanged. Although pain scales were lower in CBZ-treated TN-patients than in naïve TN-patients, oxidative stress, OXPHOS, and cytokine expression profiles were not different. PGC-1α levels found to be increased in CBZ-treated TN patients when compared with the naïve group. CoQ10 supplement in CBZ-treated TN patients reduced pain scale and oxidative stress and increased antioxidants levels when compared with placebo group. However, OXPHOS, PGC-1α, and cytokines were not different between groups. These findings suggest that increased oxidative stress could be potentially involved in the pathogenesis of TN. CoQ10 supplements can reduce oxidative stress, leading to more effective pain reduction in TN patients being treated with CBZ.