22 例糖尿病视神经病变综合治疗的疗效观察

摘要目的：总结诊断及治疗糖尿病性视神经病变（diabetic optic neuropathy,DON）的临床经验,为本病的治疗和预防提供依据。方法：回顾性研究22 例糖尿病视神经病变的发病特点,在接受治疗的患者中严格控制血糖,应用复方樟柳碱注射液病侧颞浅动脉旁皮下注射,口服或静脉滴注活血化瘀药物,并口服维生素B1、维生素B2、肌苷片等营养视神经的药物,同时给予全身检查,包括对高血压、糖尿病等全身疾病的治疗,观察经综合治疗前后的视力、眼底、视野改变及眼底荧光血管造影（fundus fluorescein angiography,FFA）的特点等。结果：接受治疗的患者共有22 例（29 只眼）,治愈10 例（12 只眼）;好转7 例（10 只眼）,总有效率为79.3%。结论：糖尿病性视神经病变的及时正确诊断、系统的综合治疗,可有效提高视力,扩大视野。     

22例糖尿病视神经病变综合治疗的疗效观察

目的：总结诊断及治疗糖尿病性视神经病变（diabeticopticneuropathy,DON）的临床经验,为本病的治疗和预防提供依据。方法：回顾性研究22例糖尿病视神经痛变的发病特点,在接受治疗的患者中严格控制血糖,应用复方樟柳碱注射液病侧颞浅动脉旁皮下注射,口服或静脉滴注活血化瘀药物,并口服维生素B1、维生素B2、肌苷片等营养视神经的药物,同时给予全身检查,包括对高血压、糖尿病等全身疾病的治疗,观察经综合治疗前后的视力、眼底、视野改变及眼底荧光血管造影（fundusfluoresceinall-giography,FFA）的特点等。结果：接受治疗的患者共有22例（29只眼）,治愈10例（12只眼）;好转7例（10只眼）,总有效率为79．3％。结论：糖尿病性视神经病变的及时正确诊断、系统的综合治疗,可有效提高视力,扩大视野。     

复方樟柳碱联合川芎嗪治疗急性缺血性视神经病变

急性缺血性视神经病变是由于营养视神经的小血管发生循环障碍,使视神经缺血、缺氧,而致组织水肿,从而导致视功能下降,视野象限性缺损为特征的一种眼底病[1].表现为发病急,如不及时治疗可造成不可逆性的视力丧失.临床上主要是应用扩血管药物加皮质类固醇激素治疗.1999年以来我院应用复方樟柳碱联合川芎嗪治疗急性缺血性视神经病变80例(86眼),取得了较好疗效,现报告如下.     

Leber遗传性视神经病变家系的线粒体基因突变分析

为探讨Leber遗传性视神经病变（Leber′s hereditary optic neuropathy,LHON）家系线粒体DNA（mtDNA）常见致病原发突变的频谱,用聚合酶链反应（polymerase chain reaction,PCR）和单链构象多态性（single-stranded conformational polymorphism,SSCP）以及DNA测序的方法,对13个家系22位临床诊断为LHON的患者及其母系亲属21人的线粒体DNA进行检测,同时检测71例正常人作为对照。临床拟诊为LHON的13个家系中,11个家系存在mtDNA位点11778 G→A突变,另2个家系存在14484位点T→C突变。说明中国LHON病人存在线粒体DNA 11778或14484位点突变,其中14484位点突变在国内尚未见报道。Abstract:The purpose of the study is to investigate the frequency of common pathogenic primary mitochondrial DNA mutations in pedigrees of Leber′s hereditary optic neuropathy (LHON).Mutations were determined by polymerase chain reaction (PCR),single-stranded conformational polymorphism (SSCP) and DNA sequencing.Twenty-two patients with suspicion of LHON and twenty-one their maternal relatives underwent molecular genetic evaluation.Seventy-one normal individuals underwent molecular genetic evaluation as control at the same time.Members from 13 families with suspicion of LHON,11 families had nucleotide position nt11778 G→A mutations.Another 2 families had nt14484 T→C mutations.It is concluded that the point mutations at nucleotides 11778 and 14484 are primary LHON mutations,but the point mutation of nt14484 is rare in Chinese.     

降纤酶治疗糖尿病周围神经病变18例临床观察

目的探讨应用蛇毒降纤酶治疗糖尿病性周围神经病变的可行性。方法选择2型糖尿病并糖尿病周围神经病变患者18例,给予降纤酶5u加入生理盐水250ml中静脉滴注,隔日1次,7次为1疗程,共3个疗程。测定治疗前后空腹血糖(FPG)、餐后2h血糖(2HPG)、尿素氮(BUN)、红细胞压积(HCT)、血小板(PLT)等,进行临床症状及体征评分,测定四肢运动及感觉传导速度。结果18例患者凝血酶原时间和活动度均有所下降,无1例有出血倾向;治疗后FPG、2HPG和PL墨较治疗前明显降低;治疗后腓总神经、胫神经：MCV比治疗前增高。结论降纤酶对糖尿病神经病变有一定的治疗作用,但其确切机制有待进一步观察。     

散发性Leber遗传性视神经病的基因诊断

为了探讨散发性Leber遗传性视神经病(LHON)的诊断方法,对无家族史原因不明视神经萎缩病例,应用PCR扩增线粒体DNA片段,限制性内切酶SfaNI、MaeⅢ双重鉴定np11 778 G→A突变及BsaH I检测np3 460 G→A突变的有无。结果二例呈现np11 778点突变阳性,np3 460点突变阴性,明确诊断为LHON。上述点突变的检测,是目前诊断散发性LHON的首选有效方法。     

神经生长因子多药联合治疗缺血性视神经病变患者的临床疗效

目的:研究神经生长因子(NGF)多药联合治疗缺血性视神经病变(AION)患者的临床疗效。方法:选择2011年5月至2013年5月在我院接受治疗的AION患者100例(100只眼),根据数字表法随机分成观察组(50例,50只眼)及对照组(50例,50只眼)。对照组给予扩血管药和维生素神经营养性药物控制高血压或糖尿病等合并症,视情况给予糖皮质类激素治疗,观察组在此基础上另给予NGF药物治疗。对比两组疗效、对数视力、视野平均缺损值(MD)及视敏度通过图形视觉诱发电位(P-VEP100)P100波的潜伏期,观察两组不良反应。结果:观察组的总有效率为90.00%(45/50),显著高于对照组的74.00%(37/50),差异有统计学意义(P0.05)。两组在治疗后的对数视力、视野MD以及P-VEP100均有改善,但观察组的改善幅度显著大于对照组,差异有统计学意义(P0.05)。两组不良反应发生率差异无统计学意义(P0.05)。结论:NGF多药联合治疗AION患者疗效更佳,可促进患者视觉功能恢复,值得临床上推广使用。     

脊髓损伤的最新治疗进展

脊髓损伤以后引起原发性损伤和继发性损伤导致损伤的神经组织难以修复。目前脊髓损伤的重点主要集中在减轻和延缓继发性损伤造成的伤害。本文总结了近年来在脊髓损伤治疗领域的进展包括传统的药物治疗,细胞移植和基因治疗。目前动物实验研究表明细胞移植和基因治疗在治疗脊髓损伤的中取得了可喜的成果,将在未来临床应用中发挥重要作用。     

糖尿病神经病变药物治疗进展

糖尿病神经病变(DN)是因糖尿病慢性高血糖状态及其所致各种病理改变而导致的神经损伤,可累及全身神经系统任何部位,是糖尿病最常见和最复杂的并发症.从糖尿病的纵向发展来看,几乎90%～100%的患者无可幸免.更值得注意的是,临床绝大多数DN的患者都未得到及时诊断、治疗,致残率和死亡率很高,探寻治疗DN的有效药物是目前的关键问题.     

外伤性急性弥漫性脑肿胀的临床分析

目的:探讨外伤性急性弥漫性脑肿胀的诊断与治疗.方法:回顾性分析颅脑创伤后脑肿胀患者52例的临床资料.结果:52例中完全恢复16例,生活基本自理者11例,重残6例,植物生存3例,死亡16例.入院格拉斯哥昏迷评分(GCS)计分3～5分(瞳孔均散大)27例,预后良好9例,预后不良18例;GOS计分6～8分18例,预后良好12例,预后不良6例;GCS计分9～12分7例,预后良好5例,预后不良2例.结论:急性弥漫性脑肿胀的死亡率高,预后差,应积极综合治疗.     

Sequence analysis of the complete mitochondrial genome in patients with Leber's hereditary optic neuropathy lacking the three most common pathogenic DNA mutations

Leber's hereditary optic neuropathy (LHON) is a maternally inherited disorder characterized by central vision loss in young adults. The majority of LHON cases around the world are associated with mutations in the mitochondrial genome at nucleotide positions (np) 3460, 11,778, and 14,484. Usually, these three mutations are screened in suspected LHON patients. The result is important not only in respect to the diagnosis but also as different LHON mutations lead to variations in expression, severity, and recovery of the disease. There are, however, a significant number of patients without any of these primary mutations. In these situations, genetic counselling of a patient and his family can be difficult. We sequenced the complete mitochondrial DNA (mtDNA) in 14 LHON patients with the typical clinical features but without a primary mtDNA mutation to evaluate the potential of extensive mutation screening for clinical purposes. Our results suggest to include the mutation at np 15,257 in a routine screening as well as the ND6 gene, a hot spot for LHON mutations. Screening for the secondary LHON mutations at np 4216 and np 13,708 may also help in making the diagnosis of LHON as these seem to modify the expression of LHON mutations. Although they do not allow to prove the clinical diagnosis, their presence increases the probability of LHON. Sequencing the complete mitochondrial genome can reveal novel and known rare disease causing mutations. However, considering the effort it adds little value for routine screening.     

Leber Hereditary Optic Neuropathy: How Do Mitochondrial DNA Mutations Cause Degeneration of the Optic Nerve?

Leber hereditary optic neuropathy (LHON) is an inherited form of bilateral optic atrophy in which the primary etiological event is a mutation in the mitochondrial genome. The optic neuropathy involves a loss of central vision due to degeneration of the retinal ganglion cells and optic nerve axons that subserve central vision. The primary mitochondrial mutation is necessary—but not sufficient—for development of the optic neuropathy, and secondary genetic and/or epigenetic risk factors must also be present although they are poorly defined at the present time. There is broad agreement that mutations at nucleotides 3460, 11778, and 14484 are primary LHON mutations, but there may also be other rare primary mutations. It appears that the three primary LHON mutations are associated with respiratory chain dysfunction, but the derangements may be relatively subtle. There is also debate on whether there are mitochondrial mutations that have a secondary etiological or pathogenic role in LHON. The specific pattern of the optic neuropathy may arise from a chokepoint in the optic nerve in the region of the nerve head and lamina cribosa, and which may be more severe in those LHON family members who become visually affected. It is hypothesized that the respiratory chain dysfunction leads to axoplasmic stasis and swelling, thereby blocking ganglion cell function and causing loss of vision. In some LHON patients, this loss of function is reversible in a substantial number of ganglion cells, but in others, a cell death pathway (probably apoptotic) is activated with subsequent extensive degeneration of the retinal ganglion cell layer and optic nerve.     

Synapses of optic nerve afferents in the rat suprachiasmatic nucleus

Summary The identification of optic synapses in the rat suprachiasmatic nucleus (Güldner, 1978) has made it possible to study them morphometrically. The measurements followed the check-list introduced by Palay and Chan-Palay (1976). There are several items which could usefully be added to this list. The structure of essential synaptic components varies considerably in what is apparently one synaptic population based on morphological criteria. The possible reasons for the variable sizes of the optic boutons containing different amounts of clear and dense core vesicles are discussed in terms of different activities or metabolic states of the individual boutons and/or different metabolic states of neuronal and glial elements in their vicinity. The active zones of optic synapses are also extremely variable. One optic bouton can form several active zones of very different sizes, or form Gray-type-I (asymmetric), Gray-type-II (symmetric) and intermediate contacts at the same time. The function and/or functional efficiency of a single optic bouton therefore could then be quite different with respect to its various postsynaptic elements. The different appearance of the active zones is discussed mainly in terms of possible regulative influences from neighboring synapses via the postsynaptic neuron.The author wishes to thank Mrs. Bassirat Pirouzmandi for her excellent technical assistance     

Optogenetic neuronal stimulation promotes axon outgrowth and myelination of motor neurons in a three-dimensional motor neuron–Schwann cell coculture model on a microfluidic biochip

Axonal regeneration and remyelination of peripheral motor neurons (MNs) are critical for restoring neuromuscular motor function after injury or peripheral neuropathy. We examined whether optogenetically mediated light stimulation (OMLS) could enhance the axon outgrowth and myelination of MNs using three-dimensional motor neuron–Schwann cell (MN–SC) coculture on a microfluidic biochip. The biochip was designed to allow SCs to interact with the axons of MNs, while preventing direct contact between SCs and the cell bodies of MNs. Following coculture with SCs on the microfluidic biochip, MNs were transfected with a light-sensitive channelrhodopsin gene. Transfected MNs subjected to repeated light stimulation (20 Hz, 1 hr) produced significantly longer axons than nontransfected MNs. OMLS of MNs greatly increased the number of myelin basic protein (MBP)-expressing SCs, promoting the initiation of myelination of MNs. Ultrastructurally, OMLS of MNs markedly enhanced the thickness of the compact myelin sheath around the MN axons such that the average thickness was closer to that of the theoretical estimates in vivo. Thus, the MN–SC coculture model on a microfluidic biochip augmented by OMLS of MNs is a feasible platform for studying the relationship of neuronal activity with regrowth and remyelination.     

Minimally-invasive Technique for Injection into Rat Optic Nerve

The rat optic nerve is a useful model for stem cell regeneration research. Direct injection into the rat optic nerve allows delivery into the central nervous system in a minimally-invasive surgery without bone removal. This technique describes an approach to visualization and direct injection of the optic nerve following minor fascial dissection from the orbital ridge, using a conjunctival traction suture to gently pull the eye down and out. Representative examples of an injected optic nerve show successful injection of dyed beads.     

Retinal ganglion cell neurodegeneration in mitochondrial inherited disorders

Since the early days of mitochondrial medicine, it has been clear that optic atrophy is a very common and sometimes the singular pathological feature in mitochondrial disorders. The first point mutation of mitochondrial DNA (mtDNA) associated with the maternally inherited blinding disorder, Leber's hereditary optic neuropathy (LHON), was recognized in 1988. In 2000, the other blinding disorder, dominant optic atrophy (DOA) Kjer type, was found associated with mutations in the nuclear gene OPA1 that encodes a mitochondrial protein. Besides these two non-syndromic optic neuropathies, optic atrophy is a prominent feature in many other neurodegenerative diseases that are now recognized as due to primary mitochondrial dysfunction.We will consider mtDNA based syndromes such as LHON/dystonia/Mitochondrial Encephalomyopahty Lactic Acidosis Stroke-like (MELAS)/Leigh overlapping syndrome, or nuclear based diseases such as Friedreich ataxia (mutations in FXN gene), deafness-dystonia-optic atrophy (Mohr-Tranebjerg) syndrome (mutations in TIMM8A), complicated hereditary spastic paraplegia (mutations in SPG7), DOA “plus” syndromes (mutations in OPA1), Charcot-Marie-Tooth type 2A (CMT2A) with optic atrophy or hereditary motor and sensory neuropathy type VI (HMSN VI) (mutations in MFN2), and Costeff syndrome and DOA with cataract (mutations in OPA3). Thus, genetic errors in both nuclear and mitochondrial genomes often lead to retinal ganglion cell death, a specific target for mitochondrial mediated neurodegeneration. Many mechanisms have been studied and proposed as the bases for the pathogenesis of mitochondrial optic neuropathies including bioenergetic failure, oxidative stress, glutamate toxicity, abnormal mitochondrial dynamics and axonal transport, and susceptibility to apoptosis.     

青年猫和老年猫视神经超微结构观察比较

目的探讨青年猫和老年猫视神经年龄相关的形态学变化及可能造成的生理影响。方法取4只青年猫(2-3岁,2-2.5kg)和4只老年猫(10-13岁,2.5-3.5kg)颅内相对应部分视神经,制作横向半薄切片和超薄切片,半薄切片用甲苯胺蓝硼砂溶液染色,光镜观察、测量视神经的直径(不含外层神经膜);超薄切片标本用醋酸和柠檬酸铅染色,电镜观察、计数视神经纤维密度、测量视神经纤维外径D(含髓鞘)和内径d(不含髓鞘),按一定分级范围算出各种直径的纤维及各种d/D比值的纤维所占百分比,分别画出直方图,对实验结果进行统计学分析并绘制纤维直径谱。结果与青年猫相比,老年猫视神经直径显著增大(P0.05);纤维数量显著下降(P0.05)。纤维直径谱分析结果显示,青、老年猫纤维直径分布范围相似,但老年猫纤维的峰直径及纤维平均直径比青年猫的显著减小(P0.05),老年猫视神经纤维的d/D比值亦明显降低。另外,老年猫视神经中部分轴突肿胀,髓鞘疏松、结构紊乱,板层脱离、空泡化,有的轴索髓鞘溶解。结论在衰老过程中,老年猫视神经纤维丢失,纤维直径减小,d/D比值下降,以及纤维髓鞘的松散解体,这些变化均可能导致视神经纤维对视觉信息的传导速度减慢,是老年个体视觉分析速度下降的重要原因。