目的评价不同治疗方案对睡眠障碍的疗效及不良反应,为睡眠障碍提供有循证证据的最佳治疗方案。方法以sleep disorde(r睡眠障碍)、insomnia(失眠)、restless legss yndrome or RLS(不宁腿综合征)、obstructive sleep apnea or OSA(阻塞...目的评价不同治疗方案对睡眠障碍的疗效及不良反应,为睡眠障碍提供有循证证据的最佳治疗方案。方法以sleep disorde(r睡眠障碍)、insomnia(失眠)、restless legss yndrome or RLS(不宁腿综合征)、obstructive sleep apnea or OSA(阻塞性睡眠呼吸暂停)、narcolepsy(发作性睡病)、REM behaviour disorder or RBD(快速眼动睡眠期行为障碍)、treatment or therapy(治疗)等英文词汇作为检索词,分别检索2006-2013年Cochrane图书馆、美国国家图书馆医学在线(MEDLINE)、Science Direct等数据库,获得临床指南、系统评价、随机对照临床试验、回顾性病例分析研究、病例观察研究及综述等文献,采用Jadad量表进行质量评价。结果经筛选共计纳入与睡眠障碍治疗有关的临床指南6篇、系统评价12篇、随机对照临床试验5篇、回顾性病例分析2篇、病例观察1篇、综述14篇;其中33篇为高质量文献、7篇为低质量文献。经对各项临床试验治疗原则及不同治疗方法疗效和安全性评价显示:(1)失眠为最常见的睡眠障碍,以药物治疗和改善认知行为为主要治疗方法,两种治疗方法各有优缺点,联合治疗为最佳方案。(2)原发性不宁腿综合征的一线治疗药物为多巴胺受体激动药和抗惊厥药,继发性患者主要为病因治疗。(3)阻塞性睡眠呼吸暂停综合征治疗包括经鼻持续气道正压通气、口腔矫正器、手术治疗,其中经鼻持续气道正压通气为一线治疗方法。(4)发作性睡病的药物治疗包括莫达非尼、羟丁酸钠及抗抑郁药,应根据临床分型选择不同药物。(5)快速眼动睡眠期行为障碍的治疗包括一般治疗如避免诱因、保证睡眠环境安全等,药物治疗主要有苯二氮类及褪黑素。结论借助循证医学评价方法可为不同类型睡眠障碍的治疗提供最佳临床证据。展开更多
目的对比早发型及晚发型发作性睡病患者的临床及电生理检测特点。方法发作性睡病者共105例,其中15岁以下起病的早发型患者63例,平均发病年龄9.7岁±3.1岁;15岁以上起病的晚发型患者42例,平均发病年龄22.8岁±9.3岁。对比分析其...目的对比早发型及晚发型发作性睡病患者的临床及电生理检测特点。方法发作性睡病者共105例,其中15岁以下起病的早发型患者63例,平均发病年龄9.7岁±3.1岁;15岁以上起病的晚发型患者42例,平均发病年龄22.8岁±9.3岁。对比分析其临床、多导生理记录仪及多次小睡睡眠潜伏时间试验(MSLT)结果。结果全部患者均有白天嗜睡。发作性猝倒在早发型患者中发生率为92%,高于晚发型患者的76%(P=0.023);两组患者睡瘫、入睡幻觉及夜间睡眠紊乱的发生率相近(P均>0.05)。MSLT检查发现早发型患者的平均睡眠潜伏期(4.5 m in±4.0 m in及7.0 m in±5.7 m in,P=0.018)和REM睡眠潜伏期(3.4 m in±3.2 m in及4.8 m in±2.2 m in,P=0.02)更短,REM睡眠次数更多(3.4±2.0及2.5±1.9,P=0.009),晚发型患者的AHI次数更多(9.2次±16.5次及1.9次±6.3次,P=0.009),睡眠呼吸障碍较严重。3例有家族史者均为早发型患者。结论早发型发作性睡病患者的嗜睡及猝倒症状及临床特点较晚发型患者典型,其发生可能与遗传因素的关系更密切。展开更多
The present study was aimed to evaluate restingstate functional connectivity and topological properties of brain networks in narcolepsy patients compared with healthy controls.Resting-state fMRI was performed in 26 ad...The present study was aimed to evaluate restingstate functional connectivity and topological properties of brain networks in narcolepsy patients compared with healthy controls.Resting-state fMRI was performed in 26 adult narcolepsy patients and 30 matched healthy controls.MRI data were first analyzed by group independent component analysis,then a graph theoretical method was applied to evaluate the topological properties in the whole brain.Small-world network parameters and nodal topological properties were measured.Altered topological properties in brain areas between groups were selected as regionof-interest seeds,then the functional connectivity among these seeds was compared between groups.Partial correlation analysis was performed to evaluate the relationship between the severity of sleepiness and functional connectivity or topological properties in the narcolepsy patients.Twenty-one independent components out of 48 were obtained.Compared with healthy controls,the narcolepsy patients exhibited significantly decreased functional connectivity within the executive and salience networks,along with increased functional connectivity in the bilateral frontal lobes within the executive network.There were no differences in small-world network properties between patients and controls.The altered brain areas in nodal topological properties between groups were mainly in the inferior frontal cortex,basal ganglia,anterior cingulate,sensory cortex,supplementary motor cortex,and visual cortex.In the partial correlation analysis,nodal topological properties in the putamen,anterior cingulate,and sensory cortex as well as functional connectivity between these regions were correlated with the severity of sleepiness(sleep latency,REM sleep latency,and Epworth sleepiness score)among narcolepsy patients.Altered connectivity within the executive and salience networks was found in narcolepsy patients.Functional connection changes between the left frontal cortex and left caudate nucleus may be one of the parameters describing the sev展开更多
Gangliosides are structurally and functionally polymorphic sialic acid containing glycosphingolipids that are widely distributed in the human body.They play important roles in protecting us against immune attacks,yet ...Gangliosides are structurally and functionally polymorphic sialic acid containing glycosphingolipids that are widely distributed in the human body.They play important roles in protecting us against immune attacks,yet they can become targets for autoimmunity and act as receptors for microbes,like the influenza viruses,and toxins,such as the cholera toxin.The expression patterns of gangliosides vary in different tissues,during different life periods,as well as in different animals.Antibodies against gangliosides(AGA)can target immune attack e.g.,against neuronal cells and neutralize their complement inhibitory activity.AGAs are important especially in acquired demyelinating immune-mediated neuropathies,like Guillain–Barrésyndrome(GBS)and its variant,the Miller–Fisher syndrome(MFS).They can emerge in response to different microbial agents and immunological insults.Thereby,they can be involved in a variety of diseases.In addition,antibodies against GM3 were found in the sera of patients vaccinated with Pandemrix®,who developed secondary narcolepsy,strongly supporting the autoimmune etiology of the disease.展开更多
文摘目的评价不同治疗方案对睡眠障碍的疗效及不良反应,为睡眠障碍提供有循证证据的最佳治疗方案。方法以sleep disorde(r睡眠障碍)、insomnia(失眠)、restless legss yndrome or RLS(不宁腿综合征)、obstructive sleep apnea or OSA(阻塞性睡眠呼吸暂停)、narcolepsy(发作性睡病)、REM behaviour disorder or RBD(快速眼动睡眠期行为障碍)、treatment or therapy(治疗)等英文词汇作为检索词,分别检索2006-2013年Cochrane图书馆、美国国家图书馆医学在线(MEDLINE)、Science Direct等数据库,获得临床指南、系统评价、随机对照临床试验、回顾性病例分析研究、病例观察研究及综述等文献,采用Jadad量表进行质量评价。结果经筛选共计纳入与睡眠障碍治疗有关的临床指南6篇、系统评价12篇、随机对照临床试验5篇、回顾性病例分析2篇、病例观察1篇、综述14篇;其中33篇为高质量文献、7篇为低质量文献。经对各项临床试验治疗原则及不同治疗方法疗效和安全性评价显示:(1)失眠为最常见的睡眠障碍,以药物治疗和改善认知行为为主要治疗方法,两种治疗方法各有优缺点,联合治疗为最佳方案。(2)原发性不宁腿综合征的一线治疗药物为多巴胺受体激动药和抗惊厥药,继发性患者主要为病因治疗。(3)阻塞性睡眠呼吸暂停综合征治疗包括经鼻持续气道正压通气、口腔矫正器、手术治疗,其中经鼻持续气道正压通气为一线治疗方法。(4)发作性睡病的药物治疗包括莫达非尼、羟丁酸钠及抗抑郁药,应根据临床分型选择不同药物。(5)快速眼动睡眠期行为障碍的治疗包括一般治疗如避免诱因、保证睡眠环境安全等,药物治疗主要有苯二氮类及褪黑素。结论借助循证医学评价方法可为不同类型睡眠障碍的治疗提供最佳临床证据。
文摘目的对比早发型及晚发型发作性睡病患者的临床及电生理检测特点。方法发作性睡病者共105例,其中15岁以下起病的早发型患者63例,平均发病年龄9.7岁±3.1岁;15岁以上起病的晚发型患者42例,平均发病年龄22.8岁±9.3岁。对比分析其临床、多导生理记录仪及多次小睡睡眠潜伏时间试验(MSLT)结果。结果全部患者均有白天嗜睡。发作性猝倒在早发型患者中发生率为92%,高于晚发型患者的76%(P=0.023);两组患者睡瘫、入睡幻觉及夜间睡眠紊乱的发生率相近(P均>0.05)。MSLT检查发现早发型患者的平均睡眠潜伏期(4.5 m in±4.0 m in及7.0 m in±5.7 m in,P=0.018)和REM睡眠潜伏期(3.4 m in±3.2 m in及4.8 m in±2.2 m in,P=0.02)更短,REM睡眠次数更多(3.4±2.0及2.5±1.9,P=0.009),晚发型患者的AHI次数更多(9.2次±16.5次及1.9次±6.3次,P=0.009),睡眠呼吸障碍较严重。3例有家族史者均为早发型患者。结论早发型发作性睡病患者的嗜睡及猝倒症状及临床特点较晚发型患者典型,其发生可能与遗传因素的关系更密切。
基金supported by the National Natural Science Foundation of China (81700088 and 81671765)the Key International (Regional) Cooperation Program of the National Natural Science Foundation of China (81420108002)+1 种基金the National Basic Research Development Program (973 Program) of China (2015CB856405)the Beijing Municipal Natural Science Foundation (7172121)
文摘The present study was aimed to evaluate restingstate functional connectivity and topological properties of brain networks in narcolepsy patients compared with healthy controls.Resting-state fMRI was performed in 26 adult narcolepsy patients and 30 matched healthy controls.MRI data were first analyzed by group independent component analysis,then a graph theoretical method was applied to evaluate the topological properties in the whole brain.Small-world network parameters and nodal topological properties were measured.Altered topological properties in brain areas between groups were selected as regionof-interest seeds,then the functional connectivity among these seeds was compared between groups.Partial correlation analysis was performed to evaluate the relationship between the severity of sleepiness and functional connectivity or topological properties in the narcolepsy patients.Twenty-one independent components out of 48 were obtained.Compared with healthy controls,the narcolepsy patients exhibited significantly decreased functional connectivity within the executive and salience networks,along with increased functional connectivity in the bilateral frontal lobes within the executive network.There were no differences in small-world network properties between patients and controls.The altered brain areas in nodal topological properties between groups were mainly in the inferior frontal cortex,basal ganglia,anterior cingulate,sensory cortex,supplementary motor cortex,and visual cortex.In the partial correlation analysis,nodal topological properties in the putamen,anterior cingulate,and sensory cortex as well as functional connectivity between these regions were correlated with the severity of sleepiness(sleep latency,REM sleep latency,and Epworth sleepiness score)among narcolepsy patients.Altered connectivity within the executive and salience networks was found in narcolepsy patients.Functional connection changes between the left frontal cortex and left caudate nucleus may be one of the parameters describing the sev
基金supported by the Sigrid Jusélius Foundation,the Academy of Finland(292393)Helsinki University Central Hospital(TYH2018313,TYH2019311)grants.
文摘Gangliosides are structurally and functionally polymorphic sialic acid containing glycosphingolipids that are widely distributed in the human body.They play important roles in protecting us against immune attacks,yet they can become targets for autoimmunity and act as receptors for microbes,like the influenza viruses,and toxins,such as the cholera toxin.The expression patterns of gangliosides vary in different tissues,during different life periods,as well as in different animals.Antibodies against gangliosides(AGA)can target immune attack e.g.,against neuronal cells and neutralize their complement inhibitory activity.AGAs are important especially in acquired demyelinating immune-mediated neuropathies,like Guillain–Barrésyndrome(GBS)and its variant,the Miller–Fisher syndrome(MFS).They can emerge in response to different microbial agents and immunological insults.Thereby,they can be involved in a variety of diseases.In addition,antibodies against GM3 were found in the sera of patients vaccinated with Pandemrix®,who developed secondary narcolepsy,strongly supporting the autoimmune etiology of the disease.
