血浆甘油三酯水平与缺血性卒中出院结局关系研究

目的   探讨急性缺血性卒中患者入院时血浆甘油三酯（triglyceride,TG）水平与出院结局不良的关系。 方法  采用回顾性队列研究的方法,连续纳入内蒙古兴安盟人民医院2009年6月1日～2012年5月31日急性缺血性卒中患者,共计3351例。结局不良组定义为患者出院时改良Rankin量表（modified Rankin Scale,mRS）评分≥3分,对结局不良组和结局良好组患者间基线资料进行比较。用四分位数法将患者入院时血浆TG水平分为4组,用非条件Logistic回归分析入院时TG水平与急性缺血性卒中出院结局不良的关系,计算比值比（odds ratio,OR）及95%可信区间（confidence interval,CI）。 结果  研究对象中发生结局不良的共341例,发生率为10.2%。单因素非条件Logistic回归分析结果显示,TG相对最高分位数组（TG＞2.12?mmol/L）,第1、2、3分位数组（TG分别为≤1.06?mmol/L、1.06～1.46?mmol/L、1.46～2.12?mmol/L）的结局不良发生率差异有显著性（P＜0.001）。在调整了年龄、住院天数、发病到入院时间、缺血性卒中首发、吸烟、饮酒、心脏病史、心房颤动史、高血压、高血糖和心率后,相对于最高分位数组,第3分位数组的结局不良发生率差异无显著性（P=0.0758）,而第1、2分位数组结局不良发生率升高（均P＜0.0001）,其OR（95%CI）分别为11.883（1.307～2.714）和2.063（1.436～2.963）。 结论  急性缺血性卒中患者入院时低水平TG可能独立地增加出院结局不良的风险。     

既往卒中病史对缺血性脑血管病患者卒中结局的影响研究

目的 探讨中国人群中首发和复发缺血性脑血管病患者的临床特征和卒中结局差异。 方法 本研究基于全国多中心前瞻性中国国家卒中登记研究Ⅲ（the third China national stroke regi stry,CNSR-Ⅲ）,连续纳入2015年8月-2018年3月急性缺血性卒中或TIA患者,收集人口学信息、血 管危险因素、既往用药史及病因分型系统（causative classification system,CCS）等临床资料,记录随 访3个月和1年时卒中结局。卒中结局包括卒中复发（缺血性卒中或出血性卒中）、联合血管事件（卒中、 心肌梗死及血管性死亡事件）、脑血管病源性死亡及不良功能结局（mRS＞2分）。依据患者既往是否 有卒中病史分为有卒中病史组和无卒中病史组,比较两组的临床特征及卒中结局差异,并分析卒中病 史与卒中结局间的关系。 结果 最终纳入15 166例患者,平均年龄62.2±11.3岁,其中女性4802例（31.7%）;有卒中病史患者 3355例,无卒中病史患者11 811例。有卒中病史组患者年龄,冠心病、高血压、脂代谢紊乱、糖尿病、心 房颤动比例,既往用药史比例、入院NIHSS评分、住院期间降糖和降压治疗比例均高于无卒中病史组, 目前吸烟和重度饮酒比例、入院时LDL-C水平及住院期间抗血小板治疗比例低于无卒中病史组,差 异均有统计学意义。两组CCS分型的分布差异有统计学意义,其中有卒中病史组大动脉粥样硬化型和 心源性栓塞型卒中比例高于无卒中病史组。多因素分析结果显示,卒中病史是随访3个月不良功能结 局（校正OR 1.25,95%CI 1.09～1.44,P =0.002）,随访1年卒中复发（校正HR 1.44,95%CI 1.25～1.67, P＜0.001）、联合血管事件（校正HR 1.43,95%CI 1.24～1.64,P＜0.001）、脑血管病源性死亡（校正 HR 1.42,95%CI 1.12～1.80,P =0.004）、不良功能结局（校正OR 1.63,95%CI 1.42～1.88,P＜0.001）的 危险因素。 结论 有无卒中病史的缺血性卒中患者的临床特征及随访结局差异较大,尽管患者进行卒中二级 预防治疗,卒中病史仍然是患者1年卒中复发、联合血管事件、脑血管病源性死亡及不良功能结局的 危险因素。     

血尿酸水平与急性缺血性卒中病情严重程度和预后的关系研究

目的 探讨急性缺血性卒中患者血清UA水平与病情严重程度及预后的关系。 方法 回顾性收集在深圳市第二人民医院神经内科2014年1月-2017年12月住院的急性缺血性 卒中患者。根据血UA水平进行三分位数分组：低分位数组（3.85～298.80）μmol/L、中分位数组 （299.80～398.00）μmol/L和高分位数组（402.30～702.10）μmol/L。多因素回归分析急性缺血性卒中 患者中病情严重程度及临床预后的危险因素，分层分析不同人群UA水平与病情严重程度及临床预后 的关系。 结果 227例入组患者中，UA低分位数组75例、中分位数组72例，高分位数组80例。调整混杂因素后， 相比低分位数组，UA高分位数组患者入院NIHSS评分下降2.16分（β=-2.16，95%CI -3.53～-0.78， P =0.002），发生早期神经功能恶化（early neurological deterioration，END）的风险下降60%（OR 0.40， 95%CI 0.16～0.97，P =0.042）。分层分析发现，在男性和既往无卒中史的患者中，随着UA水平升高，入 院NIHSS评分降低，END减少，差异具有统计学意义。 结论 高UA水平是急性缺血性卒中严重程度的保护因素，能降低END；其对男性和新发急性缺血性 卒中患者的保护性更明显。     

卒中单元对急性缺血性卒中患者医疗质量和在院预后的影响

目的 调查中国卒中单元对缺血性卒中患者收治的现况，并探索卒中单元对改善卒中医疗质量绩效 指标及患者在院预后的影响。 方法 本研究数据来自中国多中心缺血性卒中住院患者登记研究。按照是否进入卒中单元，将 研究对象分为卒中单元组与非卒中单元组。比较两组间患者的卒中医疗质量关键绩效指标（key performance index，KPI）和在院预后（卒中复发、联合血管事件、全因死亡）的差异，并采用多因素回归， 分析与卒中单元相关的KPI及卒中单元与缺血性卒中患者在院预后的相关性。 结果 本研究共纳入了全国1374家医院的269 428例急性缺血性卒中住院患者。其中，63 548例 （23.6%）患者纳入卒中单元组。卒中单元与较高比例的rt-PA静脉溶栓（OR 1.48，95%CI 1.43～1.53）、 早期抗栓治疗（OR 1.13，95%CI 1.10～1.17）、深静脉血栓预防（OR 1.19，95%CI 1.16～1.22）、吞 咽功能筛查（OR 1.36，95%CI 1.32～1.39）、康复评估（OR 1.31，95%CI 1.28～1.34）、出院抗栓治疗 （OR 1.12，95%CI 1.08～1.15）、合并心房颤动患者抗凝治疗（OR 1.13，95%CI 1.08～1.19）、戒烟宣教 （OR 1.22，95%CI 1.20～1.25）独立相关，与较低的在院卒中复发率（HR 0.79，95%CI 0.75～0.82）和 联合血管事件发生率（HR 0.80，95%CI 0.77～0.84）独立相关（均P <0.001）。 结论 进入卒中单元的缺血性卒中患者，卒中医疗质量KPI完成较好，在院卒中复发率及联合血管事 件率较低。     

贫血对急性缺血性卒中预后的影响

目的 探讨贫血对急性缺血性卒中2年预后的影响。 方法 收集在北京市老年病医院住院的急性缺血性卒中患者131例，记录患者的一般资料和临床特 征，神经功能缺损评价采用NIHSS评分。根据患者入院时有无贫血分为贫血组和非贫血组，随访患者 2年预后、复合血管事件和死亡率，其中预后采用mRS量表进行评价（mRS评分≤2分为预后良好，mRS 评分＞2分为预后不良）。复合血管事件包括再发卒中、脑出血和急性冠状动脉综合征。采用Logistic回 归分析贫血对急性缺血性卒中2年预后和死亡的影响。 结果 与非贫血组相比，贫血组患者年龄较大，神经功能缺损较重，心房颤动、慢性肾功能不全、 外周血管病患病率较高，差异有统计学意义。入院时贫血是急性缺血性卒中患者2年预后不良（OR 5.063，95%CI 1.887～13.590）、死亡（OR 13.266，95%CI 1.364～128.993）的独立危险因素。 结论 入院时合并贫血的急性缺血性卒中患者年龄较大，共存疾病较多，神经功能缺损较重。贫血 是卒中后2年预后不良、病死率高的独立危险因素。     

丁苯酞氯化钠注射液治疗急性缺血性卒中安全性及有效性研究——多中心、前瞻性、开放标签Ⅳ期临床试验

目的 评价丁苯酞氯化钠注射液在真实世界中治疗缺血性卒中的安全性和有效性。 方法 多中心、前瞻性、开放标签Ⅳ期临床试验。研究共纳入2771例发病72 h以内的急性缺血性卒 中患者,给予丁苯酞氯化钠注射液静脉滴注,每日2次,每次25 mg（100 mL）,疗程14 d。主要安全性 终点为（90±7）d的全因死亡,主要有效性终点为（90±7）d的mRS评分,次要有效性终点为（7±2）d、 （14±2）d的NIHSS评分。 结果 本研究共纳入2012年3月-2014年12月全国74家中心的2771例患者（全分析集）,其中男性 1890例（68.21%）,女性881例（31.79%）。2672例受试者（符合方案集）完成90 d随访,脱落率3.39%, 剔除率0.18%。全分析集（2771例）中,安全性终点分析：90 d全因死亡率为1.08%,研究者判定与研究 药物有关及无法判定的不良事件发生率为3.28%。有效性终点分析：治疗前、治疗第90天的mRS评分 0～1分的比例分别为23.29%和63.80%,治疗前后差值均数为（1.36±1.32）分,前后差值具有统计学 意义,P <0.0001。 结论 急性缺血性卒中患者使用丁苯酞氯化钠注射液是安全的。     

卒中单元对急性缺血性卒中患者医疗质量和在院预后的影响

目的 调查中国卒中单元对缺血性卒中患者收治的现况，并探索卒中单元对改善卒中医疗质量绩效
指标及患者在院预后的影响。
方法 本研究数据来自中国多中心缺血性卒中住院患者登记研究。按照是否进入卒中单元，将
研究对象分为卒中单元组与非卒中单元组。比较两组间患者的卒中医疗质量关键绩效指标（key
performance index，KPI）和在院预后（卒中复发、联合血管事件、全因死亡）的差异，并采用多因素回归，
分析与卒中单元相关的KPI及卒中单元与缺血性卒中患者在院预后的相关性。
结果 本研究共纳入了全国1374家医院的269 428例急性缺血性卒中住院患者。其中，63 548例
（23.6%）患者纳入卒中单元组。卒中单元与较高比例的rt-PA静脉溶栓（OR 1.48，95%CI 1.43～1.53）、
早期抗栓治疗（OR 1.13，95%CI 1.10～1.17）、深静脉血栓预防（OR 1.19，95%CI 1.16～1.22）、吞
咽功能筛查（OR 1.36，95%CI 1.32～1.39）、康复评估（OR 1.31，95%CI 1.28～1.34）、出院抗栓治疗
（OR 1.12，95%CI 1.08～1.15）、合并心房颤动患者抗凝治疗（OR 1.13，95%CI 1.08～1.19）、戒烟宣教
（OR 1.22，95%CI 1.20～1.25）独立相关，与较低的在院卒中复发率（HR 0.79，95%CI 0.75～0.82）和
联合血管事件发生率（HR 0.80，95%CI 0.77～0.84）独立相关（均P <0.001）。
结论 进入卒中单元的缺血性卒中患者，卒中医疗质量KPI完成较好，在院卒中复发率及联合血管事
件率较低。     

血清碱性磷酸酶水平与轻型脑梗死患者卒中复发相关性研究

目的 探讨血清碱性磷酸酶（alkaline phosphatase，ALP）水平与轻型脑梗死患者卒中复发相关性。 方法 通过西安脑卒中数据库，纳入西安市4所三级甲等医院2015年1-12月确诊的轻型脑梗死患者。 入院24 h内检测血清ALP水平，并按照四分位数分组法分为四组。研究的终点事件为患者1年内卒中复 发（包括脑梗死、脑出血、蛛网膜下腔出血）。采用多因素Logistic回归分析和曲线拟合评估血清ALP 水平与轻型脑梗死患者1年卒中复发的相关性。 结果 共纳入895例轻型脑梗死患者，平均年龄为63.52±12.31岁，男性572例（63.9%），入院NIHSS 评分中位数为2分，1年卒中复发为26例（2.9%）。多因素Logistic回归分析显示，血清ALP每升高1 U/L， 轻型脑梗死患者的1年卒中复发风险增加2%（OR 1.02，95%CI 1.01～1.04，P =0.030）；每升高10 U/L， 1年卒中复发风险增加19%（OR 1.19，95%CI 1.01～1.41，P =0.030）。高水平组（Q2、Q3与Q4组）与最低 水平组（Q1组）间的1年卒中复发风险差异均无统计学意义；四分组间1年卒中复发风险升高趋势无统 计学意义。 结论 血清ALP可能是轻型脑梗死患者1年卒中复发的影响因素。     

老年轻型急性缺血性卒中后认知障碍与血清β2微球蛋白的关系研究

目的 探讨血清β2微球蛋白水平与老年轻型急性缺血性卒中后认知障碍的关系，为预防老年轻型 卒中后认知障碍提供依据。 方法 回顾性分析2015年1月-2018年9月在北京中医药大学东方医院脑病科住院的老年轻型急性 缺血性卒中患者的临床资料，所有入组病例均在入院第2天采集空腹肘静脉血测定血清β2微球蛋白、 LDL-C、HDL-C等生化指标；发病第10～14天使用北京版MoCA量表进行评测，分为认知障碍组（MoCA评 分＜26分）和无认知障碍组（MoCA评分≥26分），通过统计学分析，探讨老年轻型急性缺血性卒中后 认知障碍与血清β2微球蛋白之间的关系。 结果 研究共纳入106例老年轻型急性缺血性卒中患者，其中认知障碍组66例，无认知障碍 组40例。认知障碍组患者血清β2微球蛋白水平（P =0.040）、年龄（P =0.004）、高血压患者比例 （P =0.027）均高于无认知障碍组。多因素Logistic回归分析结果显示血清β2微球蛋白水平（OR 2.645， 95%CI 1.145～6.110，P =0.023）、年龄（OR 1.112，95%CI 1.041～1.188，P =0.002）、高血压（OR 2.806， 95%CI 1.057～7.452，P =0.038）是老年轻型急性缺血性卒中后认知障碍的危险因素。 结论 血清β2微球蛋白升高是老年轻型急性缺血性卒中后认知障碍的危险因素之一，血清β2微球 蛋白水平较高的老年轻型急性缺血性卒中患者应给予重视。     

后循环急性缺血性卒中血管内治疗与静脉溶栓的对照研究

目的 比较后循环大血管闭塞致急性缺血性卒中患者接受血管内治疗（endovascular treatment，EVT） 与单纯静脉溶栓（intravenous thrombolysis，IVT）治疗后的临床结局。 方法 纳入2012年3月-2016年11月期间在北京天坛医院行EVT与IVT治疗的后循环大血管闭塞所致 急性缺血性卒中患者，以1∶1比例匹配两组的年龄、性别、基线NIHSS评分、发病至治疗时间及卒中亚型 （TOAST分型），匹配患者的NIHSS评分≥10分。主要疗效结局为治疗后90 d的mRS评分，安全性结局为 24 h ICH及90 d全因死亡率。 结果 共纳入328例后循环急性缺血性卒中患者，其中EVT组69例，IVT组259例，匹配后两组基线数 据相似，每组各55例。各卒中亚型比例在两组均有显著性差异（所有P <0.001），两组均以大动脉粥 样硬化型为主，其中EVT组63例（91.3%），IVT组164例（63.3%）。临床疗效结局显示匹配后EVT组90 d mRS评分≤1分比例（30.9% vs 38.2%，校正OR 0.724，95%CI 0.329～1.595，P =0.423）及mRS评分≤2 分比例（38.2% vs 50.9%，校正OR 0.596，95%CI 0.279～1.272，P =0.181）均低于IVT组，但差异均无统 计学意义。安全性结局方面，24 h症状性脑出血及治疗后90 d全因死亡率，两组比较差异也无统计学 意义。 结论 对于后循环大血管闭塞所致急性缺血性卒中患者行EVT治疗和单纯IVT治疗，在疗效及安全 性结局方面均无显著性差异。     

Low serum magnesium is associated with poor functional outcome in acute ischemic stroke or transient ischemic attack patients

Aim

The association between magnesium and outcomes after stroke is uncertain. We aimed to investigate the association of serum magnesium with all-cause mortality and poor functional outcome.

Methods

We included patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) from the China National Stroke Registry III. We used Cox proportional hazards model for all-cause mortality and logistic regression model for poor functional outcome (modified Rankin Scale [mRS] 2–6/3–6) to examine the relationships.

Results

Among the 6483 patients, the median (interquartile range) magnesium was 0.87 (0.80–0.93) mmol/L. Patients in the first quartile had a higher risk of mRS score 3–6/2–6 at 3 months (adjusted odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.02, 1.64; adjusted OR: 1.29; 95% CI: 1.04–1.59) compared with those in the fourth quartile. Similar results were found for mRS score 26 at 1 year. The age- and sex-adjusted hazard ratio (HR) with 95% CI in first quartile magnesium was 1.40 (1.02–1.93) for all-cause mortality within 1 year, but became insignificant (HR: 1.03; 95% CI: 0.71–1.50) after adjusting for potential variables.

Conclusions

Low serum magnesium was associated with a high risk of poor functional outcome in patients with AIS or TIA.     

Effect of left ventricular ejection fraction Spectrum on 1-Year mortality in patients with acute ischemic stroke or transient ischemic attack

Aims

We aimed to investigate the association of the left ventricular ejection fraction (LVEF) spectrum with 1-year clinical outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA).

Methods

In a prospective registry for the Third China National Stroke Registry (CNSR-III), AIS or TIA patients with echocardiography records during hospitalization were recruited. All LVEFs were categorized into intervals of 5% in width. The lowest and highest intervals are ≤40% and >70%, respectively. The primary outcome was all-cause death at 1 year. Cox proportional hazards regression analysis was performed to investigate the association between baseline LVEF and clinical outcomes.

Results

This analysis included a total of 14,053 patients. In total, 418 patients died during 1-year follow-up. Overall, LVEF ≤60% was associated with a higher risk of all-cause death compared to LVEF >60%, independent of demographic and clinical characteristics (aHR 1.29 [95% CI 1.06–1.58]; p = 0.01). The cumulative incidence of all-cause death was significantly different among the eight LVEF groups that survival declined successively with the decrease of LVEF (log-rank p ≤ 0.0001).

Conclusions

Patients with AIS or TIA with decreased LVEF (≤60%) had a lower 1-year survival rate after onset. LVEF 50%–60% even within the normal range, may still contribute to poor outcomes in AIS or TIA. Comprehensive evaluation of cardiac function after acute ischemic cerebrovascular disease should be strengthened.     

Monocyte to high-density lipoprotein ratio predicts clinical outcomes after acute ischemic stroke or transient ischemic attack

Aims

The monocyte to high-density lipoprotein cholesterol ratio (MHR) has emerged as a novel inflammatory biomarker of atherosclerotic cardiovascular disease. However, it has not yet been identified whether MHR can predict the long-term prognosis of ischemic stroke. We aimed to investigate the associations of MHR levels with clinical outcomes in patients with ischemic stroke or transient ischemic attack (TIA) at 3 months and 1 year.

Methods

We derived data from the Third China National Stroke Registry (CNSR-III). Enrolled patients were divided into four groups by quartiles of MHR. Multivariable Cox regression for all-cause death and stroke recurrence and logistic regression for the poor functional outcome (modified Rankin Scale score 3–6) were used.

Results

Among 13,865 enrolled patients, the median MHR was 0.39 (interquartile range, 0.27–0.53). After adjustment for conventional confounding factors, the MHR level in quartile 4 was associated with an increased risk of all-cause death (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.10–1.90), and poor functional outcome (odd ratio [OR], 1.47; 95% CI, 1.22–1.76), but not with stroke recurrence (HR, 1.02; 95% CI, 0.85–1.21) at 1 year follow-up, compared with MHR level in quartile 1. Similar results were observed for outcomes at 3 months. The addition of MHR to a basic model including conventional factors improved predictive ability for all-cause death and poor functional outcome validated by the C-statistic and net reclassification index (all p < 0.05).

Conclusions

Elevated MHR can independently predict all-cause death and poor functional outcome in patients with ischemic stroke or TIA.     

氯吡格雷联合阿司匹林治疗对轻型卒中与短暂性脑缺血发作患者功能预后的影响：CHANCE与POINT试验联合分析

目的 评价氯吡格雷联合阿司匹林双抗治疗对轻型缺血性卒中与TIA患者功能预后的影响。 方法 提取CHANCE和POINT试验所有的个体数据。这两项试验中,所有纳入患者在症状发作12 h （POINT）或24 h（CHANCE）以内随机接受氯吡格雷联用阿司匹林或单用阿司匹林治疗。结局指标为3个 月时功能预后不良（mRS≥2）,三等级定义卒中复发[致残性或致死性卒中复发（mRS≥2）、非致残性 卒中复发（mRS 0或1）、无卒中复发]。 结果 共10 013例患者纳入分析,其中来自CHANCE试验5132例（51.3%）,来自POINT试验4881例 （48.7%）;氯吡格雷联用阿司匹林组4995例（49.9%）,单用阿司匹林组5018例（50.1%）。氯吡格雷联 用阿司匹林组3个月时功能预后不良的患者比例低于单用阿司匹林组（11.6% vs 12.6%,校正OR 0.82, 95%CI 0.72～0.94,P =0.005）。氯吡格雷联用阿司匹林组致残性或致死性卒中复发（4.6% vs 6.1%, 校正OR 0.73,95%CI 0.61～0.87,P <0.001）、非致残性卒中复发（1.9% vs 3.0%,校正OR 0.62,95%CI 0.47～0.80,P <0.001）和卒中复发的整体致残性（校正cOR 0.70,95%CI 0.60～0.81,P <0.001）低于单 用阿司匹林组。 结论 与单用阿司匹林治疗相比,氯吡格雷联用阿司匹林治疗可进一步改善轻型缺血性卒中和TIA 患者3个月时功能预后,减少致残性卒中复发。     

Association of serum albumin to globulin ratio with outcomes in acute ischemic stroke

Background

Serum albumin to globulin ratio (A/G) has been widely used as a representative biomarker for assessing inflammation and nutrition status. However, in patients with acute ischemic stroke (AIS), the predictive value of serum A/G has rarely been reported. We aimed to evaluate whether serum A/G is associated with prognosis in stroke.

Methods

We analyzed data from the Third China National Stroke Registry. The patients were categorized into quartile groups according to the serum A/G at admission. Clinical outcomes included poor functional outcomes (modified Rankin Scale [mRS] score of 3–6 or 2–6) and all-cause mortality at 3 months and1 year. Multivariable logistic regressions and Cox proportional hazards regressions were used to evaluate the association of serum A/G with the risk of poor functional outcomes and all-cause mortality.

Results

A total of 11, 298 patients were included in this study. After adjustment for confounding factors, patients in the highest serum A/G quartile had a lower proportion of mRS score 2–6 (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.76–1.00) and mRS score 3–6 (OR, 0.87; 95% CI, 0.73–1.03) at 3 months follow-up. At 1 year follow-up, there was a significant association between higher serum A/G and mRS score 3–6 (OR, 0.68; 95% CI, 0.57–0.81). We also found that the highest serum A/G was related to decreased risk of all-cause mortality (hazard ratio [HR], 0.58; 95% CI, 0.36–0.94) at 3 months follow-up. Similar results were found at 1-year follow-up.

Conclusions

Lower serum A/G levels were associated with poor functional outcomes and all-cause mortality at 3 months and 1-year follow-up in patients with acute ischemic stroke.     

Intracranial Artery Calcium Burden Predicts Recurrent Cerebrovascular Events in Transient Ischaemic Attack Patients

Background: Patients with initial transient ischaemic attack (TIA) subsequently have a higher risk of recurrent TIA or acute ischemic stroke (AIS). The role of scoring intracranial arterial calcification (IAC) in predicting the prevalence of stroke remains unclear. We aim to evaluate if radiological CT calcium score measuring IAC burden could predict future ischemic events in a cohort of TIA patients. Methods: We studied consecutive patients from July 2014 to December 2015 who presented with first episode of TIA. All patients had noncontrasted CT or CT-angiogram of the brain on admission. CT calcium score (cm3) was quantified by measuring calcium deposition in the bilateral internal carotid arteries, middle cerebral arteries, and vertebrobasilar system. Patients were followed up for 2 years and ischemic events for either recurrent TIA or AIS were recorded. We compared patients in terms of clinical profile at presentation and CT calcium score using appropriate univariate and multivariable analyses. Results: Of 156 TIA patients studied, 22% (n = 35) had recurrent TIA or AIS within 2 years of follow-up. On univariate analyses, recurrent TIA/AIS was associated with gender (OR 0.61; 95%CI 0.40-0.95; P = .038), hypertension (mean difference 2.49; 95%CI 1.08-5.75; P = .030) and higher CT calcium score (mean difference 0.84 95%CI 0.16-1.52 P = .016). On multivariable logistic regression, a higher CT calcium score was significantly associated with recurrent TIA/AIS (adjusted OR 1.25 95%CI 1.01-1.55 P = .042). Conclusions: In TIA patients, higher IAC burden by measurement of a quantitative CT calcium score may be associated with recurrent ischemic events.     

大面积梗死急性缺血性卒中患者血管内治疗的有效性和安全性研究

目的 观察低ASPECTS评分的大面积梗死患者血管内治疗的有效性和安全性,并探讨预后的影响 因素。 方法 从急性缺血性卒中血管内治疗关键技术及急救流程改进研究-前瞻性、多中心、登记研究 （endovascular treatment key technique and emergency work flow improvement of acute ischemic stroke, ANGEL-ACT）中筛选接受血管内治疗,且ASPECTS/后循环ASPECTS（post-circulation ASPECTS,pc- ASPECTS）＜6分的大面积脑梗死患者,分析影响患者预后的因素。有效性终点为术后90 d预后良好 （mRS 0～3分）,安全性终点包括术后24 h内症状性颅内出血（symptomatic intracranial hemorrhage,sICH） 和术后90 d全因死亡。 结果 共纳入121例患者,其中男性89例（73.55%）,中位年龄62.0（54.0～72.0）岁,失访6例,纳 入统计分析的共115例患者。术后90 d预后良好53例（46.09%）,基线低NIHSS（OR 0.908,95%CI 0.841～0.980,P =0.0130）和闭塞血管再通成功（OR 13.676,95%CI 1.396～134.004,P =0.0247）是术 后90 d预后良好的独立预测因子。术后24 h内发生sICH 21例（18.26%）,穿刺至再通时间长（OR 1.009, 95%CI 1.002～1.017,P =0.0163）和病变血管合并串联狭窄（OR 4.202,95%CI 1.457～12.119,P =0.0079） 是术后24 h内sICH的独立预测因子。术后90 d全因死亡23例（20.00%）,基线高NIHSS（OR 1.089, 95%CI 1.014～1.170,P =0.0186）和术后24 h内sICH（OR 4.688,95%CI 1.382～15.898,P =0.0132）是术 后90 d全因死亡的独立预测因子。 结论 大面积梗死的急性缺血性卒中患者接受血管内治疗虽然风险较高,但术前严格地筛选低 NIHSS患者,术中尽量获得闭塞血管再通成功能够使患者获益。     

Association between Serum Insulin-Like Growth Factor-1 and Neurological Severity in Acute Ischemic Stroke

Background and PurposeSerum insulin-like growth factor-1 (IGF-1) is known to have a neuroprotective effect. This study aimed to determine the effects of serum IGF-1 on the severity and clinical outcome of acute ischemic stroke (AIS).MethodsThis study included 446 patients with AIS who were admitted to Hallym University Sacred Heart Hospital within 7 days of stroke onset from February 2014 to June 2017. Serum IGF-1 levels were measured within 24 hours of admission. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS) score at admission, and the functional outcome at 3 months after symptom onset was assessed using the modified Rankin Scale score. The effects of serum IGF-1 levels on stroke severity and 3-month functional outcomes were analyzed using multivariate logistic regression analysis.ResultsThis study evaluated 379 patients with AIS (age 67.2±12.6 years, mean±standard deviation; 59.9% males) after excluding 67 patients who had a history of previous stroke (n=25) or were lost to follow-up at 3 months (n=42). After adjusting for clinically relevant covariates, a higher serum IGF-1 level was associated with a lower NIHSS score at admission (adjusted odds ratio=0.44, 95% confidence interval=0.24–0.80, p=0.01), while there was no significant association at 3 months.ConclusionsThis study showed that a higher serum IGF-1 level is associated with a lower NIHSS score at admission but not at 3 months. Further studies are required to clarify the usefulness of the serum IGF-1 level as a prognostic marker for ischemic stroke.     

Reduced rCBV ratio in perfusion-weighted MR images predicts poor outcome after thrombolysis in acute ischemic stroke

Recent research has suggested that a perfusion-weighted image (PWI) relative cerebral blood volume (rCBV) map after acute ischemic stroke (AIS) provides information about the collateral circulation in the ischemic region. In this study, we demonstrate the usefulness of the rCBV ratio in PWI in predicting poor outcome after using IV t-PA in AIS. We recruited 58 stroke patients who were treated with IV t-PA after diagnostic magnetic resonance imaging (MRI). Poor outcome was defined as a Modified Rankin Scale (mRS) score >2 measured 90 days after ischemic insult. In total, 21 patients (36.2%) demonstrated poor outcome (i.e. mRS score 3-6). Poor outcome after t-PA correlated with age (p = 0.03), serum glucose level (p = 0.01), NIHSS (p = 0.05), and the presence of T-occlusion (p = 0.05). Poor outcome also correlated with diffusion-weighted MR images of the lesion volume (p < 0.01), lower rCBV ratio on PWI (p < 0.01), and non-recanalization (p < 0.01). Among these, non-recanalization (p < 0.01), reduced rCBV ratio on PWI (p < 0.01), age (p = 0.04), and serum glucose level (p = 0.01) had an independent significance for predicting it. This suggests that the rCBV ratio on PWI may be used to determine prognosis after thrombolysis in AIS.     

Cerebral leukoaraiosis in patients with stroke or TIA: clinical correlates and 1-year outcome

Background and purpose:  Cerebral leukoaraiosis is frequently observed in patients with acute stroke, but its clinical consequences on functional recovery remain incompletely defined. We evaluated the clinical correlates of leukoaraiosis, and its association with stroke-outcome in a cohort of consecutively hospitalized patients.
Methods:  One-thousand twenty-four consecutive patients with acute stroke or transient ischemic attack (TIA) undergoing brain CT were included in this single-center study. Patients were systematically evaluated at hospitalization and followed-up for 1 year. Mortality, functional outcome, quality of life (QoL), psychological distress, community integration, and patient perception of recovery were evaluated by leukoaraiosis severity. Adjusted ORs (95%CI) were calculated.
Results:  Moderate/severe leukoaraiosis was diagnosed in 177 patients (17.3%) and mild leukoaraiosis in 362 patients (35.3%). After 1 year, adjusted ORs for moderate/severe leukoaraiosis compared with no leukoaraiosis were 2.0 (95%CI 1.1–4.0) for Barthel Index ≤75; 1.9 (95%CI 0.9–4.0) for help needed in ADL; 2.5 (95%CI 1.0–6.3) for not feeling totally recovered; 2.0 (95%CI 1.1–4.1) for low QoL; 1.9 (95%CI 1.0–3.5) for psychological distress, and 1.6 (95%CI 0.9–2.9) for reduced community integration.
Conclusions:  In a large cohort of consecutive patients hospitalized for stroke or TIA, leukoaraiosis predicted poor functional recovery, worse QoL and community integration, and higher psychological distress during the first year following stroke onset.