缺血性脑血管病彩色多普勒、经颅多普勒联合检测结果分析

目的 研究缺血性脑血管病发病与颈部动脉粥样硬化狭窄程度和斑块性质的关系.方法 采用彩色多普勒和经颅多普勒技术对缺血性脑血管病患者100例及健康者40例（对照组）进行检测,观察颈动脉解剖形态、内膜情况,有无斑块形成及斑块大小、形态、回声特征,颅内外动脉管腔是否狭窄和狭窄程度.结果 缺血性脑血管病组颈动脉不均质、不规则斑块的检出率及其颅内外动脉狭窄的比例均明显高于对照组,且颅内动脉狭窄的比例高于颅外动脉.结论 颈动脉粥样硬化斑块的性质及颅内外动脉狭窄与缺血性脑血管病的发生密切相关.     

甲状腺疾病与脑血管病

甲状腺疾病与脑血管病的关系日益受到关注。研究显示,甲状腺疾病与缺血性脑血管病、烟雾病、脑静脉窦血栓形成、动脉夹层分离等多种脑血管病有关。文章对甲状腺疾病与脑血管病相关性的研究进展进行了综述。     

纤维蛋白原水平和血液流变学变化对颅内动脉狭窄的影响

许多研究证明，颅内动脉狭窄是缺血性华中的一个重要病变基础。我国缺血性卒中患者约1／3有颅内动脉狭窄。作者通过对206例缺血性脑血管病患者经颅多普勒超声(TCD)检测，同时检测纤维蛋白原(FIB)水平，血液流变学变化，探讨两者与颅内动脉狭窄的关系，为脑梗死患者早期预防和治疗提供客观依据。     

活化蛋白C抵抗与缺血性脑血管病

活化蛋白C抵抗与静脉血栓形成关系密切 ,与动脉血栓形成的关系尚不明确。活化蛋白C抵抗的原因有遗传性和获得性两种。文章综述了活化蛋白C抵抗与缺血性脑血管病关系的研究现状     

慢性脑缺血大鼠海马区APP mRNA的表达

Wistar大鼠20只,随机分为模型组和假手术组,假手术组仅暴露双侧颈总动脉而不结扎,模型组采用双侧颈总动脉结扎法制备慢性缺血模型,正常饲养2个月后RT-PCR法检测两组大鼠海马区APP mRNA含量,应用图像分析软件测得光密度扫描值。结果显示,模型组大鼠海马区APP mRNA的表达明显高于假手术组,提示APP与慢性缺血性脑血管病的发病关系密切。     

颈动脉粥样硬化与冠脉和周围动脉病变的关系

目的探讨颈动脉粥样硬化与冠脉和周围动脉病变的关系。方法采用连续波配合脉冲多普勒对比检测261例心肌梗死(MI)、脑血管病(CD)和周围动脉病变(PAD)患者的颈动脉粥样硬化程度及其关系。结果与对照组比较,MI、CD、PAD3组颈动脉内膜中层厚度明显增加(P＜0．05),斑块指数以CD组最明显(P＜0．05),颈总动脉内径增大(P＜0．05),搏动指数和阻力指数均增高(P＜0．05),CD组的阻力指数差异尤为显著。结论颈动脉超声检测可作为预测冠脉和周围动脉粥样硬化有价值的指标。     

经颅多普勒超声在脑血管病中的临床应用

经颅多普勒超声非侵入性地检测颅底各主要动脉的血流速度及血流状态,推断脑动脉的血流动力学变化,为脑血管病的临床诊断、监测,指导治疗提供了一种新方法。文章阐述了经颅多普勒超声的原理、技术以及对所得结果进行分析的方法。重点介绍了该方法在脑血管病中的适应症,描述了常见脑血管病脑血流动力学在经颅多普勒超声中的特征性改变。     

颈动脉粥样硬化与冠脉和周围动脉病变的关系

目的探讨颈动脉粥样硬化与冠脉和周围动脉病变的关系。方法采用连续波配合脉冲多普勒对比检测２６１例心肌梗死（ＭＩ）、脑血管病（ＣＤ）和周围动脉病变（ＰＡＤ）患者的颈动脉粥样硬化程度及其关系。结果与对照组比较,ＭＩ、ＣＤ、ＰＡＤ３组颈动脉内膜中层厚度明显增加（Ｐ＜０．０５）,斑块指数以ＣＤ组最明显（Ｐ＜０．０５）,颈总动脉内径增大（Ｐ＜０．０５）,搏动指数和阻力指数均增高（Ｐ＜０．０５）,ＣＤ组的阻力指数差异尤为显著。结论颈动脉超声检测可作为预测冠脉和周围动脉粥样硬化有价值的指标。     

活化蛋白C抵抗与缺血性脑血管病

活化蛋白C抵抗与静脑海因栓形成关系密切，与动脉血栓形成的关系尚不明确，活化蛋白C抵抗的原因有遗传性和获得性两种，文章综述了活化蛋白C抵抗与缺血性脑血管病关系的研究现状。     

缺血性脑血管病患者颈动脉粥样硬化斑块分布特点及预后

早期采用有效的干预方法可以显著改善缺血性脑血管病患者的预后。大脑组织的血液供应主要来自颈内动脉,大脑中动脉是颈内动脉的延续。在颈动脉粥样硬化斑块基础上形成血栓是缺血性脑血管病发生、发展的主要病理生理学基础。因此,分析颈动脉粥样硬化斑块与缺血性脑血管病之间的关系,并对颈动脉粥样硬化形成的危险因素进行有效干预具有重     

Increased aortic pulse wave velocity is associated with silent cerebral small-vessel disease in hypertensive patients

Aortic stiffness predicts an excess risk of stroke, supposedly via cerebral small-vessel disease. White matter hyperintensities, silent lacunar infarcts, and brain microbleeds, manifestations of cerebral small-vessel disease on neuroimaging, may precede overt cerebrovascular disease. Therefore, we assessed whether aortic stiffness is also related to such lesions. In 167 hypertensive patients (85 men) without a history of cardiovascular or cerebrovascular disease, a mean age of 51.8+/-13.1 years, and untreated office blood pressure levels of 169+/-25/104+/-12 mm Hg, we determined aortic pulse wave velocity and office and ambulatory 24-hour pulse pressure (off medication), as well as the volume of white matter hyperintensities and the presence of lacunar infarcts and microbleeds using brain MRI. Linear and logistic regression analyses were performed to assess the relationships between the arterial stiffness measures and brain lesions. Aortic stiffness and pulse pressure were significantly related to each of the brain lesions in univariate analyses (P<0.05). Multivariate analyses, adjusted for age, sex, brain volume, mean arterial pressure, and heart rate, showed that a higher pulse wave velocity was significantly associated with a greater volume of white matter hyperintensities (unstandardized regression coefficient: 0.041; 95% CI: 0.005 to 0.078; P<0.05) and the presence of lacunar infarcts (odds ratio [per SD increase in pulse wave velocity]: 1.78; 95% CI: 1.06 to 2.99; P<0.05) but not with microbleeds. The models for pulse pressure failed to reach statistical significance in multivariate analyses. In conclusion, aortic stiffness is independently associated with manifestations of cerebral small-vessel disease in hypertensive patients, linking systemic large- to cerebral small-artery disease.     

颅内外血管吻合治疗缺血性脑血管病

颅内外血管吻合术这一精细的术式由Yasargil首次完成并逐渐发展起来,已被用于脑缺血性脑血瞥病、烟雾病、颅内动脉瘤和脑肿瘤的治疗.文章重点探讨其在缺血性脑血管病中的应用,并从缺血性脑血管病的血流动力学以及血管吻合术的适应证、术前评估、手术方式、术中评估、并发症、术后护理和预后等方面进行综述.     

颅外-颅内动脉旁路术治疗缺血性脑血管病的新认识

对于颅外-颅内动脉旁路术(EIAB)治疗缺血性脑血管病的疗效目前尚未达成共识。作为缺血性脑血管病病理生理学机制中的一个重要因素,脑血流动力学状态改变已经引起人们的重视。文章从脑血流动力学角度阐述了EIAB的临床意义,着重介绍了其术前评价、手术方式和疗效判定方法。     

Arterial Stiffness in Treated Hypertensive Patients With White‐Coat Hypertension

Arterial stiffness, assessed through pulse wave velocity (PWV), independently predicts cardiovascular outcomes. In untreated persons, white‐coat hypertension (WCH) has been related to arterial stiffness, but data in treated patients with WCH are scarce. The authors aimed to determine a possible association between WCH and arterial stiffness in this population. Adult treated hypertensive patients underwent home blood pressure monitoring and PWV assessment. Variables associated with PWV in univariable analyses were entered into a multivariable linear regression model. The study included 121 patients, 33.9% men, median age 67.9 (interquartile range 18.4) years, 5.8% with diabetes, and 3.3% with a history of cardiovascular or cerebrovascular disease. In multivariable analysis, WCH in treated hypertensive patients remained a determinant of PWV: β=1.1 (95% confidence interval, 0.1–2.1 [P=.037]; adjusted R² 0.49). In conclusion, WCH is independently associated with arterial stiffness in treated hypertensive patients. Whether this high‐risk association is offset by antihypertensive treatment should be further investigated.     

经DSA分析1000例缺血性脑血管病华人患者的病因特点

目的探讨华人缺血性脑血管病的病因特点。方法回顾性分析经TCD、B超筛选过的1000例华人缺血性脑血管病患者的DSA资料,诊断为动脉粥样硬化性动脉狭窄和闭塞的患者737例,将其分为脑梗死组471例和短暂性脑缺血发作(TIA)组266例,分别对患者脑动脉狭窄及闭塞情况进行分析。结果1000例患者中,871例有与症状相关的颅内外脑血管病变。其中明确为动脉粥样硬化性动脉狭窄和闭塞的737例中,颅内病变367例,占49.8%;颅外病变245例,占33.2%;颅内外联合病变125例,占17.0%。脑梗死患者中颅内病变多于颅外病变(P=0.02),在椎基底动脉系统中表现尤为明显(P=0.002);而TIA患者颅内外病变发生率差异无显著性,但颈动脉系统仍以颅内病变为主(P=0.04),而椎基底动脉系统则主要以颅外动脉病变为主(P=0.02),狭窄部位依次为颈内动脉起始部(25.7%)、大脑中动脉(18.7%)、椎动脉起始部(15.9%)。结论在华人缺血性脑血管病患者中,颅内动脉病变发生率高于颅外动脉,但在TIA患者中,椎基底动脉病变仍以颅外病变为主。     

经DSA分析100O例缺血性脑血管病华人患者的病因特点

目的探讨华人缺血性脑血管病的病因特点.方法回顾性分析经TCD、B超筛选过的1 000例华人缺血性脑血管病患者的DSA资料,诊断为动脉粥样硬化性动脉狭窄和闭塞的患者737例,将其分为脑梗死组471例和短暂性脑缺血发作（TIA）组266例,分别对患者脑动脉狭窄及闭塞情况进行分析.结果 1 000例患者中,871例有与症状相关的颅内-外脑血管病变.其中明确为动脉粥样硬化性动脉狭窄和闭塞的737例中,颅内病变367例,占49.8%;颅外病变245例,占33.2%;颅内-外联合病变125例,占17.0%.脑梗死患者中颅内病变多于颅外病变（P=0.02）,在椎-基底动脉系统中表现尤为明显（P=0.002）;而TIA患者颅内-外病变发生率差异无显著性,但颈动脉系统仍以颅内病变为主（P=0.04）,而椎-基底动脉系统则主要以颅外动脉病变为主（P=0.02）,狭窄部位依次为颈内动脉起始部（25.7%）、大脑中动脉（18.7%）、椎动脉起始部（15.9%）.结论在华人缺血性脑血管病患者中,颅内动脉病变发生率高于颅外动脉,但在TIA患者中,椎-基底动脉病变仍以颅外病变为主.     

Arterial hypertension: a cause of cognitive impairment and of vascular dementia

Arterial hypertension is a well-documented modifiable risk factor for cerebrovascular disease and for both cerebral infarction and intracerebral hemorrhage. Recent studies indicate a relationship between high blood pressure in midlife and dementia in late life and suggest that arterial hypertension may represent a cause of vascular dementia (VaD). This paper has reviewed the main evidence of a link between arterial hypertension and vascular cognitive impairment or VaD. Brain lesions induced by hypertension, diagnostic procedures for early diagnosis of vascular cognitive impairment in at risk subjects and the need to include cognitive assessment in patient's general visits in hypertension units are discussed.     

应用瞬时波强与回声跟踪技术检测老年脑梗死患者颈动脉弹性的研究

目的应用瞬时波强和回声跟踪技术检测老年脑梗死患者颈动脉弹性变化。方法选择老年脑梗死患者76例,将不合并高血压的患者38例作为脑梗死组,合并高血压的患者38例作为合并组,同期选择年龄、性别匹配的健康体检者34例为对照组,检测颈动脉瞬时波强相关参数,并进行分析。结果与对照组比较,脑梗死组和合并组患者瞬时减速度波强、转化前的瞬时减速度波强、僵硬度、压力应变弹性系数、单点脉搏波传导速度、瞬时波强脉搏波传导速度和脉搏波放大指数等数值增加,动脉顺应性值降低,差异有统计学意义(P0.05)。合并组患者较脑梗死组患者相关参数变化明显,但差异无统计学意义(P0.05)。结论应用瞬时波强和回声跟踪技术能定量检测脑梗死患者颈动脉弹性变化,对临床防治心脑血管疾病具有一定的指导意义。     

Internal Carotid Artery Stenting for Intracranial Atherosclerosis

Intracranial atherosclerotic disease is a significant cause of stroke in the United States. Much like coronary atherosclerosis, this disease leads to arterial stenosis secondary to the buildup of lipid-based plaques in intracranial vessels. Ischemic stroke may occur following thromboembolic events near the site of stenosis or from watershed ischemia secondary to cerebral hypoperfusion. While this disease has been treated with intracranial angioplasty and stenting and cerebrovascular bypass surgery, the current literature supports aggressive medical management with dual antiplatelet therapy, treatment of comorbidities such as hypertension, diabetes, and hyperlipidemia, and lifestyle modification. Intracranial angioplasty and stenting is reserved for cases of medical failure.     

Dynamics of pulse pressure in orthostatic test: interrelationships with risk factors and involvement of the heart and vessels in elderly patients with arterial hypertension

We studied dynamics of arterial pulse pressure (APP) during active orthostatic test (AOT) in relation to cardiac and vascular involvement in 198 elderly patients with arterial hypertension. We measured and compared parameters of hemodynamics, rate of detection of risk factors, signs of affection of the heart and vessels in subgroups with elevation of APP (n=50), lowering of APP by more than 10 mm Hg (n=50) and intermediate deviations of APP (n=98) in orthostasis. In patients with elevation of APP during AOT smoking, increased aortic stiffness, history of myocardial infarction were detected more often and risk of development of cardiovascular diseases according to SCORE system was higher than in patients with lowering of APP or absence of its dynamics. Patients with lowering of APP more than 10 mm Hg significantly more often had cerebrovascular disease appearing as history of cerebral strokes and/or transitory ischemic attacks. The conclusion was made about possible significance of orthostatic increment of APP as supplementary marker of cardiovascular risk in elderly patients with arterial hypertension.