急性脑卒中患者院内死亡的危险因素分析

目的探讨急性脑卒中患者发生院内死亡的危险因素,以减少急性脑卒中的病死率。方法选取2001年8月—2011年8月我院神经科住院急性脑卒中患者2028例,对患者的病历资料进行详细的调查,对引起院内死亡的多种危险因素进行分析。结果 2028例急性脑卒中患者中死亡71例,病死率为3.5%;年龄、性别、院前时间、血压、并发症、总胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白水平与急性脑卒中患者院内死亡关系密切。结论临床医生应对急性脑卒中患者发生院内死亡的危险因素给予高度重视,可有效降低病死率。     

272例缺血性脑卒中患者危险因素分析

研究表明,针对卒中危险因素的治疗可显著降低卒中的发病率及病死率.本研究对2006年2月～2007年2月收治的272例急性缺血性脑卒中患者的临床资料进行分析研究,探讨缺血性脑卒中患者的危险因素.     

急性脑卒中患者并发肺部感染的相关因素分析

目的探讨急性脑卒中患者并发肺部感染的相关危险因素并提出相应干预措施。方法分析450例急性脑卒中患者的临床治疗资料,统计急性脑卒中患者并发肺部感染的相关因素。结果经单因素及多因素分析,患者年龄≥65岁、住院时间>3周,有脑卒中、慢性肺病史,意识障碍和吞咽困难,出血性脑卒中,合并糖尿病、低蛋白血症、肾功能不全等均为急性脑卒中并发肺部感染的独立危险因素。结论在临床工作中应采取相应措施进行积极预防,早发现、早治疗,降低肺部感染发生率,改善患者预后。     

青年脑卒中103例危险因素探析

目的探讨青年脑卒中的危险因素。方法对1999-01～2009-06住院的103例青年脑卒中相关危险因素进行回顾分析。结果青年脑卒中危险因素中,以高血压、高血脂、Lp(a)升高、心脏病为主,其他因素有糖尿病、家族史、酗酒、吸烟、脑卒中史等。青年人脑卒中以30～45岁者居多(84.6%),且男性多于女性。结论青年脑卒中病因复杂多样,对其危险因素干预可以最大程度降低青年脑卒中的发生率、复发率,改善预后,提高生活和健康水平。     

缺血性脑卒中可预防性危险因素的研究进展

缺血性脑卒中具有高发病率、高致残率、高死亡率及高复发率的特点,可严重影响患者生存质量并对其家庭及社会造成经济负担。早期筛查并通过积极调整生活方式及药物治疗等干预缺血性脑卒中的危险因素是降低缺血性脑卒中发病率的重要措施,其中可预防性危险因素是干预的主要目标。本文主要综述了缺血性脑卒中的可预防性危险因素,以期为临床早期、有针对性地预防缺血性脑卒中提供参考依据。     

青年脑卒中的临床治疗及危险因素分析

目的探讨青年脑卒中的病因特点、发病危险因素及临床治疗,为预防和控制脑卒中的发生提供依据。方法选择2014年1月-2016年3月住院治疗的青年脑卒中患者50例,通过临床对症治疗,观察疗效;对照临床资料分析患病危险因素。结果青年脑卒中的治愈好转率较高,死亡率较低;高血压、高甘油三脂血症、高胆固醇血症、饮酒、吸烟等是青年脑卒中最危险因素。结论青年脑卒中病因及危险因素较为广泛、复杂,在青年人群中重视和治疗各种原因引起的高血压、高脂血症、戒除烟酒对预防脑卒中的发生非常重要。     

中青年脑卒中的预防

中青年脑卒中的预防包括对有脑血管病危险因素而尚未发病者提供消除危险因素的干预 (一级预防 ) ;对早期患者 (如短暂性脑缺血发作 ,TIA)提供超早期治疗方案 ,力争彻底治愈 ,对已发病者预防病变进展 ,防止新发病变、病残及复发 (二级预防 ) ;这二者皆有赖于对脑卒中可控危险因素的控制。多项研究表明 ,对高危个体的针对性预防可使其人群脑卒中年发病率降低 3 5 %～ 75 %。最近 ,循证医学根据流行病学资料对脑卒中的危险因素进行了整理 ,将其归结为肯定的遗传和生活方式危险因素、肯定的疾病有关危险因素及可能的危险因素。其中年龄、性别…     

中青年脑卒中患者高密度脂蛋白水平观察

目的观察中青年脑卒中患者血脂特征,探讨高密度脂蛋白(HDL)水平降低是否为中青年脑卒中的独立危险因素。方法对云南省第二人民医院康复科2009年1月—2011年4月因脑卒中恢复期入院进行康复治疗的90例中青年患者与我院体检中心90例健康中青年体检者的HDL水平进行分析。结果中青年脑卒中患者HDL水平显著低于对照组(P<0.05);脑出血患者与脑梗死患者HDL水平无明显差异(P>0.05)。结论中青年脑卒中患者HDL水平明显降低,符合HDL水平降低是脑卒中的独立危险因素这一科学理论。对中青年HDL水平降低人群的心脑血管健康隐患,有必要予以密切关注和尽早干预。     

老年人围手术期急性脑卒中危险因素分析

目的 分析围手术期发生急性脑卒中的相关危险因素,提出降低脑卒中发生率的预防措施.方法 回顾性分析我院近5年发生围手术期急性脑卒中老年患者的临床资料,分析各种危险因素与脑卒中发生的相关性.结果 围手术期发生急性脑卒中78例,年龄60～98岁,平均70岁,56例(71.8%)急性脑卒中发生在术后1周内.与72例无急性脑卒中患者比较,回归分析显示,高血压、脑血管病史、围手术期血压波动和肥胖是发生脑卒中的危险因素;围手术期新发心房颤动和颈动脉粥样硬化是发生脑卒中的高危因素.结论 脑卒中是围手术期常见并发症,对具有脑卒中发生危险因素患者,术前进行必要检查和积极治疗并存疾病,围手术期严密血流动力学监测、减少血压波动及加强对新发心房颤动患者的抗凝治疗,对减少围手术期急性脑卒中的发生具有积极意义.     

脑卒中的危险因素

脑卒中是一种多危险因素疾病,各种危险因素之间既各自独立,又具有相互协同的交互作用.自1961年在Framingham随访6年的报告中首次提出"危险因素"这个词以来,人们逐步认识了年龄、性别、家族史、高血压、吸烟、过度饮酒、肥胖、糖尿病、心脏病和少体力活动等因素与脑卒中发病之间的关联性,但这些传统的脑卒中危险因素仅能解释60%的脑卒中事件[1].随着研究的深入,及70年代CT和80年代核磁共振等诊断技术应用于临床,使人们对脑卒中有了深入的了解.不仅对上述危险因素有了深入细致地定量的分析,而且还证实了一些新的危险因素,从而加深了对其致病作用的认识,纠正了许多旧的观念,给脑卒中的预防策略提供了新的依据.本文将简要概述脑卒中的一些主要危险因素的研究进展.     

H型高血压研究进展

H型高血压是伴有血浆同型半胱氨酸升高的原发性高血压,约占我国成年人高血压的75％,与脑卒中及其他心血管疾病密切相关。降低高血压患者同型半胱氨酸水平对预防卒中有重要意义。     

Redox status of plasma homocysteine and other plasma thiols in stroke patients

Despite the growing evidence that plasma homocysteine is a cardiovascular risk factor, the mechanism behind the vascular injuries is still unknown. Studies are difficult as a result of the fact that little is known about the formation of different homocysteine species in vivo. Since extracellular glutathione and cysteine may influence the formation of different homocysteine species, we have in the present study investigated the different fractions of homocysteine and their relation to the different fractions of glutathione and cysteine in stroke patients and control subjects. We found a ratio of about 32-33% between reduced and total plasma glutathione concentrations and 2.6 3.0% between reduced and total plasma cysteine concentrations both in patients and in healthy control subjects. We noted an elevated concentration of total plasma homocysteine in stroke patients, but no difference in the ratio between reduced and total plasma homocysteine concentrations in patients and control subjects (mean value 1.20 and 1.10%, respectively). However, in a subgroup of patients with higher concentrations of total plasma homocysteine, we observed a significantly lower ratio of reduced to total plasma homocysteine compared to a subgroup of patients with lower concentration of total plasma homocysteine. A low reduced/total ratio of plasma homocysteine in combination with elevated plasma homocysteine concentrations might reflect an increased pro-oxidant activity in plasma from these patients. Thus, increased pro-oxidant activity in plasma might be one factor, besides genetic and nutritional factors, that could explain hyperhomocysteinemia. Since substantial evidence indicates that progression of atherosclerosis is related to enhanced pro-oxidant activity, the premature vascular disease associated with increased plasma homocysteine concentration might be as a result of increased pro-oxidant activity and the elevated plasma homocysteine concentration may only reflect the increased oxidative stress.     

青年缺血性卒中患者的基因突变

缺血性卒中是一种多基因遗传性疾病 ,并由多种危险因素叠加而致发病 ,其发病率和致残率均较高。遗传因素对于青年人缺血性卒中的影响作用较大。文章对与青年人缺血性卒中有关的血小板相关基因、凝血 /纤溶基因、脂代谢基因、同型半胱氨酸代谢基因等作了综述。     

Homocysteine and risk of stroke.

The balance of evidence from observational studies suggests that elevated levels of homocysteine are associated with increased risk of carotid artery disease and stroke. There is, however, a paucity of prospective studies. There are also concerns regarding confounding caused by factors associated with hyperhomocysteinaemia, including renal impairment, an atherogenic diet and cigarette smoking. Homozygosity for a defective thermolabile variant of methylene-tetrahydrofolate reductase, a common genetic polymorphism which results in hyperhomocysteinaemia, has not been consistently linked with stroke or other vascular diseases. Additional prospective studies are required, with sufficient power to characterise the form of the association between homocysteine concentrations and stroke risk, whether linear or threshold, and to study interactions between homocysteine, other dietary markers and established stroke risk factors such as smoking and hypertension. Ultimately, the case for a causal role for elevated levels of homocysteine in vascular disease, including stroke, will depend on data from randomised controlled trials of homocysteine-lowering interventions. Given the high prevalence of hyperhomocysteinaemia in apparently well-nourished populations and the tendency for homocysteine concentrations to increase with age, modest effects of homocysteine on stroke risk will have profound implications for public health.     

Homocysteine, hypertension and stroke.

The balance of evidence from observational studies suggests that elevated homocysteine levels are associated with increased risk of carotid artery disease and stroke. There is however a paucity of prospective studies. There are also concerns regarding confounding due to factors associated with hyperhomocysteinemia, including renal impairment, an atherogenic diet and cigarette smoking. Homozygosity for a defective thermolabile variant of MTHFR, a common genetic polymorphism which results in hyperhomocysteinemia, has not been consistently linked with stroke or other vascular disease. There is a need for additional prospective studies with data on relevant confounders, sufficient power to characterise the form of the association between homocysteine concentrations and stroke risk, whether linear or threshold, and power to study interactions between homocysteine, other dietary markers and established stroke risk factors such as smoking and hypertension. Similarly, the evidence linking hyperhomocysteinemia with hypertension is limited and inconsistent. Given the biological mechanisms proposed in support of the homocysteine-CVD hypothesis, one would predict a positive association between homocysteine and blood pressure. There is a need to address this hypothesis directly in studies with reliable measurements of both homocysteine and blood pressure. Ultimately, the case for a causal role for elevated homocysteine levels in vascular disease, including hypertension and stroke, will depend on data from randomised controlled trials of homocysteine lowering interventions. Given the high prevalence of hyperhomocysteinemia in apparently well nourished populations and the tendency for homocysteine concentrations to increase with age, modest effects of homocysteine on stroke risk will have profound implications for public health.     

An association between plasma homocysteine concentrations and ischemic stroke in elderly Japanese

The present study was performed to clarify the relation between plasma homocysteine and ischemic stroke. We studied the relationship between ischemic stroke and the known risk factors for atherosclerosis including plasma homocysteine in 91 in-patients (80.3 +/- 6.8 years) in a medical ward. Those diagnosed with transient ischemic attack, cerebral infarction were placed in the disease group. Blood was drawn from in-patients in a fasting state for determination of plasma homocysteine. Plasma homocysteine concentrations were determined using a high-performance liquid chromatography assay. The odds ratio of ischemic stroke was higher in the second (10.0-13.9 micromol/l) and third highest plasma homocysteine concentration groups (> or = 14.0 micromol/l) than in the first group (< 10.0 micromol/l) by 5.18 and 4.42-fold, respectively. Logistic regression analysis using ischemic stroke as an object variable, adjusted by various risk factors including the plasma homocysteine concentration showed that the odds ratio on combining the second and third groups was 5.80 (95% confidence interval (Cl): 1.50-22.5) compared with the first group. The findings confirmed that the association between plasma homocysteine concentration and ischemic stroke in Western populations is also present among the elderly Japanese.     

血浆同型半胱氨酸与青中年脑卒中关系的探讨

目的探讨血浆同型半胱氨酸（Homocysteine，Hcy）水平与青、中年脑卒中及其不同类型、类别之间的关系。方法采用高压液相分析原理分别测定248例青中年脑卒中患者及212例正常健康青中年对照者血浆Hcy水平。结果全部脑卒中患者血浆Hcy水平均高于同年龄段健康对照组（P〈0．01），其中青年脑卒中患者血浆Hcy水平又高于中年患者（P〈0．05），同年龄组青年、中年脑梗死患者与脑出血患者血清Hcy水平比较差异无显著性意义（P〉0．05），全部脑梗死患者与全部脑出血患者Hcy水平比较，差异亦无显著性意义（P〉0．05），青、中年缺血性脑卒中组中以大动脉粥样硬化性卒中的平均Hcy水平为最高，与其他类别组比较差异有意义（P〈0．05）。结论高HCY血症是是青、中年脑卒中的独立危险因素，是大动脉粥样硬化性卒中重要病因，Hcy对青年脑卒中影响比中年大。     

高同型半胱氨酸血症与脑卒中关系的病例对照研究

目的 :探讨高同型半胱氨酸 (Hcy)血症与脑卒中的关系。方法 :选取年龄、性别、城乡分布、受教育水平和吸烟状况均匹配的 116对脑卒中患者和未患脑卒中的来自自然人群的对象进行 1∶1配对的病例对照研究。用荧光偏振免疫分析法测定血浆Hcy。结果 :1 Hcy与脑卒中关系的单因素分析显示 :脑卒中组Hcy的几何均数为 14 1μmol L ,明显高于对照组的 12 0μmol L(P <0 0 5 )。脑卒中组高Hcy的患病率为 4 6 9% ,显著高于对照组的 2 0 0 % (P <0 0 0 1)。 2 多因素logistic回归分析结果显示 :调整了性别、年龄、高血压史、心脏病史、脑卒中家族史、高密度胆固醇、低密度胆固醇后 ,高Hcy血症的OR值为 3 7(95 %CI:1 4～ 10 1) ,P <0 0 5。结论 :高Hcy血症与脑卒中密切相关     

Homocysteine and coronary heart disease

Children with homocystinuria have markedly elevated plasma homocysteine concentrations and increased risks of stroke and coronary heart disease (CHD). Supplementation with folic acid, vitamin B6, and vitamin B12 lower homocysteine levels and such therapy is remarkably effective in delaying the occurrence of vascular events in affected individuals. The relevance, if any, of moderately elevated homocysteine levels to cardiovascular disease in the general population is uncertain. The results of retrospective studies of homocysteine and risk of cardiovascular disease (where blood is collected after the onset of disease) indicate that CHD or stroke patients invariably have higher homocysteine levels than age-matched controls. In contrast, the results of prospective studies (where blood is collected before onset of disease) show much weaker associations of homocysteine with cardiovascular disease. This article examines the background, epidemiological evidence relating homocysteine with vascular disease, and effects of vitamin supplements on homocysteine concentrations. Large-scale clinical trials of folic acid-based vitamin supplements are currently in progress to test whether lowering blood homocysteine levels can reduce the risks of CHD and stroke.     

血浆同型半胱氨酸水平与脑大动脉粥样硬化性病变的相关性分析

目的探讨血浆总同型半胱氨酸（Hcy）水平与脑大动脉粥样硬化性病变的相关性。方法对行数字减影血管造影（DSA）的276例缺血性脑卒中患者进行分组,具有颅内外大动脉粥样硬化性狭窄（至少1支血管狭窄率〉50％）的224例患者为狭窄组,无狭窄或轻度狭窄（狭窄率≤50％）患者52例为对照组。对两组患者血浆总Hcy水平及脑卒中的常规危险因素如年龄、性别、高血压、糖尿病、长期吸烟、长期饮酒、血甘油三酯、高密度脂蛋白（HDL）、低密度脂蛋白水平等进行了分析。结果脑大动脉粥样硬化性狭窄组血浆Hcy升高的比例明显大于对照组（分别为38．8％及15．4％;OR3．49,95％CI 1．57～7．77,P=0．001）。多元逐步logistic回归分析发现,血浆Hcy水平升高是脑大动脉粥样硬化性狭窄独立的危险因子（OR=4．10,95％CI：1．80～9．32,P=0．001）。血浆Hcy升高与高血压、高龄及HDL降低合并存在时,其发生脑大动脉粥样硬化性狭窄的风险性增加（OR值分别4．89、4．79和10．46）。结论来自DSA的结果提示,血浆Hcy水平升高是脑大动脉粥样硬化性病变独立且强烈的危险因子;与其他危险因子并存,发生脑大动脉粥样硬化性病变的风险性增加。