心血管卒中高危人群风险评估及分析

目的通过对心血管疾病人群中发生卒中的风险进行评估及分析,依据其不同的危险程度分级,为其今后制定不同的个体化的干预措施,从而达到降低其卒中发病率的目的。方法选取我院心血管疾病患者60例,应用Framing-ham量表对每位患者进行评分,经计算得出其卒中风险评分,以预测及分析不同血压水平心血管患者10年卒中发生风险概率。结果所有进入筛查的心血管疾病患者均具有不同程度的10年内发生卒中的风险,其中高危患者比例高,本组人群10年卒中发生风险概率均>6%(中高危),其中所有男性卒中风险均>10%(高危)。卒中风险与年龄、吸烟史、糖尿病、高血压、心血管疾病有关。年龄与10年卒中风险相关性r=0.609,收缩压与10年卒中风险相关性r=0.551,提示年龄及收缩压与10年卒中风险显著相关。结论脑血管疾病现已成为我国国民第一位的死亡原因,对心血管卒中高危人群进行一级预防,对降低卒中风险有着重要意义。     

影响脑卒中发病的相关危险因素及护理干预研究

目的：了解脑卒中患者发病的危险因素,探索相应的护理对策。方法：回顾性分析124例患者资料,采用Logistic回归分析的方法研究影响脑卒中发病的危险因素。结果：影响脑卒中发病的危险因素包括年龄、饮酒、高血压、糖尿病、HDL等,而影响出血性脑卒中患者发病的危险因素则为年龄、高血压、糖尿病、CHOL、HDL等因素。结论：针对脑卒中发病的危险因素,提出了相应的干预措施,为降低脑卒中发病率提供依据。     

Falls in older adults

Falls are prevalent among older adults and can lead to injury, hospitalization, and increased healthcare costs. Environmental hazards, medications, vision problems, and impairments in strength, gait, or balance can increase fall risk. A multifactorial fall-risk assessment including a fall history, physical exam, gait and balance evaluation, and environmental assessment is recommended for all older adults who present with a fall or problem with gait or balance. Multiple-component exercise programs, tai chi, vitamin D supplementation, withdrawal of psychotropic medications, and early cataract surgery have all been shown to reduce fall rates. Multifactorial interventions that include medication review, vision correction, management of orthostasis, environmental modification, and balance, strength, and gait training can also be beneficial in preventing falls.     

某区汉族与维吾尔族脑卒中危险因素的比较

目的探讨阿拉尔地区汉族与维吾尔族脑卒中危险因素差异的比较。方法采取以医院为基础的回顾性研究,所有病例均经头颅CT或MRj证实为脑卒中。采用自行设计的调查表对研究对象进行调查,内容包括一般情况、生活方式以及既往史等。采用非条件Logistic回归模型对汉族与维吾尔族脑卒中危险因素进行估计。结果虽然糖尿病、高血压、代谢综合征、TC、TG、HDL-C,及男性均为汉族、维吾尔族脑卒中患者的危险因素,但这些因素与维吾尔族脑卒中患者关联强度要高于汉族研究对象;饮酒、LDL-C,及肥胖仅为维吾尔族脑卒中患者的危险因素。结论汉族与维吾尔族脑卒中患者的危险因素具有一定的差异性,因此需要改善人们的不良生活习惯预防脑卒中的发生,尤其是维吾尔族人。     

再发性脑卒中危险因素探讨及干预措施

目的　探讨再发性脑卒中的危险因素及干预措施。方法　对 2 0 0 0年～ 2 0 0 2年 3年间徐家汇地段医院家庭病床患者的再发性脑卒中 5 8例与对照组 1 94例在高血压、糖尿病、高血脂、冠心病、饮酒、吸烟及脑卒中家族史等危险因素和初次发病后 3年内的复发和预后情况进行对比分析。结果　复发组与对照组的危险因素是一致的 (P>0 .0 5 ) ,但复发组的预后较对照组差 (P<0 .0 5 ) ,而且再次脑卒中的血压均偏高是再次脑卒中的直接相关因素 ,且临床症状重 ,致残率高 ,危险性大 ,死亡率高。结论　预防再卒中的发生主要措施是控制危险因素 ,并加强对患者的宣教、护理和功能训练工作 ,提高患者生活质量 ,对高危人群进行健康促进教育     

The risk of stroke in patients with migraine and implications for migraine management

Assessing the risk of stroke in persons with migraine is complicated by the intricate relationship between these two conditions. Both migraine and stroke are common and co-morbidity may, in some cases, be coincidental. Given the overlap of clinical symptoms in stroke and migraine, each condition may also mimic the other. Numerous studies have, however, shown that migraine is an independent risk factor for stroke both during, and remote from, the migraine attack. Women of childbearing age and those with aura are at greatest risk of migraine-related stroke. Additional risk of stroke in migraineurs occurs in those using oral contraceptive pills and who smoke cigarettes. Elevated blood pressure, an important stroke risk factor, is less common in migraineurs. Acquired antiphospholipid antibodies, not clearly a cause of migraine per se, may raise the risk of infarction in migraineurs. Hereditary conditions, including CADASIL (cerebral autosomal dominant arteriopathy with sub-cortical infarcts and leukoencephalopathy), MELAS (mitochondrial myopathy, encephalopathy, lactacidosis and stroke) and hereditary haemorrhagic telangiectasia, appear to predispose to both migraine and stroke. Purported mechanisms for migraine-associated stroke include involvement of the vasculature (including vasospasm, arterial dissection and small vessel arteriopathy), hypercoagulability (elevated von Willebrand Factor, platelet activation) and elevated risk of cardioembolism (patent foramen ovale, atrial septal aneurysm). Triptans and ergotamines, used to treat acute migraine attacks, appear to be safe in low-risk populations. These medications should be avoided in persons with haemiplegic migraine, basilar migraine, vascular risk factor and prior cerebral or cardiac ischaemia.     

同型半胱氨酸和超敏C反应蛋白在进展性脑卒中临床意义

目的探讨检测同型半胱氨酸（Hcy）及超敏C反应蛋白（hs—CRP）在进展性脑卒中患者中的临床意义。方法采用透射免疫比浊法,分别检测302例进展组和300名非进展性脑卒中组的Hcy和hs—CRP水平。结果进展性脑卒中患者的Hcy和hs—CRP含量显著高于非进展性脑卒中患者（P〈0．01）。高Hcy和hs—CRP与高血脂、高血压、糖尿病、吸烟等动脉粥样硬化危险因素相比,相对危险度的OR值分别为4．41、5．68、3．11、2．54、2．62、1．70。结论高Hcy和hs—CRP与进展性脑卒中的发生有明显关系,高Hcy和hs—CRP作为独立的危险因素,较其他传统危险因素危险性更高。     

Genetics of ischemic and hemorrhagic stroke in Chinese population

Stroke is a major cause of adult death and disability worldwide. Epidemiological and animal studies have provided strong evidence that the pathogenesis of stroke is multi-factorial and induced by a combination of environmental and genetic risk factors, but the identification of individual causative variants remains little known. Genetic influences are likely to be polygenic with small effect sizes, and stroke itself consists of a number of different subtypes which may each have different genetic profiles. In addition, various ethnic populations may have different stroke risk, such as Asian race. The reasons for high risk of stroke among the Chinese, especially hemorrhagic stroke, remain unknown. Most human studies have taken a candidate gene approach using case-control methodology. To be reliably detected, small relative risks require large sample sizes, probably 1000 patients or more. Genome-wide association (GWA) study is an unbiased and comprehensive approach to identify common risk alleles for complex diseases. Recently, a multistage GWA study has identified three loci on chromosomes 2q, 8q and 9p to be associated with intracranial aneurysm in European and Japanese populations. Another GWA finding is the identification of risk variants for cardioembolic stroke on chromosome 4q25 in European populations. In this review, we mainly focus on the results from case-control association studies on genetic factors that play a role in the risk of ischemic and hemorrhagic stroke in Chinese population. The combined effects of multiple susceptibility genes for stroke risk are also summarized.     

New strategies for the prevention of stroke

1. Stroke is a major cause of disability and death worldwide. It is preferable to prevent stroke rather than to treat it and, for the prevention of stroke, all risk factors relating to stroke need to be understood. The present paper reviews potential new strategies for the prevention of stroke based on findings of new risk factors, as well as classical risk factors. 2. Recently, new risk factors related to stroke were reported, including dysfunction of the arterial baroreflex, pro‐inflammatory cytokines, vitamins and hormone deficiency. Correspondingly, therapies targeting these risk factors where shown to significantly reduce the incidence and/or severity of stroke. 3. Because the genesis of stroke is multifactorial, the prevention of stroke should not target one risk factor only. Combination therapies with drugs acting on different risk factors may be more effective in the prevention of stroke.     

The relationship between cholesterol and stroke: implications for antihyperlipidaemic therapy in older patients

Various studies on the relationship between serum cholesterol level and the risk of stroke have been published recently. Subsequent reviews have extrapolated information on stroke from the clinical trials originally aimed at lowering cholesterol for the primary and secondary prevention of myocardial infarction (MI) in middle-aged patients. We have reviewed the epidemiological knowledge on the relationship between serum cholesterol levels and stroke, and also focused on possible reduction of the risk of stroke with hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor treatment. Possible benefits from such therapy are particularly relevant for the elderly population which is at particularly high risk for stroke. The effects of serum cholesterol levels on the risk for haemorrhagic and ischaemic stroke have been evaluated. Indirect epidemiological evidence indicates that serum levels of total cholesterol and its subfractions are determinants of stroke, but their associations are relatively weak. When exploring the possible association of serum cholesterol levels with the increased risk of stroke with aging, we concluded that, as in younger adults, elevated total cholesterol and decreased high density lipoprotein-cholesterol levels predispose to ischaemic stroke in the elderly. The mechanism through which serum cholesterol levels increase stroke risk is based on its actions on the artery walls. Indirect evidence suggests that the reduction in the stroke risk with HMG-CoA reductase inhibitors is larger than would be expected with reduction of elevated serum cholesterol level alone. Therefore, antioxidant and endothelium-stabilising properties of HMG-CoA reductase inhibitors may contribute in reducing the risk of stroke in recipients. Lowering high serum cholesterol with HMG-CoA reductase inhibitors has been beneficial in the primary and secondary prevention of MI. No trials have specifically tested the effect of cholesterol lowering with HMG-CoA reductase inhibitors on stroke occurrence. High serum cholesterol levels are a risk factor for ischaemic stroke, although the risk imparted is lower than that for MI. Although the relative risk of stroke associated with elevated serum cholesterol levels is only moderate, its population attributable risk is high given the increase in the elderly population worldwide. The effect of cholesterol reduction with HMG-CoA reductase inhibitors on prevention of ischaemic stroke should be evaluated in prospective, randomised, placebo-controlled trials in the elderly. The tolerability of lipid-lowering drugs in the elderly and the cost effectiveness of primary prevention of stroke using lipid-lowering drugs also needs to be assessed in the elderly.     

心房颤动患者近期缺血性卒中后应用依多沙班抗凝治疗的时机和剂量的研究进展

心房颤动(Atrial fibrillation,AF)是成人中常见的持续性心律失常,给医疗保健增加巨大负担.心律失常不仅与生活质量下降和频繁住院有关,而且与缺血性卒中、其他血栓栓塞事件和死亡率增加的风险增加有关.AF患者的缺血性卒中风险因个体风险状况而异,不使用口服抗凝剂(Oral anticoagulant,OAC...     

Primary and secondary stroke prevention with antiplatelet drugs

Aspirin is not effective in the primary prevention of stroke. Patients with TIA or ischemic stroke carry a risk of recurrent stroke between 5 and 20% per year. In patients with TIA or ischemic stroke of noncardiac origin antiplatelet drugs are able to decrease the risk of stroke by 11-15% and the risk of stroke, MI and vascular death by 15-22%. Aspirin is the most widely used drug. It is affordable and effective. Low doses of 50-325 mg aspirin are as effective as high doses and cause less gastrointestinal side effects. Severe bleeding complications are dose-dependent. The combination of aspirin with slow release dipyridamole is superior to aspirin alone for stroke prevention. Clopidgrel is superior to aspirin in patients at high risk of recurrence. The combination of aspirin plus clopidogrel is not more effective than clopidogrel alone but carries a higher bleeding risk. None of the antiplatelet agents is able to reduce mortality.     

Atorvastatin in prevention of stroke and transient ischaemic attack

Besides blood pressure-lowering drugs and, in certain circumstances, antithrombotic agents, statins are among the most effective drugs in reducing the risk of stroke in populations of patients at high vascular risk, as well as the risk of major coronary events. In secondary prevention of stroke, statins clearly reduced the risk of major coronary events. In the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial, compared with placebo, the patients with a recent stroke or transient ischaemic attack without coronary heart disease randomised to atorvastatin 80 mg/day had a significant 16% relative risk reduction of stroke and a 35% reduction in the risk of major coronary events. This was obtained despite the fact that 25% of patients allocated to the placebo arm were prescribed a commercially available statin outside the trial. A post-hoc analysis used blinded low-density lipoprotein cholesterol (LDL-C) measurements (taken at study visits during the trial) as a marker of adherence to lipid-lowering therapy. Compared with the group with no change or an increase in LDL-C (the group adherent to placebo or not taking a statin), the group with >or= 50% reduction in LDL-C had a significant 31% reduction in the risk of stroke. The next step is to define whether or not achieving a LDL-C of < 70 mg/dl is better than a standard dose of statin (LDL approximately 100 - 110 mg/dl) in the secondary prevention of stroke. Statins are effective in reducing both first-ever and recurrent stroke, and this effect seems driven by the extent of LDL-C lowering.     

Atorvastatin in prevention of stroke and transient ischaemic attack

Besides blood pressure-lowering drugs and, in certain circumstances, antithrombotic agents, statins are among the most effective drugs in reducing the risk of stroke in populations of patients at high vascular risk, as well as the risk of major coronary events. In secondary prevention of stroke, statins clearly reduced the risk of major coronary events. In the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial, compared with placebo, the patients with a recent stroke or transient ischaemic attack without coronary heart disease randomised to atorvastatin 80 mg/day had a significant 16% relative risk reduction of stroke and a 35% reduction in the risk of major coronary events. This was obtained despite the fact that 25% of patients allocated to the placebo arm were prescribed a commercially available statin outside the trial. A post-hoc analysis used blinded low-density lipoprotein cholesterol (LDL-C) measurements (taken at study visits during the trial) as a marker of adherence to lipid-lowering therapy. Compared with the group with no change or an increase in LDL-C (the group adherent to placebo or not taking a statin), the group with ≥ 50% reduction in LDL-C had a significant 31% reduction in the risk of stroke. The next step is to define whether or not achieving a LDL-C of < 70 mg/dl is better than a standard dose of statin (LDL ～ 100 – 110 mg/dl) in the secondary prevention of stroke. Statins are effective in reducing both first-ever and recurrent stroke, and this effect seems driven by the extent of LDL-C lowering.     

The risk of stroke within a week of minor stroke or transient ischemic attack

Background: The risk of stroke is highest in the first week following an index stroke or transient ischemic attack (TIA). Recent evidence indicates that prompt pharmacological treatment and evaluation may help mitigate this risk. Objective: To identify risk factors for recurrent stroke 1 week after index cerebrovascular event and review evidence for early and aggressive evaluation and management. Methods: We searched the National Library of Medicine Pubmed database to identify studies reporting recurrent or secondary stroke in individuals with identified stroke or TIA. Results/conclusion: The risk of recurrent stroke in the week after a TIA or minor stroke is up to 10%. Factors identified with risk of early stroke recurrence include age, elevated blood pressure, clinical symptoms of motor weakness or speech disturbance, and large vessel atherothrombotic mechanism. Studies have shown that timely initiation of stroke preventative therapy may reduce the risk of stroke within this early period.     

Safety of clopidogrel and aspirin for stroke prevention: implications of the CHARISMA trial.

Antiplatelet therapy is universally recommended for the prevention of recurrent events in patients with noncardioembolic ischaemic stroke or transient ischaemic attack (TIA), acute and chronic coronary artery disease, or peripheral arterial disease. However, choosing which antiplatelet agents to use in these situations remains controversial. The use of aspirin, aspirin plus extended-release dipyridamole, or clopidogrel is recommended as initial therapy in patients with noncardioembolic ischaemic stroke or TIA to reduce the risk of recurrent stroke and other cardiovascular events. Based on the results of the MATCH trial, combination therapy with aspirin plus clopidogrel is not recommended for patients with ischaemic stroke or TIA due to the increased risk of haemorrhage.The results of the CHARISMA trial support this recommendation; despite previous data demonstrating a favourable benefit-risk profile of aspirin plus clopidogrel in patients with acute coronary syndrome, this combination should not be used in patients at high risk for atherothrombosis and those with previous stroke or TIA. In these patients, the CHARISMA trial demonstrated a lack of significant clinical efficacy and an increased risk of bleeding with clopidogrel plus aspirin compared with aspirin alone.Further research is needed to assess the benefit-risk ratio of clopidogrel plus aspirin in specific subpopulations of patients at high risk for atherothrombotic events, and to determine the role of clopidogrel plus aspirin in preventing cardioembolic stroke or early recurrent stroke after symptomatic large-vessel atherostenosis. Recent and ongoing studies are seeking to better define the roles of different antiplatelet regimens in preventing recurrent stroke.     

Prevention of ischemic stroke: overview of traditional risk factors

Stroke prevails as a common and devastating disease. Epidemiological studies have advanced our understanding of stroke risk factors and clinical trials have demonstrated effective interventions to decrease stroke risk by modifying risk factors. Stroke risk factors are classified as traditional and novel and may be further divided into modifiable and non-modifiable. In this review we discuss select traditional risk factors for ischemic stroke, interventions for primary and secondary prevention and areas of research progress. Stroke treatment should be comprehensive, involving patient, community and medical personnel education, evaluation of individual risk factors and overall stroke risk assessment. Ongoing research is exploring further interventions in the management of traditional risk factors. Future research will expand our knowledge about the contribution of genetic factors to stroke, their interaction with environmental factors and open exciting avenues for the development of new therapies.     

青年脑卒中患者相关危险因素分析

目的探讨青年脑卒中患者的危险因素。方法选择2003年1月至2008年12月连续登记住院的年龄18—45岁脑卒中患者共178例,其中脑梗死106例,脑出血72例,对已知危险因素进行分析。结果高血压、吸烟、过量饮酒、家族史是主要危险因素。超重、高血脂症在青年脑卒中患者中所占的比例也较高。糖尿病、心脏病、TIA不是青年脑卒中患者的主要危险因素。结论降压治疗是青年脑卒中一级预防的重点工作。应重视提倡健康的生活方式,有针对性地加强卫生知识的宣传。     

体验式学习对脑卒中高危人群知信行的影响

目的：探讨脑卒中高危人群通过体验式学习对预防脑卒中知信行的影响。方法：采用随机整群抽样方法,2013年6月选择立新村40岁以上脑卒中高危人群249人开展体验式学习,学习1年后,比较其对预防脑卒中知信行变化。结果：经过1年期体验式学习后,脑卒中高危人群对脑卒中防治知识知晓率、认知态度及不良生活方式改善率均有明细提高。结论：体验式学习能有效改善脑卒中高危人群行预防脑卒中的知识,提升防病意识,从而有效改善不良行为生活方式。     

Genetic variation in cytochrome P450 2J2 and soluble epoxide hydrolase and risk of ischemic stroke in a Chinese population

OBJECTIVE: Epoxyeicosatrienoic acids have been recognized for their protective effects on the cardiovascular system. This study investigated whether two common polymorphisms in genes believed to be influential in regulating circulating levels of epoxyeicosatrienoic acids, namely cytochrome P450 2J2 (CYP2J2) G-50T and soluble epoxide hydrolase (EPHX2) G860A, were associated with ischemic stroke risk in a Chinese population. METHODS AND RESULTS: Screening of 200 patients with ischemic stroke and 350 control participants revealed that CYP2J2-50T allele frequency was not significantly different in ischemic stroke cases versus controls. In contrast, EPHX2 860A allele frequency was 16.8% in ischemic stroke cases versus 21.7% in controls (P=0.047), and the presence of this variant allele was associated with a significantly lower risk of ischemic stroke after adjustment for sex, age and multiple cardiovascular risk factors (adjusted odds ratio=0.50, 95% confidence interval 0.29-0.86). Moreover, there was a significant interaction between the EPHX2 G860A polymorphism, smoking and ischemic stroke risk such that nonsmokers carrying the EPHX2 G860A variant allele were at the lowest risk of ischemic stroke (odds ratio=0.33, 95% confidence interval, 0.17-0.67, P=0.002), whereas no significant association was observed in smokers. CONCLUSIONS: Collectively, these data indicate a protective influence of the G860A polymorphism of EPHX2 on ischemic stroke in Chinese nonsmokers.