卒中在人群的概率分布

本文报告急性脑卒中首次发作的致死事件在非致死事件在人群中呈Ｐｏｉｓｓｏｎ分布，根据Ｐｏｉｓｓｏｎ分布的规律推测人群性脑卒中首次发病数，本文的结果对脑中的理论研究提出了科学的依据。     

血尿酸与急性缺血性脑卒中关系的研究进展

急性缺血性脑卒中是脑动脉闭塞导致的脑组织梗死,是现代社会中致死和致残的最重要的CNS血管事件。血尿酸与急性缺血性脑卒中的发生、发展、治疗和预后都有着密切的关系,尤其近期在其治疗研究中备受关注。本文就血尿酸与急性缺血性脑卒中相关关系及其机制的研究进展做一综述。     

干细胞移植治疗缺血性卒中的研究进展及临床相关问题

脑血管病与心脏病、恶性肿瘤构成人类的三大致死性疾病。其中,脑卒中是指由于急性脑循环障碍所致的局限性或全面性神经功能缺损综合征,也称急性脑血管事件。脑卒中发病率、病死率和病残率逐年升高,生存者中50%～70%遗留严重残疾,给社会和家庭带来沉重负担。现有的治疗措施尚未显示出明显的临床治疗效果,而干细胞移植治疗在动物实验和临床研究中取得的初步成果及其对     

如何正确运用Z检验——两Poisson均值比较一般差异性Z检验及SAS实现

本文的目的是介绍两Poisson均值比较一般差异性Z检验及SAS实现。围绕以下两个内容进行介绍，即“Poisson分布简介”和“两Poisson均值比较的要领及SAS实现”。“Poisson分布简介”包括：①Poisson 分布的简史；②Poisson分布的适用场合；③Poisson分布的定义；④Poisson分布的性质。“两Poisson均值比较的要领及SAS实现”包括：①问题与数据结构；②两Poisson均值比较的四要素；③两Poisson均值比较的SAS实现。     

零膨胀Poisson分布模型回归分析

本文目的是介绍零膨胀Poisson分布模型回归分析。首先,介绍零膨胀计数资料及其零膨胀Poisson分布回归模型构建原理,包括"零膨胀Poisson分布回归模型的形式"和"零膨胀Poisson分布回归模型的求解";其次,介绍"零膨胀Poisson分布回归模型的SAS实现",包括"创建SAS数据集""呈现因变量Y的频数分布""求出因变量Y的均值和方差"和"基于全部自变量对因变量Y构建多重零膨胀Poisson分布回归模型"。本文结果提示,当计数资料为非严重过离散的零膨胀计数资料时,拟合"多重零膨胀Poisson分布回归模型",可获得满意的拟合效果。     

建立北京市卒中中心与卒中远程救治体系的必要性

1脑卒中已成为危害首都人民健康的最严重疾病随着首都地区人口的老龄化,脑卒中已成为严重威胁首都人民生命、健康的疾病之一。根据WHO的MONICA方案,北京社区人群15年(1984～1998年)的监测结果显示,急性脑血管事件的发病率逐年上升,并且呈现年轻化趋势。发病率     

肠道菌群对脑卒中后免疫功能影响的研究进展

正脑卒中是一种急性的脑血管疾病,包括缺血性脑卒中和出血性脑卒中。脑卒中是目前我国国民第一致死病因,也是导致成年人残疾的首要原因。脑卒中可激活机体的炎症和免疫反应。肠道免疫系统是机体内最大的免疫系统,     

进展性卒中危险因素的研究现状

脑卒中是全球重要的致死、致残性疾病,是中国第一大致死原因和主要的致残原因,而缺血性卒中约占80%。进展性卒中是急性缺血性卒中发病几天内出现的神经功能的恶化,临床中约1/3的患者经历卒中进展,是脑卒中预后不良的重要原因。本文就进展性卒中的概念、发病机制、危险因素及影像学特征进行系统综述,旨在探讨进展性卒中科学的诊断标准、早期预防措施及治疗方法,以期降低脑血管疾病的致死、致残率。     

一般计数资料Poisson分布模型回归分析

本文目的是介绍一般计数资料Poisson分布模型回归分析。首先,介绍一般计数资料及其Poisson分布模型构建原理,包括"一般计数资料Poisson分布回归模型的形式"和"一般计数资料Poisson分布回归模型的求解";其次,介绍"一般计数资料Poisson分布回归模型的SAS实现",包括"创建SAS数据集""求出因变量Y的均值和方差""检验因变量是否存在过离散现象""对过离散进行校正"和"基于全部自变量对因变量Y构建多重Poisson分布回归模型"。本文结果提示,在"过离散"不十分严重的情况下,通过在GENMOD过程的"model语句"中增加选项"dist=poisson"和"scale=deviance",可以较好地校正"过离散"导致的不良后果。     

2018版《加拿大脑卒中最佳实践共识声明:妊娠期急性脑卒中管理》解读

鉴于目前对妊娠期及产褥期急性脑卒中人群缺乏系统性研究资料,临床医师往往根据自己的经验处理此类患者以致诊治欠规范,不能有效地维护母婴健康。2018年加拿大心脏和脑卒中基金会(Heart and Stroke Foundation of Canada,HSFC)联合加拿大脑卒中联盟(Canadian Stroke Consortium,CSC)发布了2018版《加拿大脑卒中最佳实践共识声明:妊娠期急性脑卒中管理》,该共识声明由脑卒中医学专家和母胎医学专家合作制定,涉及妊娠期及产褥期脑卒中的初步急诊管理、影像学诊断、急性脑卒中治疗、出血性脑卒中管理、麻醉管理、妊娠期脑卒中管理(产前、产时及产后)以及脑卒中后二级预防及康复,其证据主要来源于非妊娠期脑卒中或妊娠同期组群研究。由于妊娠是几乎所有急性脑卒中临床试验的排除标准,且妊娠期脑卒中事件相对少见,因此缺乏来源于随机对照试验的高质量证据,所以该共识声明还使用了基于病例报告、病例系列报告以及以人口为基础的登记研究的数据。该共识声明的推荐反映了基于专业和临床经验的专家意见。     

Evidence for age-dependent education-related differences in men and women with first-ever stroke. Results from a community-based incidence study in northern Sweden

Several studies have shown a relationship between low socioeconomic status, age and stroke mortality. However, there is lack of similar studies in relation to stroke incidence. All cases of first-ever stroke occurring in a population aged 35-85 years from the city of Ume? were collected from hospital-based registers during a 2-year study period (2000-2002), from death certificates and also from nursing homes during a 6-month period. The WHO definition of stroke was used. Register data served to analyze educational level. A total of 457 first-ever strokes (244 women and 213 men) were registered, corresponding to an overall annual incidence rate of first-ever stroke of 413.4 per 100,000. The incidence of first-ever stroke was significantly higher among low-educated compared to high-educated men and women. The highest stroke incidence was found among low-educated women aged 75-85 years. The educational-related differences in stroke incidence persisted in the oldest age group (75-85 years), also after controlling for sex and age. This is one of the first studies that analyzes first-ever stroke incidence also among elderly men and women (75-85 years) in relation to socioeconomic status. More community-based studies are needed in order to confirm the results.     

First-year results of the third stroke registry in Tartu, Estonia

BACKGROUND: The main goal of the Third Stroke Registry in Tartu was to determine the incidence and 28-day case-fatality rates for first-ever stroke in an Estonian population. METHODS: The data collection started on 01.12.2001. All patients with first-ever stroke living in Tartu were registered. RESULTS: During the first year, 234 first-ever stroke cases were registered. The incidence rate of first-ever stroke age-standardised to the European population was 195/100,000, 214 (95% CI, 185-243) for men and 181 (95% CI, 155-208) per 100,000 for women. Sixty-eight patients (29%) died within 28 days of stroke onset. CONCLUSIONS: The incidence and 28-day case-fatality rate of stroke in Estonia are high compared to other countries. It might be related to higher risk factor prevalence, stress and socioeconomic status.     

Long-term prognosis, by stroke subtypes, after a first-ever stroke: a hospital-based study over a 20-year period

BACKGROUND AND PURPOSE: The influence of stroke subtype on recurrence, and determinants of recurrence-free survival after a first-ever stroke are not fully understood. We aimed to clarify the long-term prognosis by stroke subtypes and to identify determinants for recurrence and death after a first-ever stroke. METHODS: We enrolled 1,732 consecutive patients (men/women = 1,134/598, mean age of 65 years) with a first-ever acute stroke who were admitted to our Stroke Care Unit during a period of 20 years. Stroke subtypes were classified as atherothrombotic brain infarction, lacunar infarction, cardioembolic infarction, other type of infarction, and brain hemorrhage. The prognosis was assessed by stroke subtypes. RESULTS: During the hospital stay (mean 61 days), 99 patients died: 73 died directly from stroke. A total of 198 patients had recurrent strokes, and 286 died within 3 years after the index stroke. The overall recurrence rate within the first year was 6.5%, which was different among stroke subtypes. Patients with cardioembolic infarction (9.0%) as well as other type of infarction (9.1%) had more recurrent strokes within the initial year compared with the other subtypes. A history of transient ischemic attack (relative risk = 1.38), atrial fibrillation (1.52), ischemic heart disease (1.40), and disability at discharge (2.64) were independent predictors for the recurrence and death within 3 years after the first-ever stroke. CONCLUSIONS: The recurrence rate was different among stroke subtypes within 1 year after the index stroke. Atrial fibrillation, ischemic heart disease, history of transient ischemic attack, and disability at discharge were important determinants for stroke recurrence and death.     

One-year outcome after first-ever stroke according to stroke subtype, severity, risk factors and pre-stroke treatment. A population-based study from Tartu, Estonia

The aim of the current study was to evaluate the outcome at 1 year following a first-ever stroke based on a population-based registry from 2001 to 2003 in Tartu, Estonia. The outcome of first-ever stroke was assessed in 433 patients by stroke risk factors, demographic data and stroke severity at onset using the Barthel Index (BI) score and the modified Rankin Score (mRS) at seventh day, 6 months and 1 year. Female sex, older age, blood glucose value >10 mmol/l on admission and more severe stroke on admission were the best predictors of dependency 1 year following the first-ever stroke. At 1 year, the percentage of functionally dependent patients was 20% and the survival rate was 56%. The use of antihypertensive/antithrombotic medication prior to stroke did not significantly affect the outcome. The survival rate of stroke patients in Tartu is lower compared with other studied populations. The outcome of stroke was mainly determined by the initial severity of stroke and by elevated blood glucose value on admission. Patients with untreated hypertension had more severe stroke and trend for unfavourable outcome compared with those who were on treatment.     

Stroke in an elderly population: incidence and impact on survival and daily function. The Italian Longitudinal Study on Aging

BACKGROUND: Epidemiological data are essential to estimate the burden of stroke.We evaluated stroke incidence in older Italians and the effect of first-ever stroke on survival and activities of daily living (ADL). METHODS: The analysis was performed in the Italian Longitudinal Study on Aging (ILSA) sample, consisting of 5,632 individuals aged 65-84. The ILSA aims at major cardiovascular and neurological age-associated diseases. The baseline survey was performed in 1992 to detect prevalent diseases. The longitudinal examination started on September 1995 aiming at incidence, function and survival. RESULTS: Complete follow-up data were achieved for 77% of the baseline stroke-free cohort (4,164 persons; 50.9% males; mean age 74.5 +/- 5.7 years). Incidence for first-ever stroke was 9.51 (95% CI: 7.75-11.27) per 1,000 person years and 12.99 (95% CI: 10.99-14.98) including recurrent stroke (total incidence). Crude mortality was 49.2% among first stroke patients and 15% among persons without stroke. The first-ever stroke mortality risk ratio, adjusted for demographics and comorbidity, was 2.40 (95% CI: 1.62-3.54). In survivors, impairment of at least one ADL was present in 67.6% of first-ever stroke patients vs. 31.6% of individuals without stroke. The comorbidity-adjusted OR was 2.63 (95% CI: 1.20-5.78) in the total cohort, and 4.00 (95% CI: 1.39-11.46) in individuals without disability at baseline. CONCLUSIONS: The ILSA provides the first data on stroke incidence in Italy on a national basis. Overall, 153,000 new cases can be expected annually in the Italian elderly population. First-ever stroke still has a strong effect on survival and function of older persons.     

Prospective study on soluble thrombomodulin and von Willebrand factor and the risk of ischemic and hemorrhagic stroke

The aim of the present study was to examine if soluble thrombomodulin (sTM) and von Willebrand factor (VWF) could predict a first-ever ischemic or hemorrhagic stroke. This study was an incident case-referent study from within a population-based cohort in northern Sweden. Up to 1996 about 44,000 subjects had been screened and stroke cases were classified according to the WHO MONICA criteria. A first-ever stroke occurred in 108 cases. A total of 216 controls were selected from the same cohort. This prospective study found no association with sTM or VWF and the development of a first-ever ischemic stroke (n = 87) in the logistic regression model. For the hemorrhagic stroke cases (n = 18), the multivariate logistic regression model revealed a significant negative association with sTM. When dichotomized, the upper level (>17.3 microg/L) of sTM, as compared with the lower level (<17.3 microg/L), showed one fifth of the risk for hemorrhagic stroke (OR, 0.18; CI, 0.05 to 0.69). No significant association was found for VWF. We suggest that the novel finding of an inverse relation between sTM and hemorrhagic stroke should be investigated in a larger study.     

Significance of silent infarcts in acute ischemic stroke patients aged 80 years and older

BACKGROUND: The significance of silent infarcts (SIs) is unknown in very elderly patients with first-ever acute ischemic stroke. METHODS: Fifty patients aged 80 years and older with first-ever acute ischemic stroke were studied. The conventional risk factors for stroke, the scores of age-related white matter changes, and the findings on echocardiography were compared between patients with and without SIs. RESULTS: Thirty-eight patients (76%) had one or more SIs. The patients without SIs frequently had atrial fibrillation (50% vs. 13.2%, p = 0.014) or spontaneous echo contrast or thrombi on echocardiography (57.1% vs. 0%, p = 0.026) and showed lower scores on age-related white matter changes (0.5 +/- 0.67 vs. 1.13 +/- 0.58, p = 0.002) than did patients with SIs. There were no differences in other risk factors for stroke between the two groups. CONCLUSION: In patients aged 80 years and older, the absence of SIs with a first-ever acute ischemic stroke may suggest the presence of cardiac embolic sources or atrial fibrillation.     

Prevalence of disabling spasticity 1 year after first-ever stroke

Objective:  To estimate the prevalence of disabling spasticity (DS) 1 year after first-ever stroke.
Design:  Cross-sectional survey 1 year after first-ever stroke.
Methods:  Patients above 18 years from one county with first-ever stroke were identified by use of the national stroke registry. A representative sample of 163 patients was created and 140 of these were followed up. Assessments of motor function and ability with the modified Ashworth Scale, the modified Rankin Scale (mRS), the Barthel Index (BI) and clinical evaluation were performed in order to identify patients with spasticity-related disability.
Results:  The observed prevalence of any spasticity was 17% and of DS 4%. Patients with DS scored significantly worse than those with no DS on the mRS ( P  = 0.009) and the BI ( P  = 0.005). DS was more frequent in the upper extremity, correlated positively with other indices of motor impairment and inversely with age. There was an independent effect of severe upper extremity paresis (OR 22, CI 3.9–125) and age below 65 years (OR 9.5, CI 1.5–60).
Conclusions:  The prevalence of DS after first-ever stroke is low but corresponds to a large number of patients and deserves further attention with regards to prevention and treatment .     

颅内动脉粥样硬化性狭窄致首发脑梗死患者载脂蛋白B、载脂蛋白B/载脂蛋白A1与脑卒中危险因素的关系研究

目的探讨颅内动脉粥样硬化性狭窄(ICAS)致首发动脉硬化性脑梗死(ACI)患者载脂蛋白B(Apo-B)、载脂蛋白A1(Apo-A1)与缺血性脑卒中危险因素的关系。方法选择232例ICAS致首发ACI病例,以Apo-B、Apo-B/Apo-A1比值为标准分为研究组(69例)和对照组(163例)。回顾性分析比较两组人口学特征、危险因素、血脂和脑卒中类型的差异。结果 Apo-B、Apo-B/Apo-A1比值水平与三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白、同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)和多发梗死危险因素均存在相关关系(均P=0.001)。结论 ICAS致首发ACI患者Apo-B、Apo-B/Apo-A1比值与血脂异常、Hcy、hs-CRP及多发ACI密切相关。     

Incidence and prognosis of stroke in young adults: a population-based study in Ferrara, Italy

The reported annual incidence of juvenile stroke ranges from 9 to 47 cases per 100,000 inhabitants. We sought to estimate the incidence of first-ever stroke in young adults through a population-based stroke registry in a well-defined and stable population. We planned to collect all cases of new stroke in people aged 15–44 years in Ferrara, Italy, over the period 2002–2007. During the surveillance period, a first-ever stroke was diagnosed in 39 patients, giving a mean annual crude incidence rate of 12.1 cases per 100,000 person-years (95% CI 8.6–16.5), 9.1 when adjusted to the European population. The overall 30-day case fatality rate was 7.7, 21.4% for hemorrhagic stroke. The incidence rate was in the range of estimates detected in western countries. The case-fatality rate was lower than that reported in less recent studies. The stroke subtype predicted the probability of death and the outcome.