进展性缺血性脑卒中患者超敏C反应蛋白的水平变化

目的观察进展性缺血性脑卒中患者血清超敏C反应蛋白(hsCRP)变化规律,探讨超敏C反应蛋白在进展性缺血性脑卒中发病中的作用和临床意义。方法分别于患者入院第1d、第3d、第7d和第14d分别检测缺血性脑卒中患者hsCRP水平,比较进展组与非进展组的差异,分析hsCRP动态水平与缺血性脑卒中患者病情的关系。结果进展组第1d、第3d和第7d血清hsCRP水平高于非进展组,差异有显著统计学意义。结论血清hsCRP水平可作为进展性缺血性脑卒中的预测指标。     

进展性与非进展性缺血性脑卒中患者血清NO水平变化的对比研究

目的研究进展性与非进展性缺血性脑卒中患者血清NO水平变化,为进展性缺血性脑卒中的预测及治疗提供科学的依据。方法采用比色法分别对进展性与非进展性缺血性脑卒中患者(各30例)及对照组不同相应时间点的血清进行NO水平检测,并对结果进行比较。结果进展组的NO水平顺序依次为,进展后24h内>1d及7d>14d;在发病1w内,进展组NO水平均明显高于非进展组,而在发病2w左右,两者逐渐接近正常水平。结论血清NO水平升高可作为进展性缺血性脑卒中的预测指标。     

进展性缺血性脑卒中影响因素的前瞻性研究

目的 探讨进展性缺血性脑卒中的危险因素.方法 前瞻性登记急性缺血性脑卒中患者并收集其临床资料.依据欧洲进展性卒中诊断标准将患者分组,对可能影响卒中进展的因素进行比较及多因素Logistic逐步回归分析.结果 共有569例患者纳入研究,其中127例归入进展性卒中组,442例归入非进展性卒中组.进展性卒中组患者的病程、伴糖尿病、心房纤颤史及脑卒中史、入院时发热、高血糖、合并并发症、入院时美国国立卫生研究院卒中量表及格拉斯哥昏迷量表评分与非进展性卒中组比较差异有统计学意义(均P<0.1).多因素Logistic逐步回归分析显示,糖尿病(RR=2.625,95%CI:1.422～4.844)、发热(RR=0.192,95%CI:0.075～0.491)、合并并发症(RR=2.442,95%CI:1.394～4.279)、神经功能缺损中度(RR=5.602,95%(CI:2.789～11.251)及重度(RR=24.734,95%CI:4.218～145.052)是进展性卒中的独立危险因素.结论 糖尿病、发热、合并并发症、中及重度神经功能缺损是缺血性脑卒中进展的独立危险因素.     

睡眠障碍与进展性脑卒中的相关性研究

目的探讨睡眠障碍与进展性脑卒中之间的相关性,为进展性脑卒中的预测及预防提供科学的依据。方法连续选取116例卒中发作48h内的缺血性脑卒中患者,对所有患者均采用美国国立卫生研究院卒中量表(NIHSS)及SPIEGEL睡眠量表进行评分,根据NIHSS评分的变化分为进展组和非进展组,对2组患者的平均SPIEGEL评分结果进行统计学分析,并对进展组患者的平均SPIEGEL评分与NIHSS评分变化进行Pearson相关分析。结果 116例缺血性脑卒中患者中,36例病情出现进展,发生率31.03%。平均SPIEGEL评分在进展组与非进展组之间比较差异有统计学意义(P0.05),Pearson相关分析显示进展组患者平均SPIEGEL评分与NIHSS评分变化之间呈正相关。结论睡眠障碍是进展性脑卒中的危险因素,且睡眠障碍越严重,脑卒中进展越明显。     

高血压史及平均动脉压与进展性卒中相关性的单因素分层研究

目的 通过对进展性与非进展性缺血性脑卒中患者高血压病史及入院后平均动脉压的分层对比研究,为进展性缺血性脑卒中的预测提供依据.方法 将入组的急性脑梗死患者按入院后病情变化分为进展组和非进展组,再按高血压病史及入院后平均动脉压情况分为若干亚组,并对结果进行统计学分析.结果 高血压史20年及以上组、高血压史20年?以下组及无高血压史组任意两两比较,差异显著,且进展性卒中(SIP)发病率,前者(49.4％)＞中间者(30.0％)＞后者(16.8％).平均动脉压≤75mmHg组与75mmHg＜平均动脉压＜165mmHg组比较,P＝0.005 ＜0.01,差异显著,且SIP发病率,前者(52.0％)明显高于后者(25.9％)；平均动脉压≥165mmHg组与75 mmHg＜平均动脉压＜165mmHg组比较,P＝0.011 ＜0.017,差异有统计学意义,且SIP发病率,前者(48.3％)明显高于后者(25.9％)；平均动脉压≤75mmHg组与平均动脉压≥165mmHg组比较,P＝0.785 ＞0.017,差异无统计学意义.结论 高血压病史的有无及长短均与SIP相关；平均动脉压超过一定范围,无论升高还是降低,都是SIP的危险因素.     

超微血流显像技术对老年人进展性缺血性脑卒中的诊断价值

目的 探讨超微血流显像(SMI)技术对老年人进展性缺血性脑卒中(progressive ischemic stroke,PIS)的诊断价值。方法 选择本院2016年10月-2018年2月神经内科收治的急性缺血性脑卒中患者100例,根据美国国立卫生研究院卒中量表评分将患者分为进展组与非进展组,并利用SMI对颈动脉斑块新生血管进行检测。结果 进展组SMI分级主要集中在第3级,而非进展组则主要集中在1～2级(P<0.05); 进展组SMI分值较非进展组明显增高(P<0.01)。结论 老年人进展性缺血性脑卒中与颈动脉斑块内新生血管多少存在关系,新生血管越多发展为进展性缺血性脑卒中机率越大; SMI技术可对进展性缺血性脑卒中患者的颈动脉斑块新生血管进行评估,预测缺血性脑卒中进展,指导临床干预。     

缺血性进展性脑卒中危险因素临床分析

目的探讨进展性缺血性脑卒中临床诊断与治疗中的危险因素。方法选取2010—2013年我院住院治疗的进展性与非进展性缺血性脑卒中患者各40例,对2组患者的临床资料进行对比分析。结果 2组患者高热、高血压发生率无明显差异(P0.05),观察组高血糖、同型半胱氨酸偏高比例以及降压后进展率均明显高于对照组(P0.05),颈动脉不稳定斑块检出率、中度与重度狭窄率明显高于对照组(P0.05),各项生化指标均与对照组差异显著(P0.05)。结论降压不合理、生化指标(血糖、全血黏度、纤维蛋白原偏高,高密度脂蛋白偏低)异常、颈动脉不稳定斑块以及中重度狭窄均为进展性缺血性脑卒中的危险因素。     

颈动脉粥样硬化与进展性缺血性脑卒中的关系

目的探讨颈动脉粥样硬化与进展性缺血性脑卒中的关系。方法采用彩色多普勒超声仪对564例缺血性脑卒中患者的颈动脉进行评估，比较进展性缺血性脑卒中和非进展性缺血性脑卒中患者的颈动脉粥样硬化特征和程度。结果564例缺血性脑卒中患者有135例为进展性缺血性脑卒中（23.8％）；在重度颈动脉粥样硬化110例中，有49例（44.5％）发展为进展性卒中；在重度颈动脉狭窄95例中，有48例（50．5％）发展为进展性卒中；在病理表现为溃疡斑86例中，有47例（54．7％）发展为进展性卒中：无颈动脉粥样硬化或伴轻度颈动脉粥样硬化的缺血性脑卒中患者，仅9％～10％发生进展性卒中。经Logistic回归分析发现，颈动脉粥样硬化程度、狭窄程度以及溃疡斑与进展性缺血性卒中的发生成正相关。结论颈动脉粥样硬化与进展性缺血性脑卒中的发生密切相关，颈动脉粥样硬化的严重程度可作为进展性缺血性脑卒中的预测指标。     

进展性大动脉粥样硬化型脑梗死的危险因素分析

目的探讨中国缺血性脑卒中亚型(CISS)分型中大动脉粥样硬化型(LAA)脑梗死病情进展的危险因素。方法前瞻性收集急性LAA脑梗死患者,根据美国国立卫生研究院卒中量表(NIHSS评分)评估患者病情是否进展,对可能影响患者病情进展的因素进行统计分析。结果共纳入351例患者,其中进展组112例(31.91%),非进展组239例(68.09%)。单因素分析2组患者高血压病史、饮酒史、空腹血糖、白细胞总数、纤维蛋白原水平、入院时收缩压及舒张压、入院时NIHSS评分、颅内外血管重度狭窄/闭塞、肺部感染、泌尿系感染、电解质紊乱有明显差异(P0.1),多因素Logistic逐步回归分析显示入院时收缩压、白细胞总数、颅内外血管重度狭窄/闭塞、纤维蛋白原水平、肺部感染、相较于轻度神经功能缺损的中度及重度神经功能缺损是进展性LAA脑梗死的独立危险因素。结论入院收缩压增高、白细胞总数增高、颅内外血管重度狭窄/闭塞、纤维蛋白原水平增高、肺部感染、中度及重度神经功能缺损是进展性LAA脑梗死的独立危险因素。     

高海拔地区进展性脑卒中的相关因素分析

目的分析高海拔地区进展性脑卒中的危险因素及干预对策,以期为进展性脑卒中的临床诊疗提供借鉴。方法回顾2014-06—2014-12入我院的诊断为缺血性脑卒中的患者为研究对象,对患者的一般情况如性别、年龄、基础病、感染、激动情绪、吸烟、酗酒、发展为进展性脑卒中时的季节、便秘、剧烈活动、过早活动、剧烈咳嗽等进行生存分析,评价进展性脑卒中的危险因素。结果 160例患者中,年龄16~86岁,平均(46.5±16.5)岁,男132例,女28例,共42例发展为进展性脑卒中。通过对患者众多情况的单因素Logistic分析通过分析,感染、激动情绪、酗酒、便秘、年龄、高血压、咳嗽、冬季(P0.05),将之纳入多因素分析。通过多因素非条件Logistic回归分析,激动情绪(P=0.000)、酗酒(P=0.002)、便秘(P=0.003)、年龄(P=0.000)、高血压(P=0.000)、咳嗽(P=0.000)为进展性脑卒中的危险因素,脑卒中非进展组与进展组凝血纤溶相关指标比较,差异有统计学意义(P0.05)。结论激动情绪、酗酒、便秘、年龄、高血压、咳嗽为进展性脑卒中的危险因素,进展性脑卒中患者D-二聚体偏高。     

Fever and infection early after ischemic stroke

Previous studies showed that elevated body temperature early after ischemic stroke is associated with severe neurological deficit and a poor outcome. The aim of this study was to analyse the prevalence and putative etiology of febrile body temperature (>/=38.0 degrees C) early after stroke and to investigate the association between body temperature, stroke severity and outcome. We investigated 119 consecutive patients who were admitted within 24 h after ischemic stroke. Patients were examined for infection before ischemia using a standardized questionnaire and received daily clinical examination after stroke. In case of fever, standardized radiological and microbiological examinations were performed. Fever within 48 h after stroke was observed in 30 (25.2%) patients. The probable cause of fever was infective or chemical aspiration pneumonia (n=12), other respiratory tract infection (n=7), urinary tract infection (n=4), viral infections (n=3) or insufficiently defined (n=5). (One patient had two potential causes of fever.) In thirteen of these patients, infection was most probably acquired before stroke. Fever newly developed more often during day 1 to 2 than day 3 to 7 after stroke (P=0.016). Fever was associated with a more severe deficit on admission independent from age, vascular diseases and risk factors (odds ratio 9.6; 95% confidence interval 3.1-29). Fever is a frequent complication early after stroke and in the majority of cases, it can be explained by infection or chemical aspiration pneumonia. In about half of the infected patients, infection was most probably acquired before stroke. Fever was associated with a more severe neurological deficit on admission.     

颈动脉粥样硬化与缺血性进展性脑卒中的相关性研究

目的研究颈动脉粥样硬化在缺血性进展性脑卒中的作用.方法对30例进展性脑卒中和40例非进展性脑卒中患者的颈动脉用多普勒超声进行检测,比较2组患者颈动脉粥样硬化的特征.结果进展性脑卒中患者中23例有颈动脉粥样硬化(76.7%),明显高于非进展性脑卒中组(52.5%)(P＜0.05),且进展性脑卒中组中斑块性质为软斑和溃疡斑的比例明显高于非进展性脑卒中组,2组比较有显著性差异(P＜0.05).结论进展性脑卒中的发生与颈动脉粥样硬化密切相关,可作为预测及评价缺血性进展性脑卒中的重要指标之一.     

Risk factors for progressive ischemic stroke——A retrospective analysis

BACKGROUND: Progressive ischemic stroke has higher fatality rate and disability rate than common cerebral infarction, thus it is very significant to investigate the early predicting factors related to the occurrence of progressive ischemic stroke, the potential pathological mechanism and the risk factors of early intervention for preventing the occurrence of progressive ischemic stroke and ameliorating its outcome. OBJECTIVE: To analyze the possible related risk factors in patients with progressive ishcemic stroke, so as to provide reference for the prevention and treatment of progressive ishcemic stroke. DESIGN: A retrospective analysis. SETTING: Department of Neurology, General Hospital of Beijing Coal Mining Group. PARTICIPANTS: Totally 280 patients with progressive ischemic stroke were selected from the Department of Neurology, General Hospital of Beijing Coal Mining Group from March 2002 to June 2006, including 192 males and 88 females, with a mean age of (62±7) years old. They were all accorded with the diagnostic standards for cerebral infarction set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1995, and confired by CT or MRI, admitted within 24 hours after attack, and the neurological defect progressed gradually or aggravated in gradients within 72 hours after attack, and the aggravation of neurological defect was defined as the neurological deficit score decreased by more than 2 points. Meanwhile, 200 inpatients with non-progressive ischemic stroke (135 males and 65 females) were selected as the control group. METHODS: After admission, a univariate analysis of variance was conducted using the factors of blood pressure, history of diabetes mellitus, fever, leukocytosis, levels of blood lipids, fibrinogen, blood glucose and plasma homocysteine, cerebral arterial stenosis, and CT symptoms of early infarction, and the significant factors were involved in the multivariate non-conditional Logistic regression analysis. MAIN OUTCOME MEASURES: Results of the univariate analysis of variance of the factors related to progressive ischemic stroke; Results of the multivariate regression analysis. RESULTS: All the 480 patients were involved in the analysis of results. ① Results of the univariate analysis variance: There were significantly more patients with fever, leukocytosis, history of diabetes mellitus, cerebral arterial stenosis and CT symptoms of early infarction in the progressive ischemic stroke group than in the control group (P < 0.01); The levels of blood glucose and fibrinogen in the progressive ischemic stroke group were significantly higher than those in the control group, while the level of blood pressure was significantly lower than that in the control group (P < 0.05–0.01). ② Results of the multivariate Logistic regression analysis: The independent predicting factors for progressive ischemic stroke were history of diabetes mellitus, fever, leukocytosis, cerebral arterial stenosis, CT symptoms of early infarction, blood glucose and blood pressure (OR =2.61, 2.96, 3.79, 1.03, 3.57, 2.68, 95% CI 0.92–3.59, P < 0.05–0.01). CONCLUSION: History of diabetes mellitus, fever, leukocytosis, levels of blood pressure, blood glucose, cerebral arterial stenosis and CT symptoms of early infarction are the risk factors for progress ischemic stroke     

Influence of olfactory ensheathing cell transplantation on body temperature of patients with old spinal cord injury★

BACKGROUND： Olfactory ensheathing cell transplantation may transiently raise body temperature in some patients with old spinal cord injury.
OBJECTIVE： To analyze the influence of olfactory ensheathing cell transplantation on body temperature changes and neurological functional recovery in patients with old spinal cord injury.
DESIGN, TIME AND SETTING： A non-randomized self-controlled study, which was performed in the wards of the Department of Surgery, Taian Disabled Soldier＇s Hospital of Shandong Province, between June 2004 and July 2007.
PARTICIPANTS： 119 inpatients with old spinal cord injury were selected for this study, including 110 males and 9 females, aged 5-58 years.
METHODS： The olfactory bulb of an aborted fetus was digested into a single-cell suspension of olfactory ensheathing cells, which were then cultured and purified for 7-10 days, and once again made into a single-cell suspension. The olfactory ensheathing cell suspension was then transplanted in the juncture of the normal spinal cord and the abnormal spinal cord under surgical microscopy, with 1 × 10^6 cells per target point, with 2-5 target points in total. According to changes in postoperative temperature, 119 patients were divided into three groups： body temperature （T） ≤ 38.0 ℃ （n = 40）, 38.0 ℃ 〈 T ≤ 39.0 ℃ （n = 67）, T 〉 39.0℃ （n = 12）. In particular, T 〉 38℃ （n = 79） patients were divided into two subgroups according to duration of fever： ≤3 days （n = 61） and ≥ 4 days （n = 18）.
MAIN OUTCOME MEASURES： Neurological function was evaluated by the American Spinal Cord Injury （ASIA） scale set by American Spinal Cord Injury Academy in 2000 one day prior to transplantation and one or two months after transplantation.
RESULTS： 119 patients were included in the final analysis, without any loss. Following olfactory ensheathing cell transplantation, body temperatures changed as follows： T ≤ 38.0 ℃ （n = 40, 33.6%）, 38.0 ℃ 〈 T ≤ 39.0 ℃ （n = 67, 5     

性激素、载脂蛋白和同型半胱氨酸水平与进展性缺血性脑卒中的相关性

目的 探讨性激素、载脂蛋白和同型半胱氨酸水平与进展性缺血性脑卒中(PIS)的相关性。方法 选58例进展性缺血性脑卒中患者当做观察组,62例非进展性缺血性脑卒中患者当做对照组,2组的年龄、性别等没有明显差异(P>0.05); AU480全自动生化分析仪(Beckman Coulter)对Hcy,Apo A1以及Apo B水平进行检测,荧光免疫法检测FSH,LH,T以及E₂水平,采用NIHSS评分评价患者神经功能,全自动血凝分析仪检测患者PT,FIB,APTT及PLT等凝血指标水平,ELISA检测血清中的TNF-α,IL-8,PCT水平,比浊法检测hs-CRP水平,并分析其性激素、载脂蛋白和HCY水平与进展性缺血性脑卒中的相关性。结果 观察组HCY,Apo B水平较对照组高(P<0.05),而Apo A1水平则较低(P<0.05); 2组FSH与LH水平之间没有明显差异(P>0.05); 与对照组比较,观察组男性患者具有较高的E₂水平(P<0.05),女性患者具有较低的E₂水平(P<0.05); 观察组男性患者的T水平有所降低(P<0.05),女性患者的T水平有所升高(P<0.05); 观察组的TNF-α,IL-8,PCT以及hs-CRP水平明显较对照组高(P<0.05); 与对照组比较,观察组的PT,APTT,PLT水平显著下降(P<0.05),FIB水平与NIHSS则较高(P<0.05); 相关性分析后发现,HCY、男性患者E₂、女性患者T水平与炎性因子、FIB水平、NIHSS呈正相关,与PT,APTT,PLT水平呈负相关,Apo A1/Apo B、女性患者中E₂、男性患者T水平与炎性因子、FIB水平、NIHSS呈负相关,与PT,APTT,PLT水平呈正相关; 通过Logistic回归分析得出E₂,T,HCY,Apo A1与Apo B对进展性缺血性脑卒中具有独立的预测价值,可作为其近期预后不良的危险因素。E₂,T,HCY水平,Apo A1/Apo B对进展性缺血性脑卒中具有较好的预测价值。结论 E₂与T的紊乱对于患者病情具有不佳的影响,HCY在PIS中的水平呈高表达,Apo A1/Apo B有所降低,且以上指标水平对于PIS具有一定的预测价值。     

糖尿病与进展性缺血性脑卒中相关性研究

目的 探讨糖尿病与进展性缺血性脑卒中的相关性.方法 我院神经内科2006-05～2009-05收治的缺血性脑卒中患者130例为研究对象,其中伴糖尿病患者64例为糖尿病组,非糖尿病患者66例为非糖尿病组,比较2组发展为进展性缺血性脑卒中的差异.结果 糖尿病组64例中诊断为进展性卒中41例,占64.1%;非糖尿病组66例诊...     

High level of anticardiolipin antibodies is an unusual finding in an unselected stroke population

Anticardiolipin antibodies (ACA) were analysed in 502 consecutive patients admitted to our stroke unit Elevated ACA levels ≥11 units) were found in 20 of 396 patients (5%) with ischemic stroke and TIA, in none of 42 patients with cerebral haematomas and in five of 64 patients (8%) with other diagnoses than stroke. There were no statistically significant differences in occurrence of ACA in these groups. Markedly elevated ACA levels (> 20 units) were found in nine of the 396 patients (2%) with TIA/ischemic stroke. The frequency of ACA was higher in the age group 40–50 years (15%) than in the age group 50–90 years (3.6–6.0%). Re-examination in 18 of the 20 patients with ischemic stroke and elevated ACA levels after 26–395 days (mean 100 days) showed that in 10 patients ACA levels were lower (difference ≥ 6 units = 2 SD), compared to the initial value, whereas eight patients had unchanged ACA levels. The occurrence of previous deep venous thrombosis was significantly more common in patients with elevated ACA levels, otherwise there were no differences concerning earlier stroke, risk factor analysis or other laboratory parameters between patients with and without elevated ACA levels. In conclusion, we found elevated ACA levels in patients with ischemic stroke at a rather low prevalence as compared to most previous studies. The clinical relevance of ACA is uncertain, especially in patients with multiple risk factors. We recommend screening for ACA only in stroke patients < 50 years of age, or when the antiphospholipid syndrome is suspected.     

进展性脑梗死患者红细胞分布宽度的动态变化及预后风险评估

目的观察进展性缺血性脑卒中(PIS)患者的红细胞分布宽度(RDW)、氧化低密度脂蛋白(ox-LDL)与超敏C反应蛋白(hs-CRP)水平的动态变化,探讨其对PIS病情严重程度及评估预后的价值。方法选择急性脑梗死患者100例,分为进展组(PIS组)50例、非进展组(非PIS组)50例,分别测定两组患者发病24h、2d、3d、7d、14d RDW、ox-LDL与hs-CRP水平及SSS评分,并随访患者3月时改良Rankin量表(m RS)评分,采用Cox比例风险回归分析进展性缺血性脑卒中预后。结果治PIS组RDW、ox-LDL与hs-CRP水平在发病24h、第2、3、7、14d明显高于非PIS组(P0.01);Pearson相关分析显示,RDW与ox-LDL、hs-CRP及SSS评分水平呈显著正相关(P0.01)。Cox回归分析显示RDW、ox-LDL、hs-CRP是患者预后不良的支持因素(P0.01)。结论 RDW联合ox-LDL与hs-CRP可提高对PIS病情严重程度的判断能力,同时有助于评估患者预后。