急性脑梗死患者血清尿酸、超敏C反应蛋白的改变及其临床意义

目的探讨急性脑梗死(ACI)患者血清尿酸(UA)和超敏C反应蛋白(hs-CRP)水平的改变及其临床意义。方法采用尿酸酶比色法和免疫散射比浊法检测101例ACI患者(ACI组)及40例正常对照者(正常对照组)的血清UA和hs-CRP水平。采用NIHSS评分评价ACI组患者的神经功能缺损程度。根据NIHSS评分,将患者分为轻度缺损亚组(≤5分)、中度缺损亚组(5~15分)及重度缺损亚组(15分)。结果ACI组血UA及hs-CRP水平显著高于正常对照组(均P0.01)。与轻度缺损亚组比较,中度缺损亚组及重度缺损亚组的UA及hs-CRP水平均显著升高(均P0.05)。重度缺损亚组UA及hs-CRP水平均显著高于中度缺损亚组(均P0.05)。结论 ACI患者血清尿酸和超敏C反应蛋白水平显著增高,与ACI严重程度有关。     

DSA联合血清SICAM-1评估颅内破裂动脉瘤术后脑血管痉挛的效果

目的探讨DSA联合可溶性细胞间黏附分子-1(SICAM-1)评估颅内破裂动脉瘤术后脑血管痉挛(CVS)的效果。方法选择56例颅内破裂动脉瘤急诊术后病人作为研究对象,DSA测定脑血管直径判断CVS程度,结合Hunt-Hess分级,分析CVS与SICAM-1浓度关系。结果 56例中,30例无CVS,9例轻度CVS,10例中度CVS,7例重度CVS。重度CVS血清SICAM-1最高浓度出现在术后4~5 d,其余3组均出现在术后1~3 d。无CVS、轻度CVS、中度CVS与重度CVS血清SICAM-1浓度分别为(273.47±86.54)、(393.47±79.85)、(532.79±69.7)、(664.64±98.71)ng/ml,随着CVS加重,血清SICAM-1浓度显著增高(P0.01)。结论脑动脉瘤破裂出血术后行DSA检查联合血清SICAM-1浓度监测可有效预示疾病进展,实现CVS动态观察,可作为CVS发作、进展的危险性评估指标。     

高血压脑出血患者外周血miR-155、miR-27a-3p表达水平及其临床意义

目的研究高血压脑出血(HICH)患者外周血微小microRNA-155 (miR-155)、microRNA-27a-3p (miR-27a-3p)表达水平及其临床意义。方法选取2018年01月-2020年01月四川绵阳四0四医院神经外科收治的100例HICH患者作为研究对象,设为观察组,根据格拉斯哥昏迷(GCS)评分分为轻度亚组(GCS 13~14分,n=34)、中度亚组(GCS9~12分,n=41)和重度亚组(GCS3~8分,n=25),同时选取同期于本院进行体检的60例健康者作为对照组,检测外周血miR-155、miR-27a-3p表达水平和血清肿瘤坏死因子-α (TNF-α)、血管内皮生长因子(VEGF)、内皮素-1 (ET-1)水平,并分析外周血miR-155、miR-27a-3p表达水平和血清TNF-α、VEGF、ET-1水平的相关性。结果观察组外周血miR-155高于对照组,miR-27a-3p表达水平低于对照组(P<0.05);观察组血清TNF-α、VEGF、ET-1水平高于对照组(P<0.05);重度亚组外周血miR-155表达水平和血清TNF-α、VEGF、ET-1水平高于轻度亚组和中度亚组,miR-27a-3p表达水平低于轻度亚组和中度亚组(P<0.05),中度亚组外周血miR-155表达水平和血清TNF-α、VEGF、ET-1水平高于轻度亚组,miR-27a-3p表达水平低于轻度亚组(P<0.05);预后良好组外周血miR-155表达水平和血清TNF-α、VEGF、ET-1水平低于预后不良组,miR-27a-3p高于预后不良组(P<0.05);血清TNF-α、VEGF、ET-1水平与外周血miR-155呈正相关性,与miR-27a-3p呈负相关(P<0.05)。结论外周血miR-155、miR-27a-3p表达水平和血清TNF-α、VEGF、ET-1水平对HICH病情判断和预后具有重要意义。     

急性脑梗死患者神经功能缺损程度与血清H-FABP、CD62P水平的关系

目的 探讨急性脑梗死患者神经功能缺损程度与血清心型脂肪酸结合蛋白(H-FABP)、血小板α颗粒膜蛋白(CD62P)的关系。方法 选择本院收治的180例急性脑梗死患者为研究对象,将其分为轻度组、中度组、重度组3组,每组各60例,以同期体检健康者60例为对照组; 采用神经功能缺损评分量表(NIHSS评分)评定急性脑梗死患者神经功能缺损程度,通过酶联免疫吸附法(ELISA)检测各组血清神经功能缺损指标(NES、S100B)及H-FABP、CD26P水平,分析神经功能缺损程度与血清H-FABP、CD26P的关系。结果 急性脑梗死重度组与中度组NIHSS评分、NES及S100B水平均高于急性脑梗死轻度组,而中度组高于轻度组(P<0.01); 急性脑梗死组血清H-FABP、CD26P水平均高于对照组,急性脑梗死重度组与中度组高于急性脑梗死轻度组,而中度组血清H-FABP、CD26P水平高于轻度组(P<0.01); 急性脑梗死患者血清H-FABP、CD26P水平与神经功能缺损程度呈正相关。结论 急性脑梗死患者神经功能缺损程度与血清H-FABP、CD26P水平呈显著正相关,推测临床可参照血清H-FABP、CD26P水平来评估急性脑梗死患者神经功能缺损程度。     

急性缺血性脑卒中患者血管内皮钙黏蛋白水平与神经功能缺损程度的相关性研究

目的探讨急性缺血性脑卒中(AIS)患者血清血管内皮钙黏蛋白(VE-cad)水平与神经功能缺损的相关性。方法 ELISA法检测161例AIS患者(AIS组)及110例其他患者(对照组)起病第1、3、10 d的血清VE-cad水平。根据NIHSS评分将患者分为轻度、中度及重度缺损亚组。结果与对照组比较,AIS组各时间点血清VE-cad的水平均显著增高(均P0.01)。与轻度缺损亚组比较,中度和重度缺损亚组各时间点血清VE-cad水平显著增高(均P0.05)。与中度缺损组比较,重度缺损组血清VE-cad水平显著增高(P0.05)。AIS患者发病第1 d、第3 d、第10 d的血清VE-cad水平与NIHSS评分均呈正相关(r=0.884,r=0.809,r=0.717;均P0.05)。轻度、中度和重度缺损亚组神经功能改善患者第3 d及第10 d VE-cad水平均显著低于第1 d(P0.05)。结论 VE-cad参与了AIS的发生发展过程,可能是预测AIS患者神经功能缺损程度及其预后的一个重要血清标志物之一。     

动脉内灌注维拉帕米治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛

目的 研究动脉内灌注维拉帕米治疗动脉瘤性蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)的有效性及使用方法.方法 对13例处理完动脉瘤后出现CVS的SAH患者进行脑血管造影,并在动脉内灌注维拉帕米,治疗过程中监测血压、心率,记录灌注前后经颅多普勒超声结果,随访6个月并进行GOS评分.结果 本组13例共实施了16根动脉内灌注治疗,灌注前后相比较,CVS造影上改善9例,临床症状改善8例,症状无变化5例,多普勒超声检查大脑中动脉的平均流速由治疗前的(178 ±4) cm/s降至治疗后的(139±4) cm/s(P＜0.05),监测心率和平均动脉压无明显变化.所有患者随访6个月,GOS评分:恢复良好10例,中度病残但生活自理2例,重度病残生活不能自理1例.结论 动脉内灌注维拉帕米治疗动脉瘤性SAH后CVS是安全可行的,中等剂量使用可有效改善CVS,同时对全身的血流动力方面无显著影响.     

老年脑梗死患者血清超敏C反应蛋白与颈动脉狭窄的关系

目的 探讨老年脑梗死患者血清超敏C反应蛋白(hs-CRP)水平与颈动脉狭窄的关系. 方法选择＞60岁的颈动脉系统腔隙性脑梗死患者52例行颈动脉CT血管成像(CTA)检查,分为轻度狭窄组、中度狭窄组和重度狭窄组.选健康体检者28例为对照组.采用免疫散射比浊法测定hs-CRP水平. 结果各狭窄组患者血清hs-CRP水平均显著高于正常对照组(P<0.01),重度狭窄组hs-CRP水平显著高于中度狭窄组和轻度狭窄组患者(P<0.01),中度狭窄组hs-CRP显著高于轻度狭窄组(P<0.01). 结论 hs-CRP是血管炎症的标志物,其水平与颈动脉狭窄程度呈正相关.     

老年脑梗死患者血清白介素-18与丙二醛的变化及意义

目的探讨老年脑梗死患者血清白介素-18(IL-18)与丙二醛(MDA)的变化及意义。方法选取老年急性脑梗死患者90例,健康对照组60例,测定并比较各组IL-18和MDA水平。脑梗死患者按病程分为急性期组和亚急性期组;按脑梗死面积分为大面积脑梗死组、中面积脑梗死组和小面积脑梗死组;按神经功能缺损程度分为重度、中度和轻度。结果 (1)脑梗死患者急性期组和亚急性期组IL-18和MDA水平均增高,且急性期亚急性期对照组(P0.01)。(2)大面积脑梗死组IL-18和MDA水平高于中、面积小脑梗死组,中面积脑梗死组IL-18和MDA水平高于小面积脑梗死组(P0.01)。(3)IL-18和MDA水平重度脑梗死组均高于中度、轻度脑梗死组,中度脑梗死组高于轻度脑梗死组(P0.01)。(4)血清IL-18和MDA呈正相关(P0.01)。结论急性脑梗死患者存在IL-18和MDA水平变化,且与病程、病变范围和病情程度相关,二者联合检测可作为急性脑梗死的病情监测指标。     

同型半胱氨酸高敏C反应蛋白及D-二聚体在急性脑梗死患者中的变化及意义

目的探讨同型半胱氨酸、高敏C反应蛋白及D-二聚体在急性脑梗死患者中的变化及意义。方法选择急性脑梗死180例为脑梗死组,以梗死灶大小为依据,分为大面积亚组、中面积亚组以及小面积亚组。以临床神经功能缺损严重程度为依据分为重度亚组、中度亚组以及轻度亚组;选择180例同期体检健康者为健康对照组;监测及对比2组血清同型半胱氨酸、高敏C反应蛋白及D-二聚体的水平。结果与健康对照组比较,脑梗死组患者血清同型半胱氨酸、高敏C反应蛋白及D-二聚体水平均明显升高,差异有统计学意义(P0.05);大面积亚组患者血清的含量大于中面积亚组,中面积亚组的含量大于小面积亚组(P0.05)。同型半胱氨酸、高敏C反应蛋白及D-二聚体在重度亚组患者血清的含量大于中度亚组,中度亚组的含量大于轻度亚组(P0.05)。结论急性脑梗死的发生和发展与同型半胱氨酸、高敏C反应蛋白及D-二聚体具有十分密切的关系,在判断患者疾病的严重程度时对其发生、发展的检测具有十分重要意义,且在临床治疗方面具有较好的指导作用。     

动脉瘤性蛛网膜下腔出血患者血清可溶性黏附分子-1含量动态变化的研究

目的研究动脉瘤性蛛网膜下腔出血(SAH)患者血清可溶性黏附分子1(sCAM1)的动态变化规律。方法用酶联免疫吸附法(ELISA)对30例动脉瘤性SAH患者术前、术后1～3d、7～9d、11～13d血清sCAM1进行动态观察,用经颅多普勒检测大脑中动脉血流速度(VMCA),并与20名健康对照者进行比较。结果动脉瘤性SAH患者血清sCAM在术后1～3d、7～9d各均值明显高于正常对照组(均P<0.05),尤以术后7～9d最明显;Fiaher、Hunt不同分级患者血中CAM1浓度以出血量大、病情重升高明显(P<0.05,P<0.01);脑血管痉挛(CVS)程度重者sCAM1浓度升高明显(P<0.05);术前、术后CVS组和非CVS组差异有显著性(均P<0.05)。结论动脉瘤性SAH患者血清sCAM含量与病程、病情及CVS程度有关。     

颅内动脉瘤性蛛网膜下腔出血血管痉挛治疗的临床探讨

目的探讨颅内动脉瘤性蛛网膜下腔出血脑血管痉挛的治疗方法。方法回顾性分析颅内动脉瘤性蛛网膜下腔出血合并脑血管痉挛患者临床资料67例。结果 23例并发脑血管痉挛,6例发生一侧肢体功能障碍,3例发生脑血栓形成。经治疗后61例C-反应蛋白恢复正常,6例明显下降,4例肢体功能恢复正常,1例恢复到4级,1例死亡。结论炎症因子在脑血管痉挛中明显升高;钙离子拮抗剂尼莫地平加抗氧化剂依达拉奉中药川芎嗪联合治疗动脉瘤性蛛网膜下腔出血所致的脑血管痉挛有较好疗效。     

Hyponatremia and cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage]

We studied retrospectively the relationship between hyponatremia and cerebral vasospasm in 121 consecutive patients with aneurysmal subarachnoid hemorrhage. In 19 patients sodium levels fell below 130 mEq/l on at least two consecutive days. Hyponatremia developed at average 8.9 hospital day and lasted for 4.4 days. It was mild (126 to 130 mEq/l) in 15 patients, moderate (121 to 125 mEq/l) in 3 patients, and severe (116 to 120 mEq/l) in 1 patient. Cerebral vasospasm was evaluated by angiography, symptoms and CT finding. Angiographical vasospasm was found in 57 patients, symptomatic vasospasm in 38 patients and low density area on CT in 20 patients. Angiographical vasospasm developed in 15 of the 19 patients (78.9%) with hyponatremia, symptomatic vasospasm in 16 patients (84.2%), low density area on CT in 8 patients (42.1%), the difference being significantly high. (respectively, p < 0.01, p < 0.001 and p < 0.01 by chi-square test) Polyuria of 2500 ml or more immediately before the onset of hyponatremia developed in 14 patients (87.5%). When symptomatic vasospasm and hyponatremia coincided, there were only 4 patients in which symptomatic vasospasm was preceded by hyponatremia. So, it is difficult to predict the development of vasospasm from that of hyponatremia. This study found incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage to be significantly higher in patients who developed hyponatremia, which raised suspicion about the presence of dehydration. Hyponatremia with central origin generally remains asymptomatic, but it is important to treat positively when the pathology of cerebral vasospasm is taken into consideration.     

西洛他唑用于动脉瘤性蛛网膜下腔出血患者疗效的meta分析

目的本研究旨在评价西洛他唑用于动脉瘤性蛛网膜下腔出血患者的临床疗效,为其应用提供依据。方法计算机检索西洛他唑用于动脉瘤性蛛网膜下腔出血的对照研究,时间截止2013年1月。由2位研究者独立评价纳人研究的质量、提取数据,统计分析采用RevMan5．2．3软件进行。结果纳入3个研究,共259例患者。Meta分析结果显示：西洛他唑降低症状性脑血管痉挛（RR=0．46;95％CI=0．30～0．71;P=0．0005）、血管造影脑血管痉挛（RR=0．60;95％CI=0．44～0．81;P=0．0008）、血管痉挛性脑梗死（RR=0．38;95％CI：0．22～0．67;P=0．0008）发生率,但不改善短期临床预后（RR=1．28;95％CI=0．98～1．66;P=0．07）。结论西洛他唑可预防动脉瘤性蛛网膜下腔出血后脑血管痉挛、血管痉挛性脑梗死,对患者预后影响还需大样本多中心临床研究进一步证实。     

Predictors and outcome of acute symptomatic cerebral infarctions following aneurysmal subarachnoid hemorrhage

The leading cause of unfavorable outcomes following aneurysmal subarachnoid hemorrhage (SAH) is cerebral infarction. In this 3-year retrospective study, we have retrospectively evaluated 172 hospitalized patients with aneurysmal SAH, and compared those who developed a complicated cerebral infarction with those who did not. In this study, acute symptomatic cerebral infarctions accounted for 22.6% (39/172) of all episodes. Significant statistical analysis between the two patient groups included age at onset, hypertension as the underlying disease, presence of symptomatic vasospasm, mean hospitalization days and Glasgow Outcome Score at the time of discharge. After a minimum 1.5-year follow-up period, the median (interquantile range) Barthel index score was 75 (6–85) for those patients who had cerebral infarctions, and 80 (0–90) for those who had no cerebral infarctions. Multiple logistic regression analysis demonstrated that the presence of symptomatic vasospasm was independently associated with the presence of acute symptomatic cerebral infarctions. The presence of symptomatic vasospasm implies the danger of acute symptomatic cerebral events after aneurysmal SAH. Although our study demonstrates a worse short-term outcome and longer duration of hospitalization in this special group of patients, the functional outcome for patients with cerebral infarction was not inferior to those patients without cerebral infarction after a follow-up of at least 1.5-years.     

Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage – Serum D-dimer and C-reactive Protein as Early Markers

BackgroundIdentifying patients at risk for delayed cerebral ischemia after an aneurysmal subarachnoid hemorrhage remains challenging and both delayed treatment and over-treatment are reasonable concerns.ObjectiveTo evaluate the role of the serum markers C-reactive protein, white blood count, and d-dimer as prognostic factors for the occurrence of delayed cerebral ischemia.MethodsAll patients admitted within 24 hours after an aneurysmal subarachnoid hemorrhage were included over a 6-year period. The World Federation of Neurosurgery and Fisher grading scales as well as the extended Glasgow Outcome Scale were documented at discharge and after a 3-to-6-month follow-up period. C-reactive protein, d-dimer, white blood count, and procalcitonin were assessed on admission, day 1, day 4, day 9, day 14, and at discharge. Radiologically confirmed delayed cerebral ischemia before discharge was the primary endpoint. Severe angiographic vasospasm and outcome were used as secondary endpoints.ResultsDelayed cerebral ischemia occurred in 19.6% of the 138 patients included. Delayed cerebral ischemia correlated with severe vasospasm and with a worse outcome. Serum C-reactive protein levels were higher in patients with severe vasospasm during the period of vasospasm. D-dimer levels on admission correlated with Fisher grades. Delayed cerebral ischemia occurred more frequently in patients with Fisher grade IV hemorrhage, if d-dimer levels were higher on admission. The cut-off was .445 µg/ml.ConclusionOur observations support a multifactorial genesis for delayed cerebral ischemia, including vasospasm and microthrombotic and inflammatory processes. Serum d-dimer levels greater than .445 µg/ml might be a predictor for the occurrence of delayed cerebral ischemia in patients with a Fisher grade IV aneurysmal subarachnoid hemorrhage.     

脑血管病患者神经肽Y的临床研究

目的观察脑出血（CH）、脑梗死（CI）、蛛网膜下腔出血（SAH）患者神经肽Y（NPY）水平动态变化及其临床意义。方法选择脑血管病（CVD）患者138例,其中CH组46例,CI组62例,SAH组30例。用放免法检测血浆NPY浓度。结果CI组、CH组、SAH组NPY水平显著高于对照组,于发病后24h内均显著升高,1～3d或4～7d达高峰,8～15d开始下降,15d后仍在较高水平;重型与大灶组显著高于中、轻型与小灶组;发病积分≥6分组显著高于<6分组,伴高血压组显著高于不伴高血压;伴消化道出血组显著高于不伴消化道出血组。结论NPY参与了CVD及其伴发病的病理生理过程。     

动脉瘤破裂致蛛网膜下腔出血患者死亡原因分析

目的 探讨动脉瘤破裂致蛛网膜下腔出血患者住院期间死亡的原因并提出相应的对策. 方法 回顾性分析江苏大学附属人民医院神经外科自2003年1月至2010年12月收治且住院期间死亡的24例颅内动脉瘤破裂致自发性蛛网膜下腔出血患者的临床资料和死亡原因.结果 死亡原因分别为:颅内再出血11例,其中术前再出血5例,介入栓塞术中出血3例,栓塞术后颅内再次出血3例;术后脑血管痉挛或脑梗死8例,其中早期(术后3d内)CT表现为脑梗死3例,晚期(术后3d后)脑血管痉挛或脑梗死5例;椎动脉瘤栓塞术后呼吸骤停1例;肺部感染3例;肾功能衰竭1例. 结论 颅内再次出血、脑梗死或脑血管痉挛、非神经系统并发症是动脉瘤性蛛网膜下腔出血患者住院期间主要的死亡原因.     

血浆PTX3对动脉瘤性蛛网膜下腔出血后脑血管痉挛的预测价值

目的 分析血浆正五聚蛋白3(Pentraxin 3,PTX3)对动脉瘤性蛛网膜下腔出血后脑血管痉挛的预测价值。方法 收集本院2016年2月-2019年2月186例动脉瘤性蛛网膜下腔出血患者作为研究对象,经颅多普勒检测仪检测大脑中动脉(Middle cerebral artery,MCA)流速,MCA平均流速(Mean velocity of MCA,MCA Vm)>120 cm/s,且同侧Lindegaard≥3为血管痉挛组(92例),其余为无血管痉挛组(94例); 收集2组一般资料; 酶联免疫吸附(Enzyme linked immunosorbent assay,ELISA)法检测血浆中PTX3水平; 绘制受试者工作特性曲线(Receiver operator characteristic curve,ROC)分析血浆中PTX3对动脉瘤性蛛网膜者发生脑血管痉挛的诊断价值; 以血浆PTX3水平<4.73 ng/mL和≥4.73 ng/mL分为PTX3低表达组和PTX3高表达组,分析血浆PTX3水平与一般资料的关系; Logistic分析影响动脉瘤性蛛网膜下腔出血患者发生脑血管痉挛的因素。结果 无血管痉挛组与血管痉挛组年龄、治疗方法、高血压病史、Fisher分级、Hunt-Hess分级存在明显差异(P<0.05); 与无血管痉挛组比较,血管痉挛组血浆PTX3水平升高(P<0.05); ROC曲线显示,血浆PTX3水平预测动脉瘤性蛛网膜下腔出血患者发生脑血管痉挛的ROC曲线下面积为0.777,截断值为4.73 ng/mL,其敏感性为68.50%、特异性为74.50%; 血浆PTX3水平与年龄、治疗方法、Fisher分级、Hunt-Hess分级关系密切(P<0.05); Logistic分析显示,PTX3、年龄、Fisher分级、Hunt-Hess分级是影响动脉瘤性蛛网膜下腔出血患者发生脑血管痉挛的独立危险因素。结论 动脉瘤性蛛网膜下腔出血脑血管痉挛患者血浆PTX3水平升高,PTX3对动脉瘤性蛛网膜下腔出血患者发生脑血管痉挛具有一定诊断价值。