青年脑梗死患者远期认知功能障碍的相关因素分析

目的筛选青年脑梗死患者远期认知功能障碍的相关因素。方法选择2008年1月至2013年6月在我院就诊的青年脑梗死患者58例,根据远期随访蒙特利尔认知量表(Mo CA)评分分为认知功能正常组和认知功能障碍组,比较两组患者的人口学、病情资料和活动功能,从中筛选出青年脑梗死患者远期认知功能障碍的危险因素。结果共有42例患者完成随访,平均随访时间为5.5年(3.3~7.1年),总体Mo CA评分(27.4±3.7)分。认知功能正常组18例,认知功能损害组24例,两组在性别、教育程度、TOAST分型、伴随疾病及嗜好、是否接受溶栓治疗进行组间比较,差异无统计学意义(P0.05)。认知功能障碍组的发病时年龄、美国国立卫生研究院卒中量表(NIHSS)评分大于认知功能正常组;左前循环梗死、出院时Rankin修订量表评分(mRS)2、复诊时工具性日常生活活动能力量表(IADL)8比例均高于认知功能正常组(P0.05)。经多因素Logistic回归分析得出,入院时NIHSS评分、左前循环梗死、出院时mRS2、复诊时IADL8均为认知功能障碍的独立危险因素(OR=1.039,4.329,5.143,12.800,21.333;P0.05)。结论入院时NIHSS评分左前循环梗死、出院时mRS2、复诊时IADL8是青年脑梗死患者远期认知功能障碍的危险因素;而认知功能与入院时NIHSS评分呈负相关。     

急性脑梗死患者血浆脑利钠肽变化及左心室功能的研究

目的 通过血浆N端脑利钠肽前体（NT-proBNP）测定及超声心动图检查,观察急性脑梗死患者血浆N端脑利钠肽（NT-proBNP）的变化及与心脏左心室功能（LVF）的关系,为防治急性脑梗死所致心脏损害提供依据。方法选择发病48h内经临床和颅脑CT检查确诊的急性脑梗死患者25例作为研究对象,所有患者既往无心脏病史,并除外心功能不全、心律失常等心脏并发症。选择性别和年龄相当的25例正常人作为对照组。以上2组均行超声心动图检查,同时抽血检测血浆NT-proBNP,对结果进行分析。结果（1）急性脑梗死组血浆NT-proBNP浓度高于正常对照组,二者比较差异有统计学意义（P〈0．01）。（2）急性脑梗死组心脏每搏输出量（SV）、心输出量（CO）明显低于正常对照组（39.4-13vs54±12,P〈0．01;3．10±1．49vs3．89±1．34,P=0．020）。（3）急性脑梗死组左室射血分数（LVEF）明显低于正常对照组（45±15VS66±10,P〈0．01）。（4）急性脑梗死组E峰最大速度／A峰最大速度（E／A）与正常对照组比较差异有统计学意义（0．98±0．30vs1．46±0．21,P〈0．01）。结论急性脑梗死发病后血浆NT-proBNP浓度升高;急性脑梗死可引起左心室收缩及舒张功能下降,可能主要与急性脑梗死本身的病理生理机制有关。     

青年急性脑梗死血细胞参数的研究

目的研究血细胞参数的变化在青年急性脑梗死中的意义。方法比较各血细胞参数在青年梗死组、老年梗死组及青年对照组之间的不同,分析其意义。结果青年脑梗死组与老年脑梗死组比较:血小板、白细胞青年脑梗死组显著高于老年脑梗死组,PDW、MPV、PCT及白细胞青年脑梗死组显著高于青年对照组P<0.05。结论与老年梗死组相同,血小板的活化、功能增强,及炎性细胞的增多在青年脑梗死的发生及发展中也起着关键作用。     

脑梗死并高血压病患者左心功能的研究

目的探讨脑梗死合并高血压病患者左心功能的变化。方法以脑梗死合并高血压病患者(50例)为A组,以单纯高血压病患者(50例)和单纯脑梗死患者(50例)为B组,收集他们的相关超声学指标(左心室收缩功能指标:心指数、射血分数、短轴缩短率;舒张功能指标:等容舒张时间、E/A比值、E波减速时间;整体功能指标:Tei指数;左心房功能指标:左心房内径),采用方差分析及q检验进行统计分析。结果与B组相比,A组的左心室收缩功能无显著改变(P>0.05),左心室舒张功能、整体功能及左心房功能均降低(P<0.05)。结论脑梗死并高血压病患者左心室收缩功能无明显受损,左心室舒张功能及左心房功能明显受损。     

肱动脉内皮依赖性舒张功能与脑梗死危险因素高血压、糖尿病及高脂血症的相关研究

目的探讨肱动脉内皮依赖性舒张功能(FMD)与脑梗死危险因素中高血压、糖尿病及高脂血症的相关性。方法选取急性脑梗死患者40例,健康对照组11例,将急性脑梗死患者中单一危险因素者归列为单危险因素脑梗死组,2～3个危险因素者归列为多危险因素脑梗死组,均行肱动脉内皮功能检测。组间比较采用t检验。将FMD作为因变量,高血压、糖尿病及高脂血症作为自变量行多元线性回归分析。结果脑梗死组FMD较对照组显著降低,多危险因素脑梗死组FMD较单危险因素脑梗死组显著降低。高血压和糖尿病与FMD存在线性回归关系。结论高血压、糖尿病及高脂血症等脑梗死危险因素越多,FMD降低越显著,其中以高血压病与FMD的改变关系最密切,其次为糖尿病。     

调控血脂改善脑梗死患者血管内皮功能的研究

目的　研究降低血脂水平对改善脑梗死患者内皮依赖性血管舒张功能的影响。方法　给 33例脑梗死患者口服普伐他汀 2 0mg,每日 1次 ,连续服 6周 ,观察治疗前后血脂及颈内动脉内皮依赖性血管舒张功能的变化 ,并与对照组比较。结果　治疗 6周后 ,普伐他汀组胆固醇、低密度脂蛋白胆固醇明显降低 (分别降低 2 6 9%和 2 5 8% ) ,与治疗前比较差异有显著性 (均P <0 .0 1) ;对照组血脂各项指标虽有降低 ,但与治疗前比较差异无显著性 (均P >0 .0 5 )。颈动脉内皮依赖性血管舒张功能治疗前后普伐他汀组差异有显著性 ,对照组差异无显著性。结论　普伐他汀对脑梗死患者的血脂水平和血管内皮舒张功能均有明显改善作用。     

青年脑梗死患者血浆同型半胱氨酸水平及影响因素研究

目的分析青年脑梗死患者血浆同型半胱氨酸（homocysteine，Hcy）的水平特点，并探讨其相关因素。方法采用高效液相色谱法检测55例青年脑梗死患者、316例老年脑梗死患者和40名健康青年对照者血浆Hcy水平，对青年脑梗死患者血浆Hcy的分布特征及相关因素进行统计学分析。结果青年脑梗死组血浆Hcy水平（几何均数17．35μmol/L）高于健康青年对照组（几何均数11．88μmol／L），差异有统计学意义（P〈0．01）；与老年脑梗死组（几何均数17．60μmol／L）比较差异无统计学意义（P〉0．05）；青年脑梗死患者Hcy水平与叶酸水平以及性别相关，回归系数分别为～0．513（P〈0．01）和-0．242（P〈O．05）。结论青年脑梗死患者血浆Hcy水平显著增高，男性高于女性，Hcy水平与叶酸水平呈负相关。     

影像学分型与急性脑梗死患者认知功能关系的研究

目的探讨影像学分型与急性脑梗死患者认知功能关系。方法对136例急性大脑梗死患者于发病后24～72h内行颅脑MRI检查确定梗死部位、测量病灶大小并作出影像学分型，于发病1周内，在患者床前采用简易精神状态检查法（mini—mentalstate examination，MMSE），检测患者的认知功能，并同步进行事件相关电位P300的检测，判断患者认知功能的情况，对比分析应用MRI进行的影像学分型与认知功能关系。结果额叶、颞叶脑梗死患者的MMSE和WAIS—RC评分明显低于顶枕叶和基底节区梗死患者，P300潜伏时明显长于顶枕叶和基底节区梗死的患者，但其P300波幅低于顶枕叶和基底节区梗死的惠者；中梗死和多发性梗死患者的MMSE和WAIS—RC评分明显低于顶枕叶和基底节区梗死患者，B300潜伏时明显长于顶枕叶和基底节区梗死的患者，但其P300波幅低于顶枕叶和基底节区梗死的患者。结论影像学分型与急性脑梗死患者认知功能有相关性。     

急性脑梗死患者血液流变学及凝血功能的临床意义

目的探讨急性脑梗死患者血液流变学和凝血功能的变化及其临床意义。方法选择75例急性脑梗死为观察组,其中轻度、中度、重度各25例,选择同期75例健康体检者为对照组,比较2组血液流变学和凝血功能,记录观察组不同程度脑梗死患者的血液流变学和凝血功能。结果观察组全血高切黏度、全血低切黏度、血浆黏度和红细胞比积显著高于对照组(P0.05)。观察组血浆纤维蛋白原(FIB)明显高于对照组(P0.05),2组活化部分凝血活酶时间(APTT)和血浆凝血酶原时间(PT)比较差异无统计学意义(P0.05)。重度、中度和轻度患者的全血高切黏度、全血低切黏度、血浆黏度和红细胞比积比较差异有统计学意义(P0.05);重度、中度和轻度患者的FIB比较差异有统计学意义(P0.05)。结论急性脑梗死患者的血液流变学和凝血功能存在异常,且与病情严重程度成正比,监测其动态变化可为临床治疗提供参考价值。     

急性脑梗死患者凝血功能与脑血流量的关系

目的 探讨急性脑梗死患者凝血功能与脑血流量的关系.方法 对53例急性脑梗死患者(脑梗死组)及53例正常对照者(正常对照组)行血栓弹力图(TEG)检查,比较两组的凝血反应时间(R)、凝固时间(K)、凝固角(α)、血栓最大幅度(M)、凝血块强度(G)和纤溶指数(LY30).采用3D伪连续动脉自旋标记灌注成像(3D-pCAS...     

Mild depression in young adults with cerebral infarction at long-term follow-up: A population-based study

We sought to evaluate the prevalence of and risk factors for post-stroke depression (PSD) at long-term follow-up in young adults aged 15-49 years with first-ever cerebral infarction in a population-based study. Scores on Montgomery-Asberg Depression Rating Scale (MADRS) were obtained at follow-up (mean time 6.0 years after the stroke) and analysed in subgroups. MADRS scores were obtained in 196 of 209 surviving patients. PSD (MADRS>or=7) was detected in 56 patients (28.6%). None had severe PSD. Alcoholism (P=0.006), depressive symptoms any time before the index stroke (P=0.016), and severe neurological deficits on admission for the index stroke (P=0.043) were independently associated with PSD. PSD seems milder in young ischaemic stroke patients compared with older patients. Alcoholism, depression any time before the index stroke, and severity of neurological deficits on admission for the stroke increased the risk of developing PSD in the long run.     

C型利钠肽与原发性高血压左室舒张功能障碍的关系

目的探讨C-型利钠肽与原发性高血压左室舒张功能不全的关系。方法原发性高血压患者75例,分为单纯高血压组23例,高血压伴左室舒张功能不全无症状组27例,有症状组25例,测定CNP含量。结果EH组、无症状组、有症状组CNP水平明显高于对照组(9.25±1.27ng/L vs 5.16±0.33ng/L,P<0.05;13.73±2.91ng/L vs 5.16±0.33ng/L,P<0.01;15.58±2.34ng/L vs 5.16±0.33ng/L,P<0.01)。有症状组和无症状组CNP均高于单纯EH组(15.58±2.34ng/L vs,9.25±1.27ng/L;13.73±2.91ng/L vs 9.25±1.27ng/L,P均<0.05)。有症状组CNP水平高于无症状组,但没有统计学差异(15.58±2.34ng/L vs13.73±2.91ng/L,P>0.05)。结论CNP与高血压合并左室舒张功能不全,可以在临床症状之前早期诊断左室舒张功能不全。     

急性脑梗死及其并发多脏器功能障碍综合征患者血清C反应蛋白水平的变化

目的　探讨急性脑梗死 (ACI)及其并发多脏器功能障碍综合征 (MODS)患者血清C反应蛋白(CRP)水平的变化及与MODS发生率的关系。方法　采用免疫透射比浊法测定 30名健康体检者 (正常对照组 )和 82例ACI患者血清CRP的含量 ,并对腔隙性脑梗死 (LCI)、急性单纯性脑梗死 (PACI)、ACI并发MODS患者的血清CRP水平进行比较。结果　ACI患者血清CRP水平与正常对照组比较显著升高 (P <0 0 1) ,PACI患者血清CRP水平显著高于LCI患者 ,ACI并发MODS患者又显著高于PACI患者 (均P <0 0 5 )。ACI患者MODS的发生率与血清CRP水平呈正相关 (r=0 94 ,P <0 0 5 )。结论　CRP与ACI及其并发MODS明显相关 ,血清CRP水平对判断ACI的预后是一个有效指标。     

原发性高血压患者左室舒张功能与血清瘦素浓度的关系

目的 探讨原发性高血压(EH)患者左室舒张功能与血清瘦素(Leptin)浓度关系的临床研究。方法 采用放免法测定30例正常人和54例EH患者的血清瘦素浓度。用多普勒组织成像(DTI)技术检测正常人及EH患者二尖瓣环舒张早期运动速度(Ea)、舒张晚期运动速度(Aa)及Ea/Aa,比较其测定值与血清瘦素浓度的相关性。结果 患者组二尖瓣环DTI参数明显低于正常对照组(P<0.01);患者组血清瘦素浓度与Ea、Ea/Aa呈负相关(r=-0.41 P<0.01,r=-0.43 P<0.01)。结论 检测血清瘦素浓度有利于EH患者左室舒张功能受损程度的判断。     

Etiology of and risk factors for cerebral infarction in young adults in western Norway: a population-based case-control study

We sought to study the etiology of and risk factors for cerebral infarction in young adults in Hordaland County, Norway. All patients aged 15-49 years living in Hordaland County with a first-ever cerebral infarction during 1988-97 were included. Etiology was analyzed in subgroups defined by sex, age (<40 years versus >/=40 years), circulation territory (anterior versus posterior circulation) and short-term functional outcome [modified Rankin score (mRS) 2]. A questionnaire was used to evaluate possible risk factors amongst the patients compared with an age- and sex-matched control group. The distribution of etiology was significantly different in all subgroups. Atherosclerosis was frequent amongst men (22.8% vs. 4.2%) and patients >/= 40 years (20.8% vs. 2.7%). All patients with microangiopathy had favorable short-term outcome. Significant risk factors were smoking more than 15 cigarettes per day (P < 0.001), hypertension (P = 0.001), and myocardial infarction (P = 0.035). Modifiable risk factors were frequent.     

青中年脑梗死患者颈动脉超声的研究

目的探讨青中年脑梗死与颈动脉粥样硬化的关系。方法对78例青中年脑梗死患者及30名健康对照者作颈动脉超声检查。结果(1)脑梗死组42.3%患者颈动脉内膜-中层厚度增厚(>0.8mm)与健康对照组(仅2例7.4%)比较差异有显著性(P<0.05);(2)脑梗死组动脉硬化斑块检出率为52.94%(36/68),不稳定斑块(软斑和溃疡斑)的检出率为42.03%(29/69),明显高于健康对照组(未检出);(3)多为轻度颈动脉粥样硬化(斑块积分为0.42±0.71);(4)颈动脉管腔狭窄率明显增高,以轻、中度狭窄为主(7.79%)(6/77);(5)<40岁、40~45岁、>45岁斑块发生率分别为0、33.3%和61.8%,随年龄增长,逐渐增加。结论颈动脉粥样硬化与青中年脑梗死之间存在密切关系。     

Whether chronic bronchitis is an independent risk factor for cerebral infarction in the elderly

BACKGROUND: The inflammatory reaction already becomes an important risk factor of causing acute cerebral infarction; however, the correlation between chronic bronchitis and senile cerebral infarction is still unclear. OBJECTIVE: To study whether the chronic bronchitis is the risk factor for senile cerebral infarction. DESIGN: 1∶1 pair, case contrast, and risk factor study. SETTINGS: Department of Respiratory Medicine, Third Hospital of Tangshan; Department of Neurology, Affiliated Hospital of North China Coal Medical College. PARTICIPANTS: A total of 147 patients with acute cerebral infarction who were regarded as case group were selected from Department of Neurology, the Third Hospital of Tangshan from January 2004 to December 2006. All patients met the diagnostic criteria of the Fourth National Cerebrovascular Diseases Meeting. There were 87 males and 60 females, and their ages ranged from 65 to 83 years. Based on 1∶1 pair study, another 147 subjects without cerebrovascular disease were regarded as control group. Except the diseases about infection, there were 73 males and 74 females, and their ages ranged from 62 to 81 years. All subjects provided the confirm consent and agreed with the coordinate experiment. METHODS: ① Questionnaire of risk factor of cerebral infarction was designed to measure the following items: chronic bronchitis, hypertension, diabetes mellitus, hyperlipemia, coronary heart disease, primary cerebral infarction/transient ischemic attack and history of smoking. ② Cerebral infarction was regarded as the dependent variance, while chronic bronchitis, hypertension, diabetes mellitus, hyperlipemia, primary cerebral infarction/transient ischemic attack, coronary heart disease and smoking were regarded as the independent variance for multiple regression analysis. MAIN OUTCOME MEASURES: Risk factors of senile cerebral infarction. RESULTS: All 147 patients with acute cerebral infarction and 147 subjects without cerebrovascular diseases were involved in the final analysis. ① Risk factor analysis of senile cerebral infarction: There were no significant differences in age, hyperlipemia and history of smoking between the two groups (P > 0.05). But, chronic bronchitis, diabetes mellitus, hypertension, cerebral infarction/transient ischemic attack and history of coronary heart disease were higher in the case group than those in the control group (33.6% vs. 19.0%, 38.8% vs. 23.3%, 54.3% vs. 36.2%, 29.3% vs. 17.2%, 44.0% vs. 29.3%, P < 0.05–0.01). ② Multiple Logistic regression analysis of risk factor of senile cerebral infarction: Hyperlipemia, smoking and coronary heart disease were not correlated with cerebral infarction (P >0.05), but chronic bronchitis, hypertension, diabetes mellitus and cerebral infarction/transient ischemic attack were risk factors for senile cerebral infarction (OR =2.47, 2.28, 2.18, 2.01, P < 0.05–0.01). CONCLUSION: The chronic bronchitis may become an independent risk factor senile cerebral infarction.     

高血压合并脑梗死患者血清基质金属蛋白酶-9水平的变化及其危险因素分析

目的探讨高血压合并脑梗死患者血清基质金属蛋白酶-9(MMP-9)水平的变化及其危险因素分析。方法对34例高血压合并脑梗死患者(脑梗死组)和57例高血压患者(对照组)血清MMP-9水平进行检测,并对两组患者既往糖尿病史、血脂异常史、吸烟史及心脑血管病家族史进行调查和分析。结果脑梗死组血清MMP-9为(320.62±149.91)ng/ml,显著高于对照组[(191.17±115.64)ng/ml](P<0.01);逐步Logistic回归分析显示糖尿病史(OR5.064,95%CI:1.772～14.474)和吸烟史(OR5.616,95%CI:1.986～15.885)(均P<0.01)与脑梗死的发生密切相关。结论血清MMP-9水平、糖尿病史和吸烟史是高血压患者发生脑梗死的危险因素。