Association of Initial Potassium Levels with the Type of Stroke in the Emergency Department

Serum potassium levels are considered as a marker of cerebrovascular emergencies but there is less clarity on the association between initial serum potassium levels recorded on patient's arrival at the emergency department with the type of stroke. This is a case-control study using data of a tertiary care hospital in Japan from April 2018 to September 2019. We identified adult patients with hemorrhagic stroke including subarachnoid hemorrhage (cases) and those with ischemic stroke (controls). Data on age, sex, chief complaints, vital signs, and initial blood tests were collected. We analyzed the association between serum potassium levels and the type of stroke by drawing a LOWESS curve. Additionally, we fitted a logistic regression model to examine the association of interest. There were 416 stroke patients (158 hemorrhagic and 258 ischemic). The median age was 77 years (IQR: 68, 84), and 54% were male. The mean potassium level was 3.69 ± 0.55 mEq/L for hemorrhagic stroke and 4.08 ± 0.65 mEq/L for ischemic stroke. The LOWESS curve showed that the lower initial potassium level was linearly associated with a greater likelihood of hemorrhagic stroke. In the logistic regression model, the odds ratio for the risk of hemorrhagic stroke per 1 mEq/L lower potassium level was 3.31 (95% confidence interval [CI]: 2.24–5.04). This association remained significant in a multivariable model adjusting for other covariates (OR: 2.62 [95% CI: 1.70–4.16]). Initial potassium level was lower in patients with hemorrhagic stroke compared to those with ischemic stroke.     

Tissue plasminogen activator, plasminogen activator inhibitor-1, and tissue plasminogen activator/plasminogen activator inhibitor-1 complex as risk factors for the development of a first stroke

BACKGROUND NAD PURPOSE: Abnormalities in the fibrinolytic system have been associated with an increased risk for stroke in a few studies. This study was designed to test whether plasma levels of tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), and tPA/PAI-1 complex could predict a first-ever stroke. METHODS: The study was an incident case-control study nested within the V?sterbotten Intervention Program and the Northern Sweden Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) cohorts. In this study 108 first-ever stroke cases were defined according to the MONICA classification, and 216 controls from the same cohort were randomly selected and matched for age, sex, sampling time, and geographic region. RESULTS: Stroke occurred on average 30 months after the blood sampling date. The mean plasma concentration of tPA/PAI-1 complex was higher for the stroke cases than for the controls (3.9 versus 3.0 microgram/L). In univariate regression analysis, significantly higher odds ratios were found for the tPA/PAI-1 complex as continuous variable. When divided into quartiles, the odds ratio was 2.74 for the highest quartile compared with the lowest. In the multivariate model, the tPA/PAI-1 complex remained an independent predictor for stroke. Additionally, tPA mass concentration quartiles 3 and 4 showed a significant association with all stroke as outcome. No association was found, however, for PAI-1. In subgroup analysis of cerebral hemorrhage (n=18), the mean tPA/PAI-1 complex level was higher for the cases than for the controls (4.8 versus 3.0 microgram/L), and in multivariate analysis including all controls (n=216), only tPA/PAI-1 complex remained significant. CONCLUSIONS: This prospective study shows that tPA/PAI-1 complex, a novel fibrinolytic marker, is independently associated with the development of a first-ever stroke, especially hemorrhagic stroke. This finding supports the hypothesis that disturbances in fibrinolysis precede a cerebrovascular event.     

Higher leukocyte count is associated with higher risk of 3-year mortality in non-diabetic patients with first-ever ischemic stroke

Leukocyte count predicted the risk of first-time myocardial infarction and ischemic stroke. The aim of this study was to determine the role of elevated leukocyte count in non-diabetic patients admitted for acute first-ever ischemic stroke on clinical presentation and 3-year mortality. We studied 462 patients with acute first-ever ischemic stroke without diabetes mellitus or active infection at admission. Patients were classified into 2 groups according to their leukocyte count. A white blood cell (WBC) count ≥ 10,000/μL was defined as an elevated leukocyte count, otherwise as normal. Clinical presentation, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. 64 patients (13.9%) had elevated leukocytes. Multivariate logistic regression showed that an elevated platelet count was positively associated with the elevated leukocyte count, while a low serum sodium level was negatively associated with an elevated leukocyte count (P=0.008, P=0.003, respectively). An elevated leukocyte count was associated with a higher risk of a stroke in evolution (P=0.021). Multivariate Cox regression analysis revealed that an elevated leukocyte count is a significant predictor of 3-year mortality [P=0.010, HR=3.26 (1.33-7.98)]. In conclusion, higher leukocyte counts during the acute stroke stage are associated with increased risk of 3-year mortality in patients with acute, first-ever ischemic stroke.     

Polymorphisms at the osteoprotegerin and interleukin-6 genes in relation to first-ever stroke

BACKGROUND: Arterial calcification and osteoporosis often coexist, especially in postmenopausal women. Osteoporosis associates with a substantially increased risk of stroke in elderly women, suggesting that impaired estrogen signaling may link stroke and osteoporosis. Osteoprotegerin (OPG, TNFRSF11B) and interleukin-6 (IL-6, IL6) are putative target genes for estrogen signaling and have been implicated in both cardiovascular diseases and osteoporosis. We hypothesized that specific polymorphisms in these genes may be associated with increased risk of ischemic stroke or intracerebral hemorrhage (ICH). METHODS: We performed a population-based prospective nested case-control study, in which the relationships between polymorphisms (OPG-1181G/C, OPG-950T/C and IL6-174G/C) and ischemic stroke and ICH were examined. Definitive first-ever stroke events (n = 388), i.e. ischemic stroke (n = 320), ICH (n = 61) and unspecified stroke (n = 7) cases, and controls without cardiovascular disease (n = 773), matched for age, sex and geographical region were studied. Univariate and multivariate models using conditional logistic regression, which included traditional risk factors, were used to test for association. RESULTS: Carriers of the OPG-1181C/C genotype had a significantly (p = 0.018) increased risk of ICH (OR, 2.69; 95% CI, 1.19-6.12) in the univariate analysis. After adjustments (hypertension, diabetes, BMI and triglycerides), this genotype remained significantly (p = 0.005) associated with ICH (OR, 6.04; 95% CI, 1.71-21.29). By contrast, no correlations were found between this genotype and ischemic stroke, nor between the OPG-950T/C or IL6-174G/C polymorphisms and stroke subtypes. CONCLUSIONS: In this population, the OPG-1181C/C genotype associates with first-ever ICH, implying that alterations in OPG-mediated signaling in the vasculature may be involved in the pathophysiology of this disease.     

Ischemic stroke of unusual cause: clinical features, etiology and outcome

The clinical features, etiology and neurological outcome of ischemic stroke of unusual cause (ISUC) have rarely been reported. We retrospective reviewed all patients with this stroke subtype entered in the Sagrat Cor Hospital of Barcelona Stroke Registry, which includes data from 2000 consecutive first-ever stroke patients admitted to the hospital between 1986 and 1995. Patients with previous ischemia and/or hemorrhagic stroke were excluded. Topographic, anamnestic, clinical and neuroimaging characteristics of ISUC were assessed. Predictors of this stroke subtype were determined by logistic regression analysis. Ischemic stroke of unusual etiology was diagnosed in 70 patients (32 men and 38 women), with a mean +/- SD age of 52 +/- 22.4 years. This stroke subtype accounted for 4.3% of all first-ever strokes and 6% of all first-ever brain infarcts. Etiologies included hematological disorders in 17 cases, infection in 11, migraine stroke in 10, cerebral infarction secondary to venous thrombosis in nine, primary inflammatory vascular conditions in six and miscellaneous causes in 17. In the multivariate analysis after excluding cerebral venous thrombosis (n = 9) and arterial dissection (n = 4), because of typical clinical and radiological features, independent predictors of ISUC included 45 years of age or less (odds ratio [OR] 14.8), seizures (OR 6.8), headache (OR 5.2), hemianopia (OR 2.6) and occipital lobe involvement (OR 3.0). Patients with ISUC presented a lower in-hospital mortality rate (7.1% vs. 14.4%; P < 0.05), were more frequently symptom free at discharge (35.7% vs. 25.80%; P < 0.05) and experienced a longer mean length of hospital stay (23.7 days vs. 18.2 days; P = 0.06) than non-ISUC patients. We conclude that ISUC is infrequent, etiologies are numerous and hematologic disorders are the most frequent cause. We emphasize the better prognosis and the need to distinguish it from other ischemic stroke subtypes which have a different treatment approach and outcome.     

High titer of anticardiolipin antibody is associated with first-ever ischemic stroke in Taiwan

BACKGROUND AND PURPOSE: The association between anticardiolipin antibody (aCL) and ischemic stroke is controversial, and there are few case-control studies of Asian populations. The aim of this study, therefore, was to determine whether aCL is an independent risk factor for ischemic stroke in Taiwanese patients over the age of 40 years. METHODS: Both the IgG and IgM isotypes of aCL were measured in 273 patients (> 40 years of age) hospitalized for first-ever ischemic stroke and in 181 non-stroke controls. Results were defined as: negative (< 10 IgG phospholipid units [GPL] or < 7.5 IgM phospholipid units [MPL]); low positive (10-20 GPL or 7.5-15 MPL); or, high positive (> 20 GPL or > 15 MPL). Odds ratios (OR) were estimated by logistic regression with adjustment for potential confounders. RESULTS: A high positive IgG aCL was present in 4.4% of the stroke patients and 1.2% of the controls. Age- and sex-adjusted analysis showed a borderline association between a high positive level for aCL IgG titer and stroke, with an OR of 4.01 (95% CI 0.87-18.37; p = 0.0739). Final analysis, with adjustments for age, sex, hypertension, diabetes, tobacco smoking, atrial fibrillation, left ventricular hypertrophy and hyperlipidemia, revealed an OR of 5.25 (95% CI 1.06-25.89; p = 0.0419). CONCLUSIONS: The results of this study suggest that elevated titer of aCL IgG (> 20 GPL) is associated with first-ever ischemic stroke in Taiwanese patients aged over 40 years. High positive aCL titer is related to ischemic stroke after adjustment for conventional cerebrovascular risk factors, indicating that it is probably an independent risk factor for ischemic stroke.     

青年烟雾病患者的卒中类型及危险因素分析

目的 探索青年烟雾病患者的卒中类型及临床特征,分析青年烟雾病患者发生卒中的危险因素。 方法 回顾性纳入2020年1月-2021年12月解放军总医院第五医学中心收治的青年（18～45岁）卒中型烟雾病患者,将患者分为出血性卒中组和缺血性卒中组进行亚型分析,对比不同卒中类型患者的临床及影像学特征。并以同期未发生卒中的烟雾病患者作为对照组,应用多因素logistic回归分析青年烟雾病患者发生出血性或缺血性卒中的危险因素。 结果 共入组108例卒中型烟雾病患者,其中出血性卒中22例（20.4%）,缺血性卒中86例（79.6%）。出血性卒中组中脑室出血12例（54.5%）,脑实质出血7例（31.8%）,蛛网膜下腔出血3例（13.6%）。缺血性卒中组中大动脉梗死型21例（24.4%）,血流动力学梗死36例（41.9%）,穿支动脉梗死29例（33.7%）。出血性卒中组与缺血性卒中组性别和合并动脉瘤者比例的差异有统计学意义。无卒中对照组共104例,多因素logistic回归分析结果显示,合并动脉瘤（OR?10.569,95%CI?1.524～73.274,P=0.017）为青年烟雾病患者发生出血性卒中的独立危险因素;增龄（OR?1.058,95%CI?1.004～1.115,P=0.034）、合并糖尿病（OR?4.005,95%CI?1.766～9.080,P=0.001）、高铃木分期（OR?1.363,95%CI 1.037～1.793,P=0.027）为青年烟雾病患者发生缺血性卒中的独立危险因素。 结论 青年烟雾病患者的卒中类型以缺血性卒中为主。血流动力学梗死和脑室出血分别是缺血性卒中和出血性卒中的主要类型。增龄、高铃木分期、合并糖尿病和颅内动脉瘤是引起青年烟雾病患者卒中的独立危险因素。     

Reduced Serum Adiponectin Level and Risk of Poststroke Depression in Patients with Ischemic Stroke

Background and Aims: Decreased adiponectin (APN) level has been indicated to be associated with depression. In the present study, we aimed to investigate whether serum APN could predict poststroke depression (PSD) at 3 months in patients with acute ischemic stroke. Method: Patients with first-ever ischemic stroke and hospitalized within 24 hours of symptoms onset were enrolled prospectively during March 2017 to September 2017. Serum APN level was measured at admission by enzyme-linked immunosorbent assay. Neuropsychological evaluations were performed at the 3-month follow-up. PSD was diagnosed using the Chinese version of the Structured Clinical Interview for DSM-IV. The association between APN level and predict PSD was analyzed by binary logistic regression analysis. Results: Of the 255 acute ischemic stroke patients included, the median (interquartile range) APN level was 5.4 (3.0-7.5) μg/mL. PSD was observed in 69 patients, which accounted for 27.1% (95% confidence interval, 24.3%-29.9%) of the cohort. Patients with PSD showed lower level of APN (3.5 [2.5-6.3] μg/mL versus 6.2 [3.5-8.0] μg/mL, P?=?.001) at admission. Univariate logistic regression analysis indicated that patients with APN level in the first tertile compared with the third tertile were more likely to have PSD (odds ratio, 3.550; 95% confidence interval, 1.732-7.276; P?=?.008). The association remained significant even after multivariable adjustment for potential confounders. Conclusions: This study demonstrated that decreased APN level at admission might be associated with PSD in patients after acute ischemic stroke.     

Access disparities to Magnet hospitals for ischemic stroke patients

Access disparities to centers of excellence can have detrimental consequences for population health. We investigated the presence of racial disparities in the access of stroke patients to hospitals recognized by the Magnet Recognition Program of the American Nurses Credentialing Center (ANCC). We performed a cohort study of all ischemic stroke patients who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2009 to 2013. We examined the association of African–American race with Magnet status hospitalization after ischemic stroke. A mixed effects propensity adjusted multivariable regression analysis was used to control for confounding. During the study period, 176,557 patients presented with ischemic stroke, and met the inclusion criteria. Overall, 4,624 (13.7%) African-Americans, and 27,468 (19.2%) non African-Americans with ischemic stroke were admitted to Magnet hospitals. Using a multivariable logistic regression, we demonstrate that African-Americans were associated with lower admission rates to Magnet institutions (OR 0.70; 95% CI, 0.68–0.73) (Table 2). This persisted in a mixed effects logistic regression model (OR 0.75; 95% CI, 0.71–0.78) to adjust for clustering at the county level, and a propensity score adjusted logistic regression model (OR 0.87; 95% CI, 0.83–0.90). Using a comprehensive all-payer cohort of ischemic stroke patients in New York State we identified an association of African–American race with lower rates of admission to Magnet hospitals.     

Frequency and risk factors of vascular cognitive impairment three months after ischemic stroke in china: the Chongqing stroke study

BACKGROUND: Frequency of poststroke cognitive impairment is high in western countries, and the risk factors of poststroke cognitive impairment have not been fully understood yet. We sought to examine the frequency and risk factors of cognitive impairment after ischemic stroke in a large stroke cohort of China. METHODS: A total of 434 consecutive patients with ischemic stroke were enrolled. The cognitive status before and 3 months after stroke was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly and the Mini-Mental State Examination, respectively. Poststroke cognitive impairment was defined as cognitive impairment with concomitant stroke, stroke-related cognitive impairment was defined as cognitive impairment developing after index stroke, and cognitive impairment after first-ever stroke was defined as cognitive impairment developing after first-ever stroke. Logistic regression analysis was used to find the risk factors of cognitive impairment after stroke. RESULTS: (1) Frequency of poststroke cognitive impairment was 37.1%, that of stroke-related cognitive impairment was 32.2%, and that of cognitive impairment after first-ever stroke was 29.6%. (2) The patients with cognitive impairment more often had older age, low educational level, atrial fibrillation, prior stroke, everyday drinking, left carotid territory infarction, multiple lesions, embolism, and dysphasia. (3) The factors associated with poststroke cognitive impairment in logistic regression analysis were age (OR 1.215, 95% CI 1.163-1.268), low educational level (OR 2.023, 95% CI 1.171-3.494), prior stroke (OR 5.130, 95% CI 2.875-9.157), everyday drinking (OR 2.013, 95% CI 1.123-3.607), dysphasia (OR 3.994, 95% CI 1.749-9.120), and left carotid territory infarction (OR 2.685, 95% CI 1.595-4.521). CONCLUSIONS: Cognitive impairment is common 3 months after ischemic stroke in Chinese people. Risk factors for poststroke cognitive impairment include age, low educational level, everyday drinking, prior stroke, dysphasia, and left carotid territory infarction.     

von Willebrand因子和凝血因子Ⅷ 水平与急性脑梗死的临床转归

目的探索急性脑梗死患者血浆FVIII(factor VIII,FVIII)和VWF(von Willebrand factor,VWF)水平的升高与疾病的严重性、预后、住院期间发生感染或神经功能损伤加重等事件的关系。方法在2014年12月至2015年3月期间就诊于中国医科大学附属盛京医院神经内科的住院患者中,筛选出急性脑梗死病例组90例,无急性脑梗死的对照组50例,测定血浆FVIII和VWF水平。按两因子水平是否升高将病例组分成4组:FVIII和VWF均不升高组(FVIII-/VWF-)、FVIII升高且VWF不升高组(FVIII↑/VWF-)、FVIII不升高且VWF升高组(FVIII-/VWF↑)和FVIII和VWF均升高组(FVIII↑/VWF↑)。比较各病例组和对照组的临床特点。结果病例组的VWF水平的中位数1521.88 U/L,明显高于对照组的中位数1281.77 U/L(P=0.023)。与FVIII-/VWF-组相比,FVIII↑/VWF↑组急性脑梗死的发病症状较重(入院NIHSS评分5分)(OR=3.643,95%CI:1.258~10.549,P=0.017),疾病预后较差(3个月m RS评分2分)(OR=7,95%CI:2.304~21.266,P=0.001),出院时m RS评分2分者所占比例高(OR=3.797,95%CI:1.346~10.713,P=0.012),住院期间更易发生神经功能损伤加重(OR=5.538,95%CI:1.099~27.908,P=0.038),且更易并发感染(OR=3.913,95%CI:1.115~13.729,P=0.033)。对各种混杂因素进行校正后,发现FVIII和VWF水平同时升高是急性脑梗死患者预后不良的独立预测因素(OR=4.495,95%CI:1.012~19.957,P=0.048)。结论急性脑梗死患者很可能存在FVIII或VWF水平升高,二者水平同时升高可能对疾病的严重性及临床转归有影响,并且很可能是预后不良的独立预测因素。     

Serum cholesterol levels do not influence outcome or recovery in acute ischemic stroke

OBJECTIVE: To examine the influence of admission serum cholesterol levels (SCL) on severity of initial neurological deficit, neurological outcome at month 3 and neurological recovery in patients with acute first-ever ischemic stroke. METHODS: Prospectively collected data from 889 consecutive patients with first-ever acute ischemic stroke were retrospectively analysed. Patients who suffered a recurrent ischemic stroke (n=22) or died (n=30) during the follow-up period were excluded from this study. Age, gender, arterial hypertension, diabetes mellitus, smoking, stroke etiology, SCL and severity of neurological deficit, using the National Institute of Health Stroke Scale (NIHSS), at presentation (NIHSS0) and after 3 months (NIHSS1), were assessed. Neurological recovery was defined as difference in NIHSS score (Delta(NIHSS)), according to Delta(NIHSS)=NIHSS0 - NIHSS1. RESULTS: Data from 837 patients (66% men, age: 62 +/- 14 years) were analysed. NIHSS1 was 2.3 +/- 1.8 and Delta(NIHSS) was 3.4 +/- 3. Clinically insignificant correlations between SCL and NIHSS0 (r=-0.13, p=0.0002), NIHSS1 (r=-0.09, p=0.001) and Delta(NIHSS) (r=-0.1, p=0.03) were evident. Multivariate binary logistic regression analysis revealed smoking (p=0.008), stroke etiology (p=0.023) and NIHSS0 (p<0.001) but not age, gender, arterial hypertension, diabetes mellitus or SCL as predictors for Delta(NIHSS). CONCLUSION: Our data suggest that SCL in patients with acute ischemic stroke are not associated with neurological deficit on admission, outcome or neurological recovery.     

脑梗死急性期低白蛋白血症与卒中后认知障碍相关性研究

目的探讨脑梗死患者急性期血清低白蛋白血症与卒中6个月后认知障碍的相关性。方法采用回顾性队列研究方法连续登记急性脑梗死患者,收集人口学、临床、实验室以及影像学资料,随访至出院6个月并完善MMSE量表检查;按照卒中后6个月内有无认知障碍(post-stroke cognitive impairment,PSCI)分组,建立logistic回归模型分析急性期低蛋白血症与卒中后认知障碍的关系。结果408例入组患者中57例(14.0%)合并低白蛋白血症,6个月随访时124例(30.4%)出现PSCI。PSCI组患者血清白蛋白均值水平显著低于非PSCI组[(35.3±4.6)g/L vs.(38.6±3.5)g/L,P=0.033],且低白蛋白血症患者比例显著高于非PSCI组(20.2%vs.11.2%,P=0.017)。校正年龄,高血压,基线NIHSS和Fazekas评分等因素后,血清低白蛋白血症与PSCI显著相关(OR=1.989,95%CI:1.122~3.525,P=0.019)。结论脑梗死急性期低白蛋白血症是PSCI的危险因素,及时纠正可能有助于减少PSCI风险。     

Control of blood pressure and risk of stroke among pharmacologically treated hypertensive patients

BACKGROUND AND PURPOSE: Despite improved control of blood pressure during the last decades in the United States, a considerable proportion of treated hypertensives have not achieved target blood pressure levels. We estimated the proportion of strokes occurring among treated hypertensive patients that may be attributable to uncontrolled blood pressure. METHODS: A population-based case-control study was conducted among treated hypertensive members of Group Health Cooperative of Puget Sound. Cases were treated hypertensive patients who sustained a first fatal or nonfatal, ischemic (n=460) or hemorrhagic (n=95) stroke during 1989-1996. Controls were a random sample of stroke-free, treated hypertensive Group Health Cooperative enrollees (n=2966), similar in age to the stroke cases. Multiple measurements of blood pressure and other cardiovascular risk factors were collected from medical records. Logistic regression was used to estimate the risk of ischemic stroke and hemorrhagic stroke associated with uncontrolled blood pressure, defined as diastolic blood pressure >90 mm Hg or systolic blood pressure >140 mm Hg. The fraction of strokes attributable to uncontrolled blood pressure among treated hypertensives was calculated. RESULTS: Blood pressure was uncontrolled in 78% of ischemic stroke cases, 85% of hemorrhagic stroke cases, and 65% of controls. After adjustment for potential confounders, uncontrolled blood pressure among treated hypertensive patients was moderately associated with ischemic stroke (risk ratio=1.5 [95% CI, 1.2 to 1. 9]) and strongly related to hemorrhagic stroke (risk ratio=3.0 [95% CI, 1.7 to 5.4]). We estimated that 27% (95% CI, 11% to 39%) of the ischemic strokes and 57% (95% CI, 26% to 75%) of the hemorrhagic strokes among treated hypertensive patients were attributable to uncontrolled blood pressure. Overall, 32% (95% CI, 14% to 45%) of all strokes were attributable to uncontrolled blood pressure. CONCLUSIONS: A considerable proportion of incident strokes among treated hypertensive patients may be prevented by achieving control of blood pressure.     

Effect of previous statin therapy on severity and outcome in ischemic stroke patients: a population-based study

Although statin therapy has been shown to be effective in the prevention of ischemic stroke, its effect on stroke severity and early outcome is still controversial. We aimed to evaluate the association between statin use before onset and both initial severity and functional outcome in ischemic stroke patients. All cases of first-ever ischemic stroke that occurred in Dijon, France (151,000 inhabitants) between 2006 and 2011 were prospectively identified from the Dijon Stroke Registry. Vascular risk factors, clinical severity at onset assessed by the NIHSS score, stroke subtypes, prestroke statin use, and lipid profile were collected. Functional outcome was defined by a six-level categorical outcome using the modified Rankin scale. Analyses were performed using ordinal logistic regression models. Among the 953 patients with first-ever ischemic stroke, 127 (13.3 %) had previously been treated with statins. Initial stroke severity did not differ between statin users and non-users [median NIHSS score (interquartile range) 4.0 (7.0) versus 4.0 (9.0) p = 0.104]. In unadjusted analysis, statin use was associated with a lower risk of an unfavorable functional outcome at discharge (OR 0.69; 95 % CI 0.49–0.96; p = 0.026) that was no longer significant in multivariate analyses (OR 0.76; 95 % CI 0.53–1.09; p = 0.134). After adjustment for admission plasma LDL cholesterol levels, the non-significant association was still observed (OR 0.76; 95 % CI 0.49–1.18; p = 0.221). This population-based study showed that prestroke statin therapy did not affect initial clinical severity but was associated with a non-significant better early functional outcome after ischemic stroke.     

Serum magnesium but not calcium was associated with hemorrhagic transformation in stroke overall and stroke subtypes: a case-control study in China

Association between serum calcium and magnesium versus hemorrhagic transformation (HT) remains to be identified. A total of 1212 non-thrombolysis patients with serum calcium and magnesium collected within 24 h from stroke onset were enrolled. Backward stepwise multivariate logistic regression analysis was conducted to investigate association between calcium and magnesium versus HT. Calcium and magnesium were entered into logistic regression analysis in two models, separately: model 1, as continuous variable (per 1-mmol/L increase), and model 2, as four-categorized variable (being collapsed into quartiles). HT occurred in 140 patients (11.6%). Serum calcium was slightly lower in patients with HT than in patient without HT (P?=?0.273). But serum magnesium was significantly lower in patients with HT than in patients without HT (P?=?0.007). In logistic regression analysis, calcium displayed no association with HT. Magnesium, as either continuous or four-categorized variable, was independently and inversely associated with HT in stroke overall and stroke of large-artery atherosclerosis (LAA). The results demonstrated that serum calcium had no association with HT in patients without thrombolysis after acute ischemic stroke. Serum magnesium in low level was independently associated with increasing HT in stroke overall and particularly in stroke of LAA.     

影响急性脑梗死出血性转化的危险因素

目的 探讨急性脑梗死的出血性转化的危险因素。方法 收集2012年1月～2015年1月在湖北省恩施州利川市人民医院神经内科住院的急性脑梗死患者的临床及实验室检查资料,并在入院后10 d内行头颅CT复查,采用多变量logistic回归分析确定出血性转化的独立危险因素。结果 共纳入345例急性脑梗死患者,其中男205例,女140例,101例发生出血性转化。出血性转化组的年龄、脑梗死体积、脑卒中史或TIA史、高血压病、糖尿病、抗凝药和房颤的比例均显著高于非出血性转化组(P<0.05),而2组抗血小板聚集药、他汀类、高脂血症史、吸烟或饮酒史无明显差异(P>0.05)。多变量logistic回归分析显示年龄(OR=1.168,95%,CI=1.059～3.412; P=0.021)、梗死体积(OR=3.461,95%C1=1.317～6.270; P=0.044)和房颤(OR=1.284,95%C1= 1.117～2.903; P=0.015)为出血性转化的独立危险因素。结论 急性脑梗死患者出血性转化的发生率为29.3%,年龄、脑梗死体积和房颤为出血性转化的独立危险因素,绝大多数出血性转化不会加重临床症状,临床症状加重的患者主要是脑实质血肿型。     

Association of a 27-bp repeat polymorphism in ecNOS gene with ischemic stroke in Chinese patients

OBJECTIVE: To investigate the association between a 27-bp repeat polymorphism of the ecNOS gene in 364 patients with ischemic stroke and 516 control subjects. BACKGROUND: The incidence of stroke in China is higher than that of coronary artery disease. Furthermore, ischemic stroke is more prevalent than hemorrhagic stroke. A 27-bp repeat polymorphism in intron 4 of the endothelial constitutive nitric oxide synthase (ecNOS) gene has been reported to associate with coronary artery disease in an Australian population, but no association was found between this polymorphism and ischemic stroke in a Japanese population. METHODS: All patients and unrelated control subjects were screened by CT. All participants lived in central China. Multivariate logistic regression analysis was used to determine the independent roles of this ecNOS gene polymorphism and covariates in ischemic stroke. RESULTS: These results indicated an association between the ecNOS a allele and ischemic stroke in the Chinese patients studied (7.8 versus 17.0%; OR = 2.44; 95% CI = 1.60 to 3.71, p < 0.0001). CONCLUSION: The ecNOS a allele in intron 4 may be an independent risk factor for ischemic stroke in the Chinese population studied, especially in those lacking other conventional risk factors.     

Association between high homocyst(e)ine and ischemic stroke due to large- and small-artery disease but not other etiologic subtypes of ischemic stroke

BACKGROUND AND PURPOSE: Elevated plasma homocyst(e)ine may be a causal and modifiable risk factor for ischemic stroke, but the results of previous studies have been conflicting. One possible explanation is that homocyst(e)ine may only be associated with certain pathophysiological subtypes of ischemic stroke. METHODS: We conducted a case-control study of 219 hospital cases with a first-ever ischemic stroke and 205 randomly selected community control subjects stratified by age, sex, and postal code. With the use of established criteria, cases of stroke were classified by etiologic subtype in a blinded fashion. The prevalence of conventional vascular risk factors, fasting plasma homocyst(e)ine levels, vitamin levels, and nucleotide 677 methylene tetrahydrofolate reductase (MTHFR) genotypes were determined in cases and controls. RESULTS:Increasing homocyst(e)ine was a strong and independent risk factor for ischemic stroke (adjusted OR 2.7, 95% CI 1.4 to 5.1 for a 5-micromol/L increase in fasting plasma homocyst(e)ine from 10 to 15 micromol/L). Compared with the lowest quartile, the highest quartile of homocyst(e)ine was associated with an adjusted OR of ischemic stroke of 2.2 (95% CI 1.1 to 4.2). Mean plasma homocyst(e)ine was significantly higher in cases of ischemic stroke due to large-artery disease (14.1 micromol/L, 95% CI 12.5 to 15.9, P<0.001) and small-artery disease (12.7 micromol/L, 95% CI 11. 4 to 14.1, P=0.004) compared with control subjects (10.5 micromol/L; 95% CI 10.0 to 11.0) but not in cardioembolic or other etiologic subtypes of ischemic stroke. Compared with the lowest quartile of homocyst(e)ine, the upper 3 quartiles were associated with an adjusted OR of ischemic stroke due to large-artery disease of 3.0 (95% CI 0.8 to 10.8) for the second quartile, 5.6 (95% CI 1.6 to 20) for the third quartile, and 8.7 (95% CI 2.4 to 32) for the fourth quartile (P for trend=0.0005). However, despite a clear association between the TT MTHFR genotype and elevated fasting plasma homocyst(e)ine, there was no association between MTHFR genotype and ischemic stroke or subtype of ischemic stroke. CONCLUSIONS: There is a strong, graded association between increasing plasma homocyst(e)ine and ischemic stroke caused by large-artery atherosclerosis and, to a much lesser extent, small-artery disease, but not cardioembolic or other etiologic subtypes of ischemic stroke. Our results are consistent with the hypothesis that the deleterious effect of high homocyst(e)ine is mediated primarily via a proatherogenic effect.     

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。