超选择动脉溶栓治疗80岁以上脑梗死的安全性及疗效评估-两中心研究

目的 探讨80岁以上高龄脑梗死患者超选择动脉溶栓治疗的安全性、可行性及治疗效果.方法 回顾性分析86例超选择动脉溶栓治疗的脑梗死患者的临床资料,根据年龄不同分为高龄组(≥180岁,21例)和普通年龄组(<80岁,65例),并设对照组(同时期≥80岁未行动脉溶栓治疗患者,50例).评估患者动脉溶栓术后血管良好再通率、早期临床改善率,以及各组症状性脑出血发生率、较好转归率及死亡率.结果 接受动脉溶栓治疗的两组患者血管良好再通率、早期临床改善率及症状性脑出血发生率比较差异无统计学意义(P=0.528,P=0.102,P=0.353).高龄组症状性脑出血发生率明显高于对照组,比较差异有统计学意义(P=0.034).高龄组较好转归率为42.9%,低于普通年龄组(50.8%),但高于对照组(16%),差异有统计学意义(P=0.042,P=0.017).高龄组死亡率与对照组比较差异无统计学意义(23.8%vs 28%,P=0.816),但高于普通年龄组,差异有统计学意义(23.8%vs 10.8%,P=0.034).结论 80岁以上高龄脑梗死患者超选择动脉溶栓治疗具有较高的安全性、可行性和临床疗效,高龄不是脑梗死动脉溶栓治疗的禁忌因素.

Abstract：

Objective To evaluate the feasibility, safety and efficacy of intra-arterial thrombolytic therapy on elderly patients (≥ 80 years old) with acute ischemic stroke. Methods The clinical data of 86 patients with acute ischemic stroke, received intra-arterial thrombolytic therapy, were retrospectively analyzed; according to age differences, these patients were divided into advanced age group (≥80 years old, n=21) and common age group (<80 years old, n=65); and control group (≥80 years old, not receiving thrombolytic therapy, n=50) was established. The recanalization rate and early clinical improvement rate, and the incidence, recover rate and death rate of symptomatic intracerebral hemorrhage were evaluated in these patients after treatment. Results No significant differences in the favorite recanalization rate and short-term outcome, and the incidence of symptom intracranial hemorrhage were noted between the advanced age group and common age group (P=0.528, P=0.102,P=0.353). The incidence of symptom intracranial hemorrhage in the advanced age group was obviously higher than that in the control group (P=0.034); the recover rate of symptom ntracranial hemorrhage in the advanced age group (42.9%) was obviously lower than that in the common age group (50.8%), but significantly higher than that in the control group (16%, P=0.042, P=0.017). The mortality of the advanced age group was similar to that of the control group (23.8% versus 28%, P=0.816), but higher than that of common age group (23.8% versus 10.8%, P=0.034). Conclusion Relatively high feasibility, safety and efficacy of intra-arterial thrombolytic therapy are noted in elderly patients (≥80 years old) with acute ischemic stroke, demonstrating that the use of intra-arterial thrombolytic therapy in very elderly patients should not be avoided but pursued advisably.     

超选择动脉溶栓治疗80岁以上脑梗死的安全性及疗效评估-两中心研究

Objective To evaluate the feasibility, safety and efficacy of intra-arterial thrombolytic therapy on elderly patients (≥ 80 years old) with acute ischemic stroke. Methods The clinical data of 86 patients with acute ischemic stroke, received intra-arterial thrombolytic therapy, were retrospectively analyzed; according to age differences, these patients were divided into advanced age group (≥80 years old, n=21) and common age group (<80 years old, n=65); and control group (≥80 years old, not receiving thrombolytic therapy, n=50) was established. The recanalization rate and early clinical improvement rate, and the incidence, recover rate and death rate of symptomatic intracerebral hemorrhage were evaluated in these patients after treatment. Results No significant differences in the favorite recanalization rate and short-term outcome, and the incidence of symptom intracranial hemorrhage were noted between the advanced age group and common age group (P=0.528, P=0.102,P=0.353). The incidence of symptom intracranial hemorrhage in the advanced age group was obviously higher than that in the control group (P=0.034); the recover rate of symptom ntracranial hemorrhage in the advanced age group (42.9%) was obviously lower than that in the common age group (50.8%), but significantly higher than that in the control group (16%, P=0.042, P=0.017). The mortality of the advanced age group was similar to that of the control group (23.8% versus 28%, P=0.816), but higher than that of common age group (23.8% versus 10.8%, P=0.034). Conclusion Relatively high feasibility, safety and efficacy of intra-arterial thrombolytic therapy are noted in elderly patients (≥80 years old) with acute ischemic stroke, demonstrating that the use of intra-arterial thrombolytic therapy in very elderly patients should not be avoided but pursued advisably.     

Treatment of Serious Hypertensive Intracerebral Hemorrhage with CT-location Drill-crandum Smashing-draw and Analysis of Prognosis Factors

Objective: To study curative effect of CT-location drill-cranium smashing-draw and affective pregniosis factors for serious hypertensive intracerebral hemorrhage (HIH). Methods :15 cases of serious HIH(group A)were treated with CT-location drill-cranium smashing-draw ,other 15 patients treated (group B)were treated with medicine only as controls. Results: The curative rate (20%) anis improvable rate (33.3%)in group A were higher than that of (6.7% and 26.7%)in group B (P＜0. 001). The mortality rate (46.7%)in group A was lower than that of (66.6%)in group B significantly (P＜0.001). Conclusions: The efffect of the therapy was satisfactory The higher or lower of the mortality rate was closely related to operative time 、 m-hemorrhage 、 location and range of the hemotoma     

三叉神经痛合并根区蛛网膜粘连的病毒病因学研究

Objective To assess the relationship that trigeminal neuralgia combining arachnoids' adhesions and herpes simplex virus type 1. Methods There are fifty nine patients with trigeminal neuralgia their trigeminal nerve root area combined arachnoids' adhesion, cutting their arachnoids as the experimental group. There are twenty four patients with trigeminal neuralgia their trigeminal nerve root area is not combined significant arachnoids' adhesion, cutting their arachnoids as the case - control group. Using polymerase chain reaction and Western blot technique to detecting the HSV - 1 specific DNA fragments and specific antigen,and cutting twenty arachnoids of the patients with Brain Trauma as the normal control group. Results The positive ratio of DNA fragments in the three group is 69% 、58% and 25% respectively. The positive ratio of DNA fragments in the experiment group and case -control group were higher than the normal control group,with statistical difference ( P ＜ 0. 05 ), but the experimental group and case -control group compared with no significant difference ( P ＞ 0. 05 ). The positive ratio of virus - specific antigen is 51%、 25 % and 15 %respectively. The positive ratio of virus - specific antigen was higher than the case - control group, also higher than the normal control group, were significantly different ( P ＜ 0. 05 ), while the case - control group and the normal control group compared with no significant differences ( P ＞ 0. 05 ). Conclusion HSV - 1 proliferating infected patients with trigeminal neuralgia may result in the arachnoids adhesion of trigeminal nerve root zone; arachnoids tissue may be another latent base of HSV - 1; HSV - 1 infection may be another pathogenic factor of trigeminal neuralgia.     

三叉神经痛合并根区蛛网膜粘连的病毒病因学研究

Objective To assess the relationship that trigeminal neuralgia combining arachnoids' adhesions and herpes simplex virus type 1. Methods There are fifty nine patients with trigeminal neuralgia their trigeminal nerve root area combined arachnoids' adhesion, cutting their arachnoids as the experimental group. There are twenty four patients with trigeminal neuralgia their trigeminal nerve root area is not combined significant arachnoids' adhesion, cutting their arachnoids as the case - control group. Using polymerase chain reaction and Western blot technique to detecting the HSV - 1 specific DNA fragments and specific antigen,and cutting twenty arachnoids of the patients with Brain Trauma as the normal control group. Results The positive ratio of DNA fragments in the three group is 69% 、58% and 25% respectively. The positive ratio of DNA fragments in the experiment group and case -control group were higher than the normal control group,with statistical difference ( P ＜ 0. 05 ), but the experimental group and case -control group compared with no significant difference ( P ＞ 0. 05 ). The positive ratio of virus - specific antigen is 51%、 25 % and 15 %respectively. The positive ratio of virus - specific antigen was higher than the case - control group, also higher than the normal control group, were significantly different ( P ＜ 0. 05 ), while the case - control group and the normal control group compared with no significant differences ( P ＞ 0. 05 ). Conclusion HSV - 1 proliferating infected patients with trigeminal neuralgia may result in the arachnoids adhesion of trigeminal nerve root zone; arachnoids tissue may be another latent base of HSV - 1; HSV - 1 infection may be another pathogenic factor of trigeminal neuralgia.     

Effect of electro-acupuncture combined with early rehabilitation on motor function and expressions of CD11b/CD18 and tumor necrosis factor-α in patients with acute cerebral infarction

Objective To observe the effect of electro-acupuncture combined with early rehabilitation on the motor function and expressions of the adhesion molecules CD11b and CD18 in the polymorphonuclear leucocytes (PMN) and monocytes and serum tumor necrosis factor-α (TNF-α) levels in patients with acute cerebral infarction (ACI). Methods A total of 165 ACI patients were randomly divided into control group (group A, n=50), conventional rehabilitation group (group B, n=50) and comprehensive rehabilitation group (group C, n=65). The expressions of CD11b and CD18 in the PMN and monocytes and serum TNF-α levels were determined before and at 1, 2, and 4 weeks after the treatment. Thirty-two healthy subjects were also recruited as the normal control group (group N). The neurological function of the subjects was evaluated by modified Edinburgh-Scandinavia stroke scale (MESSS) and Fugi-Meyer Assessment (FMA), and their activity of daily living (ADL) was assessed using Barthel index (BI). Results The CD11b/CD18 expression in the PMN and MN and serum TNF-α level in groups A, B and C were significantly higher than those in group N before and 1 week after the treatment (P<0.05). CD11b/CD18 expression and serum TNF-α level were significantly lower in groups B and C than in the group A at 1 week after the treatment, and significantly lower in group C than in group B (P<0.05). At 2 weeks of treatment, CD11b/CD18 and TNF-α were significantly lower in groups B and C than in the group A, being the lowest in group C (P<0.05). The scores of mESSS in both groups B and C were lower than that in group A, and the scores were lower in group C than in group B. Group C showed higher FMA scores than group B, both having higher scores than group A. At 4 weeks of treatment, the mESSS scores were significantly lower, hut the FMA and ADL score significantly higher in groups B and C than in the control group (P<0.05), and the differences were more obvious in group C. Groups B and C had greater effective rate than group A (P<0.05), and the rate was the highest in group C (P<0.05). Conclusion Electro-acupuncture combined with early rehabilitation promotes the recovery of motor function in ACI patients probably by regulating the expressions of the adhesion molecules CD11b and CD18 on the PMN and monocytes and the serum levels of TNF-α.     

Effect of electro-acupuncture combined with early rehabilitation on motor function and expressions of CD11b/CD18 and tumor necrosis factor-α in patients with acute cerebral infarction

Objective To observe the effect of electro-acupuncture combined with early rehabilitation on the motor function and expressions of the adhesion molecules CD11b and CD18 in the polymorphonuclear leucocytes (PMN) and monocytes and serum tumor necrosis factor-α (TNF-α) levels in patients with acute cerebral infarction (ACI). Methods A total of 165 ACI patients were randomly divided into control group (group A, n=50), conventional rehabilitation group (group B, n=50) and comprehensive rehabilitation group (group C, n=65). The expressions of CD11b and CD18 in the PMN and monocytes and serum TNF-α levels were determined before and at 1, 2, and 4 weeks after the treatment. Thirty-two healthy subjects were also recruited as the normal control group (group N). The neurological function of the subjects was evaluated by modified Edinburgh-Scandinavia stroke scale (MESSS) and Fugi-Meyer Assessment (FMA), and their activity of daily living (ADL) was assessed using Barthel index (BI). Results The CD11b/CD18 expression in the PMN and MN and serum TNF-α level in groups A, B and C were significantly higher than those in group N before and 1 week after the treatment (P<0.05). CD11b/CD18 expression and serum TNF-α level were significantly lower in groups B and C than in the group A at 1 week after the treatment, and significantly lower in group C than in group B (P<0.05). At 2 weeks of treatment, CD11b/CD18 and TNF-α were significantly lower in groups B and C than in the group A, being the lowest in group C (P<0.05). The scores of mESSS in both groups B and C were lower than that in group A, and the scores were lower in group C than in group B. Group C showed higher FMA scores than group B, both having higher scores than group A. At 4 weeks of treatment, the mESSS scores were significantly lower, hut the FMA and ADL score significantly higher in groups B and C than in the control group (P<0.05), and the differences were more obvious in group C. Groups B and C had greater effective rate than group A (P<0.05), and the rate was the highest in group C (P<0.05). Conclusion Electro-acupuncture combined with early rehabilitation promotes the recovery of motor function in ACI patients probably by regulating the expressions of the adhesion molecules CD11b and CD18 on the PMN and monocytes and the serum levels of TNF-α.     

Effect of electro-acupuncture combined with early rehabilitation on motor function and expressions of CD11b/CD18 and tumor necrosis factor-α in patients with acute cerebral infarction

Objective To observe the effect of electro-acupuncture combined with early rehabilitation on the motor function and expressions of the adhesion molecules CD11b and CD18 in the polymorphonuclear leucocytes (PMN) and monocytes and serum tumor necrosis factor-α (TNF-α) levels in patients with acute cerebral infarction (ACI). Methods A total of 165 ACI patients were randomly divided into control group (group A, n=50), conventional rehabilitation group (group B, n=50) and comprehensive rehabilitation group (group C, n=65). The expressions of CD11b and CD18 in the PMN and monocytes and serum TNF-α levels were determined before and at 1, 2, and 4 weeks after the treatment. Thirty-two healthy subjects were also recruited as the normal control group (group N). The neurological function of the subjects was evaluated by modified Edinburgh-Scandinavia stroke scale (MESSS) and Fugi-Meyer Assessment (FMA), and their activity of daily living (ADL) was assessed using Barthel index (BI). Results The CD11b/CD18 expression in the PMN and MN and serum TNF-α level in groups A, B and C were significantly higher than those in group N before and 1 week after the treatment (P<0.05). CD11b/CD18 expression and serum TNF-α level were significantly lower in groups B and C than in the group A at 1 week after the treatment, and significantly lower in group C than in group B (P<0.05). At 2 weeks of treatment, CD11b/CD18 and TNF-α were significantly lower in groups B and C than in the group A, being the lowest in group C (P<0.05). The scores of mESSS in both groups B and C were lower than that in group A, and the scores were lower in group C than in group B. Group C showed higher FMA scores than group B, both having higher scores than group A. At 4 weeks of treatment, the mESSS scores were significantly lower, hut the FMA and ADL score significantly higher in groups B and C than in the control group (P<0.05), and the differences were more obvious in group C. Groups B and C had greater effective rate than group A (P<0.05), and the rate was the highest in group C (P<0.05). Conclusion Electro-acupuncture combined with early rehabilitation promotes the recovery of motor function in ACI patients probably by regulating the expressions of the adhesion molecules CD11b and CD18 on the PMN and monocytes and the serum levels of TNF-α.     

趋化因子受体CCR2b基因G190A多态性与脑梗死关系的研究

目的 探讨趋化因子受体CCR2b基因G190A多态性与中国福建地区汉族人群脑梗死(cerebral infarction,CI)的关系.方法 采用聚合酶链反应-限制性片段长度多态性(polymerase chain reaction-restriction fragment length polymorphism,PCR-RFLP)和DNA序列测定法检测200例CI及200名健康对照者趋化因子受体CCR2b基因G190A多态性分布,对两组之间的基因型频率和等位基因频率进行比较.结果 CI组趋化因子受体CCR2b基因G190A多态位点的基因型和等位基因频率分布与对照组比较差异有统计学意义(P<0.05).脑梗死组GG、GA、AA基因型频率分别为83.5%、15.0%、1.5%;G、A等位基因频率分别为91.0%、9.0%.正常对照组GG、GA、AA基因型频率分别为73.0%、22.5%、4.5%;G、A等位基因频率分别为84.3%、15.7%.脑梗死组GG基因型和G等位基因频率高于对照组(P<0.05).结论 趋化因子受体CCR2b基因G190A多态性与脑梗死的发病具有相关性,G等位基因可能是中国福建地区汉族人群脑梗死发病的遗传易感基因.

Abstract：

Objective To investigate the relationship between chemokine receptor CCR2b gene G190A polymorphism and cerebral infarction(CI)of Han population in Chinese Fujian district.Methods The G190A polymorphism in ccr2b gene was detected by polymerase chain reaction-restriction fragment length polymorphism analysis(PCR-RFLP)and DNA sequencing in 200 patients with CI(CI group)and 200 normal controls(NC group).Results There were significant differences in frequencies of allele and genotype of CCR2b G190A gene polymorphism between CI and control groups(P<0.05).In CI group,genotypic frequency of GG Was 83.5%,GA wag 15.0%,AA Was 1.5%.The allele frequency of G Was 91.0%and A was 9.0%.In NC group,genotypic frequency of GG WaS 73.0%,GA was 22.5%,AA was 4.5%.The allele frequency of G was 84.3%and A was 15.7%.The frequencies of CCR2b 190GG genetype and G allele in CI group were siginificantly higher than that in NC group(P<0.05).Conclusions There was association between CCR2b gene G190A polymorphism and cerebral infarction(CI)in Chinese Fujian district Han populations.The CCR2b G190 allele may be a genetic risk factor for cerebral infarction of Hart populations in Chinese Fujian district.     

超选择动脉溶栓治疗80岁以上脑梗死的安全性及疗效评估-两中心研究

Objective To evaluate the feasibility, safety and efficacy of intra-arterial thrombolytic therapy on elderly patients (≥ 80 years old) with acute ischemic stroke. Methods The clinical data of 86 patients with acute ischemic stroke, received intra-arterial thrombolytic therapy, were retrospectively analyzed; according to age differences, these patients were divided into advanced age group (≥80 years old, n=21) and common age group (<80 years old, n=65); and control group (≥80 years old, not receiving thrombolytic therapy, n=50) was established. The recanalization rate and early clinical improvement rate, and the incidence, recover rate and death rate of symptomatic intracerebral hemorrhage were evaluated in these patients after treatment. Results No significant differences in the favorite recanalization rate and short-term outcome, and the incidence of symptom intracranial hemorrhage were noted between the advanced age group and common age group (P=0.528, P=0.102,P=0.353). The incidence of symptom intracranial hemorrhage in the advanced age group was obviously higher than that in the control group (P=0.034); the recover rate of symptom ntracranial hemorrhage in the advanced age group (42.9%) was obviously lower than that in the common age group (50.8%), but significantly higher than that in the control group (16%, P=0.042, P=0.017). The mortality of the advanced age group was similar to that of the control group (23.8% versus 28%, P=0.816), but higher than that of common age group (23.8% versus 10.8%, P=0.034). Conclusion Relatively high feasibility, safety and efficacy of intra-arterial thrombolytic therapy are noted in elderly patients (≥80 years old) with acute ischemic stroke, demonstrating that the use of intra-arterial thrombolytic therapy in very elderly patients should not be avoided but pursued advisably.     

抗心磷脂抗体与脑梗死关系的研究

目的探讨抗心磷脂抗体(ACA)与脑梗死(C I)的关系。方法应用酶联免疫吸附(ELISA)法检测137例C I患者发病后第1 d、第1周、第2周、第3周、第4周末时血清ACA阳性率,并与短暂性脑缺血发作(TIA)组、脑出血(ICH)组及正常对照组比较。结果C I组ACA阳性率(64.9%)明显高于TIA组(24.6%)、ICH组(33.6%)、正常对照组(17.6%)(均P<0.01);C I组ACA阳性率随病程进展逐渐下降,第1周末与第2周、第3周、第4周末比较差异均有显著性(P<0.05~0.01);C I组中≤50岁患者ACA阳性率明显高于>50岁患者(P<0.01),ACA阳性者3年内再发C I明显高于阴性者(P<0.01)。结论C I患者急性期ACA阳性率高,尤其是≤50岁的患者;随病程演变CAC阳性率逐渐降低,ACA阳性者3年内复发率高。     

急性脑血管病患者血清抗心磷脂抗体水平及其临床意义

目的探讨抗心磷脂抗体（ACA）与急性脑血管病（ACVD）之间的关系及其临床意义。方法应用酶联免疫吸附法测定143例脑梗死（CI）、32例短暂性脑缺血发作（TIA）、45例脑出血（CH）患者血清ACA水平，相互比较并与43例健康人比较。结果CI组ACA阳性率（46．85％），TIA组ACA阳性率（43．75％），CH组ACA阳性率（44．44％）均明显高于对照组（11.63％）（P〈0．01）；ACVD患者各组之间比较。无显著性差异（P〉0．05）。ACA分型中，IgA、IgG阳性率CI组分别为34．27％、20．28％，TIA组分别为31．25％、25．00％，CH组分别为22．22％、24．44％，均明显高于对照组（6．98％。6．98％）（P〈0．01～0．05），在CI与TIA组。IgA增高更明显（P〈0．01）。结论ACA为急性脑血管病的危险因素．IgA可能为缺血性脑血管病的主要致病性抗体。     

抗心磷脂抗体动态变化与血栓性脑梗死关系研究

目的探讨抗心磷脂抗体（anticardiolipin antibodies,ACA）与血栓性脑梗死患者发病与复发的关系。方法应用酶联免疫吸附试验（ELISA）法检测血栓性脑梗死患者发病后1d,7d．14d,21d,28d清晨空腹血清中ACA的含量,与不同组间（血栓性脑梗死组、短暂脑缺血组、脑出血组、正常对照组）相比较；通过对血栓性脑梗死患者随访观察,了解ACA阳性和阴性患者的1年到3年复发率情况,以期为血栓性脑梗死进行预防性干预寻找依据。还比较血栓性脑梗死患者中50岁以下和50岁以上ACA阳性和阴性者的差异。结果血栓性脑梗死组的ACA阳性率远较短暂脑缺血发作组、脑出血组、正常对照组高,均有显著性差异（P＜0．01,P＜0．01,P＜0．01）；随时间变化,血栓性脑梗死组ACA阳性率逐渐减少,病程第1周与第2、3、4周相比较（P＜0．01）；血栓性脑梗死ACA阳性者3年内再发血栓性脑梗死较阴性者高,差异显著（P＜0．01）；ACA阳性多发生于50岁以下（含50岁）的患者。结论抗心磷脂抗体是50岁以下血栓性脑梗死及缺血性卒中复发的重要危险因素。     

幽门螺杆菌细胞毒素相关蛋白A与动脉粥样硬化性脑梗死的关系

目的探讨幽门螺杆菌(Hp)细胞毒素相关蛋白A(CagA)与动脉粥样硬化性脑梗死的关系。方法测定100例动脉粥样硬化性脑梗死患者(脑梗死组)的CagAHpIgG抗体、中性粒细胞、C反应蛋白(CRP)、血糖、血脂、血纤维蛋白原,应用颈部彩色多普勒超声仪进行颈部血管检测,并与50名健康对照者进行比较。对Hp抗体阳性脑梗死患者给予抗Hp治疗。结果脑梗死组CagAHp抗体阳性率为62%,健康对照组为38%,两组相比差异有显著性(P<0.05)。Hp抗体阳性者颈动脉斑块和狭窄的发生率分别为100%和61%,健康对照组分别为55%和18%,差异有显著性(P<0.05)。Hp抗体阳性组较阴性组血CRP及纤维蛋白原明显升高(均P<0.05)。抗Hp治疗可促进脑梗死的恢复。结论CagA阳性Hp菌株感染与动脉粥样硬化性脑梗死有关,且可能是脑梗死的独立危险因素。     

脑梗死患者颈动脉粥样硬化斑块形成的研究

目的 探讨脑梗死(CI)患者颈动脉粥样硬化斑块形成的状况.方法 对138例CI患者行颈动脉彩色多普勒超声检查,观察其颈动脉斑块形成、性质及部位,并与正常对照组比较.结果 CI组138例中120例(87.7%)检出颈动脉粥样硬化斑块175块,正常对照组140人检出斑块为36人(25.7%)(P＜0.01).CI组中不稳定性斑块比率(80.8%)显著高于稳定性斑块(19.2%)(P＜0.01);斑块位于颈总动脉(CCA)(81.1%)显著高于颈内动脉(ICA)(18.9%)(P＜0.01);位于CCA分叉处(66.3%)又显著高于主干(14.9%)(P＜0.05).结论 CI患者颈动脉粥样硬化斑块的发生率高,多位于CCA分叉处,且大多为不稳定性斑块.提示CI与颈动脉粥样硬化有密切关系.     

代谢综合征与脑卒中类型、并发症及预后的关系

目的探讨代谢综合征与脑卒中类型、并发症及预后的关系。方法对568例有代谢综合征的脑卒中患者(代谢综合征组)及209例无代谢综合征的脑卒中患者(无代谢综合征组)的临床资料进行对比分析。结果代谢综合征组脑梗死比率(93.0%)显著高于无代谢综合征组(85.2%)(P<0.01);肺部感染(51.9%)、呼吸衰竭(27.3%)、心功能衰竭(28.0%)、肾功能衰竭(14.3%)等并发症的发生率及死亡率(25.0%)明显高于无代谢综合征组(19.1%、13.9%、14.8%、5.3%、12.9%)(均P<0.01);治疗的总有效率(64.1%)明显低于无代谢综合征组(74.6%)(P<0.01)。结论有代谢综合征的脑卒中患者以脑梗死多见,并发症发生率高,预后较差。     

抗心磷脂抗体与脑血管病关系的研究

目的探讨抗心磷脂抗体与脑血管病的关系．方法采用酶联免疫吸附试验对105例脑梗塞及48例脑出血患者的血清ACLA进行了检测，并与对照组50例结果进行比较。结果脑出血及脑梗塞组的ACLA阳性率明显高于对照组（P＜0．01），ACLA分型中，脑出血及脑梗塞组中的IgG型ACLA阳性率也明显高于对照组（P＜0．05，P＜0．01）．结论ACLA是脑出血及脑梗塞的危险因素，其中IgG型ACLA为主要致病性抗体。     

颈动脉粥样硬化斑块与脑梗死的临床相关分析

目的分析颈动脉粥样硬化斑块与脑梗死的关系。方法对临床诊断98例脑梗死(脑梗死组)和同时期的82例非脑梗死患者(对照组)行颈部血管行彩色多普勒超声检查,并对两组颈动脉粥样硬化斑块发生率、大小、性质、好发部位以及颈动脉狭窄程度进行对比分析。结果 1脑梗死组与对照组颈动脉粥样硬化斑块检出率均较高,差异无统计学意义(81.6%vs72.9%,P0.05),但面积大于20mm2斑块的检出率急性脑梗死组显著高于对照组(38.8%vs9.8%,P0.01);2两组颈动脉硬化斑块的分布部位均以颈总动脉分叉处为主,两组间比较,差异无统计学意义(66.6%vs62.7%,P0.05);3两组颈动脉狭窄发生率及程度比较,脑梗死组均高于对照组(χ2=6.98,P0.05)。结论颈动脉粥样硬化斑块形成与脑梗死的有密切相关性,彩色多普勒超声技术对高风险、老年人的脑卒中早期预防及诊治有重要意义。     

中青年脑梗死患者颈动脉粥样硬化及其血清基质金属蛋白酶-9、组织基质金属蛋白酶抑制剂-1、超敏C反应蛋白水平的改变

目的研究中青年脑梗死患者颈动脉粥样硬化及其血清基质金属蛋白酶-9(MMP-9)、组织基质金属蛋白酶抑制剂-1(TIMP-1)、超敏C反应蛋白(hs-CRP)水平的改变。方法应用彩色多普勒超声仪探测42例急性脑梗死患者(ACI组)、29例无症状颈动脉硬化患者(ACA组)及17名健康体检者(NC组)的双侧颈动脉粥样硬化的情况。采用酶联免疫吸附法检测各组血清MMP-9和TIMP-1水平,免疫散射比浊法检测血清hs-CRP水平。结果 NC组均未检出颈动脉粥样硬化斑块。ACI组易损斑块的比例(69.2%)及检出率(47.6%)均明显高于ACA组(46.4%,20.7%)(均P<0.05)。ACI组血清MMP-9、TIMP-1、hs-CRP水平及MMP-9/TIMP-1比值均明显高于ACA组(均P<0.05);ACA组血清MMP-9、TIMP-1、hs-CRP水平均明显高于NC组(均P<0.05)。ACI组中,易损斑块亚组血清MMP-9、TIMP-1、hs-CRP水平及MMP-9/TIMP-1比值均明显高于稳定斑块亚组(均P<0.05);稳定斑块亚组血清MMP-9、TIMP-1、hs-CRP水平均明显高于无斑块亚组(均P<0.05)。结论血清MMP-9、TIMP-1、hs-CRP可作为反映颈动脉粥样硬化及斑块稳定性的血清学指标。MMP-9/TIMP-1比值增高及颈动脉易损斑块可能提示中青年脑梗死的风险。     

抗心磷脂抗体与脑出血血肿扩大的相关性分析

目的探讨抗心磷脂抗体(ACA)与脑出血早期血肿扩大的关系。方法应用酶联免疫吸附(ELISA)法对101例健康人,271例脑出血患者发病1～3 h内、24、72 h检测ACA水平。结果血肿扩大组ACA阳性率(77.38%)高于无血肿扩大组(43.91%)(P<0.05,P<0.01)。血肿扩大组随着病情加重ACA阳性率逐渐增高,随发病时间的延长ACA阳性率逐渐降低(P<0.05)。结论 ACA与脑出血早期血肿扩大呈正相关,为脑出血早期血肿扩大的机制和脑出血免疫治疗提供新的观点,为临床上筛选脑出血血肿扩大高风险预警提供有效指标。