脑梗死急性期OCSP分型的效度评价

目的　评价脑梗死急性期OCSP分型的真实性。方法　 1名神经科医生将连续就医、首次发生的急性脑梗死患者 14 3例按 0CSP分型法分型 ,然后与脑CT/MR结果盲法比较分型的准确性。结果　分型总正确率70 6 % (10 1/ 14 3) ,敏感度 :TACI 76 % (95 %CI:5 8%～ 94 % ) ,PACI 85 % (95 %CI:74 %～ 96 % ) ,LACI 6 0 % (95 %CI:4 8%～ 72 % ) ,POCI 73% (95 %CI:5 1%～ 95 % ) ;特异度 :TACI 98% (95 %CI:95 %～ 10 1% ) ,PACI 70 % (95 %CI:6 1%～79% ) ,LACI 93% (95 %CI:87%～ 99% ) ,POCI 96 % (95 %CI:92 6 %～ 99 4 % ) ;阳性预测值TACI 89% (95 %CI:75 %～10 3% ) ,PACI 5 2 % (95 %CI:4 0 %～ 6 4 % ) ,LACI89% (95 %CI:80 %～ 98% ) ,POCI73% (95 %CI :5 1%～ 95 % ) ;阴性预测值TACI 96 % (95 %CI:93%～ 99% ) ,PACI92 % (95 %CI:86 %～ 98% ) ,LACI72 % (95 %CI :6 3%～ 81% ) ,POCI96 % (95 %CI:92 6 %～ 99 4 % )。结论　脑梗死急性期OCSP分型的效度较好 ,神经体征变动和评价时间是影响分型准确性的主要因素。     

OCSP分型对超早期动脉溶栓治疗的价值

目的　探讨OCSP(Oxfordshirecommunitystrokeproject)分型应用于超早期动脉溶栓治疗的价值。方法　将我院 2 7例超早期动脉溶栓患者进行OCSP分型并与血管造影 (DSA)、NIHSS评分进行比较分析。结果　以DSA为金标准 ,OCSP分型各组患者诊断的敏感度和特异度分别为完全前循环梗塞 (TACI) (87 5 % ,95 % ) ,部分前循环梗塞(PACI) (72 7% ,88 9% ) ;腔隙性梗塞 (LACI) (6 6 7% ,92 3% ) ;后循环梗塞 (POCI) (10 0 % ,10 0 % )。患者入院NIHSS评分与分型显著相关 (P =0 0 2 1)。结论　对超早期动脉溶栓患者进行OCSP分型是可行的 ,与DSA、NIHSS的一致性较好 ;但这需要由更大样本的研究来验证。     

卒中后急性期抑郁状态的相关因素临床分析

目的探讨脑卒中后急性期抑郁的发生率及相关因素。方法对139例住院诊断为脑卒中的急性期患者用自制的一般情况调查表及汉密尔顿抑郁量表、改良的爱丁堡斯堪的那维亚神经功能缺损评分表进行调查及评分。结果脑卒中后抑郁的发生率为35.97%,抑郁的发生与性别、职业、文化程度及病灶部位没有关系,与神经功能缺损及日常生活能力依赖有密切关系。结论脑卒中后抑郁是脑卒中的常见并发症,与神经功能缺损、日常生活能力依赖等有密切关系,为预防脑卒中后抑郁的发生提供依据。     

炎性指标和颈动脉粥样斑块稳定性与急性脑梗死的关系

目的 探讨炎性指标和颈动脉粥样斑块稳定性与急性脑梗死的关系。方法 对71例急性脑梗死患者（A组）、44例无症状颈动脉硬化患者（B组）和21名健康对照者（C组）进行研究，彩色多普勒超声仪测量颈动脉内中膜厚度（IMT）、斑块类型，酶联免疫法测定可溶性血管细胞黏附分子-1（sVCAM-1）、可溶性E-选择素（sE-选择素）、可溶性CD40配体（sCD40L）、单核细胞趋化因子．1（MCP-1）含量。结果 IMT在A组和B组比较差异无统计学意义，但与c组比较差异有统计学意义；A组颈动脉斑块以脂质型斑块（59．2％）为主，B组以纤维型（32．9％）为主；MCP．1、sVCAM-1、sCD40L、sE-选择素含量在A组、B组和C组之间差异有统计学意义（均P〈0．05）。结论 多种细胞因子参与炎症反应是影响颈动脉粥样斑块稳定性的重要原因，在急性脑梗死发病机制中发挥作用。     

The role of cognitive impairment in the quality of life after ischaemic stroke

Many patient- and disease-related factors influence the quality of life (QL) after stroke. Few studies address the direct relation between cognition and quality of life. The objective of this study was to investigate the role of cognitive impairment in the QL of patients after stroke. We evaluated several variables including age, degree of paralysis, cognitive deficits and volume of infarcts, in 129 patients (64 men, 65 women; mean age 63.2, SD 14.6 years), who had been hospitalized a mean of 2.3 (range 0.25–4) years previously with ischaemic stroke. Cognitive function was assessed with the CAMCOG and QL with a visual analogue scale (VAS). Ninety-seven patients (75%) of our sample completed all the tests. Univariate analysis showed that substantial infarct volume, aphasia, impaired motor function, disability relating to activities of daily life, disturbed global functional health and impaired cognitive function were significantly associated with poorer QL. Age, sex and education of the patient, co-morbidity and location of the infarcts were not related to QL. Linear regression analysis revealed that disturbed global functional health, larger volume of infarcts and severity of aphasia were significant independent explanatory factors for poorer QL (adjustedR ² = 22%). In conclusion, we did not find a significant impact of cognitive impairment on the patients' QL. However, this conclusion is restricted to a relatively well group of stroke survivors.     

急性脑梗死早期OCSP分型研究☆

目的验证OCSP(OxfordshireCommunityStrokeProject)分型法在急性脑梗死临床中的使用价值.方法回顾分析我院近2年202例急性脑梗塞早期OCSP分型情况及影像学特征.结果OCSP分型与影像学结果有良好对应关系;我院急性脑梗死的亚型构成脑隙性脑梗塞占65.3%,部分前循环梗塞19.3%,完全前循环梗塞9.9%,后循环梗塞5.4%.结论OCSP法可用于急性脑梗死的早期分型、指导治疗、评估预后;我国急性脑梗死的亚型构成中轻型病例多,重型少.     

脑梗死急性期血清MMP-9的动态变化及其与脑梗死分型关系的研究

目的　探讨微循环分子标志物的改变与脑梗死临床分型和病情的关系 ,以指导临床的诊治。方法　收集急性脑梗死病人 4 7例 ,分别测定 4 8小时内、第 3天和第 5天的血清MMP 9含量 ,然后分析它与病情轻重、临床分型及预后的关系。结果　脑梗死后MMP 9的含量升高 ,升高幅度和变化规律在OCSP各亚型不同 ;MMP 9在大梗死组的含量显著高于其它组 ;MMP 9与NIHSS呈正相关 ,r=0 4 87;Logistic回归显示 4 8小时内的血清MMP 9含量是预后的独立预测因素。结论　脑梗死后血清MMP 9水平升高 ,并与病灶大小成正比 ,但与病变部位关系不大 ;此外 ,MMP 9可能对病情的严重程度和预后有预示作用。     

急性缺血性与出血性卒中危险因素的对比研究

目的通过对1个大样本的医院脑卒中注册资料的分析,观察各种危险因素在脑卒中患者中的发生率,并对脑梗死与脑出血的危险因素,特别是心脏和动脉病变的因素进行比较。方法研究资料来自瑞士洛桑卒中注册的卒中患者共3901例,其中脑梗死3525例,脑出血376例,均预先对各项临床和辅助资料进行编码,输入计算机数据库。所有病例均进行系统的临床和辅助检查,心脏病变经心电图和超声心动图证实;颈内动脉和椎基底动脉的病变采用彩色超声多普勒、磁共振血管成像或常规脑血管造影确诊。结果高血压在脑出血和脑梗死患者中的发生率分别为53.7%和46.7%,两者相比差异有统计学意义(P<0.01)。高血压是本组脑卒中最突出的危险因素,其后依次是吸烟、轻度颈内动脉狭窄(≤50%)、高胆固醇血症、短暂性脑缺血发作、糖尿病以及心脏缺血。多因素分析研究发现,本组卒中患者无论是男性还是女性,吸烟、高胆固醇血症、短暂性脑缺血发作、心房纤颤、器质性心脏疾病以及动脉病变是脑梗死而非脑出血密切相关的危险因素。易患脑出血的惟一显著相关的危险因素是高血压(OR=0.64,P<0.01);心脏和动脉病变患者更容易发生脑梗死,但是,器质性心脏病和轻度颈内动脉狭窄在全体卒中患者中均特别常见。结论缺血性卒中和出血性卒中的危险因素并不一致,心脏和动脉病变是脑梗死而非脑出血的重要的危险因素,某些危险因素还存在性别差异。     

脑梗死急性期OCSP分型的信度评价

目的　评价脑梗死急性期OCSP分型的观察者间信度。方法　 2名神经科医生分别将连续就医、首次发生的急性脑梗死 1 1 0例分为 4个OCSP亚型。结果　 2名神经科医生分型的一致性为尚好 (kappa =0 3 9,95 %CI=0 3 0～ 0 48)至中度 (kappa =0 42 ,95 %CI=0 3 3～ 0 5 1 )。而对某些神经体征检查的一致性较差。结论　OCSP分型在脑梗死急性期的观察者间信度较为满意 ,是一种简便、实用的临床分型工具 ,神经体征变异是影响分型一致性的主要因素     

Agreement between the clinical Oxfordshire Community Stroke Project classification and CT findings in Poland

The Oxfordshire Community Stroke Project (OCSP) classification provides a simple means of classifying the clinical syndromes associated with acute stroke. The validity of the classification can depend on many factors. Accuracy and time of the clinical and radiological examination are very important. It was used in the International Stroke Trial (IST). The study was conducted in 467 hospitals in 34 countries. Our aim was to assess how well the OCSP classification could predict infarct site and size on computed tomography (CT) scan when performed in a trial within 48 h after the onset of stroke and the clinical assessment was carried out by different doctors in different hospitals. We examined data on the patients randomized in the IST by the seven participating hospitals in Poland. Patients admitted to the hospital were examined by the doctor on duty. Eight aspects of the neurological deficit present just before randomization were recorded. The computer system in the randomization centre employed a validated algorithm to assign the patient to one of the four infarct syndromes: lacunar syndrome (LACS), partial anterior circulation syndrome (PACS), total anterior circulation syndrome (TACS) and posterior circulation syndrome (POCS). We assessed the localization and extent of the recent infarction on available CT scans and correlated these with the computer-assigned OCSP category. CT scans were available for 558/759 (74%) of the patients randomized in Poland. In 458 (82%) of cases, CT was carried out in the first 24 h after the onset of stroke. In 444 (80%) scans, a recent infarct was visible. These radiological lesions were appropriate to the clinical classification in 56% of patients with TACS, 73% with PACS, 61% with LACS and 59% with POCS. In Polish centres in IST, amongst the patients with infarction visible on CT, the OCSP subtype predicted the size and site of the infarct in about two-thirds of cases. These data suggest that, provided its limitations are taken into account, the classification can be usefully applied in multicentre clinical trials (or epidemiological studies) and to aspects of the routine clinical care of patients with acute stroke.     

Computed tomography in patients with transient ischaemic attacks: when is a transient ischaemic attack not a transient ischaemic attack but a stroke?

Summary In a prospective community-based study, 184 patients with transient ischaemic attacks (TIAs) were identified from a study population of about 105,000 between 1981 and 1986. Computed tomography (CT) was attempted in all those with cerebral ischaemic attacks (n=152, 83%); patients with amaurosis fugax only (n=32, 27%) were not scanned routinely. Scans were obtained in 120 (79%) of those with cerebral attacks and 12 (38%) of those with amaurosis fugax. The scans were reported by a neuroradiologist who was blinded to the patients' clinical features. Of 120 (27% :95% confidence interval 19–35) scans in patients with cerebral attacks, 32 showed a focal area of hypodensity or cortical loss, but in only 14 (12% :95% confidence interval 6–18) was this in an area of the brain appropriate to the patients' symptoms. There were no significant differences in the clinical features, the duration of attacks or the prognosis (i.e, risk of death, stroke or myocardial infarction) of patients with and without ischaemic lesions on CT. It is concluded that patients with clinically definite TIAs who have a presumed ischaemic and appropriately sited lesion on CT should not be re-classified as having had a stroke.     

规范治疗急性脑卒中显著降低患者住院病死率

目的　制定卒中规范治疗方案并观察其在实际操作中对降低卒中病死率的效果。方法　采用多中心病例历史对照。根据循证资料,结合国情,由专家制定急性脑梗死和脑出血规范诊断和治疗方案,内容包括建立卒中单元方案、诊断方案、发病不同时间段治疗方案以及康复和护理方案等。收集全国 30家医院 2002年 7月至 2003年 5月间首次发病 7d内的脑梗死或者脑出血患者,根据预定的统一方案(见附录)进行诊治。以各单位 2001年全年同条件的脑梗死或脑出血患者为对照。两组均随诊 6个月,比较住院期间和随诊 6个月的病死率差别。结果　对照组收集 6967例,治疗组 1115例。与对照组比较,规范治疗明显降低患者的并发症,尤以呼吸道感染率降低比较明显,其中气管插管减少 79 1%, 气管切开减少 80 0%。住院期间患者病死率治疗组为 3 8%, 对照组为10 7%,两组比较差异有统计学意义(P<0 01)。长期效果更为明显, 6个月时患者病死率在治疗组为 0 5%, 对照组 7 1% (P<0 01)。结论　急性脑卒中患者的规范治疗可以降低患者住院期间和短期的病死率。     

急性缺血性卒中NEW-TOAST分型各亚型与血糖的关系

目的 研究急性缺血性卒中NEW-TOAST分型各亚型与血糖的关系。方法 回顾性分析624例住院急性缺血性卒中患者的病史及相关检查结果,按NEW-TOAST分型标准对所有患者进行分型,并对各亚型的血糖水平分布资料进行多分类资料的关联分析,比较各亚型糖代谢异常及糖化血红蛋白异常的频率,然后计算血糖、血压和血脂的优势比（OR）及95％的置信区间(CI)。结果 (1) 624例患者NEW-TOAST分型中,以动脉粥样硬化血栓形成型(AT)为主,小动脉闭塞型(SAO)次之;其中原有糖尿病病史119例(19.1％),新发现糖尿病40例(7.5％),糖调节受损71例(11.4％);(2)AT、SAO患者糖代谢异常及糖化血红蛋白的比例均较高,分别为40.4％、39.7％及48.6％、48.1％;各亚型与高血糖的关联分析,x2=14.83,P=0.020,r=0.152。SAO患者高血糖的OR为1.925,95％ CI 1.392 ～2.664,AT患者与高血糖无明显相关;AT患者高血压的OR为2.874,95％ CI1.957 ～4.222,SAO患者高血压的OR为1.609,95％ CI 1.100 ～1.235;各亚型与高低密度脂蛋白胆固醇(LDL-C)的关联分析,SAO患者高LDL-C的OR为1.419,95％CI1.026 ～ 1.962,AT与高LDL-C无明显相关;(3)各亚型糖代谢异常频率差异的比较：x2=17.79,P=0.000,AT及SAO分别与其他3型相比,均P＜0.05;而各亚型糖化血红蛋白异常频率差异的比较：x2=35.57,P=0.000,两两比较发现,AT与SAO,x2=0.014,P=0.906;AT及SAO分别与其他3型相比,均P＜0.05。结论 急性缺血性卒中NEW-TOAST分型中以AT、SAO所占比例更高;各亚型与血糖水平有关联性,且SAO与血糖关联最为密切;高血压对大小血管均有损伤作用,高LDL-C可能对小血管的损伤较明显。     

Intravenous thrombolysis for acute ischemic stroke: The Malabar experience 2003 to 2008

We report the 5-year experience with thrombolysis in acute ischemic stroke from a tertiary care hospital in the Malabar region of South India. All stroke patients thrombolyzed with intravenous recombinant tissue plasminogen activator (rt-PA) from May 2003 to May 2008 were studied in an open, non-randomized, prospective study. Of 2,308 ischemic stroke patients admitted, 57 patients (2.5%) were thrombolyzed with rt-PA (age range, 35–78 years: 40 males, 17 females). The time from presentation at the hospital to initiation of thrombolysis ranged from 15 to 120 minutes (median 50 minutes). The dose of rt-PA used was from 0.6 mg/kg to 0.9 mg/kg. At 3 months 29 patients (51%) were functionally independent, with a modified Rankin scale score of 2 or less. Seven patients (12%) died within 3 months; one had an intracerebral hemorrhage (1.7%). The benefit of treatment was seen in all stroke subtypes. We have been able to show that intravenous thrombolysis in acute ischemic stroke is safe, effective and feasible in our part of the world.     

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。     

Pure motor stroke as the most frequent lacunar syndrome: A clinical update

Pure motor stroke (PMS), also known as pure motor hemiparesis, is the most common of any lacunar form (between one half and two thirds of cases, depending on the series). In an acute stroke registry, 733 patients presented a lacunar infarct and PMS accounted for 12.7% (n = 342) of all first-ever stroke patients and for 48% of all lacunar syndromes. The posterior limb of the internal capsule, corona radiata, and pons are the most frequent brain topographies. Infarcts in the mesencephalus or medullary pyramid have been exceptionally reported. This present update is focused on the clinical evidence and mechanisms underlying the relationship between PMS and different stroke etiologies.     

脑卒中患者临床神经功能缺损评分标准的信度和效度研究

目的;研究脑卒中患者临床神经功能缺损评分标准的信度和效度。方法：１００例连续住院的急性脑卒中患者,按照“评分标准”和美国国立卫生研究院卒中量表的评分规则进行评定。重测信度,评定者间信度检验用Ｋａｐｐａ相关;内容一致性检验用Ｃｒｏｎｂａｃｈα相关;共同效度用Ｓｐｅａｒｍａｎ相关;预测效度用协方差分析和ｌｏｇｉｓｔｉｃ回归。     

Variability of stroke patients meeting endovascular stroke trial criteria in a non-clinical trial setting

Background

Five randomized trials proving the efficacy and safety of mechanical embolectomy for ischemic stroke within 8 hours used differing radiological methods to select patients. We aimed to evaluate the proportion of patients in clinical practice that would meet radiological criteria for inclusion in these trials.

CT脑灌注与血管造影在急性缺血性脑卒中的临床应用与分析

目的探讨CT脑灌注(CTPI)与血管造影在急性缺血性脑卒中中的临床应用价值。方法选择29例急性缺血性脑卒中患者为研究对象,采用东芝Aquilion 64排CT行头颈部CTA及CTPI检查,观察两者对急性缺血性脑卒中诊断情况,分析CTPI与CTA对急性缺血性脑卒中诊断的一致性。结果①29例患者CT灌注图上发现与临床症状相对应的灌注异常区共25例,阳性率为86.2%(25/29),高于普通CT扫描的27.6%(8/29),差异具有统计学意义(P0.05)。②灌注异常区的CBF、CBV、MTT三组参数值与镜像健侧相比差异有显著统计学意义(P0.05);③CTA血管检查结果发现单纯颈内动脉狭窄5处;单纯颅内动脉狭窄10处;颈内动脉及颅内动脉均狭窄4例。④病例组CTPI联合CTA检查结果比较,病例组存在责任血管的患者CTPI检查阳性率为65.51%(19/29)高于无责任血管者的20.69%(6/29),差异具有统计学意义(P0.05)。结论 CTPI与CTA可以清晰的显示缺血性脑卒中脑内病灶及责任动脉,能够提高更多有价值的信息。