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。     

脑梗死患者颈动脉粥样硬化的危险因素分析

目的探讨急性脑梗死患者颈动脉粥样硬化的危险因素以及影响斑块稳定性的因素。方法入选2005~2006年间住院的急性脑梗死患者644例,超声检查其颈动脉内膜-中层厚度(intima-media thickness,IMT)及颈动脉斑块情况,并与血管性危险因素和代谢因素进行相关分析。结果年龄、吸烟、糖尿病史、收缩压、总胆固醇及血清尿酸增高与颈动脉IMT增厚存在独立相关性,而年龄、收缩压、总胆固醇及脂蛋白(a)增高则可独立预测颈动脉斑块的形成。性别、高血压史、总胆固醇及高密度脂蛋白和颈动脉斑块的稳定性之间存在独立相关性。结论年龄、吸烟、糖尿病史、收缩压、总胆固醇、脂蛋白(a)及血清尿酸增高可独立预测颈动脉粥样硬化。     

高血糖对急性缺血性卒中早期预后影响的初步研究

目的 探讨高血糖对急性缺血性卒中早期预后的影响。方法 采用前瞻性研究设计,连续纳入发病72h内入院的急性缺血性卒中患者143例。急诊入院时检测入院随机静脉血清血糖,高血糖定义为入院随机静脉血清血糖≥7.2mmol/L。入院时评定美国国立卫生研究院卒中量表（NIH Stroke Scale,NIHSS）评分,根据病史及辅助检查确定缺血性卒中类型（TOAST分型）。发病30d时进行改良Rankin’s评分（mRS）,作为评估早期预后的指标。结果 （1）本研究入选的143例急性缺血性卒中患者中,85例（59.4%）出现高血糖,单因素分析显示,年龄、糖尿病史、NIHSS评分是急性缺血性卒中合并高血糖的危险因素（P＜0.05）,logistic回归分析显示,糖尿病史、NIHSS评分是急性缺血性卒中合并高血糖的独立危险因素（P＜0.05）。（2）单因素分析显示,年龄、感染、高血糖、NIHSS评分和TOAST分型对mRS评分的影响有统计学差异（P＜0.05）,logistic回归分析显示,高血糖、NIHSS评分是预后不良的独立危险因素（P＜0.05）。结论 高血糖在急性缺血性卒中患者中的发生率较高,其出现与卒中的严重程度密切相关,可以作为反映急性缺血性卒中发病时病情较重的指标之一,高血糖是急性缺血性卒中早期预后不良的独立危险因素。     

Risk Factors for Pressure Sores in Hospitalized Acute Ischemic Stroke Patients

BackgroundAcute ischemic stroke patients are a group at high risk for pressure sores. It is important to identify risk factors for pressure sores in acute ischemic stroke patients in order to facilitate early adoption of appropriate preventive and treatment measures.MethodsData were derived from the China National Stroke Registry. Acute ischemic stroke patients aged >18 years who presented at the hospital within 14 days after the onset of symptoms were eligible for this study. Comprehensive baseline data were collected. The definition of pressure sores was based on assessment at discharge of whether the patient had pressure sores at any time during hospitalization.Results12,415 patients with a mean age of 67 years and a mean length of hospitalization of 14 days were included in the study. Among these patients, 97 (0.8%) had pressure sores during hospitalization. In the multivariate analysis of risk factors for pressure sores, age (each increment of 5 years), being unmarried, NIHSS at admission (each increment of 3 points), mRS at admission (3-5 points), diabetes mellitus, hemoglobin at admission (each incremental reduction of 10 units), and history of peripheral vascular disease all were significantly correlated with the occurrence of pressure sores among acute ischemic stroke patients during hospitalization.ConclusionsOld age, severe neurological disability, being unmarried, low hemoglobin, and history of diabetes mellitus and peripheral vascular disease were risk factors for pressure sores in acute ischemic stroke patients.     

Acute ischemic stroke and transient ischemic attack in the very old – risk factor profile and stroke subtype between patients older than 80 years and patients aged less than 80 years

Old age groups have different risk profile and stroke features compared to younger groups. Our aim was to examine the risk factor profile and stroke subtype in patients older than 80 years with ischemic stroke. Data of 535 patients with ischemic stroke or transient ischemic attack (TIA) were prospectively recorded. Cardiovascular risk factors and stroke subtype in individuals aged 80 years or older were compared with patients under 80. Of 535 patients a total of 179 were over 80 years (33.5%). The mean age was 84.4 ± 4.4 years (61.8%; 111 women). The most common risk factors included hypertension (82.7%) and hyperlipidemia (40.2%). Lacunar stroke was the most frequent subtype of stroke (41.7%). When the groups were compared, we observed the following risk factors more frequently in the group older than 80: female patients ( P  = <0.001), hypertension (OR = 1.62), atrial fibrillation (OR = 2.64); whereas diabetes (OR = 0.54), hyperlipidemia (OR = 0.57), smoking (OR = 0.17) and obesity (OR = 0.58) were more frequent in the group younger than 80. In the old group we found a high incidence of ischemic stroke in women. We also found a higher frequency of hypertension and atrial fibrillation. The available and future epidemiological data will provide a better knowledge about the effect of typical risk factors in old people.     

High prevalence of unrecognized cerebral infarcts in first-ever stroke patients with cardioembolic sources

Background:  With magnetic resonance imaging (MRI) analysis, we investigated the prevalence, clinical significance, and factors related to the presence of unrecognized cerebral infarcts in patients with first-ever ischaemic stroke.
Methods:  We consecutively included patients who were admitted with first-ever stroke. Unrecognized cerebral infarct was defined as an ischaemic infarction or primary intracerebral hemorrhage on MRI irrelevant to the index stroke, without acute lesions on diffusion-weighted image.
Results:  Of the total 203 patients, 78 (39.4%) patients were observed as having unrecognized cerebral infarct. Patients with high-risk cardioembolic sources (e.g., atrial fibrillation) more frequently had unrecognized stroke than those without ( P  = 0.008, 21/36 [58.3%] vs. 57/167 [34.1%]). On univariate analysis, male sex ( P  = 0.027) and cardioembolic source ( P  = 0.008) were associated with the presence of unrecognized cerebral infarcts. After adjustment for gender, age and risk factors, the presence of cardioembolic sources independently increased the risk of unrecognized cerebral infarct ( P  = 0.002, odds ratio 3.56, 95% confidence interval 1.58–8.02). Regarding clinical outcome at 3 months, the presence of unrecognized cerebral infarct was not associated with the poor clinical outcome.
Conclusion:  In our study, the presence of cardioembolic sources was an independent risk factor for the unrecognized cerebral infarct in patients with first-ever stroke.     

Vascular adhesion protein-1 in human ischaemic stroke

Aims: Leukocyte extravasation exacerbates tissue injury after ischaemic stroke. Vascular adhesion protein-1 (VAP-1) is an endothelial adhesion molecule with the potential capacity to guide transmigration of inflammatory cells into ischaemic brain. Moreover, VAP-1 could worsen ischaemic brain injury due to its function as a semicarbazide-sensitive amine oxidase (SSAO) producing toxic metabolites from primary amines. The purpose of this study was to elucidate these aspects of VAP-1-function in the pathogenesis of human ischaemic stroke. Methods: We studied VAP-1 expression in infarcted and control brains post mortem using immunohistochemistry. Levels of soluble VAP-1 (sVAP-1) in the serum of patients with acute stroke and in control sera were determined using enzyme-linked immunosorbent assay. Results: In the acute phase of ischaemic stroke, the frequency of VAP-1-stained vessels was strongly diminished in the ipsilateral hemisphere but in the contralateral hemisphere it was comparable with the expression in the control brains. In the serum of acute stroke patients with a symptom duration <6 h the level of sVAP-1 was significantly increased (652 ± 224 ng/ml; mean ± SD) when compared with an age- and sex-matched control group (542 ± 104 ng/ml; P  < 0.05). Conclusions: As both cell surface and sVAP-1 possess vasculopathy-promoting SSAO enzymatic activity, our results imply that by inducing SSAO-derived toxic metabolites, VAP-1 might aggravate ischaemic vascular changes. The subsequent release of sVAP-1 into circulation could be further examined as a potential marker of early ischaemic vasculopathy.     

Prevalence and risk factors of middle cerebral artery stenosis in asymptomatic residents in Rongqi County, Guangdong

BACKGROUNDS: Intracranial atherosclerosis is the commonest vascular lesion for ischemic stroke in Asians. Most research on risk factors for middle cerebral artery (MCA) stenosis has been conducted in symptomatic patients with ischemic stroke or transient ischemic attack. The present study aimed to investigate risk factors for MCA stenosis in an asymptomatic population in Rongqi County in Southern China. METHODS: We assessed 1,068 asymptomatic subjects over 50 years of age by transcranial Doppler. Medical history documentation and investigation of biochemical markers were performed for each subject. Multivariant, unconditioned, logistic regression analyses were employed to assess the risk factors associated with MCA stenosis. RESULTS: MCA stenosis was found in 63 subjects (5.9%). Male gender, advancing age, hypertension, diabetes and systolic blood pressure were significant risk factors for MCA stenosis (p < 0.001). Based on logistic regression analyses, 4 factors emerged as independent risk factors (p < 0.001) of MCA stenosis: male gender [95% confidence interval (CI) = 1.49-4.66, OR = 2.63], age (95% CI = 1.01-1.06, OR = 1.04), hypertension (95% CI = 4.57-18.35, OR = 9.16) and diabetes mellitus (95% CI = 3.09-11.29, OR = 5.9). CONCLUSION: MCA stenosis is relatively common among asymptomatic Chinese subjects. Male gender, advanced age, hypertension and diabetes mellitus are risk factors for MCA stenosis.     

缺血性卒中患者吞咽障碍危险因素的meta分析

目的 系统分析缺血性卒中患者发生吞咽障碍的危险因素。 方法 计算机检索Cochrane Library、PubMed、Embase、Web of Science、中国知网、万方、维普等数据库, 检索建库至2020年2月关于缺血性卒中患者发生吞咽障碍危险因素的文献。采用纽卡斯尔-渥太华量 表对文献质量进行评价,纳入该量表≥7分的文献。采用RevMan 5.3软件进行meta分析,先对各影响 因素进行异质性评估,如无异质性,采用固定效应模型分析;如存在异质性,则采用随机效应模型分 析,计算各影响因素的合并MD 值或OR 值及95%CI。 结果 共纳入9篇文献,合计样本量为4095例,其中发生吞咽障碍患者981例（23.96%）。经 m eta分析结果显示,年龄（MD 4.98,95%CI 3.84～6.11,P ＜0.001）、高血压（OR 2.21,95%CI 1.44～3.38,P ＜0.001）、糖尿病（OR 1.79,95%CI 1.36～2.36,P＜0.001）、脑干卒中（OR 2.07, 95%CI 1.31～3.26,P =0.002）是缺血性卒中患者发生吞咽障碍的独立危险因素。 结论 对于缺血性卒中患者,年龄增长、高血压、糖尿病及脑干卒中是发生吞咽障碍的独立危险 因素,临床中应注意评估和早期干预吞咽障碍的危险因素。     

Prevalence and vascular risk factors of basal ganglia calcifications in patients at risk for cerebrovascular disease

Background and purposeRisk factors for and meaning of basal ganglia calcifications outside Fahr syndrome are poorly understood. We aimed to assess the prevalence of basal ganglia calcifications and the association with vascular risk factors.Materials and methods1133 patients suspected of acute ischemic stroke from the Dutch acute stroke (DUST) study who underwent thin-slice unenhanced brain CT were analyzed. Basal ganglia calcifications were scored bilaterally as absent, mild (dot), moderate (multiple dots or single artery) and severe (confluent). Uni- and multivariable logistic regression analysis was used to determine possible risk factors (age, gender, history of stroke, smoking, hypertension, diabetes mellitus, hyperlipidemia, body mass index (BMI), renal function and family history of cardiovascular disease under 60 years) for presence of basal ganglia calcifications and ordinal regression analysis for severity of basal ganglia calcifications.ResultsMean age was 67.4 years (SD: 13.8), 56.8% were male. 337 (29.7%) patients had basal ganglia calcifications, of which 196 (58%) were mild, 103 (31%) moderate, 38 (11%) severe. In multivariable logistic regression analysis, age (OR: 1.02, 95% CI 1.01–1.03, P < 0.01) and BMI (OR: 0.95, 95% CI 0.91–0.98, p 0.01) were significantly associated with the presence of basal ganglia calcifications. Ordinal regression analysis gave comparable results. Age (OR: 1.02, 95% CI 1.01–1.03, P < 0.01) and BMI (OR: 0.95, 95% CI 0.92–0.99, P 0.01) were significantly associated with severity of basal ganglia calcifications.ConclusionsIn this study with patients suspected of acute ischemic stroke, basal ganglia calcifications were common and significantly associated with older age and lower BMI.     

Respiratory infectious complications after acute ischemic stroke]

BACKGROUND AND PURPOSE: Respiratory infection is a frequent complication in acute ischemic stroke, but it seems to have been made light of in stroke care. The purpose of this study is to examine the clinical characteristics of respiratory infectious complications in patients with acute ischemic stroke. METHOD: Two-hundred and fifty-eight consecutive patients (158 men, 100 women, 70.6 +/- 12.9 years old) with acute ischemic stroke were admitted to our hospitals between May and October in 1999. Age, gender, history of stroke, the severity of stroke on admission, stroke subtype (lacunar brain infarction, atherothrombotic brain infarction, cardioembolic brain infarction, and others), aspiration, naso-gastric tube feeding, vascular risk factors, the length of hospital stay and outcome of patients were noted. We compared them between patients with and without respiratory infections. RESULTS: Forty-five (17.4%) patients were developed respiratory infections. Cardioembolic stroke patients were more frequently developed respiratory infections (67%) compared with other stroke subtypes. The independent risk factors for respiratory infectious complications by multiple logistic regression model were the aspiration (OR, 5.513; 95% CI, 1.793-16.946) and the severity of stroke on admission (OR, 1.090; 95% CI, 1.034-1.150). Mortality of patients with respiratory infectious complications was as high as 24%, and all survivors discharged to another hospital. After adjustment for age and the severity of stroke, respiratory infection was one of the independent risk factors of poor stroke outcome (OR, 5.838; 95% CI, 1.792-19.018). CONCLUSION: Aspiration and the severity of stroke independently predict development of respiratory infectious complication in acute ischemic stroke. Respiratory infections may make worse their stroke outcome. A measure to infectious complications and aspiration needs to be taken for the patients suffering from severe ischemic stroke.     

Predictors of Recurrent Ischemic Stroke in Patients with Embolic Strokes of Undetermined Source and Effects of Rivaroxaban Versus Aspirin According to Risk Status: The NAVIGATE ESUS Trial

Background: Embolic stroke of undetermined source (ESUS) identifies patients with cryptogenic ischemic stroke presumed due to embolism from several unidentified sources. Among patients with recent ESUS, we sought to determine independent predictors of recurrent ischemic stroke during treatment with aspirin or rivaroxaban and to assess the relative effects of these treatments according to risk. Methods: Exploratory analyses of 7213 participants in the NAVIGATE ESUS international trial who were randomized to aspirin 100 mg/day or rivaroxaban 15 mg/day and followed for a median of 11 months, during which time there were 309 first recurrent ischemic strokes (4.6% per year). Baseline features were correlated with recurrent stroke by multivariate analysis. Results: The 7 independent predictors of recurrent stroke were stroke or transient ischemic attack (TIA) prior to the qualifying stroke (hazard ratio [HR] 2.03 95% confidence internal [CI] 1.58-2.60), current tobacco user (HR 1.62, 95% CI 1.24-2.12), age (HR 1.02 per year increase, 95%CI 1.01-1.03), diabetes (HR 1.28, 95% CI 1.01-1.64), multiple acute infarcts on neuroimaging (HR 1.49, 95% CI 1.09-2.02), aspirin use prior to qualifying stroke (HR 1.34, 95% CI 1.02-1.70), and time from qualifying stroke to randomization (HR .98, 95% CI .97-.99). The rate of recurrent stroke rate was 2.6% per year for participants without any of these risk factors, and increased by an average of 45% for each independent predictor (P < .001). There were no significant interactions between treatment effects and independent stroke predictors or stroke risk status. Conclusions: In this large cohort of ESUS patients, several features including prior stroke or TIA, advanced age, current tobacco user, multiple acute infarcts on neuroimaging, and diabetes independently identified those with an increased risk of ischemic stroke recurrence. The relative effects of rivaroxaban and aspirin were similar across the spectrum of independent stroke predictors and recurrent stroke risk status.     

Leuko-araiosis and stroke: a case-control study

Objective – Association of leuko-araiosis (LA) with certain risk factors has been reported in Western patients. This is a case-control study to determine the risk factors and the type of stroke associated with LA in Saudi patients. Design and setting - 398 consecutive Saudi patients with the diagnosis of stroke admitted over a 6-year period were evaluated for presence or absence of LA on cranial computed tomography. LA and non-LA groups were compared with regards to the presence of certain risk factors such as type of stroke, age, brain atrophy, systemic hypertension and history of cardiac disease or diabetes mellitus. The odds ratio and its 95% confidence interval (CI) were used to estimate the strength of association between the different parameters. Results – The mean age in the LA group was 67.8±8.5 years as compared to 61.2±13.2 years in the non-LA group. No patient younger than 40 years had LA on CT. Incidence of LA increased with age. Forty-seven percent of the LA group were over 70 years of age compared to 31 % of the non-LA group (OR=2, CI 1.26–3.15). Generalized atrophy was detected in 40% of patients with LA compared to 20% of non-LA group (OR 2.7, CI 1.65–4.39). Sixty-nine percent of patients in the LA group had lacunar infarct compare to 39% in the non-LA group (OR 3.4, CI 2.15–5.59). The difference was not significant between the two groups in relation to the frequency of cerebral hemorrhage or larger infarcts. Systemic hypertension was also significantly associated with the presence of LA (OR 2.15, CI 1.34–3.43). Conclusion – LA is associated mainly with lacunar infarcts, cerebral atrophy, systemic hypertension and advanced age in Saudi patients.     

Silent stroke in a case of beta-thalassemia major associated with chronic renal failure and diabetes mellitus

Severe anemia, growth retardation, diabetes mellitus, cardiac disorders, and, infrequently, stroke are well-known complications of thalassemia major. We report a girl, age 7 years, 2 months, with beta-thalassemia major associated with chronic renal failure, diabetes mellitus, and cardiomyopathy in whom a silent stroke was noted during follow-up. She was diagnosed with thalassemia major at age 6 months, chronic renal failure at age 3 years, 3 months, and diabetes mellitus and cardiomyopathy at age 7 years. Although cranial computed tomography was found to be normal at the age of 3 years, 3 months, magnetic resonance imaging showed cerebral infarct in the right frontal region at 7 years, 2 months. A thrombophilic panel revealed increased factor VIII and decreased protein C concentrations. She died from disseminated intravascular coagulation at age 7 years, 9 months. We did not record any clinical findings of stroke during her follow-up. We think that diabetes mellitus, dilated cardiomyopathy, and increased factor VIII and decreased protein C concentrations led to the occurrence of cerebral infarct. In conclusion, we emphasize that children with thalassemia major should be monitored closely for stroke. We also suggest that stroke can show a silent progression in severely affected children, as in our case.     

Hyperhomocysteinaemia is a significant risk factor for white matter lesions in Japanese type 2 diabetic patients

The presence of white matter lesions (WML) is an important prognostic factor for the development of stroke. Plasma total homocysteine (tHcy), which increases with diabetes, has been flagged as a novel predictor for cerebrovascular events. We tested the hypothesis that the presence of WML correlates with tHcy and insulin resistance in type 2 diabetic patients not receiving insulin treatment. Based on brain magnetic resonance imaging findings, 81 type 2 diabetic patients were divided into two groups, with-WML group (57 ± 8 years, mean ± standard deviation, n  = 31) and without-WML group (57 ± 6 years, n  = 50). The blood glucose level was assessed by fasting plasma glucose (FPG), fasting immunoreactive insulin, Homeostasis Model Assessment (HOMA) Index and hemoglobin A1c. The body mass index was higher in the with-WML group than in the without-WML group ( P  < 0.05). Plasma levels of triglyceride were higher whilst high-density lipoprotein cholesterol was lower in the with-WML group than in the without-WML group ( P  < 0.05 and P  < 0.0001 respectively). FPG ( P  < 0.005), insulin concentrations ( P  < 0.0001), HOMA Index ( P  < 0.0001) and tHcy (<0.0001) levels were higher in the with-WML group than in the without-WML group. Multivariate logistic analysis revealed that WML was independently predicted by the high tHcy and insulin resistance. Our findings indicate that the presence of WML was associated with the high tHcy and insulin resistance in these Japanese patients with type 2 diabetes mellitus.     

脑微出血与不同亚型缺血性脑卒中的关系及预后分析

目的探讨脑微出血(CMBs)与不同亚型缺血性脑卒中的关系及预后。方法收集2014年3月~2016年5月期间就诊我院,并确诊为缺血性脑卒中的患者116例,根据中国缺血性脑卒中亚型(CISS)标准分为5种亚型,即大动脉粥样硬化型卒中(LAA)、心源性卒中(CS)、其他病因型(OE)、穿支动脉疾病型(PAD)和病因不确定型(UE)。每个亚型分为CMBs组和非CMBs组,比较各组血清相关指标,采用Logistic回归分析每种亚型伴CMBs的影响因素,采用NIHSS评分评价每种亚型伴CMBs的预后情况。结果 PAD组同型半胱氨酸(Hcy)水平(23.32±2.79)μmol/L,明显高于LAA(20.64±3.11)μmol/L、CS(20.7±2.63)μmol/L、OE(18.92±2.91)μmol/L和UE(17.63±3.06)μmol/L,差异具有统计学意义(P0.05)。OE组和LAA组糖化血红蛋白(Hb A1)水平(7.60±0.25和7.11±0.32)明显高于CS组(5.03±0.11)、PAD组(5.10±0.11)和UE组(4.99±0.12),差异具有统计学意义(P0.05);而OE和LAA两组间、CS、PAD和UE三组间Hb A1水平差异不明显(P0.05)。长期饮酒是CS和PAD伴CMBs的独立危险因素;Hcy是每种亚型伴CMBs的独立危险因素;Hb A1是PAD、LAA伴CMBs的独立危险因素。结论 Hcy、Hb A1和长期饮酒是缺血性脑卒中伴CMBs的独立危险因素。不同亚型缺血性脑卒中伴CMBs的预后差异不明显。     

Effect of metformin on outcome after acute ischemic stroke in patients with type 2 diabetes mellitus

IntroductionDiabetes mellitus is a well-known risk factor for ischemic stroke and is associated with unfavorable outcome after stroke. Metformin is recommended as first-line treatment in these patients. Pre-stroke metformin use might have neuroprotective properties resulting in reduced stroke severity. However, results of the effects of pre-stroke metformin use on functional outcome are conflicting and has not been previously described in patients with type 2 diabetes mellitus regardless of stroke severity or revascularization treatment. In this study, we aimed to assess the association between metformin use and functional outcome in patients with type 2 diabetes mellitus and acute ischemic stroke.MethodsWe used data from patients with known type 2 diabetes mellitus who were admitted with acute ischemic stroke between 2017 and 2021 in the Isala Hospital Zwolle and Medisch Spectrum Twente (MST) Enschede, the Netherlands. The association between pre-stroke metformin use and favorable functional outcome at 3 months (defined as modified Rankin Scale (mRS) < 3) was expressed as Odds Ratios (ORs) with corresponding confidence intervals (CIs). Adjustments were made for age, sex, hyperglycemia on admission and revascularization treatment by means of multiple logistic regression.ResultsNine hundred thirty seven patients were included of whom 592 patients (63%) used metformin. Six hundred seventy eight (74%) patients were hyperglycemic on admission. Median mRS was 3 (IQR 2–6) and 593 patients (63%) had a favorable outcome. Pre-stroke metformin use was associated with favorable outcome (aOR of 1.94 (95%- CI 1.45–2.59)).ConclusionIn this study, we showed that pre-stroke metformin use was associated with favorable outcome after acute ischemic stroke in patients with diabetes mellitus type 2.     

同型半胱氨酸对高血压患者脑卒中复发风险的影响

目的探讨高血压合并脑卒中患者的血浆同型半胱氨酸（Hcy）水平与其他危险因素对于脑卒中复发的影响。 方法分析徐州市中心医院心内科和徐州医科大学附属医院神经外科自2012年5月至2013年12月收治的1623例高血压脑卒中患者的基线资料，中位随访4.9年，根据随访事件中是否发生脑卒中分为复发组（312例）与未复发组（1311例）。Kaplan-Meier生存分析比较不同危险因素脑卒中复发率的差异，单因素与多因素Cox回归模型分析影响脑卒中复发的独立危险因素，以及危险因素之间的交互作用。 结果复发组年龄、空腹血糖、Lg Hcy的水平，以及糖尿病、房颤的患病率均高于未复发组（P<0.05）。Kaplan-Meier生存分析显示，糖尿病、房颤、年龄≥60岁、空腹血糖≥7.0 mmol/L、Hcy≥15 μmol/L的脑卒中复发率明显升高（Log-rank检验，P<0.05）。多因素Cox回归模型分析显示，高龄、Lg Hcy水平升高，以及房颤、糖尿病是脑卒中复发的独立危险因素。Lg Hcy分别与糖尿病、空腹血糖、年龄存在交互作用。 结论血浆Hcy水平升高既是高血压合并脑卒中患者卒中复发的独立危险因素，又通过与糖尿病、高龄、空腹血糖水平升高的交互作用显著增加脑卒中复发风险。     

Ischemic stroke subtypes: risk factors, functional outcome and recurrence

The etiology of ischemic stroke affects its prognosis, outcome and management. Our aims were to determine risk factors, clinical and imaging variables and prognostic differences in acute ischemic stroke subtypes. In this study, we prospectively investigated 264 consecutive patients with acute ischemic stroke between 1996 and 2000. All of the patients were categorized to one of four major ischemic stroke subtype based on TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. The mean age was greater in patients with stroke of undetermined etiology (SUE). Prevalence of hypertension was higher in patients with lacunar infarct (LAC) than other subtypes. Smoking was less frequent in patients with cardioembolism (CARD). The mean infarct size was largest in patients with large artery atherosclerosis (LAA) while there were no differences in location or conversion of the infarct into hemorrhage. The proportion of the patients with milder neurological deficits at entry was higher in patients with LAC subtype. The rate of independent patients were different between subtypes: 62% in LAC, 43% in CARD, 38% in SUE, 35% in LAA at discharge (p=0.01), and 91% in LAC, 69% in CARD, 59% in SUE, 60% in LAA at 6 months (p<0.001). Recurrence rates were not different between groups. We conclude that risk factors, clinical imaging variables are different among ischemic stroke subtypes and that neurological status on admission and during follow-up strongly favors LAC. Received: 20 June 2001 / Accepted in revised form: 30 October 2001