血脂与脑卒中

1脑卒中的现状与危险因素 急性脑血管破裂(脑出血)和阻塞(脑梗死或脑栓塞)引起的疾病统称为脑卒中,是一类危害人们健康的常见病、多发病,其发病率、患病率、致残率、致死率均相当高.在我国,脑卒中是仅次于癌症的第二位致死疾病,每年新发患者＞150万例,现有幸存者＞600万例,其中75%丧失劳动力,40%中度致残,是老年人致残和认知障碍的主要原因.     

应重视老年人首次脑卒中的预防

人口老龄化是人类社会进步的标志和必然趋势。目前,我国老龄人口已超过1.24亿,占总人口的10%,已进入老年型人口国家。脑血管疾病是老年人常见病,患病率高达1788/10万,死亡率为882/10万,高居人口死亡原因的第二位。我国每年新发脑卒中患者>150万,现有脑卒中幸存者600万,其中75%丧失劳动力,40%重度致残,是我国老年人致残和认知功能障碍的主要原因,每年直接或间接经济损失高达数百亿元。高血压、心肌梗死、房颤、糖尿病、高脂血病,无症状性颈动脉狭窄以及不良生活方式,包括吸烟,酗酒等均被认为是老年脑卒中可能的危险因素,与脑卒中的发生密切相…     

脑血管反应性降低与缺血性脑卒中的关系

缺血性脑卒中具有高病发率、高致残率、高病死率、高复发率及高医疗费用的特点，但到目前为止，对其真正有效的治疗手段仍很有限，因此寻找缺血性脑卒中的危险因素并及早进行预测、预防就显得格外重要。除了已知的众多危险因素如高血压、糖尿病、血脂异常、冠心病、吸烟、脑卒中家族史及老龄等之外，还有一些危险因素尚待发现。随着研究的不断深入，脑血管反应性降低在缺血性脑卒中发病、发展中的作用逐渐被证实，但尚未引起大家的足够重视，国内的相关研究更为少见。     

颈动脉狭窄与缺血性脑卒中的相关性研究进展

1概述 脑卒中占据美国死亡榜的第3位（仅次于心脏病和癌症），也是最常见的致死、长期致残和住院的原因之一。每年有近100万脑卒中相关事件发生，包括70万新的或复发的脑卒中。医疗费用巨大，估计2006年脑卒中的直接和间接费用约579亿美元。     

老年人群脑卒中现患率及危险因素调查

目的　探讨脑卒中的现患率及相关危险因素。方法　北京万寿路地区脑卒中患者现况调查 ,对老年人群进行整群抽样 ,总调查人数 2 12 4人 ,调查结果进行统计学分析。结果　被调查老年人群脑卒中现患率为 16 .31% ,logistic回归分析显示与脑卒中有显著相关的因素包括 :高血压病、冠心病、短暂性脑缺血发作病史、饮酒。结论　被调查人群脑卒中现患率较高 ,相关危险因素包括高血压病、冠心病、短暂性脑缺血发作病史等。     

CD14基因启动子区多态性与缺血性脑卒中及血脂的相关分析

目的探讨CD14基因启动子-159C/T-、260C/T多态性与缺血性脑卒中的相关性,并对其与血脂、脂蛋白水平的关系进行分析。方法应用PCR-RFLP的方法检测132例缺血性脑卒中患者(缺血性脑卒中组)和145例对照组的CD14基因型;同时按常规方法测定血浆脂质、脂蛋白水平。结果缺血性脑卒中组总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平明显高于对照组(P<0.05),CD14基因-159C/T多态性在两组人群中的分布差异有显著性意义(P<0.05),等位基因频率的相对风险分析发现,C等位基因携带者患缺血性脑卒中的风险是T等位基因的1.556倍(OR=1.556,95%CI:1.108~2.184),携带C等位基因的缺血性脑卒中个体血浆低密度脂蛋白胆固醇水平显著高于不携带者(P<0.05)。结论CD14基因-159C/T多态性与缺血性脑卒中的发病具有相关性,其中C等位基因是缺血性脑卒中的遗传危险因素;CD14基因-159C/T多态性可能通过影响血脂水平而影响缺血性脑卒中的发生。     

社区卫生服务机构就诊的缺血性脑卒中患者抑郁患病率及影响因素

目的 调查社区卒中患者卒中后抑郁(PSD)的患病率及其相关影响因素. 方法在北京市城区选择五家二级医院所属社区卫生服务中心,登记2003年1月至2006年12就诊的缺血性脑卒中患者.采用抑郁自评量表(SDS)评价脑卒中患者PSD患病情况,同时还收集了脑卒中起病情况、脑卒中危险因素等资料. 结果共登记1089例脑卒中患者,其中1074例符合入选标准并有完整资料,平均年龄(65.0±8.9)岁,脑卒中病程中位数为13.0个月.PSD总患病率为49.9%(536/1074),其中轻、中、重度PSD分别占52.2%、36.0%和11.8%.不同脑卒中病程的PSD患病率差别不大,脑卒中后6个月内、7～18个月、18个月以上的PSD患病率分别是51.3%、47.1%和53.2%.PSD患病与文化程度、日常生活依赖、认知功能情况、脑卒中发作次数、文化程度独立相关. 结论在社区卫生服务机构就诊的缺血性脑卒中患者中有较高的PSD患病率,但是以轻中度为主,积极采取有效的早期干预,可以有效控制PSD的发生和发展,促进患者神经功能的康复,改善预后,提高生活质量.

Abstract：

Objective To estimate the prevalence and related risk factors of post-stroke depression (PSD) in ischemic stroke survivors from community-based medical centers in urban areas of Beijing.Methods Five community-based medical centers in urban areas of Beijing were selected.Patients with first-ever or recurrent ischemic stroke were evaluated from January 2003 to December 2006. The prevalence of PSD was evaluated by Self-Rating Depression Scale (SDS), and the information on the onset of stroke, vascular risk factors and living style was also collected.Results Totally 1089 stroke patients were registered, 1074 cases among which had complete information and met inclusion criteria. The mean age of the patients was (65.0 ± 8.9) years with a median stroke course of 13.0 months. The overall prevalence of PSD was 49.9% (536/1074), and the proportions of mild, moderate and major PSD were 52.2%, 36.0% and 11.8%, respectively. There were no significant differences in prevalence of PSD among different stages of stroke and the prevalence of PSD was 51.3% within 6 months after stroke onset, 47. 1% during 6-18 months and 53.2% after 18months. Low education, activities of Daily Living (ADL) dependence, cognition impairment and recurrence of stroke were independent risk factors for PSD.Conclusions The prevalence of PSD among ischemic stroke patients is higher in community-based medical centers, but most of PSD patients are mild or moderate. More effective early intervention should be adopted to decrease PSD,promote the recovery of neural function and improve their quality of life.     

陕北地区非瓣膜病性心房颤动患者缺血性脑卒中的多因素分析

目的：对陕北地区非瓣膜病性心房颤动患者缺血性脑卒中的危险因素进行多因素临床分析。方法：选择非瓣膜性心房颤动患者551例为研究对象,分为非瓣膜病性心房颤动组（432例）及非瓣膜病性心房颤动伴缺血性脑卒中组（119例）。将收集到的各项临床及辅助检查资料先进行单因素分析,再将单因素分析中具有显著性差异的因子进行多因素Logistic回归分析,得出危险因素,建立回归方程。结果：非瓣膜病性房颤患者发生脑卒中的独立危险因素为：年龄（〉60岁）,房颤病程（〉1年）,左房附壁血栓,血浆凝血酶原时间国际标准化比值（INR）降低,高敏C反应蛋白（hsCRP）水平升高,P均〈0.05。建立了预测非瓣膜病性心房颤动患者脑卒中发生概率的Logistic回归方程。工作特征曲线（ROC）显示年龄（〉60岁）,房颤病程（〉1年）,hsCRP水平升高有一定预测价值（曲线下面积均〉0.7）;左房附壁血栓,INR降低预测价值较高（曲线下面积均〉0.9）。结论：本研究所探讨出的危险因素及回归方程对于非瓣膜病性房颤伴缺血性脑卒中高危患者的筛选及早期的一级预防有一定的指导意义。     

缺血性脑卒中的预防

过去的世纪,医学在为延长生命而拼搏。血栓病是人类的第一天敌,包括心肌梗死和脑梗死。过去的10年,心肌梗死病死率下降1/3;脑梗死病死率下降1/4。然而,我国在步入老龄化社会的同时,脑梗死的发病率呈上升趋势,发病年龄也趋于年轻化。2005年11月WHO统计公布全球脑卒中死亡人数为5     

缺血性脑卒中病因分型与临床分型的关系

目的探讨缺血性脑卒中急性期的病因分型与临床分型是否有关。方法回顾性调查急性缺血性脑卒中患者226例,分别在急性期行临床分型,和完善辅助检查后行病因分型,通过统计学处理了解二者是否相关。结果早期的临床分型与病因分型有关(P=0.012),其中,完全前循环梗死中有44.12%的患者具有颅内大动脉的异常,而腔隙性梗死中病因为小动脉闭塞的占48.72%,未发现部分前循环梗死与病因的明确关系。结论缺血性脑卒中急性期的临床分型能部分预示病因,指导临床诊治。     

Effects of simvastatin on lipid levels and platelet activation in elderly patients with hypercholesterolemia

Background and Objective To investigate the effects of simvastatin on lipid lowering therapy and platelet activation in elderly patients with hypercholesterolemia. Methods Fasting serum lipids, CD63, CD41a, serum glucose, hepatic and renal function, routine urine analysis (UA) were measured in 50 healthy subjects, and in 50 elderly patients with hypercholesterolemia before and after 4 weeks treatment with simvastatin (20mg daily for 4 weeks). Results 1. After simvastatin treatment for 4 weeks, the fasting serum level of lipids in elderly patients with hypercholesterolemia was significantly lower than before treatment (P<0.01). 2. CD63 and CD41a were decreased after treatment compared with before, respectively (1.36 0.34) vs (4.26 1.06), (P<0.01) and (123.54 19.73) vs (253.78 16.75), (P<0.01). 3. Changes in serum lipid level tended to be positively correlated with the declines in CD63 and CD41a, but there was no statistical significance (P>0.05). Conclusions The results suggested that lipid lowering therapy with simvastatin inhibit platelet activity.(J Geriatr Cardiol 2007;4:215-217.)     

Rapid effects of simvastatin on lipid profile and C-reactive protein in patients with hypercholesterolemia

BACKGROUND: Rapid lowering of low-density lipoprotein (LDL) cholesterol levels as well as C-reactive protein (CRP) by administration of drugs may produce early benefit to the coronary endothelium in patients with coronary heart disease and reduce angina and coronary events after revascularization. Limited information has been available in evaluating a potentially effective first 2-week therapeutic approach for the treatment of patients with hypercholesterolemia using a statin. HYPOTHESIS: The study was undertaken to investigate whether a rapid LDL cholesterol and CRP reduction can be achieved by 2-week simvastatin therapy using a common lipid-lowering protocol in patients with hypercholesterolemia. METHODS: Forty-two patients were randomly assigned to 20 or 40 mg/day of simvastatin. Blood samples were drawn at Day 0 and at Day 14 for measuring lipid profile, CRP levels, and hepatic enzymes in all patients. RESULTS: The results showed that both doses of simvastatin (20 and 40 mg) induced significant reductions in total cholesterol (TC, 25 and 38%) and LDL cholesterol (31 and 46%) compared with baseline. However, the highest dose of simvastatin (40 mg) resulted in significantly greater reductions in TC and LDL cholesterol (p = 0.04, p = 0.02, respectively) compared with the group receiving 20 mg (p < 0.04, p < 0.02, respectively). A less significant reduction was observed in mean triglycerides (TG) level (16 and 25%) compared with TC and LDL cholesterol. There was no significant difference in mean high-density lipoprotein (HDL) cholesterol levels compared with baseline in either group. In addition, both doses of simvastatin induced significant reductions in mean CRP levels on Day 14 (22.3 and 23.1%) in a non dose-dependent manner (p < 0.001, respectively. CONCLUSIONS: Our data suggest that a common daily dose of simvastatin, especially 40 mg, is an effective 2-week therapy for patients with hypercholesterolemia, and benefit to the vascular endothelium can be derived quickly by reduction of CRP levels.     

辛伐他汀对原发性高胆固醇血症患者血管内皮功能的影响

目的探讨辛伐他汀对原发性高胆固醇血症患者血管内皮功能的影响。方法选择原发性高胆固醇血症患者48例口服辛伐他汀,分别于治疗前、治疗后4周和8周进行血浆内皮素-1（ET-1）、血清一氧化氮（NO）和血脂等指标测定;另选15例健康体检者为对照。结果治疗前高胆固醇血症患者组血浆ET-1显著高于对照组（P<0.05）,而NO显著低于对照组（P<0.01）;辛伐他汀治疗4周后,ET-1、胆固醇、低密度脂蛋白、三酰甘油均显著降低（P<0.01）,NO显著升高（P<0.05）,高密度脂蛋白虽亦升高,但无统计学意义;8周后血浆ET-1继续降低,血清NO继续升高,但两者与健康对照组比较,无统计学意义。结论高胆固醇血症患者存在明显的内皮功能损害;辛伐他汀不仅能够显著降低血脂,而且能够改善血管内皮功能。     

2103例脑卒中登记患者发病危险因素分析

目的评价我院脑卒中单元运行以来登记的连续住院的脑卒中患者发病危险因素的构成情况。方法选择2005年5月~2007年4月在我院连续登记住院的脑卒中患者2103例,其中脑梗死1 568例,脑出血311例,短暂性脑缺血发作190例,蛛网膜下腔出血34例,对已知危险因素进行统计学分析。结果在所有类型脑卒中患者中,高血压的发生率排序第一,是各类脑卒中最重要的危险因素。吸烟是排序第二位的危险因素。不同性别脑卒中患者危险因素的构成情况有所不同,男性患者中吸烟和酗酒的比例高于女性患者,而女性患者中血脂异常和肥胖的比例高于男性患者。心房颤动患者更容易发生前循环栓塞。男性患者发生脑动脉狭窄的概率高于女性患者。结论降压治疗仍是脑卒中一级预防和二级预防的重点工作。应当重视提倡健康的生活方式,有针对性地进行个体化的健康教育。     

Treatment of hypercholesterolemia with the HMG CoA reductase inhibitor,simvastatin

Summary We report the results of a two center study on the use of the HMG Co A reductase inhibitor, simvastatin, in 44 patients suffering from familial hypercholesterolemia or from primary hypercholesterolemia of unknown etiology. The study included two separate phases: Phase I was part of a multicenter, 4-week, placebo-controlled trial; phase II was a 6-month, open extension trial, the object of which was to reduce low density lipoprotein (LDL) cholesterol levels to below the 50th percentile by increasing the dose of simvastatin, by the use of additional lipid-lowering medication, or both. Our phase I results were commensurate with those reported for the entire international cohort of 272 patients, indicating a clear dose-response relationship, with approximately 75% of the maximum reduction in LDL-C levels being achieved with 20 mg/day and over 90% of the maximum being achieved with 40 mg of simvastatin per day. In the open extension trial, the results from the 2 centers were essentially similar. Total cholesterol fell by 29% on the 20 mg/day dose and by 34% on the full dose of 40 mg/day. LDL-C levels were reduced by 40% on the 40 mg/day schedule, and triglycerides also fell to between 20% and 40% below baseline values. HDL-C concentration rose by 14% and 17.6%. The effects of simvastatin were uniform, both within and between the two cohorts. The addition of cholestyramine caused a further substantial reduction in LDL-cholesterol to below 55% of the initial value in four patients, whereas bezafibrate further enhanced the fall in triglycerides and the increase in high-density lipoprotein cholesterol, but had only a slight effect on LDL-C levels. Adverse reactions included asymptomatic increases in plasma creatine kinase activity, generally associated with previous physical exertion, and transient rises in transaminase levels. In one patient with a history of alcoholic excess, transaminase levels were persistently greater than normal. These results indicate that the HMG Co A reductase inhibitor, simvastatin, is a powerful therapeutic agent for the lowering of plasma cholesterol levels in patients with genetic hypercholesterolemia.     

缺血性脑卒中患者G蛋白β3亚单位基因C825T多态性及相关危险因素的研究

目的　观察缺血性脑卒中患者G蛋白 β 3亚单位基因 (GNB3)C82 5T多态性和相关危险因素 ,探讨遗传和环境相互作用在缺血性脑卒中发病机制中的作用。方法　急性缺血性脑卒中患者 72例 ,并按性别、年龄配对设对照组。用聚合酶链反应 (PCR)方法扩增目的基因 ,用限制性内切酶 (BseDI)酶切PCR产物用于基因分型 ,同时观察血压、体重指数、饮酒、膳食、性格等。结果　脑卒中组GNB3C82 5T基因型分布 (基因型频率CC =0 .32 ,CT =0 .5 8,TT=0 .10 )与对照组比较 ,差异有显著性意义 (基因型频率CC =0 .6 5 ,CT =0 .32 ,TT =0 .0 3;χ2 =14 .6 ,P <0 .0 1) ,但在脑卒中患者中有或无原发性高血压亚组之间基因型分布无差异。logistic回归分析显示 ,与脑卒中发病有关联的是收缩压 (SBP)、GNB382 5T等位基因、饮酒和空腹血糖 (FPG)升高。结论　SBP、FPG增高、饮酒和GNB3C82 5T多态性的T等位基因可能是缺血性脑卒中发病的危险因素 ,GNB382 5T等位基因对脑卒中的影响不依赖于血压、饮酒等其他危险因素 ,可能是缺血性脑卒中的独立危险因子。     

Effect of simvastatin on high density lipoprotein subfractions and apolipoproteins in Type IIa hypercholesterolemia

Summary Changes in plasma concentrations of high density lipoproteins (HDL) and triglycerides may partly explain the ability of cholesterol-lowering drugs to decrease the incidence of coronary heart disease. We measured the response of fasting plasma lipids, lipoproteins, and apolipoproteins in 46 subjects with Type IIa hypercholesterolemia treated with simvastatin for 3 months. The initial dose of simvastatin (10 mg/day) was subsequently increased up to 40 mg/day if the plasma cholesterol concentration had not fallen below 5.2 mmol/l. Plasma concentrations of HDL cholesterol and of the apolipoproteins AI and AII were increased by simvastatin. The increase in HDL cholesterol (9%) was due to increases in both subfractions (HDL₂ 17%; HDL₃ 7%), changes that would be consistent with a beneficial effect on cardiovascular risk. Simvastatin decreased plasma triglyceride concentrations by 25%. Plasma total cholesterol concentrations fell by 35% after 3 months of treatment; this fall was proportional to the initial concentration and was due almost entirely to a 45% fall in low density lipoprotein cholesterol. In contrast, plasma concentrations of lipoprotein Lp(a) were not affected by simvastatin.     

北京高血压患者脑卒中后相关危险因素的调查

目的探讨北京高血压患者脑卒中后的相关危险因素。方法采用横断面流行病学调查的方法对北京地区5005例脑卒中高危人群进行调查分析,根据是否发生脑卒中将其分为卒中组(1076例)和非卒中组(3929例)。记录已往危险因素和靶器官损害情况,包括血压、血糖、血脂、家族史、颈动脉病变和左心室肥厚等指标。结果卒中组患者血压、血脂治疗达标率明显低于非卒中组患者(40.6%vs51.5%,P=0.007;44.7%vs59.9%,P=0.001);卒中组患者糖化血红蛋白治疗达标率低于非卒中组患者,但两组之间无显著性差异(42.4%vs48.8%,P=0.124)。卒中组患者的颈动脉内膜中层厚度明显高于非卒中组患者[(1.18±0.36)mmvs(1.10±0.31)mm,P=0.036],左心室肥厚的患者也明显高于后者(21.3%vs25.8%,P=0.001)。患者血压控制是否达标、糖化血红蛋白是否达标、心房颤动、心脑血管疾病家族史是脑卒中发生的相关危险因素。结论高血压患者脑卒中后相关危险因素的治疗仍有部分未达标,积极控制危险因素有利于脑卒中的一级和二级预防。