缺血性卒中并发高钠血症危险因素的分析

目的探讨缺血性卒中患者并发高钠血症的危险因素，为早期干预提供依据。方法回顾性分析连续入院的缺血性卒中患者322例的临床资料。患者入院后1h内采用离子电极法测量血液生化指标。其中高钠血症43例，非高钠血症279例，记录可能影响血钠水平的9项危险因素，进行X^2或t检验，并采用多元Logistic回归分析，筛选出独立的危险因素。终点指标以发病后4周的病死率作为判断。结果缺血性卒中患者并发高钠血症危险因素的多因素分析显示，使用大剂量甘露醇（OR=4．9，95％ CI：2．40-9．71）、大脑中线结构损害（OR=3．9，95％ CI：2．00～7．65）、血糖增高（OR=1．4，95％CI：1．18～1．69）3项因素进入模型（P〈0．05）。高钠血症组4周病死率为67．4％（29／43），明显高于非高钠血症组的17．2％（48／279），两组比较差异有统计学意义（X^2=51．68，P〈0．01）。结论引起高钠血症的主要危险因素是大剂量甘露醇、大脑中线损害和血糖增高。高钠血症患者预后差，生存率低。     

进展性卒中危险因素的临床分析

目的探讨进展性卒中的危险因素。方法回顾性分析进展性卒中78例患者的临床资料,并随机抽取同期住院的非进展性缺血性卒中患者72例作为对照组。对两组患者的血压、山糖、体温、周围血白细胞、血脂、血浆纤维蛋白原、经颅多普勒超声和颈部血管彩超进行分析。结果进展组与对照组比较：①两组高血压病史差异无统计学意义,发病后用降压药使平均动脉压24h内下降30％后的病情加重者,进展组有27例（34．6％）,对照组有4例（5．6％）,两组间差肄有统计学意义（P〈0．01）。②进展组有糖尿病史者51例（65．4％）,对照组有16例（22．2％）,两组间差异有统计学意义（P〈0．01）。③进展组人院后体温〉37．5℃者有23例（29．5％）,对照组有6例（8．3％）;进展组周围白细胞〉10×10。／L者有45例（57．7％）,对照绀有12例（16．7％）,两组间差异均有统计学意义（P〈0．01）。④进展组有高脂血症者56例（71．8％）,对照组有50例（69．4％）,两组间差异无统计学意义（P〉0．05）。⑤进展组患者血浆纤维蛋白原为（5．1±1．8）g／L,对照组为（2．3±1．4）g／L,两者比较差异有统计学意义（P〈0．01）。⑥两组大血管狭窄发生率分别为53．8％和20．8％,差异有统计学意义（P〈0．01）。进展组颈动脉斑块总检出数为68个,检出率为87．2％。低或不规则回声威块数为31个,检出率为59．7％。溃疡斑块检出数为33个,检出率为42．3％。对照组的检出率为69．4％。低或不规则回声斑块数和检出率分别为16个和22．2％;溃疡斑块检出数为7个,检出率为9．7％,两者比较差异有统计学意义（P〈0．05）。结论过度降版、糖尿病、感染、高纤维蛋白原水平、大动脉狭窄、颈动脉不稳定斑块是进展性卒中的危险因素。     

后循环脑梗死的临床特点及相关危险因素分析

目的分析后循环脑梗死的临床表现、病变部位和危险因素,为预测后循环脑梗死的预后,并进一步为预防后循环脑梗死的发生和发展提供科学依据。方法前瞻性研究收集自2011年1月至2012年12月共110例后循环脑梗死患者的临床资料,分析症状和体征的出现频率,记录病变部位和危险因素,推测后循环脑梗死的病因。结果后循环脑梗死患者的年龄39⁹2岁,平均(68.1±11.9)岁,男性患者占66.4%。后循环脑梗死最常见的症状为头晕/眩晕(69.1%),肢体无力(47.3%),一般常见的症状为言语不清(29.1%),行走不稳(26.4%)和吞咽困难/饮水呛咳(24.5%)。最常见的体征为肢体瘫痪(55.5%),Babinski征/Chaddock征阳性(47.3%),共济失调(42.7%),中枢性面瘫(40.0%)和感觉减退(30.0%)。后循环脑梗死的危险因素有高血压(76.4%),糖尿病(44.5%),吸烟(42.7%),血脂异常(34.5%)和冠心病(26.4%)。病变部位以脑干病变最多(40.9%),其次为后循环供血区多发性脑梗死(31.8%)。大动脉硬化是后循环脑梗死主要的病因,颅内动脉狭窄(33.6%)和颅外动脉狭窄(34.5%)较常见。结论后循环脑梗死最常见的症状和体征是头晕/眩晕,肢体瘫痪,危险因素是高血压、糖尿病、吸烟、血脂异常和冠心病,脑干梗死最常见,颅内外大动脉病变是主要的病因。     

Reduction of stroke risk factors

In October 2006, a panel of experts participated in a teleconference to discuss the reduction of stroke risk factors in patients at risk for stroke. The panel was chaired by John B. Kostis, MD, Professor and Chairman, Department of Medicine at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ. Also participating were Philip B. Gorelick, MD, MPH, Director, Center for Stroke Research, University of Illinois College of Medicine, Chicago, IL, and Franz H. Messerli, MD, St Luke's-Roosevelt Hospital Center, New York, NY.     

Vascular risk factors and dementia--towards prevention strategies

Several cohort studies have shown that vascular risk factors including hypertension, hypercholesterolaemia, diabetes mellitus, smoking, obesity and lack of physical exercise in midlife and to a lesser extent in late life, are associated with an increased risk of dementia. The results from randomised controlled clinical trials on treatment of these risk factors are not conclusive for the effect on cognitive decline and dementia. Studies investigating the effect of a multi-component intervention aimed at vascular risk factors to prevent or slow down cognitive decline and dementia will hopefully give the answer as to whether such an intervention is efficacious. This requires large clinical trials in an elderly population with long follow-up and several competing risks, making it difficult from an organisational and methodological point of view. Major challenges for future studies are to select the optimal population, set the optimal treatment targets and select clinically relevant outcome parameters.     

循环内皮祖细胞与急性脑卒中及脑血管危险因素的相关研究

目的观察循环内皮祖细胞(EPC)数量和急性脑卒中及脑血管危险因素的关系。方法以CD133和KDR双阳性细胞作为EPC标记,对74例急性脑卒中患者(脑卒中组)和29例健康志愿者(正常对照组)的外周血淋巴细胞进行流式细胞分析,检测EPC数量;并检测血脂及高敏C反应蛋白(hs-CRP)。结果调整年龄、性别、收缩压及血清低密度脂蛋白胆固醇(LDL-C)后,与正常对照组比较,脑卒中组EPC数量明显减少,hs-CRP水平显著升高(P<0.01);EPC数量与年龄、收缩压、舒张压、血清总胆固醇、甘油三酯、LDL-C、hs-CRP均呈负相关(P<0.001),与性别及高密度脂蛋白胆固醇水平无关(P>0.36);多因素逐步回归分析显示,收缩压和LDL-C与EPC数量独立相关。结论循环EPC数量减少与急性脑卒中显著相关,收缩压与LDL-C水平是影响循环EPC数量的主要独立因素。     

高尿酸血症与缺血性卒中及其危险因素

高尿酸血症与高血压、糖尿病、高脂血症、肥胖等卒中危险因素均有显著相关性,且与缺血性卒中及其预后相关.文章对高尿酸血症与卒中危险因素的相关性及其对缺血性卒中预后的影响进行了综述.     

Acute stroke outcome: effects of stroke type and risk factors

We studied 925 consecutive patients hospitalised with acute stroke to determine how stroke type, age, gender and risk factors influence acute, in-hospital outcome. Stroke types included carotid territory cortical or large subcortical infarction (52%), vertebrobasilar infarction (12%), lacunar infarction (11%), intracerebral haemorrhage (16%), and subarachnoid haemorrhage (9%). Mean age (mean ± 1 SD) was 66 ± 15 years, but patients with cerebral infarction were older than those with cerebral haemorrhage. The prevalence of hypertension, diabetes mellitus and cardiac disease increased with age across all stroke types, while the prevalence of smoking decreased with age. Mortality was 19% overall, but varied significantly between stroke types, highest in intracerebral haemorrhage (34%), and lowest in lacunar infarction (1%). Age had a marked adverse effect on mortality, independent of stroke type, the probability of death increasing by 3 ± 0.5% per year from 20–92 years, whereas gender had no effect. Cardiac disease and diabetes were independent adverse prognostic factors (Odds Ratios 1.6 and 1.5 respectively). Cerebral haemorrhage, age, cardiac disease and diabetes all independently worsen acute stroke outcome. (Aust NZ J Med 1992; 22: 30–35.)     

Ischemic heart disease risk factors after age 50

Previous studies have suggested that the predictive power of the three major risk factors for ischemic heart disease (hypertension, hypercholesterolemia, and cigarette smoking) decreases sharply with age. We re-examined this question in a cohort of 3187 adults aged 50–79 with baseline evaluation in 1972–1974 who were followed at least 9 years during a period of a marked decline in national cardiovascular disease mortality. Four-hundred and eighty-three subjects died, 123 of ischemic heart disease. Predictors of outcome were studied separately in younger (age 50–64) and older (age 65–79) groups. After multivariable adjustment for potential confounders using Cox proportional hazards models, cholesterol retained a significant independent predictor of ischemic heart disease mortality at older ages for both men and women. Cigarette smoking and hypertension were significantly related to all-cause but not to ischemic heart disease mortality in this older population. We suggest that the persistence of cholesterol as an independent predictor of fatal ischemic heart disease in old age may reflect the consequences of a shift in risk factor distribution with deferred selective mortality in a cohort with an overall favorable risk factor status.     

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。     

脑血管意外预后危险因素的病例—对照研究

目的 为探讨影响脑血管意外预后的有关因素,以住院病死病例作为病例组;存活病人为对照组。对华西医科大学附属第一医院神经内科的1990年至1996年297例患者作了回顾性的分析和研究。方法 全部病例资料应用国际临床流行病脑卒中协作组调查表,逐项记录,特别是对影响预后的有关重要因素如:病程、病情程度、神智状态、病型、年龄、合并症、并存症以及即往史和住院治疗等作了详细统计。并用双输法建立相关的数据库,资料分析处理采用x~2检验,非条件Logistic多元回归分析,并在STATA 5.0软件包上运行。结果 全部297例患者中,死亡者31例(10.4％),存活者266例。脑梗塞型179例(60％)。病例组中神智和语言障碍程度明显严重于对照组,并发高血压的比例亦高;但糖尿病及心脏病变致心律失常者,两组无差异。多因素分析链激酶类药和中西结合治疗有保护性作用(OR<1)。结论 提示住院患者脑卒中的病死率与年龄、梗塞类型、精神状态、高血压等有关。在常规治疗的基础上,中西医结合用药及溶栓抗凝药STK疗效较好。     

进展性脑梗死的危险因素分析

目的探讨进展性脑梗死患者的危险因素。方法回顾性分析60例进展性脑梗死患者的血管狭窄、血压、血糖、血脂及纤维蛋白原指标，并进行统计学分析。结果进展性脑梗死患者合并高血压例数明显高于稳定性脑梗死组（P〈0.01），血管狭窄、血糖、血脂和纤维蛋白原指标也高于对照组（P〈0．01或0．05）。结论血管狭窄、高血压、糖尿病、高血脂及高纤维蛋白原血症是进展性脑梗死患者的危险因素。感染、消化道出血、忧虑、精神紧张等也是相关因素。     

卒中危险因素及病因学的研究进展

卒中分为缺血性和出血性两种，前者是因为脑供血动脉的闭塞、狭窄、血黏度增高、严重动脉硬化及不明原因的血管炎性病变所导致的脑血栓形成以及脑栓塞等；后者主要是由于动脉瘤、动静脉畸形、动静脉瘘以及高血压等导致的动脉破裂。     

青年人卒中的病因和危险因素

青年人卒中发病率有逐年增高的趋势,其病因和危险因素相对于传统的老年人卒中更为复杂.文章针对该领域临床研究进行了综述.     

甄别卒中危险因素,开展个体化卒中一级预防

美国心脏协会/美国卒中协会(American HeartAssociation/American Stroke Association,AHA/ASA)于2010年12月6日在线发布了卒中一级预防指南[1],并明确该指南作为神经科医生的继续教育工具.<国际脑血管病杂志>已刊出其中文版[2].这是10年来第2次更新该指南[3-4],虽然在结构上与2006版没有太大变化,但其覆盖范围大大增加.就标题而言,由原来的"缺血性卒中一级预防",改为"卒中一级预防",内容包含了原先未涉及的出血性卒中.过去的10年里,美国在卒中预防方面做了大量工作,取得了显著成绩.AHA制定了降低心血管和卒中死亡率的目标:10年内下降25%.1996-2006年期间,因卒中死亡的总人数下降了18.4%.卒中死亡率降低了33.5%.尽管减少卒中死亡已取得进步,但卒中发病率仍在上升.因此,指南继续强调卒中一级预防的重要意义.