缺血性脑卒中/短暂性脑缺血发作患者脑动脉病变分布相关危险因素分析

目的 探讨缺血性脑卒中(ischemic stroke,IS)/短暂性脑缺血发作(transient ischemic attack,TIA)脑动脉病变分布的相关危险因素.方法 对169例IS/TIA患者行颈部及颅内脑血管检查,记录血管病变危险因素如年龄、性别、高血压、糖尿病、长期吸烟、长期饮酒等病史,同时记录实验室、心电图、超声心动图、腹部B超、胸X片等检查结果.确定单变量与不同狭窄模式的相关性采用单变量Logistic回归分析,确定不同颅内外大动脉狭窄模式的独立危险因素采用多元逐步和多变量多项分类Logistic回归分析.结果 高龄、长期吸烟及高低密度脂蛋白(LDL-C)是颅内外大动脉狭窄的独立危险因素,发生颅内外大动脉狭窄的风险分别增加了1.83、6.918、1.656倍;脑卒中史(OR=4.816)、长期吸烟(OR=121.608)、高LDL-C(OR=3.067)是单纯颅内大动脉狭窄的独立危险因素;高龄(OR =2.486)、长期吸烟(OR=25.072)、高LDL-C(OR=5.160)是颅内外大动脉狭窄并存的独立危险因素;而高纤维蛋白原(OR =4.790)是单纯颅外大动脉狭窄的独立危险因素.结论 不同类型颅内外大动脉狭窄病变的独立危险因素不同.     

Expression of platelet glycoprotein VI is associated with transient ischemic attack and stroke

Background and purpose: Platelet collagen receptor glycoprotein VI (GPVI) contributes significantly to platelet adhesion and thrombus formation. We aimed to investigate GPVI in patients presenting with symptoms of acute cerebrovascular disease and to define GPVI as biomarker for acute stroke. Methods: We consecutively evaluated 205 patients, who admitted the stroke unit with symptoms for stroke. Surface expression of the platelet activation markers (GPVI, CD62P, GPIb) was determined by two‐color whole blood flow cytometry. Results: Patients with transient ischemic attack (TIA) (n = 18; 8.8%) as well as with stroke (n = 133; 64.9%) showed a significantly enhanced GPVI expression (mean fluorescence intensity ± SD) on admission compared to patients with non‐ischemic (NI) events (n = 54; 26.3%) (TIA: 20.9 ± 7.1 vs. NI: 16.2 ± 3.9; P = 0.002; stroke: 20.4 ± 5.7 vs. NI; P = 0.002). Neither CD62P nor GPIb surface expression showed a significant difference. Logistic regression analysis revealed that on admission GPVI was associated with stroke independent of conventional laboratory markers such as C‐reactive protein, blood glucose, and creatine kinase. Using a receiver operating characteristic curve on GPVI, we have determined the cut off value of 18.2 for stroke. Thus, patients with enhanced GPVI expression levels (≥18.2) had a 2.4‐fold relative risk for stroke. Patients with elevated platelet GPVI expression level had a poorer clinical outcome in cumulative event‐free survival for stroke, myocardial infarction, and cerebro‐/cardiovascular death at 3‐month follow‐up (log rank; P = 0.045). Conclusions: These findings indicate that platelet GPVI surface expression is significantly enhanced in patients with TIA and stroke compared to patients with NI events. Determination of platelet‐specific GPVI may be useful as an early biomarker for cerebral ischemia.     

Prognosis of dolichoectasia in non-cardioembolic transient ischemic attack and minor stroke

Objectives This study aimed to estimate the prognosis of dolichoectasia in non-cardioembolic transient ischemic attack (TIA) and minor stroke patients.

Methods Data were derived from the imaging subgroup of patients in the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. Dolichoectasia was defined as ectasia (basilar artery diameter >4.5 mm) and dolichosis (either basilar artery bifurcation above the suprasellar cistern or lateral to the margin of the clivus or dorsum sellae). The prognosis included ischemic stroke recurrence and poor functional outcome (modified Rankin scale 2–6) at 12-month follow-up. The association of dolichoectasia with risk factors and prognosis of patients were assessed using multivariable Cox regression models.

Results Overall, 1089 patients with magnetic resonance images in the CHANCE trial were included in this subanalysis. A total of 98 (9.0%) patients were detected with dolichoectasia, and 106 (9.7%) patients had a recurrent ischemic stroke at 12 months. Small artery occlusion (SAO) was more prevalent in patients with dolichoectasia compared with those without dolichoectasia (29.6% vs. 22.7%, hazard ratio [HR] 2.87, 95% confidence interval [CI] 1.59–5.17, p < 0.001). However, multivariate analysis showed no association of dolichoectasia with 12-month recurrent stroke (9.2% vs. 9.8%, HR, 1.15; 95%CI, 0.32–4.12; p = 0.83) and poor functional outcome (7.6% vs. 8.4%, odds ratio, 1.22; 95%CI, 0.24–6.08; p = 0.81) in the current subgroup analysis.

Conclusions Dolichoectasia was significantly associated with SAO. There was no relationship between dolichoectasia and 12-month prognosis of patients with non-cardioembolic TIA or minor stroke.     

小剂量瑞舒伐他汀钙对老年短暂性脑缺血发作患者二级预防的疗效

目的 探讨小剂量瑞舒伐他汀钙对老年短暂性脑缺血发作(TIA)患者二级预防的疗效.方法 检测103例老年TIA患者的血脂、血浆高敏C反应蛋白(hs-CRP)及同型半胱氨酸(Hcy)水平及颈动脉粥样硬化斑块状况.给予5 mg/d的瑞舒伐他汀钙进行治疗,于治疗后30 d及180 d进行复查,并随访6个月.结果 与治疗前比较,治疗后30 d及180 d时患者总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(Apo A)、载脂蛋白B(Apo B)、hs-CRP、Hcy均显著下降,高密度脂蛋白胆固醇(HDL-C)升高(P＜0.05 ～0.01).治疗第30 d时LDL-C＜ 2.07 mmol/L的达标率为23.4％,180 d时为40.2％;治疗30 d时LDL-C下降幅度＞40％的达标率为30.8％,180 d时为64.2％.与治疗前比较,治疗后30 d时颈动脉内-中膜厚度(IMT)明显减少(P＜0.05);治疗后180 d时IMT、低密度及混合密度斑块面积均明显减少(均P＜0.01).随访6个月内,TIA再发作11例(10.7％);出现丙氨酸转氨酶(ALT)＞1倍正常上限的患者9例(8.7％),ALT＞3倍正常上限1例(1.0％),天冬氨酸转氨酶(AST) ＞1倍正常上限8例(7.8％),AST ＞3倍正常上限2例(1.9％).结论 小剂量瑞舒伐他汀钙对老年TIA患者是安全有效的,适合脑卒中二级预防的长期使用.     

Long-term mortality and risk of stroke after transient ischemic attack

Background   Stroke and mortality rates in patients with transient ischemic attack (TIA) differ widely between community-based studies and research cohorts. Our aim therefore was to provide a reliable estimate for TIA patients treated in German neurology departments with an acute stroke unit. Methods   A total of 1951 consecutively admitted TIA patients were prospectively documented in 13 centers and 1480 (75.9 %) gave consent for long-term follow-up. During a mean follow-up of 23.4 months, we assessed recurrent cerebrovascular events and cause of death in 1448 patients via standardized telephone interview including confirmation of endpoint events by the treating physician. Results   Overall 94 patients (6.5 %) suffered a stroke and 118 patients (8.1 %) died, 21 due to stroke. The Kaplan-Meier estimate for stroke during the first year was 4.4 % (95 % CI 3.2–5.6 %) which corresponds to a relative risk of 9.5 (95 % CI 7.4–12.3) compared to the population-based stroke incidence in Germany. The annual rates after the first year were 2.2 % (95 % CI 1.7–2.7 %) for stroke and 3.2 % (95 % CI 2.7–3.8 %) for death. Independent predictors for stroke during follow-up were age and previous cerebrovascular events. The ABCD₂ score did not provide any meaningful prediction of stroke risk at 90 days. Conclusion   While the in-hospital risk of stroke was low, long-term stroke rates in our well-defined multicenter hospital-based cohort were comparable to a large randomized trial. In patients with a well-established diagnosis of TIA, only age and previous cerebrovascular events seem to constitute independent predictors for stroke during long-term follow-up. Participating Departments of Neurology (investigator): Ostalbklinikum Aalen (M. Heyden, MD), Klinikum Bernburg (M. Muller, MD), Krankenanstalten Gilead Bielefeld (C. Hagemeister, MD), Krankenhaus Buchholz (K. Luckner, MD), University of Essen (C. Weimar, MD), University of Freiburg (C. Fritzsch, MD), University of Greifswald (A. Khaw, MD), University of Hannover (K. Weissenborn, MC), Klinikum Heidenheim (S. Kaendler, MD), University of Jena (C. Terborg, MD), Krankenhaus Koln-Mehrheim (U. Frost, MD), University of Leipzig (D. Michalski, MD), Landesklinik Lubben (C. Rohrig, MD), University of Magdeburg (M. Goertler, MD), Ruppiner Kliniken Neuruppin (G. Zindler, MD), University of Rostock (A. Kloth, MD), Burgerhospital Stuttgart (T. Mieck, MD), University of Ulm (R. Huber, MD), Heinrich- Braun-Krankenhaus Zwickau (S. Grieshammer MD).     

短暂性脑缺血发作患者出院后二级预防用药情况及服药行为的混合性研究

目的 探讨短暂性脑缺血发作（transient ischemic attack,TIA）患者出院后二级预防用药情况及其影响因素,并通过质性研究探讨患者服药的动机和障碍。方法 选取2016年1月至2020年12月中国人民解放军联勤保障部队第九八一医院神经内科出院的TIA患者270例,根据服药依从性分为依从性佳（116例）和依从性差（154例）两组,对比两组患者的临床资料及药物依从性,通过多因素Logistic回归分析探讨TIA患者服药依从性的影响因素。以受访者资料饱和为标准纳入10例TIA患者,采用质性研究法对患者进行半结构式深度访谈,采用Giorgi资料分析法提取和归纳主题,探讨TIA患者服药行为的内在影响因素。结果 TIA患者出院后对降压药、降糖药、降脂药、抗血栓药及抗血小板聚集药的依从性分别为69.36%、57.38%、78.95%、69.91%、68.32%。受教育程度低、卒中病程、发病次数≥2次、卒中自我效能低、无自我感知照护需求是TIA患者二级预防用药依从性差的独立危险因素（P<0.05）。从质性访谈资料中共提取出五大主题：疾病相关知识欠缺及二级预防意识淡薄、担心药物不良反应、经济负担加重、负性情绪、家庭与社会支持不足。结论 TIA患者出院后二级预防用药依从性较差,影响其服药依从性的因素主要包括患者自身因素、药物种类、医疗体系的支持、社会及家庭的支持等。受教育程度、病程、卒中自我效能及自我感知照护需求等因素在TIA患者二级预防用药中起到重要作用。 [国际神经病学神经外科学杂志, 2023, 50(2): 12-17]     

Transient ischemic attacks presenting as hemiballism.

Hemiballism is continuous, nonpatterned involuntary movement characterized by irregular, coarse, flinging movement involving the limbs on one side. Hemiballism is most commonly caused by stroke. However, very rarely a transient ischemic attack (TIA) presents as hemiballism. We describe 2 such patients with hemiballism presenting as TIA.     

Effects of an individualized multimedia computer program for health education in patients with a recent minor stroke or transient ischemic attack - a randomized controlled trial

BACKGROUND: Transient ischemic attack (TIA) and stroke patients often show a striking lack of knowledge about their disease. We developed a computer program that provided health education fitting the educational level, risk profile and symptoms of patients and evaluated it in a randomized controlled trial. METHODS: Transient ischemic attack or minor stroke patients were allocated to health education by a physician (n = 32) or to a combination of education by a physician and the computer program (n = 33). Knowledge was tested by means of a questionnaire at 1 and 12 weeks after inclusion. The maximum possible score was 71 points. RESULTS: Overall knowledge was low - the mean score was 43.6 at 1 week and 42.0 points at 12 weeks for both the groups. The intervention group had slightly better scores at 1 week after using the computer program, 45.4 vs 41.5 (P = 0.09), with the difference increasing to 4.3 points after (post-hoc) adjustment for age and level of education (P = 0.06). After 12 weeks, the score in the intervention group dropped significantly to 42.0 points (P = 0.05), and was no longer different from the standard group. CONCLUSION: This study did not show a lasting effect of health education by an individualized computer program on the knowledge of TIA and minor stroke patients.     

Wide-range C-reactive protein efficacy in acute ischemic stroke patients

OBJECTIVE: To compare the recently introduced wide-range C-reactive protein (wr-CRP) with the widely used high-sensitivity Behring Dade method (hs-CRP) in acute stroke/transient ischemic attack (TIA) patients. MATERIALS AND METHODS: A total of 119 consecutive patients admitted to a tertiary medical center with acute ischemic stroke/TIA were included in the study. Venous blood was obtained for both assays during the first 24 h, 3-5 days, as well as 3-6 months thereafter. RESULTS: A highly significant correlation (r=0.994, P<0.0001) was found between the two methods even when analyzed at three different time points. In addition, a similar correlation was noted between these two assays and other commonly used biomarkers, including white blood cell count, Westergren's sedimentation rate and quantitative fibrinogen. CONCLUSION: Real-time, on-line and low-cost wr-CRP assay is a reasonable alternative to the Behring Dade hs-CRP method in acute stroke/TIA patients.     

中国缺血性脑卒中患者抗血小板药物的应用现状

目的探讨中国缺血性脑卒中(IS)患者抗血小板类药物的使用现状及影响用药的相关因素。方法对我国北方和中、东部14个城市的病程>3个月的IS患者的基本资料及服用抗血小板类药物的情况进行调查和分析。结果共有6422例IS患者被调查,均有服用抗血小板药物的适应证,但仅有72.4%患者(4652例)服用抗血小板药物;其中98.7%服用阿司匹林;IS≥3年的患者服药率(64.0%)明显低于IS<1年的患者(72.0%)(P<0.001);合并冠心病、高血压的患者服药率明显高于无此类合并症的患者(均P<0.001)。结论中国IS患者抗血小板药物使用现状与IS二级预防指南推荐的均应服用抗血小板药物的要求存在明显的差距,尤其是病程较长的IS患者。     

糖尿病合并短暂性脑缺血发作患者发展为脑梗死的独立预测因素

目的 评估糖尿病合并短暂性脑缺血发作患者发展为脑梗死的独立预测因素。方法 入选2013年1月-2015年6月就诊于航天中心医院卒中中心的短暂性脑缺血发作合并糖尿病的患者,收集临床资料(常规、生化、凝血功能、糖化血红蛋白、心脏超声),行核磁共振造影检查,并随访30个月,记录脑梗死事件和较差的功能结局(改良的Rankin量表2～6分)。结果 最终235例患者入选,其中有70例(29.8%)在随访期内发生脑梗死,59例患者被发现Rankin量表达到2～6分,14例患者6月内发生脑梗死,cox多因素回归分析发现,基底动脉动脉延长扩张和高龄是30个月内发生脑梗死的独立预测因素。基底动脉延长扩张能够独立预测随访期内2～6分的改良Rankin量表评分。基底动脉动脉延长扩张和高水平糖化血红蛋白能够预测6个月内脑梗死的发生,而且生存曲线提示基底动脉延长扩张者6个月内及30个月内发展为脑梗死风险明显高于其余患者,糖化血红蛋白水平高于中位数者(6.2%)6个月内发展为脑梗死风险明显高于糖化血红蛋白水平相对低的患者。结论 血管畸形和血糖控制差的患者容易由短暂性脑缺血发作进展为脑梗死,远期生活质量也受到影响。