缺血性脑卒中复发危险因素分析及预测模型的构建

目的 探讨影响缺血性脑卒中复发的危险因素并建立Cox比例风险回归模型.方法 回顾性收集2008-2009年河北联合大学附属医院神经内科确诊的连续性初发缺血性脑卒中患者为研究对象,同时随访患者的复发情况,于2010年6月30日完成随访工作,应用Kaplan-Meier法进行复发率分析,应用Cox比例风险回归模型对影响患者复发的危险因素进行单因素和多因素分析,建立复发模型.结果 随访期间共79例患者复发,患者1年复发率为12.75%,2年复发率为18.87%,经Cox比例风险回归模型单因素及多因素分析显示,年龄(X1)(RR=1.025,95%CI:1.003～1.048)、高血压史(X2)(RR=1.976,95%CI:1.014～3.851)、家族卒中史(X3)(RR=2.647,95%CI:1.175～5.961)、总胆固醇(X4)(RR=1.485,95%CI:1.214～1.817)、ESRS评分(X5)(RR=1.327,95%CI:1.057～1.666)和病情进展(X6)(RR=1.889,95%CI:1.123～3.178)是影响患者复发的独立危险因素,建立复发模型的个体预后指数(PI)为0.025X1+0.681X2+0.973X3+0.395X4+0.283X5+0.63X6.PI值越小,复发危险性越低;PI值越大,复发危险性越高.结论 年龄、高血压史、家族卒中史、总胆固醇、ESRS评分和病情进展是缺血性脑卒中患者复发的独立危险因素,并成功建立复发模型及个体PI方程.

Abstract：

Objective To investigate the risk factors and establish the Cox' s regression model on the recurrence of ischemic stroke. Methods We retrospectively reviewed consecutive patients with ischemic stroke admitted to the Neurology Department of the Hebei United University Affiliated Hospital between January 1,2008 and December 31,2009. Cases had been followed since the onset of ischemic stroke. The follow-up program was finished in June 30, 2010. Kaplan-Meier methods were used to describe the recurrence rate. Monovariant and multivariate Cox' s proportional hazard regression model were used to analyze the risk factors associated to the episodes of recurrence.And then, a recurrence model was set up. Results During the period of follow-up program, 79 cases were relapsed,with the recurrence rates as 12.75% in one year and 18.87% in two years. Monovariant and multivariate Cox' s proportional hazard regression model showed that the independent risk factors that were associated with the recurrence appeared to be age (X1)(RR=1.025,95% CI: 1.003-1.048),history of hypertension (X2) (RR= 1.976, 95% CI: 1.014-3.851), history of family strokes (X3) (RR=2.647,95%CI: 1.175-5.961), total cholesterol amount (X4) (RR= 1.485,95%CI: 1.214-1.817), ESRS total scores (X5) (RR= 1.327,95%CI: 1.057-1.666) and progression of the disease (X6) (RR= 1.889,95%CI: 1.123-3.178). Personal prognosis index (PI) of the recurrence model was as follows: PI=0.025X1 + 0.681X2+ 0.973X3 + 0.395X4+ 0.283X5 + 0.636X6. The smaller the personal prognosis index was, the lower the recurrence risk appeared, while the bigger the personal prognosis index was, the higher the recurrence risk appeared. Conclusion Age, history of hypertension, total cholesterol amount, total scores of ESRS, together with the disease progression were the independent risk factors associated with the recurrence episodes of ischemic stroke. Both recurrence model and the personal prognosis index equation were successful constructed.     

Influencing factors of post stroke cognitive impairment in patients with acute ischemic stroke and their correlation with cognitive scoresCSCD

Objective To analyze the influencing factors of post stroke cognitive impairment (PSCI) and their correlation with cognitive scores in patients with acute ischemic stroke. Methods In this cross‑section study, 36 patients diagnosed with acute ischemic stroke and post stroke cognitive impairment (PSCI) admitted to the Department of Vascular Neurology of Beijing Tiantian Hospital Affiliated to Capital Medical University from June 1, 2022 to September 30, 2022 were selected as the PSCI group. And one to one matching was performed for patients without PSCI (PSNCI group) with an age±1 year and same gender admitted to the hospital during the same period (as control, 36 cases). Basic clinical data of the two groups were collected, the laboratory and imaging examinations were completed. Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) were used for cognitive evaluation by neuropsychologists. Hypothesis testing was used to compare the differences in basic data, laboratory tests and lesion sites between the two groups. Multi‑factor conditional logistic regression was performed to analyze the influencing factors of PSCI, and Spearman correlation analysis was carried out to analyze the correlation between influencing factors of PSCI and the cognitive scores. Results Compared with those in PSNCI group, the proportion of patients with stroke/transient ischemic attack history, hyperhomocysteinemia (HHcy), apolipoprotein E(ApoE) ε4 carriers and the ratio of temporal lobe and thalamus infarction were higher in PSCI group (41.7% vs 13.9%, 36.1% vs 2.8%, 30.6% vs 5.6%, 22.3% vs 2.8%, 25.0% vs 5.6%), the MMSE and MoCA scores were lower in PSCI group [16.50 (8.25, 19.00) vs 28.00 (27.00, 30.00), 10.00 (4.25, 14.50) vs 27.00 (25.00, 28.00)] (all P<0.05). Logistic regression analysis showed that HHcy was a positive correlation factor for PSCI (OR=2.342, 95%CI= 1.186-4.622, P=0.014). Spearman correlation analysis showed that MMSE (r=-0.415) and MoCA (r= -0.417) scores were negatively correlated with homocysteine (Hcy) (both P<0.05). Conclusion HHcy is an important factor affecting the occurrence and development of PSCI in patients with acute ischemic stroke, and Hcy level is negatively correlated with cognitive scores in those patients. © 2022 Chinese Medical Journals Publishing House Co.Ltd     

颅内动脉瘤在电解可脱式弹簧圈栓塞术中破裂危险因素分析及处理体会

目的 探讨颅内动脉瘤在电解可脱式弹簧圈(GDC)栓塞术中发生破裂的危险因素及处理方法.方法 2000年8月至2010年6月,以GDC栓塞术治疗420例动脉瘤性蛛网膜下隙出血(SAH)患者,对其临床资料进行回顾性总结,统计分析颅内动脉瘤在GDC栓塞术中发生破裂的危险因素.结果 共16例术中发生动脉瘤破裂,发生率为3.8%(16/420),术后13例致密填塞,3例部分填塞.单因素分析显示:SAH发作次数≥2次、瘤体≤4 mm、有假性动脉瘤、Hunt-Hess分级为Ⅳ～Ⅴ级、有高血压病史以及瘤颈窄是引起颅内动脉瘤GDC栓塞术中发生破裂的危险因素.多因素 Logistic回归分析显示:SAH发作次数≥2次(P=0.0424,OR=6.798)以及有假性动脉瘤(P=0.0069,OR=4.423)是引起颅内动脉瘤GDC栓塞术中发生破裂的独立危险因素.结论 颅内动脉瘤在GDC栓塞术中发生破裂主要与SAH多次发作以及存在假性动脉瘤有关,临床上对存在危险因素者应警惕发生术中破裂,一旦发生应积极给予合理的治疗,大多数患者能获得良好预后.

Abstract：

Objective To investigate the risk factors and treatment experience of cerebral aneurysms rupture in the course of Gugliemi detachable coil (GDC) embolization. Methods From August 2000 to June 2010,420 patients with aneurysmal subarachnoid hemorrhage (SAH) received GDC embolization and their clinical data were retrospectively reviewed to analyse the risk factors of cerebral aneurysms rupture in the course of treatment. Results Sixteen patients had intraoperative aneurysm rupture, the incidence rate was 3.8%(16/420),including 13 cases density filling,3 cases partial filling postoperative.Univariate analysis showed:SAH episodes ≥2 times,tumor size ≤4 mm,the presence of pseudoaneurysm,Hunt-Hess grade Ⅳ - Ⅴ as well as history of hypertension were the risk factors of cerebral aneurysms rupture in the course of GDC embolization. Logistic regression analysis showed:SAH episodes ≥2 times (P = 0.0424,OR =6.798)and the presence of pseudoaneurysm (P = 0.0069, OR = 4.423) were the independent risk factors of cerebral aneurysms rupture. Conclusions Rupture of intracranial aneurysm in the course of GDC embolization is mainly related to the multiple SAH and the presence of pseudoaneurysm. It should be alert to the risk factors and take active treatment as soon as the occurrence of rupture in clinic work, for this, most patients can get a good prognosis.     

Safe addition of vitamins and minerals to foods: setting maximum levels for fortification in the Netherlands

Background In 2004, the European Court of Justice decided that the prohibition of fortification with vitamin A, vitamin D, folic acid, selenium, copper, and zinc in the Netherlands conflicts with the principle of free movement of goods in the European Union. This decision led to a change in the Dutch policy, resulting in a more flexible handling of requests for exemption from this prohibition to fortify. Therefore, an investigation was proposed in which it would be determined whether a general exemption could be granted for food fortification with a certain maximum safe amount per micronutrient. Aim of the study To develop a risk assessment model to estimate maximum safe fortification levels (MSFLs) of vitamins and minerals to foods on the Dutch market, and to evaluate these levels to derive allowed fortification levels (AFLs), which can be used for a general exemption. Methods We developed a risk assessment model to estimate MSFLs of vitamins and minerals to foods on the basis of existing models. We used European tolerable upper intake levels in combination with national food consumption data to estimate MSFLs for fortification of foods for several age groups. Upon extensive stakeholder dialogue, the risk manager considered these estimated MSFLs and the final AFLs for a general exemption were set. Results For folic acid, vitamin A, and vitamin D, the MSFLs were calculated in the risk-assessment model. Children up to 6-years old were the group most sensitive to folic acid fortification, and they had an MSFL of 0 μg/100 kcal, but following a risk management evaluation, this was upgraded to an AFL of 100 μg/100 kcal. The MSFL for vitamin D was 3.0 μg/100 kcal (children 4–10 years old), and the risk manager increased this to an AFL of 4.5 μg/100 kcal. Children up to 10 years old, men, and postmenopausal women were the groups most sensitive to vitamin A fortification (MSFL = 0 μg/100 kcal). Because these groups represent a large part of the population and because of the seriously harmful effects of excessive vitamin A, the risk manager did not allow a general exemption. Conclusions The combination of a risk assessment model and risk manager evaluation led to the setting of AFLs for general exemption of fortification with folic acid and vitamin D. This model is also applicable for other micronutrients, for which an UL is derived, and in other countries.     

影响突发性耳聋治疗效果的相关因素分析

目的 探讨影响突发性耳聋治疗效果的相关因素.方法 回顾性分析133例(148耳)突发性耳聋患者的临床资料.结果 133例患者经系统治疗后,痊愈25例,显效18例,有效39例,总有效率为61.7%(82/133).单因素分析显示,与突发性耳聋预后相关的因素有年龄、发病至治疗时间、耳聋分级、是否伴有眩晕和治疗时间.年龄<60岁、发病至治疗时间越早、耳聋分级越轻、不伴有眩晕以及治疗时间较长的患者疗效明显占优.Logistic逐步回归分析显示,与突发性耳聋预后相关的独立因素是发病至治疗时间和耳聋分级.结论 突发性耳聋病因不明,从发病到治疗时间间隔和发病后听力损失的程度是影响其预后的主要因素,临床应予以重视,尽量早诊断、早治疗,以提高疗效.

Abstract：

Objective To investigate the relevant factors on the prognosis of sudden deafness. Method The clinical data of 133 patients (148 ears) with sudden deafness were analyzed retrospectively. Results Through systemic treatment, 25 cases got recovery, 18 cases were excellence and 39 cases were effective, the total effective rate was 61.7%(82/133). Univariate analysis showed that the factors related to the prognosis of sudden deafness were age, the time from onset to treatment, deafness classification,accompanied by vertigo or not and the duration of treatment. Patients with the age lower than 60, the earlier the time from onset to treatment, the lighter the deafness classification, not accompanied by vertigo and the longer duration of treatment got a better efficacy. Logistic regression analysis showed that the independent factors related to the prognosis of sudden deafness were the time from onset to treatment and deafness classification. Conclusion The etiology of sudden deafness is still unclear, the time from onset to treatment interval and the degree of hearing loss are the main factors affecting the prognosis of it, in clinic, it should be paid attention and took a early diagnosis and early treated so as to get good efficacy.     

斯奇康注射液辅助治疗肺结核的临床研究

目的 观察斯奇康注射液辅助治疗肺结核的临床疗效、对细胞免疫功能的影响及不良反应的发生情况,为肺结核的辅助治疗提供一种安全、有效且价格低廉的药物.方法 将60例肺结核患者按随机数字表法分为治疗组和对照组,每组30例,两组均予标准抗结核化疗方案,治疗组加斯奇康注射液,观察患者的症状、病灶影像学改变、血常规、肝肾功能及T淋巴细胞亚群变化.结果 治疗后两组症状均较治疗前明显改善(P＜0.05),但治疗组明显优于对照组(P＜0.05);治疗组的有效率及控制率分别为36.7%(11/30)、96.7%(29/30),显著高于对照组的23.3%(7/30)、86.7%(26/30)(P＜0.05);治疗后,两组CD3、CD4和IL-2均升高,CD8下降,治疗组改善优于对照组(P＜0.05);治疗组白细胞减少率[10.0%(3/30)]明显低于对照组[33.3%(10/30)](P＜0.05).两组对肝肾功能损害程度差异无统计学意义.结论 斯奇康注射液治疗肺结核患者,能有效改善肺结核的症状,提高病灶吸收好转率,提高机体细胞免疫力,减轻结核化疗所致的白细胞下降的发生率,对肝肾功能无明显影响,临床用药较安全.

Abstract：

Objective To evaluate the effectiveness, the influence on cellular immune function and the side-effect of bacillus of Calmette-Guerin polysaccharide nucleic acid(BCG-PSN)combined with antituberculous chemotherapy in the treatment of pulmonary tuberculosis. Methods A total of 60 pulmonary tuberculosis patients were divided into treatment group(30 patients)and control group(30 patients)by random digits table. All patients accepted the same standard antituberculous chemotherapy, meanwhile patients in treatment group were injected with BCG-PSN. Observed and compared the clinical symptom,the size of the focas nidus,the change of toxic response and immunity. Results The symptoms were significantly relieved in both groups after treatment(P＜0.05), but it was significantly better in treatment group(P＜0.05), the effective rate and control rate in treatment group[36.7%(11/30),96.7%(29/30)]were significantly higher than those in control group[23.3%(7/30), 86.7%(26/30)](P ＜ 0.05). After treatment,the levels of CD3,CD4 and IL-2 were higher, and the level of CD8 was lower, but the treatment group improved significantly better than control group(P ＜ 0.05). The rate of leukopenia was lower in treatment group than that in control group[10.0%(3/30)vs. 33.3%(10/30),P ＜0.05]. As to the safety,no other toxicities were observed in the treatment group. Conclusions BCG-PSN combined with antituberculous chemotherapy in the treatment of pulmonary tuberculosis contributes to relieve the symptom, reduce size of the nidus, decrease leukopenia incidence and enhance the cell immunity. It is safe.     

95例甲型H1N1流感患者危险因子及临床治疗分析

Objective To explore the curative effect of antivirus drugs to the patients with different degree A(H1N1) influenza, and to summarize the reasonable treatment protocols. Methods The clinical data of 95 adult patients with A( H1N1) influenza from June 2009 to February 2010 were collected and analyzed retrospectively. The differences in mild, severe and critical patients in physical status, hospital days, temperature peak, persistent fever period, oseltamivir treatment, other antiviral drugs and combined therapy were compared. Results There were statistical differences in risk factor (5.3%, 18.2%,66.1%, P<0.05), persistent fever period (2.2 days,5.6 days, 9.4 days, P<0.01), courses of treatment of oseltamivir were (4.1 ±0.4) days, (6.3 ±0.5) days, (9.2±1.8) days respectively ( P < 0.05). There were statistical differences among critical patients and mild, severe patients in mean onset days of oseltamivir oral(P<0.01). Cleaning time of virus in critical cases was longer than others cases. Comprehensive therapy included mechanical ventilation, antibiotics, corticoeteroid and blood plasma was necessary in severe patients. Conclusions The patients with critical high risks, especially with respiratory diseases or endocrine diseases, would progress to severe condition. The longer the fever, the easier to progress to severe condition. Oseltamivir is safe and effective, it is important to use it as early as possible. Oseltamivir should be used longer on the patients with severe condition, especially with respiratory disease. The comprehensive therapy is extremely important to severe patients.     

95例甲型H1N1流感患者危险因子及临床治疗分析

Objective To explore the curative effect of antivirus drugs to the patients with different degree A(H1N1) influenza, and to summarize the reasonable treatment protocols. Methods The clinical data of 95 adult patients with A( H1N1) influenza from June 2009 to February 2010 were collected and analyzed retrospectively. The differences in mild, severe and critical patients in physical status, hospital days, temperature peak, persistent fever period, oseltamivir treatment, other antiviral drugs and combined therapy were compared. Results There were statistical differences in risk factor (5.3%, 18.2%,66.1%, P<0.05), persistent fever period (2.2 days,5.6 days, 9.4 days, P<0.01), courses of treatment of oseltamivir were (4.1 ±0.4) days, (6.3 ±0.5) days, (9.2±1.8) days respectively ( P < 0.05). There were statistical differences among critical patients and mild, severe patients in mean onset days of oseltamivir oral(P<0.01). Cleaning time of virus in critical cases was longer than others cases. Comprehensive therapy included mechanical ventilation, antibiotics, corticoeteroid and blood plasma was necessary in severe patients. Conclusions The patients with critical high risks, especially with respiratory diseases or endocrine diseases, would progress to severe condition. The longer the fever, the easier to progress to severe condition. Oseltamivir is safe and effective, it is important to use it as early as possible. Oseltamivir should be used longer on the patients with severe condition, especially with respiratory disease. The comprehensive therapy is extremely important to severe patients.     

脐血胆红素预测新生儿病理性黄疸的价值

Objective To investigate the predictive value of umbilical cord blood bilirubin for pathological jaundice in healthy term newborns. Methods Two ml navel string vein blood of baby were collected after giving birth in the normal newborn, and the hemobilirubin was detected by accidentally oxidation method. After birth, the infant's bilirubin level was tested on the forehead by the transcutaneous bilirubinometer at 8:00 -9:00 every morning until discharging from hospital. The ration of pathological jaundice of newborn and its treatment were analyzed in different levels of cord blood hemobilirubin. Results Fifty-nine cases ( 22.96% ) with pathological jaundice were diagnosed in 257 newboms.The concentration of cord blood hemobilirubin in baby with pathological jaundice [(39.68 ±8.10) μmol/L] was significantly higher than that of the normal newborn [(30.05 ±5.51) μmol/L](P＜0.01). As the concentration of cord blood hemobilirubin was increased, the incidence of pathological jaundice was raised (P＜ 0.01), and the cases that needed to intervention treatment was increased(P＜ 0.01). Conclusion The detection of the level of cord blood hemobilirubin is not only very worthy to estimate the occurrence of pathological jaundice of newborn, but also offer reliable evidence for clinical early diagnosis and treatment.     

辅助生殖技术后输卵管间质部妊娠 10 例临床分析

Objective： This is ten cases report of the interstitial pregnancy after assisted reproductive technology （ART）. Methods：Ten cases of the interstitial pregnancy after IVF/ICSI-ET in our center, from July 2011 to July 2013, were retrospectively analyzed. Clinical features and related risk factors were summarized. Results：Ten patients aged （32.9±3.7）years, with the tubal-related operation history, accepted IVF/ICSI treatment due to their tubal factors. Four cases had a history of ectopic pregnancy. Nine patients had been transferred 2 embryos in their ART cycles,and only 1 case transfered a single embryo. As for clinical manifestations,6 cases were firstly suspected for ectopic pregnancy by B ultrasound, 1 case suffered from abdominal pain ,1 case had a small amount of vaginal bleeding,and the other 2 cases were complained of abdominal pain and vaginal bleeding. After diagnosed, eight patients underwent direct operation,one case successfully received MTX treatment while another one case underwent operation after her unsuccessful MTX treatment. Conclusions：The interstitial pregnancy after IVF/ICSI was possibly related to abnormal function of fallopian tube after the tubal-related operation, especially tube resection or the proximal tubal occlusion. The number of transferred embryos should be controlled in those IVF/ICSI patients with high-risk factors,while B ultrasound monitoring after transplantation and health education should be added so as to reduce the adverse outcome of the interstitial pregnancy after ART. [ABSTRACT FROM AUTHOR]     

影响卒中患者脑白质高信号严重程度的相关危险因素

目的 探讨缺血性卒中患者脑白质高信号（WMHs）严重程度的相关危险因素.方法 回顾性分析急性缺血性卒中（AIS）患者的临床及影像学资料.结果 共纳入144例AIS患者,美国国立卫生研究院卒中量表评分（6.06±3.98）分,高血压89例,糖尿病32例,高脂血症43例,冠心病21例,心房颤动44例;大动脉粥样硬化型60例,穿支动脉疾病型8例,心源性卒中型64例,其他原因型4例,不明原因型8例.WMHs评分（7.81 ±4.93）分,中位评分6.5分.WMHs评分0～6分组72例,7～24分组72例,两组年龄、收缩压、高同型半胱氨酸血症（HHe）发生率比较差异有统计学意义[（61.08±12.45）岁比（72.03±10.13）岁、（149.40±25.43）mmHg（1 mmHg=0.133 kPa）比（159.19±23.63）mmHg、12.5％（9/72）比29.2％（21/72）]（P＜0.05）.多因素Logistic回归分析结果显示年龄和HHe是AIS患者WMHs严重程度的独立危险因素（P＜0.05）.结论 年龄、HHe是AIS患者WMHs严重程度的独立危险因素.     

入院时血浆脑利钠肽水平与急性缺血性脑卒中预后的关系探讨

[目的]探讨急性缺血性脑卒中病人入院时血浆脑利钠肽(BNP)水平能否成为急性缺血性脑卒中病人发病后3个月神经功能恢复程度的预测指标。[方法]根据《中国急性缺血性脑卒中诊治指南2010》诊断标准,前瞻性入选88例24 h内发病的急性缺血性脑卒中病人,于入院24 h内检测血浆BNP,将3个月后神经功能恢复良好组与3个月后神经功能恢复较差组进行比较。[结果]发病3个月后神经功能恢复程度与入院时BNP值等级、梗死体积均有显著相关性(P值﹤0.001),3个月后神经功能恢复较差组入院时血浆BNP水平[(884.75±330.07)pg/mL]显著高于3个月后神经功能恢复良好组[(263.27±281.89)pg/mL],P<0.001。入院时血浆BNP水平≥366.40 pg/mL可作为发病3个月后神经功能恢复较差组的预测指标,其敏感性为96.00%,特异性为76.19%。[结论]急性缺血性脑卒中病人入院时血浆BNP水平可作为其发病3个月后神经功能恢复程度的预测因子。     

Relationship between Paraoxonase 1 (PON1) gene polymorphisms and susceptibility of stroke: a meta-analysis

Genetic variants of paraoxonase 1 (PON1) were implicated in stroke susceptibility in several case–control association studies. However, the studies have reported apparently conflicting results, rendering precise assessment of the disease risk associated with the variants difficult. A meta-analysis was therefore conducted by including the studies that examined the association between two common polymorphisms (L55M and Q192R) in the coding region of PON1 gene and the risk of stroke. Altogether 10 studies on L55M polymorphism and 11 studies on Q192R polymorphism were included in this meta-analysis. The results showed, although there was no significant association of the 55L allele with stroke [random effects OR = 1.09, 95% CI (0.93, 1.27), P = 0.29], the 192R allele conferred significant risk of stroke in the overall study population [random effects OR = 1.25, 95% CI (1.07, 1.46), P = 0.006]. Same pattern of results as both the allele contrasts was obtained for the homozygote contrasts and the dominant, recessive and additive models. Subgroup analyses for stroke type, age of patients and ethnicity revealed no association of the 55L allele with stroke, whereas the association of the 192R allele persisted significantly in the groups comprising ischemic stroke patients, stroke patients with mean age >60 years and Caucasian subjects. But no significant association of this allele with stroke susceptibility was detected in the East Asian population. Therefore, the results of this meta-analysis indicate, the Q192R polymorphism could be an important risk factor for stroke, especially in the Caucasian population.     

非对称二甲基精氨酸与急性缺血性脑卒中的相关性研究

目的:通过检测急性缺血性脑卒中患者血浆非对称二甲基精氨酸(ADMA)水平,探讨两者的关系,为临床早期诊断、治疗提供依据。方法:选择急性缺血性脑卒中患者(162例)为研究对象,未卒中患者(100例)作对照,血浆ADMA检测采用高效液相色谱法。结果:(1)急性缺血性脑卒中组血浆ADMA水平明显高于对照组,差别有统计学意义(t=1.438,P=0.000)。血浆ADMA浓度与急性缺血性脑卒中的风险成正相关(2)各型急性缺血性脑卒中血浆ADMA水平差别均无统计学意义(P>0.05)。结论:ADMA是急性缺血性脑卒中的危险标志物,测定ADMA水平有助于指导预防策略,为急性缺血性脑卒中的预防及临床治疗提供依据。     

高龄急性缺血性脑卒中患者认知功能障碍影响因素的Logistic回归分析

目的 了解高龄急性缺血性脑卒中患者（acute ischemic stroke,AIS）认知功能障碍的发生率及影响因素。方法 选取2013年1月~2016年9月海口市第三人民医院收治的AIS患者725例,最终纳入患者426例。根据患者病情稳定即将出院时采用简易精神状态量表（mini mental state examination,MMSE）评估其是否存在认知功能障碍,分为认知功能障碍组201例和认知功能正常组225例。应用单因素及多元Logistic回归分析急性缺血性脑卒中患者认知功能障碍的影响因素,并绘制受试者工作特征曲线来评估Logistic回归模型的效果。结果 单因素及多元Logistic回归分析显示,高血压史、高脂血症、高同型半胱氨酸血症、体育锻炼、交流频率、日常生活能力是脑卒中患者发生认知功能障碍的独立影响因素（均有P<0.05）。受试者工作特征曲线评价Logistic回归模型效果的曲线下面积为0.853（95%CI:0.781~0.926）。>3个独立危险因素组MMSE评分低于≤ 3个独立危险因素组MMSE评分（t=4.183,P=0.016）。结论 高龄急性缺血性脑卒中患者认知功能障碍的发生率较高,影响认知功能障碍的危险因素较多,需采取预防措施,以减少或延缓认知障碍的发生。     

伴S100蛋白增高的缺血性脑卒中患者相关危险因素Logistic回归分析

目的 分析伴S100蛋白增高的缺血性脑卒中患者的相关危险因素.方法 选取2010年1月～2011年12月某院收治的80例S100蛋白含量＞0.105 μg/L的缺血性脑卒中患者为研究对象,并选取96例健康体检者作为对照,应用单因素和多因素非条件Logistic回归分析,研究与S100蛋白含量增高的危险因素.结果 男性、高血压病史、糖尿病病史、吸烟史、脑卒中家族史以及规律作息是伴S100蛋白增高的缺血性脑卒中患者的独立危险因素,其中男性、高血压病史以及糖尿病病史的关联强度较大,而规律作息是伴S100蛋白增高的缺血性脑卒中发生的保护因素.结论 伴Sl00增高的缺血性脑卒中患者受性别、高血压病史、糖尿病病史、吸烟史、脑卒中家族史以及作息不规律的影响,对这类人群进行与危险因素相关的必要的干预具有重要的意义.     

Effects of policosanol on patients with ischemic stroke: a pilot open study

Stroke is a major health problem worldwide. Its pharmacological management includes thrombolytic therapy for the acute phase and antiplatelet drugs for stroke recovery and prevention. Statins can help in the acute phase and in preventing stroke in secondary prevention patients. Policosanol is a cholesterol-lowering drug with concomitant antiplatelet effects, with protective effects in stroke models. This observational study investigated the effects of policosanol (20 mg/day) administered during the acute phase and for 5 years later on the neurological recovery of patients with ischemic stroke treated with antiplatelets and vitamins. After hospital discharge, patients were followed up every 3 (first year) and 6 (thereafter) months. Neurological improvement was assessed with the modified Canadian Neurological Scale. Adverse events were recorded. Fifty patients were included; all completed the study. Neurological score improved throughout the study. No patient died, and most [40 (80.0%)] did not experience new vascular events; only one (2.0%) suffered a new stroke, and two (4.0%) suffered more than one transient ischemic attack. The time to the first recurrent event was 46.2 months. Policosanol persistently lowered serum total cholesterol, with such reduction correlating with the neurological improvement (R = 0.995253301). Triglycerides were unchanged. Treatment was well tolerated. Policosanol administered to patients suffering ischemic stroke treated with aspirin and vitamins showed good results on neurological outcomes and recurrent events. This study, however, has limitations, since it was open and uncontrolled, and patients also consumed aspirin and vitamins. New randomized, controlled studies are needed to assess the usefulness of policosanol in stroke management.     

The Impact of Atrial Fibrillation on the Cost of Stroke: The Berlin Acute Stroke Study

OBJECTIVES: Atrial fibrillation (AF) is an important risk factor for stroke. The primary purpose of this study was to determine the resource use for patients admitted to hospital with acute stroke and to calculate stroke-related direct costs, stratifying the results according to the presence of AF as a risk factor. METHODS: Data from 558 consecutive patients hospitalized with confirmed acute stroke between August 2000 and July 2001 were analyzed as part of the Berlin Acute Stroke Study. Sociodemographic variables were assessed by direct interview, while hospital data were derived from patient medical records. Patients or their carers completed a follow-up questionnaire about resource utilization and absenteeism from work during the 12-month period after hospital admission. RESULTS: Out of the 367 patients with follow-up data and ECG findings, 71 (19%) had AF. Patients with AF were generally older, more likely to be female, and had more severe strokes compared with those without AF. Mean direct costs per patient were significantly higher in those with AF-related strokes (EURO 11,799 vs EURO 8817 for non-AF-related strokes; P < 0.001). After adjustment for confounding factors, direct costs were comparable in the two groups, except for acute hospitalization costs, which remained significantly higher in the group with AF (P < 0.05). CONCLUSION: Medical care for stroke patients with AF is associated with higher costs compared with those without AF; this is explained mainly by confounding factors and driven essentially by a significant difference in acute hospitalization costs.     

口服避孕药与缺血性脑卒中关系的Meta分析

[目的]研究口服避孕药与缺血性脑卒中之间的关系。[方法]检索Pub Med等数据库中1990年以来公开发表的脑卒中与口服避孕药的相关文献,按照所制定的纳入标准筛选,最终确定15篇符合条件的国外病例-对照研究文献,并运用RevMan4.2软件,对其中的数据应用随机效应模型和固定效应模型进行综合的定量分析。[结果]口服避孕药与缺血性脑卒中合并OR值为1.54,95%CI为1.11~2.14。[结论]使用口服避孕药可能是缺血性脑卒中的危险因素。     

徐州市社区缺血性脑卒中患者二级预防知识行为现状及影响因素研究

目的 了解徐州市社区缺血性脑卒中患者二级预防知识行为现状及二级预防行为的影响因素,为制定和评价健康教育政策、干预措施提供参考依据。方法 采取入户调查的方法,对徐州市社区212例缺血性脑卒中患者进行脑卒中二级预防知识行为问卷调查。结果 社区缺血性脑卒中患者抗栓药服用率为79.2%,他汀类降脂药物服用率为35.6%;防治知识得分为（11.13 ±1.43）分,占知识总分的70.6%,行为得分为（56.17±5.60）分,占行为总分的59.1%;知识和行为得分成正相关（r = 0.666,P＜0.01）;不同年龄、文化程度、家庭人均月收入患者在知识和行为方面得分均有统计学差异（P＜0.05）。年龄、文化程度、家庭人均月收入以及知识均为患者二级预防行为的影响因素（P＜0.05）。结论 社区缺血性脑卒中患者二级预防行为现状与指南之间仍有一定的差距,应结合影响二级预防行为的影响因素,采取有效的措施缩短二级预防实践与指南之间的距离。