胰岛素抵抗与非致残性缺血性脑血管病患者卒中复发之间的关系

目的 探讨不同胰岛素抵抗状态对无糖尿病史的非致残性缺血性脑血管病（non-disabling ischemic cerebrovascular events,NICE）患者卒中复发风险的影响。 方法 使用稳态模型胰岛素抵抗（homeostasis model assessment of insulin resistance,HOMA-I R）指数 对胰岛素抵抗进行评估。根据不同胰岛素抵抗状态,使用四分位法将无糖尿病史的NICE患者分为4 组。该研究的主要研究终点为90 d新发卒中（包括缺血性和出血性卒中）。利用多元Cox回归模型校正 潜在协变量,评估不同胰岛素抵抗状态与卒中复发风险之间的关系,同时对不同抗血小板聚集治疗、 不同胰岛素抵抗状态与卒中复发之间的交互作用进行统计分析。 结果 本研究共纳入2325例NICE患者。根据患者不同胰岛素抵抗状态分组,4组界值分别为Q1 （HOMA-IR指数﹤1.35）、Q2（1.35≤HOMA-IR指数﹤2.17）、Q3（2.17≤HOMA-IR指数﹤3.39）及Q4（HOMAIR 指数≥3.39）,4组患者人数分别为585例、575例、585例及580例。90 d随访时,共出现167例卒中复 发,其中氯吡格雷联合阿司匹林组为68例,阿司匹林组为99例。与Q1组（6.3%）比较,Q2组（9.2%,校 正HR 1.56,95%CI 1.01～2.41,P =0.04）、Q3组（5.6%,校正HR 1.04,95%CI 0.64～1.69,P =0.89）和 Q4组（7.6%,校正HR 1.35,95%CI 0.85～2.15,P =0.21）患者卒中复发风险均未明显上升。 结论 本研究未在NICE患者中发现胰岛素抵抗与卒中复发风险升高相关。     

急性非致残性脑梗死患者卒中后认知功能障碍与胰岛素抵抗的相关性北大核心CSCD

目的探讨急性非致残性脑梗死患者胰岛素抵抗与早期卒中后认知功能的关系。方法收集2018年4月至2020年4月在南通大学第二附属医院神经内科住院的首发急性非致残性脑梗死患者临床资料。入院第2天检测空腹血糖、胰岛素,计算胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)。随访12个月,记录卒中复发的类型及时间。于发病后3个月随访时剔除再发脑卒中者,其余患者行蒙特利尔认知量表(Montreal cognitive assessment,MoCA)评分。根据3个月MoCA分值将患者分为早期卒中后认知功能障碍(post stroke cognitive impairment,PSCI)组与早期卒中后无认知功能障碍(Non-PSCI)组,比较两组资料;采用logistic回归分析确定急性非致残性脑梗死患者早期PSCI的影响因素。采用Kaplan-Meier分析确定HOMA-IR与卒中复发的关系。结果共收集243例首发急性非致残性脑梗死患者,3个月随访时剔除18例,纳入研究225例。PSCI组的HOMA-IR[3.17(1.42,29.15)vs 1.94(1.25,7.84),Z=2.872,P=0.004]显著高于Non-PSCI组。HOMA-IR(OR=1.032,95%CI 1.010~1.055,P=0.004)是急性非致残性脑梗死患者早期PSCI的危险因素;当HOMA-IR≥2.36时,其与PSCI的关联强度显著增强(HOMA-IR:2.36~<15.24,OR=6.589,95%CI 1.203~36.037,P=0.030;HOMA-IR:≥15.24,OR=9.238,95%CI 1.362~62.634,P=0.023)。随着HOMA-IR水平的升高,非致残性脑梗死患者1年内卒中复发率显著升高(Log Rank检验:χ2=10.54,P=0.014)。结论胰岛素抵抗是急性非致残性脑梗死患者早期PSCI的危险因素,还会增加其1年内的卒中复发率。     

脑梗死患者血脂代谢紊乱与胰岛素抵抗

目的 探讨脑梗死患者血脂代谢紊乱与胰岛素抵抗相关关系。方法 选取脑梗死患者40例及健康对照者30例为研究对象,测定总胆固醇(CH)、甘油三脂(TG)、高密度脂蛋白(HDL-C)、低密底脂蛋白(LDL-C)、血糖(G)、胰岛素(INS)含量,同时采用李光伟等提出的胰岛素敏感指数(ISI)方法进行计算。结果 脑梗死患者CH、TG、LDL-C显著高于对照组(P<0.01)而HDL-C明显低于对照组(P<0.01);INS显著高于对照组(P<0.01),而ISI显著低于对照组(P<0.01)。结论 脑梗死患者血脂代谢紊乱与胰岛素抵抗呈正相关,两者共同参与脑梗死发生及发展。     

胰岛素抵抗与缺血性脑血管病之间关系的动态研究

目的；研究胰岛素抵抗与缺血性脑血管病之间的关系。方法：选取脑梗死病人作为研究对象，测定血糖，胰岛素，Ｃ－Ｐ等指标，以胰岛素敏感指数与对照组比较。结果：ＦＩＮＳ，Ｃ－Ｐ和ＩＳＩ均有显著性差异，ＩＳＩ与ＦＩＮＳ和Ｃ－Ｐ存在极显著负相关Ｃ－Ｐ与ＦＩＮＳ存在极显著正相关，与ＩＳＩ存在极显著负相关。     

胰岛素抵抗与缺血性脑血管疾病

众多的研究表明:胰岛素抵抗与缺血性脑血管病的发生密切相关。胰岛素抵抗和（或）高胰岛素血症可导致血管内皮损伤、糖脂代谢紊乱、高血压、凝血功能异常、炎症反应等,这些病理生理改变均是缺血性脑血管病的危险因素。因此,胰岛素抵抗在缺血性脑血管病的发病中具有一定的作用,并与病情的严重程度相关。     

抗血小板药物抵抗与复发性缺血性脑卒中

缺血性脑卒中在抗血小板治疗期间1/3~1/2的患者卒中复发。卒中复发有多种原因,多认为病人的不依从性是实验室抗血小板药物抵抗的最常见原因,但需要正确识别卒中的原因和发病机制。目前还没有良好指征用于缺血性卒中抗血小板药物抵抗的检测,或根据检测结果调整药物剂量的方法。选择预防卒中复发的抗血小板药物取决于卒中发作的时间,轻度缺血性卒中在发病3个月内选用阿司匹林联合氯吡格雷优于单一的抗血小板药物,但对长期二级预防来说,联合应用抗血小板治疗不仅无益处,且有增加出血的风险。     

脑梗死与胰岛素抵抗关系的实验研究

目的 对胰岛素抵抗与脑梗死之间的关系进行探讨。方法 分别对62例单纯性脑梗死患者和35例健康对照组进行空腹血糖(FBG)、空腹破岛素(FINs)、胆固醇(Tc)、甘油三酯(TG)，计算胰岛素敏感指数(ISI)，并与神经功能缺失评分和梗死灶面积进行直线相关分析。结果 脑梗死患者组FB6、FINS、TC、TG显著高于对照组(尸＜0．05)；ISI显著低于对照组。脑梗死轻型组与脑梗死重型组之间FINS和IsI也存在显著差异。IsI与梗死灶面积、神经功能缺失评分呈负相关。结论 破岛素抵抗与脑梗死有密切关系，可能是脑梗死的一个重要危险因素，它参与了脑梗死的发生发展。     

胰岛素抵抗,血脂异常与缺血性脑血管病关系的动态研究

目的 研究胰岛素抵抗（ＩＲ），血脂异常与缺血性脑血管病之间的关系。方法 测定不同病程脑梗死患者的血脂，胰岛素，血糖及ｃ－肽（ｃ－ｐ）等，并与健康对照组（２９例）比较。结果 在脑梗死的不同发展阶段，血脂，血糖，ｃ－ｐ及胰岛素敏感指数（ＩＳＩ）与对照组相比均有显著性差异（Ｐ〈０．０５），ＩＳＩ在恢复期组与甘油三酯和ａｐｏＢ有显著负相关（Ｐ〈０．０５），在其他各组均无相关。结论 在脑梗死发病的全过程中Ｉ     

胰岛素抵抗与高血压并脑梗死关系的探讨

目的 探讨高血压并脑梗死患者是否存在胰岛素抵抗（ＩＲ）与高胰岛素血症（ＨＩＳ）,以及ＩＲ与脑大小血管病变的关系。方法 测定５７例高血压并脑梗死患者及１５例非脑血管病患者的血糖（ＦＰＧ）与血清胰岛素（ＦＩｎｓ）,同时采用李光伟等提出的胰岛素敏感性指数（ＩＳＩ）方法进行计算。结果 高血压并脑梗死患者ＦＩｎｓ明显高于对照组（Ｐ〈０．００１）,其ＩＳＩ较对照组明显减低（Ｐ〈０．００１）。脑微小血管病变组Ｆ     

脑卒中患者胰岛素抵抗的初步研究

目的 探讨脑梗死、脑出血患者与胰岛素抵抗的相关性。方法 对16例脑梗死、11例脑出血及15例对照组者的空腹血糖、血胰岛素、C-肽和胰岛素敏感性指数的测值进行比较和分析。结果 脑梗死组所测空腹血胰岛素(16.82±8.32μIU/ml)、C-肽(2.44+1.13ng/ml)显著高于对照组(8.89±6.84μIU/ml,1.59±0.96ng/ml)(P<0.05),胰岛素敏感性指数(-4.43±0.57)显著低于对照组(-3.67±0.69)(P<0.01);脑出血组的空腹血胰岛素(21.47±16.27μIU/ml)、C-肽(2.51±0.87ng/ml)和胰岛素敏感性指数(-4.57+0.70)与对照组相比有显著性差异(P<0.05,P<0.01);脑梗死组和脑出血组之间的空腹血糖、血胰岛素、C-肽、胰岛素敏感性指数无显著性差异(P>0.05)。结论 胰岛素抵抗在脑梗死和脑出血的急性期有重要作用,是脑卒中的危险因素。     

nsulin resistance and occurrence and prognosis of schemic stroke——A non-randomized concurrent control and intra-group comparison

BACKGROUND： Clinical evidence has demonstrated that insulin resistance might be an independent risk factor for ischemic stroke, which has not been recognized. At present, insulin resistance has been proven to be an independent risk factor for coronary arteriosclerotic heart disease. However, the relationship between the onset and prognosis of ischemic stroke remains unclear. OBJECTIVE： This study was designed to analyze the relationship between insulin resistance and ischemic stroke and the correlation between insulin resistance and stroke risk factor, and to investigate the relationship between insulin resistance and ischemic stroke prognosis as well as whether insulin resistance is an independent prognostic factor. DESIGN： A non-randomized concurrent control experiment. SETTING： Department of Geriatric Disease, Second Affiliated Hospital of Kunming Medical College. PARTICIPANTS： A total of 106 inpatients with ischemic stroke of the cervical internal carotid artery, who had suffered from the disease within the previous 72 hours, were admitted to the Department of Neurology, First Affiliated Hospital of Kunming Medical College from March to December in 2005 and, recruited for the present study. All 106 inpatients corresponded to the diagnostic criteria of ischemic stroke, formulated at the Fourth National Cerebrovascular Disease Conference in 1995, and were confirmed as having had an ischemic stroke by CT/MRI examinations. The patient group consisted of 54 males and 52 females. An additional 50 healthy individuals, who received health examinations simultaneously, were included as controls. Among the control subjects, there were 26 males and 24 females. Informed consent for laboratory measurements was obtained from all subjects; this study was approved by the Hospital Ethics Committee. METHODS： Following admission, all subjects were inquired of age, gender, previous history, blood pressure, body temperature, admission time, and smoking habits. Meanwhile, they were scored on clinical neurological functi     

动脉内溶栓治疗急性缺血性脑卒中的临床分析

目的:探讨使用动脉内溶栓方法治疗急性缺血性脑卒中的效果。方法:回顾138例急性缺血性脑卒中患者,发病距接受治疗的时间为3～24h,采取超选择性动脉溶栓。结果:颈内动脉闭塞22例,大脑中动脉主干闭塞38例,大脑中动脉分支闭塞33例,大脑前动脉闭塞1例,椎基底动脉系统血管闭塞12支。脑血管造影未见异常32例。闭塞血管再通者,颈内动脉12例;大脑中动脉24例;大脑中动脉分支21例;椎基底动脉8例。8例患者因明显血管狭窄,治疗后予以球囊扩张,支架植入术。临床症状完全恢复或明显好转83例,溶栓后脑出血患者5例。结论:超选择动脉内溶栓是治疗急性缺血性脑卒中的有效方法。     

替格瑞洛与西洛他唑对氯吡格雷抵抗的急性缺血性脑卒中患者的疗效及安全性比较

目的 探讨替格瑞洛与西洛他唑对氯吡格雷抵抗的急性缺血性脑卒中(AIS)患者的疗效及安全性的影响。方法 将80例对氯吡格雷抵抗(血小板聚集率>50%)AIS患者按照数字表法随机分为替格瑞洛组(入组40例,完成37例)和西洛他唑组(入组40例,完成39例); 在AIS常规治疗的基础上替格瑞洛组将氯吡格雷换用替格瑞洛治疗(90 mg/次,2次/d); 西洛他唑组将氯吡格雷换用西洛他唑治疗(100 mg/次,2次/d)。于改变治疗方案前及改变治疗方案后1、3、6、12个月分别检测血小板聚集率(PIR),观察2组治疗12个月内的缺血事件、出血事件及药物的不良反应。结果 改变治疗方案后12个月替格瑞洛组总有效率显著高于西洛他唑组(z=-2.086,P=0.037)。替格瑞洛组缺血事件发生率低于西洛他唑组(χ²=4.057,P=0.034); 替格瑞洛组的出血事件发生率高于西洛他唑组(χ²=4.501,P=0.034); 替格瑞洛组的呼吸困难发生率高于西洛他唑组(χ²=4.505,P=0.034); 替格瑞洛组的其他不良反应发生率高于西洛他唑组(χ²=4.021,P=0.045)。改变治疗方案后1、3、6、12个月替格瑞洛组患者的PAR低于西洛他唑组(F=15.320,P=0.000)。结论 对氯吡格雷抵抗的AIS患者,替格瑞洛比西洛他唑的血小板抑制作用更强,缺血事件发生率更低,但出血事件、呼吸困难及其他不良反应的发生率更高,因此对于血栓风险较高、出血风险较低的患者,建议换用替格瑞洛; 对于血栓风险较低、出血风险较高的患者,建议换用西洛他唑。     

Prevalence of high IgM anticardiolipins in patients with ischemic stroke

Lupus anticoagulant (LA), IgG and IgM isotypes of anticardiolipins (aCL), lipoprotein (a), and the resistance to activated protein C were determined in patients with ischemic stroke. The raised concentration of the aCL-IgM isotype was noted in 42% of patients with this type of stroke, and it was in contrast with an 8% frequency of an increased level of aCL-IgG isotype in these cases. The high level of lipoprotein (a) was found with similar frequency in stroke patients and in age-matched control subjects. It is concluded that the elevated concentration of IgM isotype of anticardiolipin antibodies can be regarded as significant in the ethiological work-up in elderly stroke patients.     

The association between high on-treatment platelet reactivity and early recurrence of ischemic events after minor stroke or TIA

Objectives: To evaluate the role of HTPR in predicting early recurrence of ischemic events in patients with minor ischemic stroke or high-risk TIA.

Methods: From January 2014 to September 2014, a single center continuously enrolled patients with minor ischemic stroke or high-risk TIA and gave them antiplatelet therapy consisting of aspirin with clopidogrel. HTPR was assessed by TEG after 7 days of antiplatelet therapy and detected CYP2C19 genotype. The incidence of recurrent ischemic events was assessed 3 months after onset. The incidence of recurrent ischemic events was compared between the HTPR and NTPR groups with the Kaplan-Meier method, and multivariate Cox proportional hazards models were used to determine the risk factors associated with recurrent ischemic events.

Results: We enrolled 278 eligible patients with minor ischemic stroke or high-risk TIA. Through TEG testing, patients with HTPR were 22.7%, and carriers were not associated with HTPR to ADP by TEG-ADP(%) (p = 0.193). A total of 265 patients completed 3 months of follow-up, and Kaplan-Meier analysis showed that patients with HTPR had a higher percentage of recurrent ischemic events compared with patients with NTPR (p = 0.002). In multivariate Cox proportional hazards models, history of ischemic stroke or TIA (HR 4.45, 95% CI 1.77–11.16, p = 0.001) and HTPR (HR 3.34, 95% CI 1.41–7.91, p = 0.006) was independently associated with recurrent ischemic events.

Discussion: In patients with minor stroke or TIA, the prevalence of HTPR was 22.7%, and HTPR was independently associated with recurrent ischemic events.     

缺血性脑卒中患者血清尿酸水平与颅内动脉狭窄的关系

目的 研究缺血性脑卒中患者血清尿酸水平与颅内动脉狭窄的关系.方法 对60例缺血性脑卒中患者进行数字减影血管造影检查,根据其颅内动脉狭窄程度分为狭窄组与无狭窄组.检测其血清尿酸、血脂及同型半胱氨酸(Hcy)水平,并进行比较.结果 根据DSA检查结果,将患者分为狭窄组(45例)和无狭窄组(15例).狭窄组男性、高血压、糖尿病、吸烟史、饮酒史、高血脂的比率及血尿酸水平显著高于无狭窄组(P ＜0.05～0.01).Logistic回归分析显示,高血压是颅内动脉狭窄的独立危险因素(OR=55.730,95％CI:1.100 ～2823.152;P ＜0.05).结论 高尿酸与颅内动脉狭窄有关,但不是其独立危险因素.