基质金属蛋白酶-3基因Lys45Glu多态性与缺血性卒中亚型的相关性

目的 探讨基质金属蛋白酶-3(matrix metalloprotemase-3,MMP-3)血浆水平及其基因Lys45Glu(rs679620)多态性与缺血性卒中及其TOAST亚型的关系.方法 纳入根据TOAST病因学分型分为大动脉粥样硬化性卒中(large artery atherosclerotic stroke,LAA)和小动脉闭塞性卒中(small artery occlusion stroke,SAO)患者(缺血性卒中组)和健康体检者(对照组).采用酶联免疫吸附法检测血浆MMP-3水平,多聚酶链反应-限制性片段长度多态性法检测MMP-3 Lys45 Glu基因型.结果共纳入急性缺血性卒中患者233例,其中LAA 162例,SAO 71例;200名健康体检者作为对照组.缺血性卒中组血浆MMP-3水平显著高于对照组[(253.99±75.02)ng/ml对(196.38±78.17) ng/ml;=7.813,P=0.000];LAA组[(262.81±69.23)ng/ml]血浆MMP-3水平均显著高于SAO组[(233.85±83.90)ng/ml,P=0.008]和对照组(P=0.000),SAO组也显著高于对照组(P=0.000).多变量logistic回归分析显示,血清MMP-3水平增高是缺血性卒中的独立危险因素[优势比(odds ratio,OR)1.012,95％可信区间(confidence interval,CI)1.008～1.015;P=0.000].缺血性卒中组MMP-3Lys45Glu基因型(x2 =2.085,P=0.353)和等位基因(x2 =2.29,P=0.130)频率与对照组均无显著差异.LAA、SAO和对照组之间MMP-3 Lys45Glu基因型频率存在显著差异(x2=10.39,P=0.034),其中LAA组AA +GA频率显著高于SAO组(65.4％对49.3％;x2=5.375,P=0.020)和对照组(65.4％对54.0％;x2 =4.84,P=0.028);3组间MMP-3 Lys45Glu等位基因频率无显著性差异(x2=3.887,P=0.143).多变量logistic回归分析显示,Lys45Glu多态性是LAA的独立危险因素(OR1.783,95％ CI1.183 ～2.688;P=0.006).AA基因型(n=73)、GA基因型(n=176)和GG基因型(n=184)患者血浆MMP-3水平分别为(235.70±70.85)ng/ml、(244.20±85.90) ng/ml和(207.98±77.61) ng/ml,3组间存在显著性差异(F=9.682,P=0.000);AA +GA基因型(n=249)患者血浆MMP-3水平显著高于GG基因型患者[(241.71±81.73) ng/ml对(207.98±77.61) ng/ml;=4.336,P =0.000].结论 LAA或SAO患者血浆MMP-3水平增高,以LAA亚型增高最为显著;MMP-3Lys45Glu多态性可能与MMP-3血浆水平和LAA有关.     

基于TOAST分型的急性缺血性卒中临床疗效分析

目的研究急性缺血性卒中TOAST分型与临床短期预后的关系。方法收集2010年5月—2011年4月在三峡中心医院神经内科病房住院治疗的700例急性缺血性卒中患者。缺血性卒中依据TOAST标准分型,即大动脉粥样硬化型(LAA)、心源性栓塞型(CE)、小动脉闭塞型(SAO),其他明确病因型(SOE)和不明原因型(SUE)5型。应用NIHSS评分了解不同亚型患者入院时和出院时的功能状态,以出院时神经功能好转率评价其临床短期预后,分析各亚型与临床短期预后的相关性。结果缺血性脑卒中男性患者发病年龄较女性患者早(P<0.01)。脑卒中亚型:LAA 194例(27.7%),SAO 220例(31.4%),CE 70例(10.0%),SOE8例(1.1%),SUE 208例(29.7%)。其中SAO亚型所占比例最高。各亚型与临床短期预后的关系:CE型患者入院时病情危重,神经功能缺损最严重,NIHSS评分最高(20.11±1.42)分,出院时神经功能好转率显著降低(P<0.01)。SAO亚型入院时病情最轻,NIHSS评分最低(4.10±0.36)分,出院时神经功能好转率显著增高(P<0.01)。结论 SAO亚型入院时病情最轻,临床疗效及临床短期预后最好;CE亚型入院时病情最重,临床疗效及临床短期预后最差。     

急性缺血性脑卒中TOAST病因分型对血浆纤维蛋白原的影响

目的 探讨急性脑卒中TOAST病因分型对血浆纤维蛋白原(Fib)的影响.方法 2009年8月-2011年12月在神经内科住院登记的符合入选标准的223例急性缺血性卒中患者,依TOAST标准进行分型,分为5组(亚型),分别为大动脉粥样硬化性卒中组(LAA组)、心源性脑栓塞组(CE)、小动脉闭塞性卒中组(SVA组)、其他原因卒中组(SOE组)和不明原因卒中组(SUE组).检测各亚型的Fib水平,并分析LAA组Fib水平与神经功能缺损程度以及临床疗效的相关性.结果 本研究急性缺血性卒中的构成中,最多为LAA组(42.2%),其次分别为SVA组(23.3%),CE组(18.8%)和SUE组(14.3%).与对照组(正常健康体检者)相比,急性缺血性卒中组Fib水平升高有统计学意义.各亚型中,LAA组的Fib水平最高,与其他亚型组相比差异有统计学意义.以LAA组为研究对象,Fib水平与神经功能缺损程度有关.结论 血浆Fib的水平与脑卒中患者的神经功能缺损程度和临床疗效密切相关,临床上检测血浆Fib的水平,可以为急性脑卒中各亚型的治疗提供一定的理论指导.     

不同亚型卒中患者血清基质金属蛋白酶-2含量及其意义

Objective To investigate the change of serum matix metalloproteinase-2(MMP-2) level and its significance in patients with acute ischemic stroke of different subtypes. Methods Seventy-seven patients with acute ischemic stroke were classified into large-artery atherosclerosis (LAA) (n =29, 37. 66% ), small artery occlusion (SAO, lacunar infarction) (n =23, 29.87%), cardioembolism (CE) (n = 13,16. 88%), stroke of undemonstrated etiology (SUE) (n = 7, 9.09% ), and stroke of other demonstrated etiology (SOE) (n = 5, 6. 49%) according to the TOAST criteria. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum MMP-2 in patients with acute ischemic stroke at 24 hours and 7 days, and they were compared with 42 controls. Results The serum MMP-2 levels at 24 hours and 7 days of the onset of symptoms in the acute ischemic stroke group according to the TOAST criteria were 189. 55 ±24.79 and 307.46 ±84. 16 ng/ml respectively, and they were all significantly higher than 159.76 ± 10. 32 ng/ml in the control group (all P <0.05). Among all the TOAST subtypes, SOE and SUE were not analyzed because of the small numbers of cases; among other subtypes, the serum MMP-2 levels at 24 hours of the onset of symptoms in the LAA, SAO and CE groups were 218. 60 ± 13.42,175.21 ±9.92, and 167.26 ±9.7 ng/ml respectively, and they were all significantly higher than those in the control group (all P < 0. 05); at day 7 of the onset of symptoms they were 404.75 ± 10. 30, 293.18 ± 10.91, and 211.81 ±11.14 ng/ml respectively, and they were also significantly higher than those in the control group (all P < 0.05). Among those, the LAA group was increased significantly (P < 0. 01). Conclusions The serum MMP-2 levels were increased in patients with acute cerebral infarction. "l'ne changes of the serum MMP-2 levels in each TOAST subtype group were different. The LAA group increased most significantly, which supported the different views of the etiology of cerebral infarction subtypes. The serum MMP-2 plays an important role in the process of cerebral infarction of the LAA type.     

不同亚型卒中患者血清基质金属蛋白酶-2含量及其意义

Objective To investigate the change of serum matix metalloproteinase-2(MMP-2) level and its significance in patients with acute ischemic stroke of different subtypes. Methods Seventy-seven patients with acute ischemic stroke were classified into large-artery atherosclerosis (LAA) (n =29, 37. 66% ), small artery occlusion (SAO, lacunar infarction) (n =23, 29.87%), cardioembolism (CE) (n = 13,16. 88%), stroke of undemonstrated etiology (SUE) (n = 7, 9.09% ), and stroke of other demonstrated etiology (SOE) (n = 5, 6. 49%) according to the TOAST criteria. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum MMP-2 in patients with acute ischemic stroke at 24 hours and 7 days, and they were compared with 42 controls. Results The serum MMP-2 levels at 24 hours and 7 days of the onset of symptoms in the acute ischemic stroke group according to the TOAST criteria were 189. 55 ±24.79 and 307.46 ±84. 16 ng/ml respectively, and they were all significantly higher than 159.76 ± 10. 32 ng/ml in the control group (all P <0.05). Among all the TOAST subtypes, SOE and SUE were not analyzed because of the small numbers of cases; among other subtypes, the serum MMP-2 levels at 24 hours of the onset of symptoms in the LAA, SAO and CE groups were 218. 60 ± 13.42,175.21 ±9.92, and 167.26 ±9.7 ng/ml respectively, and they were all significantly higher than those in the control group (all P < 0. 05); at day 7 of the onset of symptoms they were 404.75 ± 10. 30, 293.18 ± 10.91, and 211.81 ±11.14 ng/ml respectively, and they were also significantly higher than those in the control group (all P < 0.05). Among those, the LAA group was increased significantly (P < 0. 01). Conclusions The serum MMP-2 levels were increased in patients with acute cerebral infarction. "l'ne changes of the serum MMP-2 levels in each TOAST subtype group were different. The LAA group increased most significantly, which supported the different views of the etiology of cerebral infarction subtypes. The serum MMP-2 plays an important role in the process of cerebral infarction of the LAA type.     

不同亚型卒中患者血清基质金属蛋白酶-2含量及其意义

Objective To investigate the change of serum matix metalloproteinase-2(MMP-2) level and its significance in patients with acute ischemic stroke of different subtypes. Methods Seventy-seven patients with acute ischemic stroke were classified into large-artery atherosclerosis (LAA) (n =29, 37. 66% ), small artery occlusion (SAO, lacunar infarction) (n =23, 29.87%), cardioembolism (CE) (n = 13,16. 88%), stroke of undemonstrated etiology (SUE) (n = 7, 9.09% ), and stroke of other demonstrated etiology (SOE) (n = 5, 6. 49%) according to the TOAST criteria. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum MMP-2 in patients with acute ischemic stroke at 24 hours and 7 days, and they were compared with 42 controls. Results The serum MMP-2 levels at 24 hours and 7 days of the onset of symptoms in the acute ischemic stroke group according to the TOAST criteria were 189. 55 ±24.79 and 307.46 ±84. 16 ng/ml respectively, and they were all significantly higher than 159.76 ± 10. 32 ng/ml in the control group (all P <0.05). Among all the TOAST subtypes, SOE and SUE were not analyzed because of the small numbers of cases; among other subtypes, the serum MMP-2 levels at 24 hours of the onset of symptoms in the LAA, SAO and CE groups were 218. 60 ± 13.42,175.21 ±9.92, and 167.26 ±9.7 ng/ml respectively, and they were all significantly higher than those in the control group (all P < 0. 05); at day 7 of the onset of symptoms they were 404.75 ± 10. 30, 293.18 ± 10.91, and 211.81 ±11.14 ng/ml respectively, and they were also significantly higher than those in the control group (all P < 0.05). Among those, the LAA group was increased significantly (P < 0. 01). Conclusions The serum MMP-2 levels were increased in patients with acute cerebral infarction. "l'ne changes of the serum MMP-2 levels in each TOAST subtype group were different. The LAA group increased most significantly, which supported the different views of the etiology of cerebral infarction subtypes. The serum MMP-2 plays an important role in the process of cerebral infarction of the LAA type.     

不同亚型卒中患者血清基质金属蛋白酶-2含量及其意义

Objective To investigate the change of serum matix metalloproteinase-2(MMP-2) level and its significance in patients with acute ischemic stroke of different subtypes. Methods Seventy-seven patients with acute ischemic stroke were classified into large-artery atherosclerosis (LAA) (n =29, 37. 66% ), small artery occlusion (SAO, lacunar infarction) (n =23, 29.87%), cardioembolism (CE) (n = 13,16. 88%), stroke of undemonstrated etiology (SUE) (n = 7, 9.09% ), and stroke of other demonstrated etiology (SOE) (n = 5, 6. 49%) according to the TOAST criteria. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum MMP-2 in patients with acute ischemic stroke at 24 hours and 7 days, and they were compared with 42 controls. Results The serum MMP-2 levels at 24 hours and 7 days of the onset of symptoms in the acute ischemic stroke group according to the TOAST criteria were 189. 55 ±24.79 and 307.46 ±84. 16 ng/ml respectively, and they were all significantly higher than 159.76 ± 10. 32 ng/ml in the control group (all P <0.05). Among all the TOAST subtypes, SOE and SUE were not analyzed because of the small numbers of cases; among other subtypes, the serum MMP-2 levels at 24 hours of the onset of symptoms in the LAA, SAO and CE groups were 218. 60 ± 13.42,175.21 ±9.92, and 167.26 ±9.7 ng/ml respectively, and they were all significantly higher than those in the control group (all P < 0. 05); at day 7 of the onset of symptoms they were 404.75 ± 10. 30, 293.18 ± 10.91, and 211.81 ±11.14 ng/ml respectively, and they were also significantly higher than those in the control group (all P < 0.05). Among those, the LAA group was increased significantly (P < 0. 01). Conclusions The serum MMP-2 levels were increased in patients with acute cerebral infarction. "l'ne changes of the serum MMP-2 levels in each TOAST subtype group were different. The LAA group increased most significantly, which supported the different views of the etiology of cerebral infarction subtypes. The serum MMP-2 plays an important role in the process of cerebral infarction of the LAA type.     

不同亚型卒中患者血清基质金属蛋白酶-2含量及其意义

Objective To investigate the change of serum matix metalloproteinase-2(MMP-2) level and its significance in patients with acute ischemic stroke of different subtypes. Methods Seventy-seven patients with acute ischemic stroke were classified into large-artery atherosclerosis (LAA) (n =29, 37. 66% ), small artery occlusion (SAO, lacunar infarction) (n =23, 29.87%), cardioembolism (CE) (n = 13,16. 88%), stroke of undemonstrated etiology (SUE) (n = 7, 9.09% ), and stroke of other demonstrated etiology (SOE) (n = 5, 6. 49%) according to the TOAST criteria. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum MMP-2 in patients with acute ischemic stroke at 24 hours and 7 days, and they were compared with 42 controls. Results The serum MMP-2 levels at 24 hours and 7 days of the onset of symptoms in the acute ischemic stroke group according to the TOAST criteria were 189. 55 ±24.79 and 307.46 ±84. 16 ng/ml respectively, and they were all significantly higher than 159.76 ± 10. 32 ng/ml in the control group (all P <0.05). Among all the TOAST subtypes, SOE and SUE were not analyzed because of the small numbers of cases; among other subtypes, the serum MMP-2 levels at 24 hours of the onset of symptoms in the LAA, SAO and CE groups were 218. 60 ± 13.42,175.21 ±9.92, and 167.26 ±9.7 ng/ml respectively, and they were all significantly higher than those in the control group (all P < 0. 05); at day 7 of the onset of symptoms they were 404.75 ± 10. 30, 293.18 ± 10.91, and 211.81 ±11.14 ng/ml respectively, and they were also significantly higher than those in the control group (all P < 0.05). Among those, the LAA group was increased significantly (P < 0. 01). Conclusions The serum MMP-2 levels were increased in patients with acute cerebral infarction. "l'ne changes of the serum MMP-2 levels in each TOAST subtype group were different. The LAA group increased most significantly, which supported the different views of the etiology of cerebral infarction subtypes. The serum MMP-2 plays an important role in the process of cerebral infarction of the LAA type.     

不同亚型卒中患者血清基质金属蛋白酶-2含量及其意义

Objective To investigate the change of serum matix metalloproteinase-2(MMP-2) level and its significance in patients with acute ischemic stroke of different subtypes. Methods Seventy-seven patients with acute ischemic stroke were classified into large-artery atherosclerosis (LAA) (n =29, 37. 66% ), small artery occlusion (SAO, lacunar infarction) (n =23, 29.87%), cardioembolism (CE) (n = 13,16. 88%), stroke of undemonstrated etiology (SUE) (n = 7, 9.09% ), and stroke of other demonstrated etiology (SOE) (n = 5, 6. 49%) according to the TOAST criteria. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum MMP-2 in patients with acute ischemic stroke at 24 hours and 7 days, and they were compared with 42 controls. Results The serum MMP-2 levels at 24 hours and 7 days of the onset of symptoms in the acute ischemic stroke group according to the TOAST criteria were 189. 55 ±24.79 and 307.46 ±84. 16 ng/ml respectively, and they were all significantly higher than 159.76 ± 10. 32 ng/ml in the control group (all P <0.05). Among all the TOAST subtypes, SOE and SUE were not analyzed because of the small numbers of cases; among other subtypes, the serum MMP-2 levels at 24 hours of the onset of symptoms in the LAA, SAO and CE groups were 218. 60 ± 13.42,175.21 ±9.92, and 167.26 ±9.7 ng/ml respectively, and they were all significantly higher than those in the control group (all P < 0. 05); at day 7 of the onset of symptoms they were 404.75 ± 10. 30, 293.18 ± 10.91, and 211.81 ±11.14 ng/ml respectively, and they were also significantly higher than those in the control group (all P < 0.05). Among those, the LAA group was increased significantly (P < 0. 01). Conclusions The serum MMP-2 levels were increased in patients with acute cerebral infarction. "l'ne changes of the serum MMP-2 levels in each TOAST subtype group were different. The LAA group increased most significantly, which supported the different views of the etiology of cerebral infarction subtypes. The serum MMP-2 plays an important role in the process of cerebral infarction of the LAA type.     

不同亚型卒中患者血清基质金属蛋白酶-2含量及其意义

Objective To investigate the change of serum matix metalloproteinase-2(MMP-2) level and its significance in patients with acute ischemic stroke of different subtypes. Methods Seventy-seven patients with acute ischemic stroke were classified into large-artery atherosclerosis (LAA) (n =29, 37. 66% ), small artery occlusion (SAO, lacunar infarction) (n =23, 29.87%), cardioembolism (CE) (n = 13,16. 88%), stroke of undemonstrated etiology (SUE) (n = 7, 9.09% ), and stroke of other demonstrated etiology (SOE) (n = 5, 6. 49%) according to the TOAST criteria. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum MMP-2 in patients with acute ischemic stroke at 24 hours and 7 days, and they were compared with 42 controls. Results The serum MMP-2 levels at 24 hours and 7 days of the onset of symptoms in the acute ischemic stroke group according to the TOAST criteria were 189. 55 ±24.79 and 307.46 ±84. 16 ng/ml respectively, and they were all significantly higher than 159.76 ± 10. 32 ng/ml in the control group (all P <0.05). Among all the TOAST subtypes, SOE and SUE were not analyzed because of the small numbers of cases; among other subtypes, the serum MMP-2 levels at 24 hours of the onset of symptoms in the LAA, SAO and CE groups were 218. 60 ± 13.42,175.21 ±9.92, and 167.26 ±9.7 ng/ml respectively, and they were all significantly higher than those in the control group (all P < 0. 05); at day 7 of the onset of symptoms they were 404.75 ± 10. 30, 293.18 ± 10.91, and 211.81 ±11.14 ng/ml respectively, and they were also significantly higher than those in the control group (all P < 0.05). Among those, the LAA group was increased significantly (P < 0. 01). Conclusions The serum MMP-2 levels were increased in patients with acute cerebral infarction. "l'ne changes of the serum MMP-2 levels in each TOAST subtype group were different. The LAA group increased most significantly, which supported the different views of the etiology of cerebral infarction subtypes. The serum MMP-2 plays an important role in the process of cerebral infarction of the LAA type.     

基质金属蛋白酶3基因rs522616多态性与脑梗死亚型的关系

目的探讨基质金属蛋白酶3(MMP-3)血清水平及其启动子区基因rs522616(-709A/G)多态性与低分子肝素试验病因分型(TOAST)中,大动脉粥样硬化性(LAA)和小动脉闭塞性(SAO)卒中的相关性。方法选取289例急性缺血性卒中(发病≤3d)患者,LAA卒中185例,SAO卒中104例,应用酶联免疫吸附法(ELISA)检测血清MMP-3水平,聚合酶链反应后直接测序法检测其启动子基因rs522616多态性。结果①LAA组MMP-3血清水平为(245±56)ng/ml,高于SAO组的(227±51)ng/ml,差异有统计学意义(P0.01)。②LAA组患者中,MMP-3基因rs522616多态位点AA基因型频率为50.8%,A等位基因频率为71.1%,分别高于SAO组的38.5%和61.5%,差异有统计学意义(P0.05)。③多因素Logistic回归分析发现,AA基因型(OR=1.72,95%CI:1.04～2.85)和MMP-3(OR=0.014,95%CI:0.00～0.29)水平增高是LAA型卒中的独立危险因子。结论与SAO性卒中比较,MMP-3血清增高水平及rs522616基因多态性位点AA基因型与LAA性卒中关系更为密切。     

急性脑梗死患者血清CXCL16水平与卒中亚型的关系

目的 探讨急性脑梗死患者血清CXCL16水平变化及其与脑梗死TOAST病因学分型之间的关系.方法 应用酶联免疫吸附法检测113例急性脑梗死患者血清CXCL16水平,按TOAST分型进行分组,将各亚组之间以及与32例健康对照者进行比较.结果 病例组血清CXCL16水平显著高于对照组[(2.29±0.21)ng/ml对(1.75±0.21)ng/ml,t=12.863,P=0.000];大动脉粥样硬化性卒中组血清CXCL16水平显著高于小动脉闭塞性卒中组[(2.38±0.23)ng/ml对(2.21±0.11)ng/ml,q=5.743,P=0.000],而且两者均显著高于对照组(q=20.501,P=0.000;q=13.527,P=0.000).在大动脉粥样硬化性卒中组中,≥2条动脉狭窄组血清CXCL16水平与仅有1条动脉狭窄组无显著差异[(2.34±0.24)ng/ml对(2.46±0.19)ng/ml,t=-1.969,P=0.054].多变量logistic回归分析显示,CXCL16(OR=0.972,95% CI 0.956～0.978,P=0.001)和高脂血症(OR=3.547,95% CI1.160～10.848,P=0.020)足脑梗死发生的独立危险因素.结论 血清CXCL16水平在脑梗死急性期升高,与脑梗死发生密切相关,且大动脉粥样硬化性卒中组显著高于小动脉闭塞性卒中组.     

趋化因子CXCL16基因rs3744700多态性与脑梗死亚型的相关性研究

目的研究血清趋化因子CXCL16（CXCL16）水平及CXCL16基因rs3744700多态性与急性卒中治疗低分子肝素试验病因分型（TOAST）亚型的关系。方法选择发病≤7 d的动脉粥样硬化性脑梗死患者248例,其中大动脉粥样硬化性脑梗死（LAA）组149例,小动脉闭塞性脑梗死（SAO）组99例。采用聚合酶链式反应（PCR）及基因测序技术检测基因型、酶联免疫吸附法检测血清CXCL16水平。结果①LAA组血清CXCL16水平为（2.5±0.3）μg/L;SAO组为（2.3±0.6）μg/L,P〈0.01。②149例LAA组患者中,CXCL16基因rs3744700多态位点GG基因型频率为91.9%（137/149）,G等位基因频率为96.0%（286/298）,高于SAO组的81.8%及89.9%,差异有统计学意义,P〈0.05。③LAA组GG基因型患者血清CXCL16水平为（2.5±0.3）μg/L,高于GT＋TT基因型患者的（2.1±0.3）μg/L;SAO组GG基因型患者血清CXCL16水平为（2.4±0.6）μg/L,高于GT＋TT基因型患者的（2.1±0.3）μg/L,均P〈0.05。GG基因型患者中,LAA组血清CXCL16水平高于SAO组,P=0.01;GT＋TT基因型患者中两组CXCL16水平差异无统计学意义。④多因素Logistic回归分析显示,血清CXCL16水平（OR=0.37,95%CI：0.19～0.70）、CXCL16基因rs3744700多态位点GG基因型（OR=2.57,95%CI：1.23～5.36）是影响LAA型脑梗死的独立危险因素。结论TOAST亚型中,血清CXCL16水平及CXCL16基因rs3744700多态位点GG基因型与LAA型脑梗死的相关性高于SAO型脑梗死。     

采用TOAST分型对高龄缺血性脑卒中患者的单中心资料分析

目的 探讨高龄(≥80岁)缺血性脑卒中TOAST分型亚组患者的临床特征、影像学、血管学以及实验室检查结果等方面的差异.方法 回顾分析神经科连续住院的91例高龄急性缺血性脑卒中患者的病历和影像学资料,根据TOAST分型进行分组,对各TOAST分型亚组患者的危险因素、临床表现、并发症、短期预后、影像学表现、脑血管病变以及实验室检查结果等情况进行分析对比.结果 大动脉粥样硬化(34/91)是高龄缺血性脑卒中的最常见病因,罪犯血管多位于颅内(25/34).大动脉粥样硬化组颅内(28/34)和颅外(12/34)脑动脉闭塞性病变患者比例均高于其他各组.心脏源性栓塞组患者血脂水平偏低,短期预后不良(7/15)患者比例高于大动脉粥样硬化组和小动脉闭塞组,严重脑水肿(4/15)患者比例高于其他各组,后循环梗死(1/15)和脑白质病变(3/15)患者比例低于小动脉闭塞组.小动脉闭塞组出现并发症(4/20)患者较少,无短期预后不良.结论 高龄缺血性脑卒中各TOAST分型亚组患者的临床特征、影像学表现、脑血管病变以及实验室检查结果等方面均存在不同程度的差异,上述差异的临床意义有待进一步探索.     

MMP-2C735T、MMP-9C1562T基因多态性与缺血性卒中患者的卒中及其亚型大动脉粥样硬化性卒中有关，但与转归无关

目的 探讨基质金属蛋白酶（matrix metallop roteinase,MMP）-2C735T和MMP-9C1562T基因多态性与缺血性卒中患者的TOAST分型和转归的关系。方法232例缺血性卒中患者根据TOAST标准分被为大动脉粥样硬化性卒中（large arery atherosclerosis,LAA）(n...     

缺血性脑卒中复发与相关因素分析

目的观察缺血性脑卒中患者2年复发率及复发的相关危险因素。方法采用前瞻性的队列研究方法,共纳入首发缺血性脑卒中患者860例,根据2年随访是否复发分为复发组(106例)和无复发组(754例)。并按照TOAST标准进行病因分型,大动脉粥样硬化型(LAA)261例,小动脉闭塞型(SAO)186例、心源性栓塞型(CES)191例、其他明确病因或不明原因型(UND)222例,随访2年,观察不同病因分型脑卒中复发率的差异,并进行多因素回归分析相关因素。结果复发组年龄、高血压、糖尿病、吸烟及纤维蛋白原水平较无复发组明显升高(P<0.05,P<0.01);抗血小板药物依从性较无复发组明显降低,差异有统计学意义(P<0.01)。复发脑卒中106例,其中LAA 29例,SAO 22例,CES 36例,UND 19例。多因素回归分析显示,年龄、高血压史、糖尿病史、纤维蛋白原、TOAST分型及抗血小板药物依从性与缺血性脑卒中复发相关。结论不同病因型脑卒中2年复发率存在差异;纤维蛋白原、TOAST病因分型及抗血小板药物依从性也是缺血性脑卒中复发的独立危险因素。     

MMP-2 C735T、MMP-9 C1562T基因多态性与缺血性卒中患者的卒中及其亚型大动脉粥样硬化性卒中有关，但与转归无关

目的探讨基质金属蛋白酶（matrix metalloproteinase,MMP）-2C735T和MMP-9C1562T基因多态性与缺血性卒中患者的TOAST分型和转归的关系。方法232例缺血性卒中患者根据TOAST标准分被为大动脉粥样硬化性卒中（large artery atherosclerosis,LAA）（n=37）、心源性脑栓塞（cardioembolism,CE）（n=31）、小动脉闭塞性卒中（small artery occlusion,SAO）（n=65）、其他明确原因导致的卒中（stroke of other demonstrated etiology,SOE）（n=2）和原因不明性卒中（stroke of undemonstrated etiology,SUE）（n=97）;对照组为235名健康者。采用限制性片段长度多态性技术检测MMP-2基因C735T和MMP-9基因C1562T多态性。采用Barthel指数（Barthel Index,BI）评价缺血性卒中患者发病21d和90d时的转归。结果缺血性卒中组（CC基因型：63．36％对54．04％,χ2=4．182,P=0．014;C等位基因：79．31％对74．04％,χ2=3．936;P=0．047）及其LAA亚型（CC基因型：78．37％对54．04％,χ2＝7．740,P=0．005;C等位基因：87．83％对74．04％,χ2=6．655,P=0．01）MMP-2735CC基因型和C等位基因频率均显著高于对照组;缺血性卒中组（CT＋TT基因型：21．98％对13．19％,χ2=6．233,P=0．013;T等位基因：11．64％对7．02％,χ2=5．891,P=0．015）及其LAA亚型（cT＋TT基因型：32．43％对13．19％,χ2=8．892,P=0．003;T等位基因：20．27％对13．19％,χ2=13．950,P=0．000）MMP-91562CT＋TT基因型频率和T等位基因频率也均显著高于对照组。多变量logistic回归分析显示,MMP-2735CC基因型（缺血性卒中：优势比1．099,95％可信区间1．038～1．260,P=0．028;LAA：优势比1．360,95％可信区间1．167～5．774,P=0．009）和MMP-91562TT基因型（缺血性卒中：优势比9．409,95％可信区间1．154—76．722,P=0．036;LAA：优势比8．962,95％可信区间1．380～58．218,P=0．022）携带者缺血性卒中以及LAA亚型发病风险显著增高。MMP-2和MMP-9不同基因型与卒中预后无显著相关性（P均〉0．05）。结论MMP-2735CC基因型和MMP-91562TT基因型与卒中及其LAA亚型的发病风险有关,但与其转归无关。     

小血管闭塞性卒中的危险因素分析

目的 探讨小血管闭塞性卒中(small artery occlusion,SAO)及其2种亚型的相关危险因素.方法 从南京卒中注册系统中收集2009年12月至2010年11月注册、符合TOAST标准中大血管动脉粥样硬化性卒中(large artery atherosclcrosis,LAA)或SAO的首发急性缺血性卒中患者的临床和影像学资料.病例分为LAA组和SAO组,后者再分为腔隙性脑梗死伴缺血性白质疏松(ischaemic leukoaraiosis,ILA)亚组和单纯腔隙性梗死(isolated lacunar infarction,ILI)亚组,比较LAA组与SAO组及其亚组的危险因素,并进行多变量logistic回归分析,筛选独立危险因素.结果 共纳入291例病例,其中LAA组120例,SAO组171例(ILI亚组87例,ILA亚组84例).SAO组平均年龄大于LAA患者,高血压患者比例和血清同型半胱氨酸(homocysteine,Hcy)水平显著高于LAA患者(P均＜0.05).多变量logistic分析表明,高龄[优势比(odds ratio,OR)1.041,95%可信区间(confidence interval,CI)1.02～1.06,P=0.045]、高血压(OR=2.912,95%CI 1.11～6.46,P=0.031)和血浆Hcy水平增高(OR=1.109,95%CI 1.11～1.32,P=0.001)是SAO的独立危险因素.在SAO的两亚组中,高龄(OR=1.047,95%CI 1.00～1.09,P=0.043)、高血压(OR=2.632,95%CI 1.08～6.41,P=0.033)和血浆Hcy水平增高(OR=1.211,95%CI 1.11～1.32,P＜0.001)是ILA的独立危险因素,而高胆固醇血症(OR=0.136,95%CI 0.05～0.37,P＜0.001)则是ILI的独立危险因素.结论 高龄、高血压和血浆Hcy水平增高可能在SAO的发病机制中起着重要作用.高胆固醇血症是ILI的独立危险因素,而高龄、高血压病和血浆Hcy水平增高是ILA的独立危险因素.

Abstract：

Objective To investigate the related risk factors for small artery occlusion (SAO) and its 2 subtypes. Methods The clinical and imaging data in 291 patients with first-ever stroke who met the TOAST criteria of large artery atherosclerotic stroke (LAA) or SAO were collected from the Nanjing Stroke Registry Prog-am from December 2009 to November 2010. All the patients were divided into a LAA group (n = 120) and a SAO group (n = 171). The latter was redivided into either a lacunar infarction with ischemic leukoaraiosis (ILA) subgroup (n = 84)or an isolated lacunar infarction (ILI) subgroup (n = 87). The risk factors of the LAA group and SAO group and its subgroups were compared. Multivariate logistic regression analysis was conducted and the independent risk factors were screened. Results The mean age in the SAO group was larger than that in the LAA group. The proportion of the patients with hypertension and the serum homocysteine (Hcy) level were significantly higher than those in the LAA group (all P ＜0. 05). Multivariate logistic analysis showed that the advanced age (odds ratio, [OR] = 1.041,95% confidence interval [CI] 1.02-1.06, P = 0.045), hypertension (OR = 2. 912,95% CI 1. 11-6. 46, P =0. 031) and increased plasma Hcy (OR = 1. 109, 95% CI 1. 11-1. 32, P =0. 001) were the independent risk factors for SAO. The advanced age (OR = 1. 047,95% CI 1.00-1.09, P = 0.043), hypertension (OR = 2. 632, 95% CI 1.08-6.41, P= 0.033) and increased plasma Hcy (OR = 1. 211, 95% CI 1. 11-1. 32, P ＜0. 001) were the independent risk factors for ILA, while the hypercholesterolemia (OR =0. 136, 95% CI 0. 05-0. 37, P ＜0. 001) was the independent risk factor for ILI. Conclusions The advanced age, hypertension and increased plasma Hcy level may play important roles in the pathogenesis of SAO. The hypercholesterolemia is an independent risk factor for ILI, while advanced age, hypertension and increased plasma Hcy level are the independent risk factors for ILA.     

急性缺血性脑卒中TOAST分型后早期降压治疗对3个月结局的影响

目的探讨TOAST分型与急性缺血性脑卒中急性期降压治疗预后的关系。方法收集2009年8月~2013年5月在解放军第九六○医院(泰安院区)、肥城市人民医院、东平县人民医院住院的缺血性脑卒中合并高血压、非溶栓患者416例,大动脉粥样硬化型(large artery atherosclerosis,LAA)组168例,降压治疗82例,无降压治疗86例;心源性栓塞型(cardioembolism,CE)组84例,降压治疗43例,无降压治疗41例;小动脉闭塞型(small artery occlusion,SAO)组144例,降压治疗74例,无降压治疗70例;其他病因明确型(10例)和病因不明型组(10例)样本数太少,未做统计学分析。观察患者出院后3个月全因病死率、死亡/致残率。结果LAA组、CE组和SAO组降压治疗患者治疗2周或出院时血压下降幅度明显高于无降压治疗患者,差异有统计学意义(P<0.05,P<0.01)。随访3个月,LAA组降压治疗患者病死率明显高于无降压治疗患者(13.4%vs 3.5%,P=0.041),CE组降压治疗患者病死率明显低于无降压治疗患者(14.0%vs 34.1%,P=0.030),SAO组降压治疗与无降压治疗患者病死率比较,差异无统计学意义(1.4%vs 2.9%,P=0.961)。LAA组、CE组和SAO组死亡/残疾率比较,差异无统计学意义(46.3%vs 39.5%,51.2%vs 70.7%,20.3%vs 20.0%,P>0.05)。结论LAA缺血性脑卒中急性期降压有增加3个月病死率风险;CE缺血性脑卒中急性期应避免血压维持在较高水平,降压治疗是获益的;SAO缺血性脑卒中急性期降压治疗未改变其3个月死亡结局。     

血清脂蛋白(a)与缺血性卒中及其病因学亚型的相关性

目的 探讨血清脂蛋白(a)[lipoprotein(a),Lp(a)]水平与急性缺血性卒中及其病因学亚型的相关性.方法 回顾性纳入连续的急性缺血性卒中住院患者(病例组)以及年龄和性别相匹配的同期健康体检者(对照组).收集病例组和对照组人口统计学和基线临床资料以及空腹血糖、纤维蛋白原、高半胱氨酸、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、Lp(a)浓度.病例组根据TOAST病因学分型标准分为大动脉粥样硬化(large artery atherosclerosis,LAA)、小动脉闭塞(small artery occlusion,SAO)、心源性栓塞(cardioembolism,CE),并排除其他明确病因和病因不明的患者.对病例组和对照组人口统计学和基线临床资料进行比较,并采用多变量logistic回归分析明确血清Lp(a)与急性缺血性卒中及其病因学分型的相关性.结果 共纳入214例缺血性卒中组患者,其中LAA 97例(45.33%),SAO 64例(29.91%),CE 53例(24.77%);对照组118例.病例组高血压、糖尿病、高脂血症、心房颤动和饮酒的比例以及收缩压、舒张压、空腹血糖、总胆固醇、低密度脂蛋白胆固醇、Lp(a)、纤维蛋白原、高半胱氨酸水平与对照组存在统计学差异(P均<0.001).多变量logistic回归分析显示,校正年龄和性别后,Lp(a)是缺血性卒中的独立危险因素[优势比(odds ratio,OR)2.014,95%可信区间(confidence interval,CI)1.273~3.092;P=0.036];LAA的独立危险因素包括高血压(OR 3.353,95%CI 1.714~6.558;P<0.001)、收缩压(OR 2.786,95%CI 1.136~5.538;P=0.016)、高半胱氨酸(OR 1.108,95%CI 1.031~2.191;P=0.005)、总胆固醇(OR 2.169,95%CI 1.599~4.943;P<0.001)、低密度脂蛋白胆固醇(OR 2.782,95%CI 1.093~5.238;P=0.024)和Lp(a)(OR 3.072,95%CI 1.907~8.064;P=0.001),SAO的独立危险因素包括高血压(OR 7.042,95%CI 3.189~25.55;P<0.001)、糖尿病(OR 5.162,95%CI 2.372~11.23;P<0.001)、纤维蛋白原(OR 1.667,95%CI 1.434~2.025;P=0.045)和高半胱氨酸(OR 1.967,95%CI 1.859~1.995;P=0.036),CE的独立危险因素包括心房颤动(OR 13.340,95%CI 4.637~39.20;P<0.001)、纤维蛋白原(OR 2.365,95%CI 1.147~4.904;P=0.029)和Lp(a)(OR 1.656,95%CI 1.996~3.001;P=0.035).结论 Lp(a)是缺血性卒中的独立危险因素,可作为预测缺血性卒中发病风险的血清生物学标记物.不同卒中病因学亚型之间的独立危险因素存在差异,Lp(a)与LAA和CE独立相关,但与SAO无独立性相关性.