血清和肽素水平与急性缺血性卒中患者转归的相关性

目的 探讨血清和肽素水平与急性缺血性卒中患者转归的关系.方法 纳入发病24 h内的首次缺血性卒中患者,应用酶联免疫吸附法检测血清和肽素水平,应用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评估基线卒中严重程度.在发病后90 d时应用改良Rankin量表(modified Rankin Scale,mRS)评分评价转归,0～2分定义为转归良好.年龄和性别相匹配的健康体检者作为对照者.结果 共纳入连续86例发病24 h内首次缺血性卒中患者和50名年龄和性别相匹配的健康体检者作为对照者.急性缺血性卒中患者发病24 h、7d和14 d血清和肽素水平分别为(7.81±0.66) pmol/L、(4.78±1.76) pmol/L和(2.82±1.42) pmol/L,均显著高于对照组[(1.67±0.56) pmol/L;P均＜0.05].86例患者中,74例(86.05％)转归良好,12例(13.95％)转归不良.转归不良组年龄[(67.64 ±9.62)岁对(61.12±7.31)岁;t=-3.420,P=0.020]、NIHSS评分[(14.16±4.22)分对(6.96±2.04)分;t=-8.26 3,P＜ 0.001]、基线收缩压[(166.06±13.42)mmHg对(154.12±11.69)mmHg;t=5.216,P=0.037;1mmHg=0.133 kPa]、空腹血糖[(8.79±2.98) mmol/L对(6.92±2.24) mmol/L;t=2.076,P=0.041]、C反应蛋白[(7.02±1.72) mg/L对(4.07±1.58) mg/L;t=-1.724,P=0.019]、24 h时和肽素水平[(9.67±2.28)p mol/L对(6.88±2.82)pmol/L;t=13.962,P＜ 0.001]、7d时和肽素水平[(8.22±2.14) pmol/L对(2.97±2.04)pmol/L;t=20.564,P＜0.001]、14 d时和肽素水平[(4.77±1.86)p mol/L对(2.02±0.76) pmol/L;t=8.428,P=0.032]以及心房颤动(33.33％对8.11％;x2=4.986,P=0.036)、大动脉粥样硬化性卒中(41.67％对21.62％;x2 =6.729,P=0.038)、心源性栓塞(33.33％对8.11％;x2=4.986,P=0.036)的患者构成比均显著高于转归良好组,小动脉闭塞性卒中的患者构成比显著低于转归良好组(16.67％对70.27％;x2=16.972,P=0.041).多变量logistic回归分析显示,血清24 h(优势比2.424,95％可信区间1.920 ～ 3.562;P＜0.001)和7d(优势比2.326,95％可信区间1.768 ～3.482;P＜0.001)时和肽素水平以及基线NIHSS评分(优势比2.146,95％可信区间1.616～3.268;P＜0.001)是转归不良的独立危险因素.结论 基线血清和肽素水平增高是急性缺血性卒中患者90 d时转归不良的独立预测因素.     

和肽素在心血管疾病诊断与预后评价中应用的研究进展

和肽素是精氨酸加压素前体的C末端部分,它随循环中精氨酸加压素的变化而变化,稳定性好、检测方便.近年来研究发现,和肽素在心血管疾病的诊断及预后判断等方面具有重要临床应用价值,联合检测和肽素与其他标志物时可进一步提高对急性心肌梗死和心力衰竭的诊断和预后判断的准确性.本文简要介绍近年来和肽素在心血管疾病诊断中的研究进展.     

脂肪因子与老年急性缺血性脑卒中血管内介入治疗短期预后的关系

目的探讨脂肪因子在老年急性缺血性脑卒中(AIS)血管内介入治疗短期预后中的价值。方法选择AIS患者86例(AIS组),AIS组又根据入院时美国国立卫生研究院卒中量表(NIHSS)评分分为轻度组20例、中度组54例和重度组12例,术后24 h NIHSS评分分为好转组47例和未好转组39例,术后3个月改良Rankin量表评分分为预后良好组62例和预后不良组24例。收集同期我院健康体检者50例(对照组)。比较各组血清脂肪因子(内脂素、趋化素、抵抗素及网膜素1)水平;并采用logistic回归分析短期预后的影响因素。结果AIS组血清内脂素、趋化素及抵抗素水平明显高于对照组,网膜素1水平明显低于对照组(P<0.01)。重度组血清内脂素、趋化素、抵抗素水平明显高于轻度组,中度组和重度组网膜素1水平明显低于轻度组(P<0.05)。预后不良组内脂素、趋化素及入院时NIHSS评分明显高于预后良好组(P<0.05,P<0.01),网膜素1和早期神经功能好转比例明显低于预后良好组[(170.09±21.09)g/Lvs(158.97±17.13)g/L,P=0.024;61.3%vs 37.5%,P=0.047]。logistic回归分析显示,高血压、糖尿病、内脂素、趋化素、入院时NIHSS评分及早期神经功能好转是AIS患者短期预后的独立影响因素(P<0.05,P<0.01)。结论血清内脂素、趋化素、抵抗素和网膜素1水平与AIS的发病、病情严重程度密切相关,同时内脂素和趋化素水平是老年AIS患者短期预后不良的预测因素。     

血液生物学标记物与急性缺血性卒中患者的神经功能转归

急性缺血性卒中具有高发病率、高致死率和高致残率等特点,严重影响着中老年人群的健康,寻找影响急性缺血性卒中患者神经功能转归的相关因素,并对其干预是该领域的研究热点之一.近年来的研究显示,基质金属蛋白酶-9、神经元特异性烯醇化酶、S-100B蛋白、脑利钠肽、和肽素、血脂、血糖等血液学指标均可能与急性缺血性卒中患者的神经功能转归有关.     

和肽素临床应用的新进展

和肽素是精氨酸加压素的替代物,性质稳定,易于检测。和肽素与TnT联合检测提高冠状动脉综合征的诊断。和肽素是急性非ST段心肌梗死不良事件发生的独立预测因子。联合检测和肽素和脑钠肽预测心力衰竭的预后。     

和肽素在下呼吸道感染中的临床应用

作为一种生物标志物,和肽素用于抗利尿激素释放的测定.近年研究表明,和肽素有望成为一种较为理想的炎性标志物,应用于下呼吸道感染的诊治.在社区获得性肺炎、慢性阻塞性肺疾病急性加重等下呼吸道感染中,血和肽素水平明显升高,与疾病严重程度和预后密切相关.     

和肽素对慢性心力衰竭患者预后的预测

目的 探讨血清和肽素（Copeptin）水平与慢性心力衰竭患者近期预后的关系.方法 入选160例心力衰竭患者,依照纽约心脏协会功能分级系统（NYHA）分为4组,心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级组各40例,对四组患者的一般临床资料、心脏超声数据、血清和肽素水平及1年内心血管事件发生率进行分析.再按随访1年内是否发生心血管事件分为事件组与非事件组,并对相关数据进行统计.结果 心衰患者血清和肽素水平与心功能严重程度密切相关（P＜0.05）.事件组和肽素水平高于非事件组（P＜0.05）.多因素logistic回归分析显示,和肽素水平、LVEF、和β受体阻滞剂的应用是预测心血管事件发生的危险因素,和肽素水平预测患者1年内发生心血管事件的ROC曲线下面积为0.887,95％的可信区间为0.834～0.939 （P＜0.05）.结论 和肽素水平作为一个新的心力衰竭标志物,可以评估心力衰竭患者的预后.     

和肽素在慢性心力衰竭急性发作期治疗中的变化与预后的关系

目的 研究和肽素在慢性心力衰竭急性发作期治疗前后的变化,及其对病情评估、预后判断的价值.方法 选择慢性心力衰竭急性发作患者80例为心力衰竭组,健康对照组30例.心力衰竭组分别于入院即刻、治疗10 d后测定血浆和肽素、氮末端脑钠肽前体（NT-proBNP）水平,入院后24h内行心脏超声检查,测量左心室舒张末期内径（LVIDd）和左心室射血分数（LVEF）;出院后3个月时随访其是否发生心血管事件（包括心力衰竭、恶性心律失常、死亡等）.结果 心力衰竭组入院即刻和肽素、NT-proBNP水平均高于对照组（均为P＜0.01）;心力衰竭组治疗10 d后和肽素、NT-proBNP水平较入院时明显下降（均为P＜0.01）;出院后3个月时间内,与未发生心血管事件的患者相比,发生心血管事件患者的和肽素、NT-proBNP水平在治疗前后均较高（均为P＜0.01）;用全模型多元Logistic回归分析,入院时和肽素水平为慢性心力衰竭患者独立预后指标（P＜0.01）.结论 慢性心力衰竭急性发作期和肽素、NT-proBNP水平升高,治疗后其水平明显下降;监测和肽素浓度对心力衰竭患者的危险分层及预后判断有重要意义.     

和肽素与心力衰竭的研究进展

随着老龄化社会的进展,心力衰竭的发病率一直居高不下,尽管心力衰竭相关治疗改善了患者的生活质量和预后,但目前心力衰竭仍是中国患者住院和死亡最常见的原因之一。近年相关研究表明,和肽素与心力衰竭的发生密切相关,和肽素可影响心室重构和舒张功能不全,从而导致心力衰竭的发生。此外,和肽素与心力衰竭发病预测、病情评估以及患者预后密切相关。现从和肽素与心力衰竭发生的关系和相关机制以及和肽素与心力衰竭的临床研究展开综述。     

和肽素的临床研究进展

和肽素(copeptin)是前精氨酸加压素(arginine vasopressin,AVP)原C末端的一部分.近年研究发现,其在心肺疾病、脓毒症等早期诊断及预后评价方面有一定的临床价值.现就和肽素的一些生理特性及其在各系统疾病中的研究作一综述.     

Educational Approach on Stroke Training in Europe

According to the European Stroke Initiative (EUSI), stroke care is best delivered within a stroke unit by a specialized multidisciplinary stroke team led by stroke specialists. At present, there is no guideline or consensus regarding training requirements or clinical standards that stroke specialists should achieve. It is envisaged that stroke specialists in training would need to acquire adequate knowledge and competency across three major areas of stroke care: acute stroke, stroke rehabilitation, and stroke prevention. With an EUSI document, the European Association of Young Neurologists and Trainees Stroke Subspeciality Group aims to promote discussion on the many aspects of stroke training and the requirements to be a stroke specialist in the European community. The ultimate purpose is to agree on common standards to promote good clinical care and effective stroke prevention across Europe. In the future, this may be translated into better patient outcome and a reduction in the global burden of this condition.     

Educational approach on stroke training in Europe

According to the European Stroke Initiative (EUSI), stroke care is best delivered within a stroke unit by a specialized multidisciplinary stroke team led by stroke specialists. At present, there is no guideline or consensus regarding training requirements or clinical standards that stroke specialists should achieve. It is envisaged that stroke specialists in training would need to acquire adequate knowledge and competency across three major areas of stroke care: acute stroke, stroke rehabilitation, and stroke prevention. With an EUSI document, the European Association of Young Neurologists and Trainees Stroke Subspeciality Group aims to promote discussion on the many aspects of stroke training and the requirements to be a stroke specialist in the European community. The ultimate purpose is to agree on common standards to promote good clinical care and effective stroke prevention across Europe. In the future, this may be translated into better patient outcome and a reduction in the global burden of this condition.     

Stroke in patients with diabetes mellitus

The article's objective is to review the key advances in the scientific literature related to the association of stroke with diabetes mellitus and to summarize the current approaches to stroke prevention in diabetic patients. The key findings from the literature regarding stroke incidence in patients with diabetes, specific and nonspecific risk factors of stroke in the diabetic population, such as arterial hypertension, dyslipidemia, hyperglycemia, diabetes duration, diabetic complications, insulin resistance/hyperinsulinemia, course and outcome of stroke in subjects with diabetes and/or hyperglycemia, and the peculiarities of type, site and size of stroke in diabetic patients are discussed. The results of recent clinical trials aimed at correcting hyperglycemia, hypertension, and dyslipidemia, to prevent stroke in people with diabetes, are reviewed. The medical database Medline along with original articles from peer-reviewed journals were used for analysis.There is convincing evidence suggesting that diabetes mellitus represents a strong independent risk factor of stroke. The contribution of hyperglycemia to increased stroke risk is not proven. Data suggest an association of the full cluster of the insulin resistance syndrome and stroke. Diabetes is a risk factor mainly for ischemic stroke, while its association with hemorrhagic stroke remains controversial. Hyperglycemia is common in stroke patients, but it is not known whether it independently influences the course and outcome of stroke or merely reflects stroke severity and location. Aggressive control of arterial hypertension and dyslipidemia allows to decrease the risk of stroke in diabetic patients substantially, while the importance of glucose control for stroke prevention remains unproven.     

Stroke in HIV

Stroke is a heterogeneous disease in persons living with human immunodeficiency virus (HIV). HIV is thought to increase the risk of stroke through both HIV-related and traditional stroke risk factors, which vary with respect to the patient’s age and clinical characteristics. Numerous studies show that detectable viremia and immunosuppression increase the risk of stroke across all ages, whereas traditional risk factors are more common in the aging population with HIV. As persons living with HIV age and acquire traditional stroke risk factors, the prevalence of stroke will likely continue to increase. Large- and small-vessel disease are the most common causes of stroke, although it is important to evaluate for infectious etiology as well. Research regarding the management of stroke in patients with HIV is scant, and recommendations often parallel those for the general population. Treatment of HIV and effective reduction of traditional stroke risk factors is important to reduce the risk of stroke in persons living with HIV. Future research will help elucidate the pathophysiology of HIV and stroke risk, investigate sex differences in stroke risk, and evaluate the safety and benefits of standard stroke preventative measures and HIV-specific interventions in this population.     

糖尿病与卒中二级预防

糖尿病是脑卒中的重要危险因素。对糖尿病患者进行积极降糖治疗,对于卒中一级预防有重要意义。糖尿病是卒中复发的独立危险因素,其在不同亚型卒中复发中的作用是不同的。强化降糖治疗在卒中二级预防中的作用尚未明确。     

氧化三甲胺在脑卒中患者中应用价值的研究进展

急性缺血性脑卒中(AIS)是最常见的脑卒中类型,占脑卒中患者总数的70%~80%。2016年全球疾病负担(GBD)研究数据显示:中国是全世界终生脑卒中风险最高的国家,为39.3%,其中男性脑卒中风险为41.1%,女性脑卒中风险为36.7%,故早期预防、早期诊断、早期治疗、早期康复及早期预防脑卒中再发是脑卒中防治的有效方法。氧化三甲胺(TMAO)是目前研究最广泛的新型靶点生物标志物之一,研究表明其具有促进动脉粥样硬化形成、增加血小板反应性及促进血栓形成等作用,故可能参与脑卒中的发生、发展过程。笔者通过检索相关文献,主要综述了TMAO的代谢机制、影响因素及其在脑卒中患者中的应用价值,旨在为进一步研究TMAO与脑卒中的关系提供一定理论基础。     

Stroke in Italy: A Disease to Prevent

Stroke, a disease determining an increasing socioeconomic burden in aging populations, represents the second cause of mortality worldwide and the third cause of mortality in western countries. In our study, crude annual incidence rate of stroke was 293/100,000. Several conditions and life-style factors have been identified as risk factors for stroke. Their recognition is important to prevent stroke. Atherothrombosis contributes a large proportion of cases; however, conventional stroke risk factors do not fully account for the risk of stroke, and often stroke victims with documented atherosclerosis may not show any conventional risk factor. A major goal is to promote prevention of stroke through identification and clarification of new risk factors and pathogenic mechanisms. Moreover, early stroke prevention requires a comprehensive multidisciplinary strategy to educate and promote adherence to preventive protocols.     

Serum total bilirubin level, prevalent stroke, and stroke outcomes: NHANES 1999-2004

Background

Bilirubin inhibits experimental atherosclerosis, is inversely associated with carotid plaque burden, and confers neuroprotection in experimental stroke. Clinical data addressing the association of bilirubin with stroke are not available. We hypothesized that higher bilirubin levels would be associated with reduced stroke prevalence and improved stroke outcomes.

Methods

We used the National Health and Nutrition Examination Survey 1999 to 2004, a nationally representative cross-sectional examination of the United States civilian population, to examine the association of bilirubin with stroke. Of 13,214 adult participants with data on stroke history, serum total bilirubin level, and stroke risk factors, 453 reported a history of stroke. Of these, 138 participants reported an adverse stroke outcome, defined as a long-term health problem or disability due to stroke. We performed multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) with adjustment for demographic characteristics and stroke risk factors.

Results

After multivariable adjustment, a 1.71 μmol/L (0.1 mg/dL) increment in bilirubin level was associated with a 9% reduced odds of stroke (OR 0.91; 95% CI, 0.86-0.96) among all participants and with a 10% reduced odds of an adverse stroke outcome (OR 0.90; 95% CI, 0.80-1.00) among participants with a history of stroke.

Conclusions

These results suggest that a higher serum total bilirubin level is associated with reduced stroke prevalence and improved stroke outcomes. Our findings support the hypothesis that bilirubin may protect from stroke events and from neurologic damage in stroke.     

The association between migraine and cerebral vascular events: an analytical review

This paper explores the uncertain relationship between migraine headache and thromboembolic stroke. In reviewing the literature that links migraine with thromboembolic cerebral vascular events, a distinction is made between two stroke events that occur in migraine patients: stroke associated with a migraine attack (a migrainous stroke) and stroke unrelated to a migraine attack (a non-migrainous stroke). In a recent community-based stroke register, migrainous strokes occurred at a rate of 3.4 per 100,000 per annum. Prevalence rates for migraine in young stroke populations (11-28%) are similar to those in the general population and do not support an additional long-term risk of non-migrainous stroke in migraine patients. The only study providing a controlled estimate of long-term thromboembolic stroke risk (odds ratio = 1.7; 95% CI 1.3, 2.2) included only women and has not been independently confirmed. The contribution of migraine to other known risk factors for thromboembolic stroke needs to be examined further by controlled studies.