C-reactive protein and long-term ischemic stroke prognosis

C-reactive protein (CRP) is an inflammatory biomarker of inflammation and may reflect progression of vascular disease. Conflicting evidence suggests CRP may be a prognostic biomarker of ischemic stroke outcome. Most studies that have examined the relationship between CRP and ischemic stroke outcome have used mortality or subsequent vascular event as the primary outcome measure. Given that nearly half of stroke patients experience moderate to severe functional impairments, using a biomarker like CRP to predict functional recovery rather than mortality may have clinical utility for guiding acute stroke treatments. The primary aim of this study was to systematically and critically review the relationship between CRP and long-term functional outcome in ischemic stroke patients to evaluate the current state of the literature. PubMed and MEDLINE databases were searched for original studies which assessed the relationship between acute CRP levels measured within 24 hours of symptom onset and long-term functional outcome. The search yielded articles published between 1989 and 2012. Included studies used neuroimaging to confirm ischemic stroke diagnosis, high-sensitivity CRP assay, and a functional outcome scale to assess prognosis beyond 30 days after stroke. Study quality was assessed using the REMARK recommendations. Five studies met all inclusion criteria. Results indicate a significant association between elevated baseline high sensitivity CRP and unfavorable long-term functional outcome. Our results emphasize the need for additional research to characterize the relationship between acute inflammatory markers and long-term functional outcome using well-defined diagnostic criteria. Additional studies are warranted to prospectively examine the relationship between high sensitivity CRP measures and long-term outcome.     

Risk of Hyperglycemia and Hypoglycemia in Patients with Acute Ischemic Stroke Based on Continuous Glucose Monitoring

BackgroundIn patients with acute ischemic stroke, current guidelines recommend maintaining blood glucose levels in a range of 140-180 mg/dL and closely monitoring to prevent hypoglycemia (<60 mg/dL). We aimed to assess glucose variability by continuous glucose monitoring (CGM) and to demonstrate the risk of acute ischemic stroke patients with glucose levels outside of the glucose management recommendations.MethodsPatients with ischemic stroke admitted within 7 days after onset were prospectively enrolled, and their blood glucose levels were monitored every 15 minutes for 72-hour period using the FreeStyle Libre Pro. Multivariate logistic regression analyses were used to analyze potential predictors for hyperglycemic (>180 mg/dL) and hypoglycemic (<60 mg/dL) events.ResultsA total of 39 acute ischemic stroke patients (mean age 75.9 ± 11.5 years) were enrolled, and CGM was started from 58.6 ± 41.9 hours after stroke onset. CGM showed hypoglycemic events in 19 patients and hyperglycemic events in 21 patients, and the frequencies of hypo- and hyperglycemic events during CGM were 10.1 ± 15.7% and 11.9 ± 22.5%, respectively. Hypoglycemic events were mainly observed in the night-time in patients with normoglycemia at admission. Logistic regression analyses demonstrated significant associations between the blood glucose level at admission and hypo- and hyperglycemic events on CGM.ConclusionsThis study of CGM found that many stroke patients have blood glucose levels outside the recommended guideline range in the acute phase. Blood glucose level on admission may be used as a predictor for hypo- and hyperglycemic events after admission.     

脑梗死急性期超敏C反应蛋白水平与神经功能恢复的关系

目的探讨脑梗死急性期超敏C反应蛋白（hs-CRP）水平与脑梗死神经功能恢复的关系。方法选取发病72h内的急性脑梗死患者269例,入院第2天测定hs-CRP,按hs-CRP水平分为低hs-CRP组（hs-CRP≤3mg/L）及高hs-CRP组（hs-CRP〉3mg/L）,比较2组患者的临床资料,分析影响hs-CRP水平的因素;入选患者进行90d随访,比较2组患者90d时神经功能恢复情况（改良Rankin量表评分3～6分为恢复不良）,分析影响神经功能恢复的因素。结果 共266例患者完成随访,hs-CRP中位数3.15mg/L（1.12～8.89mg/L）。高hs-CRP组（138例）年龄较大（P〈0.001）,糖尿病发病率较高（P=0.001）,房颤发病率较高（P=0.004）,入院时脑梗死较严重（P=0.003）;高龄、合并糖尿病及房颤、入院时脑梗死严重程度与hs-CRP水平高独立相关（P均〈0.05）;高hs-CRP组神经功能恢复不良比例高于低hs-CRP组（P〈0.001）;hs-CRP升高与神经功能恢复不良独立相关（OR1.213,P=0.001,Logistic分析）。结论 高龄、糖尿病史、房颤病史、脑梗死严重程度重可能是hs-CRP升高的独立危险因素;hs-CRP升高可能是神经功能恢复不良的独立危险因素。     

Cerebral hemorrhage after intra-arterial thrombolysis for ischemic stroke: the PROACT II trial.

OBJECTIVE: To analyze the frequency, clinical characteristics, and predictors of symptomatic intracerebral hemorrhage (ICH) after intraarterial (IA) thrombolysis with recombinant pro-urokinase (r-proUK) in acute ischemic stroke. METHOD: The authors conducted an exploratory analysis of symptomatic ICH from a randomized, controlled clinical trial of IA thrombolysis with r-proUK for patients with angiographically documented occlusion of the middle cerebral artery within 6 hours from stroke onset. Patients (n = 180) were randomized in a ratio of 2:1 to either 9 mg IA r-proUK over 120 minutes plus IV fixed-dose heparin or IV fixed-dose heparin alone. As opposed to intention to treat, this analysis was based on "treatment received" and includes 110 patients given r-proUK and 64 who did not receive any thrombolytic agent. The remaining six patients received out-of-protocol urokinase and were excluded from analysis. The authors analyzed centrally adjudicated ICH with associated neurologic deterioration (increase in NIH Stroke Scale [NIHSS] score of > or =4 points) within 36 hours of treatment initiation. RESULTS: Symptomatic ICH occurred in 12 of 110 patients (10.9%) treated with r-proUK and in two of 64 (3.1%) receiving heparin alone. ICH symptoms in r-proUK-treated patients occurred at a mean of 10.2 +/- 7.4 hours after the start of treatment. Mortality after symptomatic ICH was 83% (10/12 patients). Only blood glucose was significantly associated with symptomatic ICH in r-proUK-treated patients based on univariate analyses of 24 variables: patients with baseline glucose >200 mg/dL experienced a 36% risk of symptomatic ICH compared with 9% for those with < or =200 mg/dL (p = 0.022; relative risk, 4.2; 95% CI, 1.04 to 11.7). CONCLUSIONS: Symptomatic ICH after IA thrombolysis with r-proUK for acute ischemic stroke occurs early after treatment and has high mortality. The risk of symptomatic ICH may be increased in patients with a blood glucose >200 mg/dL at stroke onset.     

Temporal profile of molecular signatures associated with circulating endothelial progenitor cells in human ischemic stroke

Endothelial progenitor cells (EPC) have been associated with good functional outcome in ischemic stroke. From preclinical studies, it has been reported that EPC proliferation is mediated by several molecular markers, including vascular endothelial growth factor (VEGF), stromal cell-derived factor-1α (SDF-1α), and the activity of matrix metalloproteinase-9 (MMP-9). Therefore, our aim was to study the role of these molecular factors in EPC proliferation in human ischemic stroke. Forty-eight patients with first episode of nonlacunar ischemic stroke were prospectively included in the study within 12 hr of symptom onset. EPC colonies were classified as early-outgrowth colony forming unit-endothelial cell (CFU-EC) and quantified at admission, at 24 and 72 hr, at day 7, and at 3 months. At the same time, serum levels of VEGF, SDF-1α, and active MMP-9 were measured by ELISA. The primary endpoint was EPC increment during the first week, which was defined as the difference in the number of CFU-EC between day 7 and admission. We found that VEGF (r = 0.782), SDF-1α (r = 0.828), and active MMP-9 (r = 0.740) levels at 24 hr from stroke onset showed a strong correlation with EPC increment. Similar results were found for VEGF levels at 72 hr (r = 0.839) and at day 7 (r = 0.602) as well as for active MMP-9 levels at 72 hr (r = 0.442) and at day 7 (r = 0.474). In the multivariate analyses, serum levels of VEGF at 72 hr (B: 0.074, P < 0.0001) and SDF-1α at 24 hr (B: 0.049, P = 0.008) were independent factors for EPC increment during the first week of evolution. These findings suggest that VEGF and SDF-1α may mediate EPC proliferation in human ischemic stroke.     

Better outcome after stroke with higher serum cholesterol levels

OBJECTIVE: To examine whether serum cholesterol levels have any prognostic value in the first month following acute ischemic stroke. BACKGROUND: Although the association between serum cholesterol levels and cerebrovascular disorders has been extensively studied, the relationship between cholesterol levels and outcome following ischemic stroke has not been investigated. METHODS: Using data from 3,273 consecutive patients with first-ever ischemic stroke, the authors compared poor functional outcome (severe disability or death) at 1 month in patients with high cholesterol (total serum cholesterol greater than 6.5 mmol/L or 250 mg/dL) and normal cholesterol (level equal to or less than 6.5 mmol/L or 250 mg/dL). Data were analyzed by univariate and multivariate analysis. RESULTS: In comparison with patients with normal cholesterol levels, patients with high cholesterol levels had a 2.2-fold lower risk of death (p = 0.002) and a 2.1-fold lower risk of poor functional outcome at 1 month (p < 0.001). After adjustment for known confounding variables, multivariate analysis showed that higher cholesterol levels remained an independent predictor of better functional outcome (OR 0.48, CI 0. 34 to 0.69, p < 0.001). CONCLUSIONS: The authors' findings suggest that higher levels of cholesterol are associated with a better outcome in the early phase after ischemic stroke.     

C-reactive protein and white blood cell count increases in the first 24 hours after acute stroke

Levels of C-reactive protein (CRP) and white blood cell count (WBC) in acute stroke may reflect the stroke lesion itself or pre-existing factors such as infections, smoking or atherosclerosis. The aim of this study was to investigate the relation between CRP and WBC levels and time from onset of stroke, stroke severity and outcome. PATIENTS AND METHODS: The analyses were based on 719 patients in whom WBC test material was obtained within 9 h of stroke onset and CRP test material within 24 h of stroke onset. Stroke severity was assessed by the Scandinavian Stroke Scale Score on admission and outcome by death 7 days, 3 months and 1 year after symptom onset as well as modified Rankin Scale 3 months after stroke onset. RESULTS: CRP and WBC levels correlated significantly with time from symptom onset as well as with stroke severity and outcome. Levels of CRP and WBC were higher in later determinations in severe stroke. In multivariate logistic regression analysis, CRP(+10 mg/l) was independently related to 1-year mortality (OR 1.1, 95% CI 1.02-1.2). CONCLUSION: Levels of WBC and CRP increase within the first 24 h in patients with severe stroke. CRP but not WBC is related to long-term mortality possibly by reflecting the vascular risk profile.     

Serum albumin level and nosocomial pneumonia in stroke patients

Hypoalbuminemia is associated with increased risk of infections. The aim of this study was to determine if serum albumin level is an independent predictor of nosocomial pneumonia in stroke patients. Data of 705 consecutive ischemic stroke patients admitted within 24 h after stroke onset were analyzed retrospectively. Serum albumin level was measured within 36 h after stroke onset. Nosocomial pneumonia was found in 10.5% of stroke patients. Patients with pneumonia had significantly lower serum albumin level than those without pneumonia (31.9 +/- 7.5 g/l vs. 35.5 +/- 6.9 g/l) and serum albumin level was associated with risk of pneumonia on multivariate analysis (OR: 0.95, 95% CI: 0.91-0.98). Our results show that serum albumin level is an independent predictor of nosocomial pneumonia in stroke patients.     

C-reactive protein in the very early phase of acute ischemic stroke: association with poor outcome and death

Acute ischemic stroke may trigger an inflammatory response that leads to increased levels of C-reactive protein (CRP). High levels of CRP may be associated with poor outcome because they reflect either an inflammatory reaction or tissue damage. We evaluated the prognostic value of CRP within 12 h of onset of ischemic stroke. Levels of CRP were routinely obtained within 12 h of symptom onset in 561 patients with ischemic stroke. CRP values were dichotomized as <7 or ≥7 mg/L. The full range of CRP values was used to detect a possible level-risk relationship. We studied the relation between CRP values and poor outcome (modified Rankin Scale score >2) or death at 3 months. A multiple logistic regression model was applied to adjust for age, sex, NIHSS score, current cigarette smoking, diabetes mellitus, hypertension, statin use, and stroke subtype. After adjustment for potential confounders, patients with CRP levels ≥7 mg/L had a significantly increased risk of poor outcome (adjusted OR 1.6, 95% CI 1.1–2.4) or death (adjusted OR 1.7, 95% CI 1.0–2.9) at 3 months. In addition, the risk of poor outcome or death at 3 months increased with higher levels of CRP. CRP within 12 h of ischemic stroke is an independent prognostic factor of poor outcome at 3 months.     

Flunarizine in stroke treatment (FIST): a double-blind, placebo-controlled trial in Scandinavia and the Netherlands

Introduction - An international, multicenter trial was conducted in 331 patients to determine the effect of a large dose of flunarizine (a calcium entry blocker) in the treatment of acute ischemic stroke in the territory of the Middle cerebral artery. Methods - The administration of the trial medication should start within 24 h after the initial symptoms of stroke. According to a random schedule, the patients were assigned to a 4-weeks double-blind treatment with either flunarizine ( n = 166) or placebo ( n = 165): one week intravenous administration (50 mg daily), followed by 3 weeks oral treatment (week 2, 21 mg daily; week 3–4, 7 mg daily). All patients had to be investigated by computerized tomography (CT) within 7 days after stroke onset; 36 patients were secundarily excluded because the CT showed another pathology. During the treatment period, other "stroke therapies" were not allowed. Patients were followed up for 24 weeks. Results - After the 24 weeks trial period, the percentage of patients who were dead or pendent (modified Rankin score 3–5) was similar in both treatment groups (flunarizine 67%, placebo 65%). During the trial, the scores for handicap severity (modified Rankin scale), neurological status (Orgogozo) and activities of daily living (modified Barthel index) strongly improved in both treatment groups, but no differences were found between the treatment groups. In this trial, the administration of trial treatment started relatively late after stroke onset (flunarizine group: mean time interval 13.5 h; placebo 12.3 h). A subgroup of patients received trial medication within 6 h after stroke onset (flunarizine n = 31; placebo n = 29). Also in this subgroup, no differences were found between the flunarizine and placebo group. Conclusion - Flunarizine did not improve neurologic and functional outcome in patients with acute ischemic stroke.     

不同剂量重组组织型纤溶酶原激活剂静脉溶栓治疗对超早期急性脑梗死预后的影响

目的 通过对超早期脑梗死患者接受不同剂量重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗的分析，探讨使用rt-PA对超早期脑梗死预后的影响。方法 超早期脑梗死患者308例，根据家属的意愿及是否签署溶栓治疗知情同意书分别给予溶栓治疗和非溶栓治疗。溶栓组221例，接受rt-PA静脉溶栓，其中92例给予rt-PA 0.9 mg/kg，发病在3 h内68例，>3～≤4 h内9例，>4～≤6 h内15例。129例给予rt-PA0.6～0.8 mg/kg，发病在3 h内72例，>3～≤4 h内24例，>4～≤6 h内33例。对照组87例，未应用rt-PA治疗。记录各组在基线、治疗24 h、发病90 dNIHSS评分、Barthel指数。预后良好定义为发病90 d Barthel指数≥95；颅内出血分为症状性颅内出血和非症状性颅内出血。同时记录随访期间的血管性死亡事件和卒中再发事件。应用logistic多因素分析预后的独立相关因素。结果 预后良好的独立相关因素为患者接受治疗前NIHSS评分（OR＝2.067，95%CI 1.201～3.556，P =0.009），冠心病史（OR =1.942，95%CI 1.040～3.625，P =0.037）和溶栓治疗（rtPA 0.9 mg/kg时，OR =0.414，95%CI 0.207～0.826，P =0.012；rtPA 0.6～0.8 mg/kg时，OR =0.261，95%CI 0.137～0.497，P＜0.01）。症状性颅内出血发生率在rtPA 0.9 mg/kg溶栓组与rtPA 0.6～0.8 mg/kg溶栓组分别为3.3%（3/92）和4.7%（6/129），差别无统计学意义。结论 静脉应用r t - PA溶栓治疗超早期急性脑梗死可获得较好的预后，不同剂量 r t - PA（0.6～0.8 mg/kg vs 0.9 mg/kg）对预后的影响无统计学差异，伴有心房颤动、糖尿病史将可能影响预后。     

Undernutrition as a predictor of poor clinical outcomes in acute ischemic stroke patients

OBJECTIVE: To determine whether changes in nutritional status in the first week after acute ischemic stroke and undernutrition predicts poor clinical outcomes. DESIGN: Prospective observational study. SETTING: Tertiary university hospital. PATIENTS: We included 131 acute ischemic stroke patients who underwent nutritional assessments within 24 hours and at 1 week after symptom onset. MAIN OUTCOME MEASURES: Undernutrition was diagnosed when 1 or more of the following 5 parameters were present: (1) weight loss 10% or more during the past 3 months or 6% or more during the week after admission, (2) a weight index less than 80%, (3) a serum albumin level less than 3.0 g/dL, (4) a transferrin level less than 150 mg/dL, or (5) a prealbumin level less than 10 mg/dL. We assessed poststroke complications and 3-month outcome using modified Rankin Scale responder analysis. RESULTS: Of 131 patients included in this study, undernutrition was observed in 16 (12.2%) patients at admission and in 26 (19.8%) at 1 week. Multiple logistic regression analysis showed that baseline undernutrition independently predicted 1-week undernutrition (odds ratio [OR], 14.85; 95% confidence interval [CI], 3.52-62.76; P< .001) and poststroke complications (OR, 6.72; 95% CI, 1.09-41.56; P= .04), and that 1-week undernutrition (OR, 4.49; 95% CI, 1.07-18.94; P= .04) and 1-week National Institutes of Health Stroke Scale score (OR, 1.76; 95% CI, 1.31-2.37; P< .001) independently predicted poor 3-month outcomes. CONCLUSIONS: These findings suggest that acute ischemic stroke patients with baseline undernutrition are being undernourished during hospitalization. Strategic nutritional support, particularly in patients with baseline undernutrition, may improve clinical outcomes.     

High‐Sensitivity C‐Reactive Protein is a Strong Risk Factor for Death after Acute Ischemic Stroke among Chinese

Background and purpose: Elevated plasma C‐reactive protein (CRP) has been suggested as a risk factor for ischemic stroke (IS) and coronary ischemic disease. Evidence has shown that high‐sensitivity CRP (hs‐CRP) is related to a worsening prognosis after IS, but hs‐CRP was rare in a large‐sample study in a Chinese population. We investigated the associations between hs‐CRP and outcome of Chinese patients after acute IS. Methods: Seven hundred and forty‐one consecutive acute IS patients (74.9% male, mean age 60.9 years), with baseline characteristics and hs‐CRP measured within 24 h after hospitalization, were admitted in this study. We also prospectively followed up for clinical outcome and death 3 months after disease onset. hs‐CRP was divided into two categories: hs‐CRP >3 mg/L and hs‐CRP ≤3 mg/L. Survival analysis using multivariable Cox regression was performed to analyze the association between hs‐CRP and stroke outcomes after adjusting for potential confounding factors. Results: Compared with low hs‐CRP, patients with high hs‐CRP (>3 mg/L) had a significantly higher rate of all‐cause death (0.71% vs. 10.00%; P < 0.001) at 3 months after stroke onset. High hs‐CRP was an independent risk factor for all‐cause death (HR, 6.48; 95% CI, 1.41 to 29.8; P= 0.016), as well as history of atrial fibrillation (HR, 5.24; 95% CI, 1.83 to 15.0; P= 0.002), no statin therapy during hospitalization (HR, 4.56; 95% CI, 2.18 to 9.55; P < 0.001), high homocysteine (>15.1 mmol/L) (HR, 2.66; 95% CI, 1.26 to 5.60; P= 0.01); fasting glucose (>6.1 mmol/L) (HR, 9.14; 95% CI, 3.34 to 25.0; P < 0.001), NIHSS at admission (HR, 2.35; 95% CI, 1.35 to 4.09; P= 0.003) and history of coronary heart disease (CHD) (HR, 2.34; 95% CI, 1.06 to 5.17; P= 0.035). Kaplan–Meier survival curves showed a higher risk of death for patients with hs‐CRP >3 mg/L (P= 0.016). Conclusion: Elevated plasma hs‐CRP independently predicted risk of all‐cause death within 3 months after acute IS in Chinese patients.     

Microembolic signals after 7 days but not within 24 hours of stroke onset should be predictor of stroke recurrence

BACKGROUND AND PURPOSE: Microembolic signals (MES) on transcranial Doppler ultrasonography (TCD) are occasionally detected in acute ischemic stroke patients and gradually decrease over time. If MES is detectable at 7 days after stroke onset, embolic source lesions may still be active. We hypothesized that presence of MES at 7 days after stroke onset is strongly associated with stroke recurrence. METHODS: Subjects comprised 143 patients with acute ischemic stroke who were prospectively examined for the presence of MES using TCD both within 24 h and at 7 days after stroke onset. Stroke recurrence was assessed within 3 months of stroke onset. The association between presence of MES and stroke recurrence was investigated. RESULTS: MES was detected in 70 of 143 patients (49%) within 24 h of stroke onset and in 34 patients (24%) at 7 days. Stroke recurrence was observed in 6 patients after 7 days and in 10 patients between 7 days and 3 months after stroke onset. Presence of MES within 24 h of stroke was not associated with stroke recurrence (10% for MES-positive vs. 12% for MES-negative, p=0.792). At 7 days after onset, stroke recurrence was more frequent in the MES-positive group at 7 days than in the MES-negative group (24% vs. 7%, p<0.0001). Cox's proportional hazard analysis demonstrated presence of MES as an independent factor of stroke recurrence (hazard ratio, 6.4; 95% confidence interval, 1.4-28; p=0.015). CONCLUSION: Presence of MES detected on TCD at 7 days of stroke onset should be a predictor of stroke recurrence.     

联合血压变异性和血清N端脑钠肽前体在急性脑梗死中的临床研究

目的 探讨急性脑梗死患者血压变异性和血清N 端脑钠肽前体(NT-pro-BNP)的水平变化及其两者之间的关系。方法 选取急性脑梗死患者78例作为脑梗死组,抽取56例为对照组,为本院同期非脑血管疾病患者; 对比分析组间血压变异性、血清NT-pro-BNP水平; 对比分析脑梗死组亚组间(脑梗死面积、脑梗死部位、是否合并高血压病、随访90d时的预后)血压变异性、血清NT-pro-BNP水平。结果 脑梗死组血压变异性、血清NT-pro-BNP水平显著高于对照组(P<0.05); 大面积脑梗死组和脑梗死死亡组患者血清NT-pro-BNP水平和24 h收缩压变异系数、24 h舒张压变异系数、白昼收缩压变异系数、白昼舒张压变异系数、夜间收缩压变异系数及夜间舒张压变异系数均分别明显高于非大面积脑梗死组与脑梗死存活组(P<0.01); 脑梗死合并高血压病组血清NT-pro-BNP水平和24 h收缩压变异系数、白昼收缩压变异系数、白昼舒张压变异系数、夜间收缩压变异系数及夜间舒张压变异系数均显著高于脑梗死且血压正常组(P<0.05); 前循环供血区脑梗死组与后循环供血区脑梗死组的24 h收缩压变异系数、24 h舒张压变异系数、白昼收缩压变异系数、白昼舒张压变异系数、夜间收缩压变异系数及夜间舒张压变异系数均有明显差异(P<0.05)。血清NT-pro-BNP水平与血压变异性相关指标24 h收缩压变异系数、24 h舒张压变异系数、白昼收缩压变异系数、白昼舒张压变异系数、夜间收缩压变异系数及夜间舒张压变异系数等呈正相关(r=0.339,0.341,0.339,0.330,0.380,0.374,P<0.01)。结论 急性脑梗死患者血压变异性和血清N 端脑钠肽前体(NT-pro-BNP)的水平明显升高,且血清NT-pro-BNP水平与血压变异性有关。     

急性缺血性卒中不同剂量阿替普酶静脉溶栓疗效比较

目的 对不同剂量阿替普酶静脉溶栓治疗人群进行比较,探讨对于中国急性缺血性卒中人群,标准 剂量与低剂量阿替普酶是否具有一样的安全性及有效性。 方法 本研究的入选患者来自中国急性缺血性卒中溶栓监测登记研究,从中选取发病4.5 h内且阿 替普酶使用剂量约为0.6 mg/kg（0.5～0.7 mg/kg）及0.9 mg/kg（0.85～0.95 mg/kg）的静脉溶栓患 者,对溶栓后症状性颅内出血（symptomatic intracranial hemorrhage,SICH）、死亡率及90 d随访结局等进 行比较。 结果 共入选753例患者,0.5～0.7 mg/kg组75例,0.85～0.95 mg/kg组678例,两组剂量中位数分别 为0.64 mg/kg及0.90 mg/kg,发病-给药时间中位数分别为2.92 h及2.79 h。在校正了基线变量差异 后,两组的死亡率（5.41% vs 7.36%,P =0.603）及SICH（0% vs 1.62%,P =0.972）均无显著差异,而 0.5～0.7 mg/kg 组90 d随访获得良好预后的比例显著低于0.85～0.95 mg/kg组［41.89% vs 53.83%, 比值比（odds ratio,OR）=0.58,P =0.031）］。 结论 本研究提示,在中国人群中,标准剂量（0.9 mg/kg）较低剂量（0.6 mg/kg）阿替普酶静脉溶 栓具有更好的有效性,且不会显著增加SICH风险。     

Association between Serum Insulin-Like Growth Factor-1 and Neurological Severity in Acute Ischemic Stroke

Background and PurposeSerum insulin-like growth factor-1 (IGF-1) is known to have a neuroprotective effect. This study aimed to determine the effects of serum IGF-1 on the severity and clinical outcome of acute ischemic stroke (AIS).MethodsThis study included 446 patients with AIS who were admitted to Hallym University Sacred Heart Hospital within 7 days of stroke onset from February 2014 to June 2017. Serum IGF-1 levels were measured within 24 hours of admission. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS) score at admission, and the functional outcome at 3 months after symptom onset was assessed using the modified Rankin Scale score. The effects of serum IGF-1 levels on stroke severity and 3-month functional outcomes were analyzed using multivariate logistic regression analysis.ResultsThis study evaluated 379 patients with AIS (age 67.2±12.6 years, mean±standard deviation; 59.9% males) after excluding 67 patients who had a history of previous stroke (n=25) or were lost to follow-up at 3 months (n=42). After adjusting for clinically relevant covariates, a higher serum IGF-1 level was associated with a lower NIHSS score at admission (adjusted odds ratio=0.44, 95% confidence interval=0.24–0.80, p=0.01), while there was no significant association at 3 months.ConclusionsThis study showed that a higher serum IGF-1 level is associated with a lower NIHSS score at admission but not at 3 months. Further studies are required to clarify the usefulness of the serum IGF-1 level as a prognostic marker for ischemic stroke.     

Higher serum triglyceride level in patients with acute ischemic stroke is associated with lower infarct volume on CT brain scans

We investigated the relationship between serum triglyceride level and acute ischemic stroke severity using infarct volume on CT brain scans as a marker. A total of 121 consecutive acute ischemic stroke patients (53 males and 68 females, age 47-93 years) with anterior circulation (75%), posterior circulation (9%) or lacunar infarcts (16%) were examined. All patients were admitted within 24 h of the symptom onset, and CT scans were taken over the subsequent 24-72 h. With adjustment for the infarct type, age, sex, timing of CT imaging (24-36, >36-48 or >48-72 h since admission), atrial fibrillation, hypertension, fasting cholesterol and glucose levels, a higher (> or =1.70 mmol/l) fasting serum triglyceride level (within 24 h after admission) was associated with a lower infarct volume (p = 0.014). In line with a recent report on milder clinical symptoms in acute ischemic stroke patients with higher triglycerides, the results suggest an independent association between serum triglyceride level and stroke severity.     

Changes in lipoprotein (a) [Lp(a)] level after an ischemic stroke

The aim of the work was to recognize whether often observed high levels of apolipoprotein (a) [Lp(a)] in patients shortly after an ischemic stroke are a result of the acute phase reaction. In 13 patients Lp(a) was determined within the first 24 hours after the stroke onset, after the next 7 days and after three months i.e. when it could be considered that Lp(a) level was the same as before onset of the disease. In 17 patients only two determinations were performed. Another acute phase indicator: C-reactive protein (CRP), as well as serum lipids were also determined. CRP level was increased in the first determination and increased further after 7 days. After three months it returned to low values. High density lipoprotein (HDL) cholesterol which demonstrates a negative acute phase response changed in the opposite way. No similar fluctuations of Lp(a) level were observed. It can be concluded that during the investigated period Lp(a) had no properties of the acute phase reactant.     

Release of neurobiochemical markers of brain damage is related to the neurovascular status on admission and the site of arterial occlusion in acute ischemic stroke

OBJECTIVES: The study aimed at an analysis of the kinetics of protein S100B and neuron-specific enolase (NSE) and their relation to the site of arterial occlusion in patients with acute ischemic stroke. METHODS: We investigated 32 consecutive patients admitted within 6 h after stroke onset. Serial venous blood samples were taken hourly between 1 and 6 h, and at 12, 18, 24, 48, 72, 96, and 120 h after stroke onset. The neurovascular status was assessed on admission and monitored by repetitive extracranial and transcranial duplex sonography. In all patients, infarct volume was calculated. The neurological deficit was quantified by the National Institutes of Health stroke scale score, and functional outcome after 3 months was assessed with the modified Rankin Scale. RESULTS: Patients with normal flow velocities in basal cerebral arteries at admission showed significantly less S100B release than those with main stem or multiple branch occlusions (p<0.01). S100B cut-off values of 0.15 microg/l (between 6 and 18 h), 0.21 microg/l (between 24 and 48 h) and 0.5 microg/l (from 72 to 120 h) differentiated best between patients with initially normal and pathological sonographic vessel findings. The release of S100B and NSE was highly correlated with the severity of the corresponding neurological deficit as well as with the final infarct volume. S100B concentrations from 6 h on were associated with the functional outcome. S100B values 48 h after stroke above 0.2 microg/l indicated a poor functional status 3 months after stroke. CONCLUSIONS: Protein S100B may serve as a monitoring parameter in acute ischemic stroke, especially with respect to the neurovascular status. Furthermore, S100B obtains additional information about functional outcome.