C-Reactive Protein and T3: New Prognostic Factors in Acute Ischemic Stroke

Background

Several studies have shown that high level of plasma C-reactive protein (CRP) is associated with stroke outcomes and future vascular events, and a decrease in serum triiodothyronine (T3) was reported to be associated with stroke severity and poor prognosis.

既往卒中病史对缺血性脑血管病患者卒中结局的影响研究

目的 探讨中国人群中首发和复发缺血性脑血管病患者的临床特征和卒中结局差异。 方法 本研究基于全国多中心前瞻性中国国家卒中登记研究Ⅲ（the third China national stroke regi stry,CNSR-Ⅲ）,连续纳入2015年8月-2018年3月急性缺血性卒中或TIA患者,收集人口学信息、血 管危险因素、既往用药史及病因分型系统（causative classification system,CCS）等临床资料,记录随 访3个月和1年时卒中结局。卒中结局包括卒中复发（缺血性卒中或出血性卒中）、联合血管事件（卒中、 心肌梗死及血管性死亡事件）、脑血管病源性死亡及不良功能结局（mRS＞2分）。依据患者既往是否 有卒中病史分为有卒中病史组和无卒中病史组,比较两组的临床特征及卒中结局差异,并分析卒中病 史与卒中结局间的关系。 结果 最终纳入15 166例患者,平均年龄62.2±11.3岁,其中女性4802例（31.7%）;有卒中病史患者 3355例,无卒中病史患者11 811例。有卒中病史组患者年龄,冠心病、高血压、脂代谢紊乱、糖尿病、心 房颤动比例,既往用药史比例、入院NIHSS评分、住院期间降糖和降压治疗比例均高于无卒中病史组, 目前吸烟和重度饮酒比例、入院时LDL-C水平及住院期间抗血小板治疗比例低于无卒中病史组,差 异均有统计学意义。两组CCS分型的分布差异有统计学意义,其中有卒中病史组大动脉粥样硬化型和 心源性栓塞型卒中比例高于无卒中病史组。多因素分析结果显示,卒中病史是随访3个月不良功能结 局（校正OR 1.25,95%CI 1.09～1.44,P =0.002）,随访1年卒中复发（校正HR 1.44,95%CI 1.25～1.67, P＜0.001）、联合血管事件（校正HR 1.43,95%CI 1.24～1.64,P＜0.001）、脑血管病源性死亡（校正 HR 1.42,95%CI 1.12～1.80,P =0.004）、不良功能结局（校正OR 1.63,95%CI 1.42～1.88,P＜0.001）的 危险因素。 结论 有无卒中病史的缺血性卒中患者的临床特征及随访结局差异较大,尽管患者进行卒中二级 预防治疗,卒中病史仍然是患者1年卒中复发、联合血管事件、脑血管病源性死亡及不良功能结局的 危险因素。     

SIRT1: The Value of Functional Outcome,Stroke-Related Dementia,Anxiety, and Depression in Patients with Acute Ischemic Stroke

Background: The outcome of ischemic stroke depends on multiple factors and their function of each other. Studies have shown that Sirtuin1 (SIRT1) plays a chief role in the key procedure during ischemia/hypoxia by protecting against cellular stress and controlling the metabolic pathways. Aims: To explore the alterations in serum SIRT1 concentrations in acute ischemic stroke (AIS) patients and the relationship between SIRT1 and poststroke dementia, anxiety, and depression. Methods: One hundred and twenty four consecutive patients with clinically diagnosed AIS were recruited to participate in the study. Serum SIRT1 levels were measured using a commercially available ELISA equipment for SIRT1 (Cusabio, Wuhan, China). In 1 year after admission, the severity of stroke was assessed with the National Institutes of Health Stroke Scale score, and the functional outcome was measured by a modified Rankin scale, the Hamilton Anxiety Scale scores were evaluated to define patients with or without anxiety, and the Hamilton Depression Scale scores for depression. Results: We found the levels of serum SIRT1 was significantly higher (P = .036) in AIS patients (.62 ± .77 ng/mL) compared with healthy control subjects (.45 ± .69 ng/mL), but not significantly higher SIRT1 concentration (.58 ± .69 versus .64 ± .81 ng/mL, P = .298) than patients in the unfavorable functional outcome group. Conclusions: There is no potential diagnostic and prognostic role of SIRT1 in AIS-related dementia, anxiety, and depression. The role of SIRT1 in AIS among human race needs to be further investigated.     

奥扎格雷钠治疗进展性脑卒中疗效观察

目的探讨奥扎格雷钠治疗进展性脑卒中的疗效与安全性。方法将90例进展性脑卒中患者随机分为两组,治疗组45例患者应用奥扎格雷钠注射液80 mg溶于0．9%氯化钠溶液250 ml中静滴,早晚各1次,同时加用低分子右旋糖酐500 ml,川芎嗪80 mg,1次/d静滴,连用14 d;对照组45例患者应用低分子右旋糖酐500 ml,川芎嗪80 mg,1次/d静滴,连用14 d。两组患者同时应用低分子肝素钠5000U皮下注射,2次/d,连用7 d。观察两组患者治疗前后神经功能缺损评分,血小板聚集率等指标的变化。结果两组患者疗效间差别有显著性意义(P＜0．05);治疗后两组患者的全血黏度、纤维蛋白原水平、血小板聚集率间差别均有显著性意义(P＜0．05);两组患者的不良反应经对症处理后消失,差别无显著性意义。结论奥扎格雷钠治疗进展性卒脑中安全有效。     

血浆甘油三酯水平与缺血性卒中出院结局关系研究

目的   探讨急性缺血性卒中患者入院时血浆甘油三酯（triglyceride,TG）水平与出院结局不良的关系。 方法  采用回顾性队列研究的方法,连续纳入内蒙古兴安盟人民医院2009年6月1日～2012年5月31日急性缺血性卒中患者,共计3351例。结局不良组定义为患者出院时改良Rankin量表（modified Rankin Scale,mRS）评分≥3分,对结局不良组和结局良好组患者间基线资料进行比较。用四分位数法将患者入院时血浆TG水平分为4组,用非条件Logistic回归分析入院时TG水平与急性缺血性卒中出院结局不良的关系,计算比值比（odds ratio,OR）及95%可信区间（confidence interval,CI）。 结果  研究对象中发生结局不良的共341例,发生率为10.2%。单因素非条件Logistic回归分析结果显示,TG相对最高分位数组（TG＞2.12?mmol/L）,第1、2、3分位数组（TG分别为≤1.06?mmol/L、1.06～1.46?mmol/L、1.46～2.12?mmol/L）的结局不良发生率差异有显著性（P＜0.001）。在调整了年龄、住院天数、发病到入院时间、缺血性卒中首发、吸烟、饮酒、心脏病史、心房颤动史、高血压、高血糖和心率后,相对于最高分位数组,第3分位数组的结局不良发生率差异无显著性（P=0.0758）,而第1、2分位数组结局不良发生率升高（均P＜0.0001）,其OR（95%CI）分别为11.883（1.307～2.714）和2.063（1.436～2.963）。 结论  急性缺血性卒中患者入院时低水平TG可能独立地增加出院结局不良的风险。     

Impact of Elevated Hemoglobin A1c Levels on Functional Outcome in Patients with Acute Ischemic Stroke

Background: The association between hemoglobin A1c (HbA1c) and clinical outcomes of acute ischemic stroke is uncertain. We aimed to evaluate the association between initial hemoglobin A1c level and clinical outcome after acute ischemic stroke.Methods: A total of 408 patients with first-ever acute ischemic stroke were included in this study. We divided the patients into three groups according to HbA1c level: low HbA1c level (HbA1c <5.7%), moderate HbA1c level (HbA1c 5.7-6.4%), and high HbA1c level (HbA1c ≥6.5%). Poor neurological outcomes were defined as modified Rankin Scale (mRS) score of 2-6 at 3 months after stroke. The relation between HbA1c value and clinical outcomes were evaluated by using multivariate logistic regression analyses.Results: Moderate HbA1c level was present in 126 (30.9%) patients and high HbA1c level in 129 (31.6%) patients. After adjustment for potential confounding variables, both patients in the high HbA1c level group (adjusted odds ratio [OR]: 2.387; 95% confidence interval [CI], 1.201-4.745; P?=?.013) and moderate HbA1c level group (adjusted OR: 1.797; 95% CI, 1.005-3.214; P?=?.048) had a significantly higher poor neurological outcomes than the group in the low HbA1c level. When separately analyzed according to with or without diabetes, the HbA1c level as continuous variable was also associated with poor functional outcome at 3 months in the diabetic patients (adjusted OR: 1.482, 95% CI, 1.013-2.167, P?=?.042), nor in nondiabetic group.Conclusions: Higher HbA1c on admission was an independent predictor of adverse functional outcome in ischemic stroke patients. Based on this point, tight glycemic control must be necessary for high-risk diabetic patients.     

The Impacts of Peptic Ulcer on Functional Outcomes of Ischemic Stroke

Background and Purpose: Studies have shown that peptic ulcer increased the risk of ischemic stroke and stroke recurrence. This study aimed to evaluate the impacts of peptic ulcer on functional outcomes of ischemic stroke. Methods: Patients with first-ever ischemic stroke were grouped as with and without history of peptic ulcer. Functional outcomes were evaluated with modified Rankin scale at 90 days after the index stroke. Favorable functional outcomes were defined as with a modified Rankin scale score of 0-2. Logistic regression was used to identify predictors for favorable functional outcomes at 90 days. Results: Among the 2577 enrolled patients with ischemic stroke, 129 (5.0%) had a history of peptic ulcer. The proportion of favorable outcome was higher in patients without peptic ulcer than those with (59.3% versus 42.6%, P < .001). Multivariate logistic analysis detected that history of peptic ulcer (odds ratio [OR] = 2.89, 95% confidence interval [CI], 1.03-8.10, P?=?.043), National Institute of Health Stroke Scale score (OR?=?2.11, 95% CI, 1.79-2.48, P < .001), and large-artery atherosclerosis stroke subtype (OR?=?4.08, 95% CI, 1.11-15.03, P?=?.035) decreased the likelihood of favorable outcomes. Conclusions: Ischemic stroke patients with peptic ulcer may have an increased risk of less favorable neurological outcome at 90 days after the index stroke.     

高血压合并脑梗死患者血浆C-反应蛋白、纤维蛋白原及白细胞变化的研究

目的探讨高血压合并脑梗死患者急性期血浆C-反应蛋白(CRP)、纤维蛋白原(Fib)水平、白细胞(WBC)及分类计数的变化与高血压合并脑梗死的关系。方法将患者分为两组,高血压合并脑梗死组(68例)和单纯高血压组(65例),检测两组患者急性期血浆CRP、Fib和WBC水平。结果高血压合并脑梗死患者急性期CRP、Fib水平、WBC总数、中性粒细胞数均比单纯高血压患者明显增高(P＜0．01)。结论C-反应蛋白、纤维蛋白原和白细胞升高可能与脑梗死的发生和进展相关,抗炎治疗可能是脑梗死治疗的一个选择。     

Leukoaraiosis on Magnetic Resonance Imaging Is Related to Long-Term Poor Functional Outcome after Thrombolysis in Acute Ischemic Stroke

Objective

Leukoaraiosis (LA) has been suggested to be related to the poor outcome or the occurrence of symptomatic intracerebral hemorrhage (sICH) after acute ischemic stroke. We retrospectively investigated the influences of LA on long-term outcome and the occurrence of sICH after thrombolysis in acute ischemic stroke (AIS).

Methods

In this study, we recruited 164 patients with AIS and magnetic resonance image (MRI)-detected thrombolysis. The presence and extent of LA were assessed using the Fazekas grading system. The National Institutes of Health Stroke Scale score was used to assess the baseline measure of neurologic severity, and the modified Rankin Scale score assessment was used up to 1 year after thrombolysis.

Results

Of 164 subjects, 56 (34.2%) showed LA on MRI. Compared to the 108 patients without LA, the patients with LA were of much older age (p<0.01), had a higher prevalence of hypertension (p<0.01), and had a much poorer outcome at 90 days (p=0.05) and 1 yr (p=0.01) after thrombolysis. There were no significant differences in sICH between patients with and without LA on MRI. In univariate analysis for the occurrence of poor outcome at 90 days after thrombolysis, the size of ischemic lesion on diffusion weighted images (DWI), [odds ratio (OR), 1.03; 95% confidence interval (95% CI), 1.01-1.04; p<0.01], recanalization (OR, 0.03; 95% CI, 0.01-0.10; p<0.01), sICH (OR, 12.2; 95% CI, 1.54-95.8), neurologic severity (OR, 1.17; 95% CI, 1.09-1.25; p<0.01), blood glucose level (OR, 1.01; 95% CI, 1.00-1.02; p=0.03), and the presence of LA on MRI (OR, 2.01; 95% CI, 1.04-3.01; p=0.04) were statistically significant. In multivariate analysis, neurologic severity (OR, 1.14; 95% CI, 1.04-1.24; p<0.01), recanalization (OR, 0.03; 95% CI, 0.01-0.11; p<0.01), lesion size on DWI (OR, 1.02; 95% CI, 1.01-1.03; p=0.02), serum glucose level (OR, 1.01; 95% CI; 1.01-1.02; p=0.03), and the presence of LA on MRI (OR, 3.2; 95% CI, 1.22-8.48; p<0.01) showed statistically significant differences. These trends persisted up to 1 yr after thrombolysis.

Conclusion

In this study, we demonstrated that the presence of LA on MRI might be related to poor outcome after use of intravenous tissue plasminogen activator in AIS.     

Impact of CHADS2 Score on Neurological Severity and Long-Term Outcome in Atrial Fibrillation-Related Ischemic Stroke

Background and Purpose

The CHADS₂ (an acronym for congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack or thromboembolism) score is a widely used system for estimating the risk of stroke in patients with atrial fibrillation. However, how the CHADS₂ score is related to stroke severity and outcome in patients with strokes due to atrial fibrillation has not yet been elucidated.

Methods

We enrolled patients with atrial fibrillation who visited our stroke center within 7 days after the onset of acute ischemic stroke between October 2002 and September 2008. CHADS₂ scores were categorized into three groups: 0 points, low risk; 1 or 2 points, intermediate risk; and 3-6 points, high risk. Poor neurological state was defined as follows: a National Institutes of Health Stroke Scale (NIHSS) score of ≥2, and a modified Rankin Scale (mRS) score of ≥3 at discharge. Mortality information was ascertained as at December 2008.

Results

A cohort of 298 patients with atrial-fibrillation-related stroke was included in this study. A high-risk CHADS₂ score at admission was a powerful predictor of poor neurological outcome [for NIHSS: odds ratio (OR), 4.17; 95% confidence interval (CI), 1.76-9.87; for mRS: OR, 2.97; 95% CI, 1.23-7.16] after controlling for all possible confounders. In addition, a high-risk CHADS₂ score was an independent predictor of all causes of death during the follow-up [hazard ratio (HR), 3.01; 95% CI, 1.18-7.65] and vascular death (HR, 12.25; 95% CI, 1.50-99.90).

Conclusions

Although the CHADS₂ score was originally designed to distinguish patients with a future risk of stroke, our study shows that it may also be used to predict poor neurological outcome after atrial-fibrillation-related stroke.     

缺血性卒中后血浆超敏C-反应蛋白和白介素-6的早期动态变化与临床表现的关系探讨

目的 观察急性缺血性卒中患者发病后早期血浆超敏C反应蛋白（high sensitive C-reactive protein,hs-CRP）及白介素-6（interleukin-6,IL-6）水平的动态变化规律,探讨其与卒中患者临床表现及预后的关系。方法 连续入选急性缺血性卒中患者47例,正常对照组40例,比较卒中组发病后系列时间点血浆hs-CRP和IL-6水平与正常对照组之间的差异,分析其动态变化规律;按照基线美国国立卫生研究院卒中量表（national institutes of health stroke scale,NIHSS）评分将患者分为轻型组（n=15）和重型组（n=32）,比较两组血浆hs-CRP和IL-6水平;并比较不同临床预后患者血浆hs-CRP和IL-6水平的差异。结果 卒中组发病3h时血浆hs-CRP较对照组差异无统计学意义,6 h、12 h、24 h、48 h、3 d及7 d血浆hs-CRP较对照组明显升高（均P ≤0.01）。卒中组各时间点血浆IL-6水平均高于正常对照组（均P <0.01）。重型组血浆hs-CRP水平在12 h、24 h、48 h、3 d及7 d时水平均高于轻型组（P =0.046,0.012,0.030,0.007,0.041）;重型组血浆I L-6水平在12 h、24 h、48 h、3 d及7 d时水平均高于轻型组（P =0.002,0.001,0.006,0.026,0.043）。不同预后组之间血浆hs-CRP和IL-6水平差异不明显。结论 急性缺血性卒中患者血浆hs-CRP和IL-6水平升高,且与临床严重程度有关。     

卒中单元对急性缺血性卒中患者医疗质量和在院预后的影响

目的 调查中国卒中单元对缺血性卒中患者收治的现况，并探索卒中单元对改善卒中医疗质量绩效
指标及患者在院预后的影响。
方法 本研究数据来自中国多中心缺血性卒中住院患者登记研究。按照是否进入卒中单元，将
研究对象分为卒中单元组与非卒中单元组。比较两组间患者的卒中医疗质量关键绩效指标（key
performance index，KPI）和在院预后（卒中复发、联合血管事件、全因死亡）的差异，并采用多因素回归，
分析与卒中单元相关的KPI及卒中单元与缺血性卒中患者在院预后的相关性。
结果 本研究共纳入了全国1374家医院的269 428例急性缺血性卒中住院患者。其中，63 548例
（23.6%）患者纳入卒中单元组。卒中单元与较高比例的rt-PA静脉溶栓（OR 1.48，95%CI 1.43～1.53）、
早期抗栓治疗（OR 1.13，95%CI 1.10～1.17）、深静脉血栓预防（OR 1.19，95%CI 1.16～1.22）、吞
咽功能筛查（OR 1.36，95%CI 1.32～1.39）、康复评估（OR 1.31，95%CI 1.28～1.34）、出院抗栓治疗
（OR 1.12，95%CI 1.08～1.15）、合并心房颤动患者抗凝治疗（OR 1.13，95%CI 1.08～1.19）、戒烟宣教
（OR 1.22，95%CI 1.20～1.25）独立相关，与较低的在院卒中复发率（HR 0.79，95%CI 0.75～0.82）和
联合血管事件发生率（HR 0.80，95%CI 0.77～0.84）独立相关（均P <0.001）。
结论 进入卒中单元的缺血性卒中患者，卒中医疗质量KPI完成较好，在院卒中复发率及联合血管事
件率较低。