微量白蛋白尿与急性缺血性卒中患者短期转归的相关性

目的 探讨尿微量白蛋白(microalbuminuria, MAU)与急性缺血性卒中患者短期转归的关系.方法 前瞻性纳入住院治疗的连续急性缺血性卒中患者.入院后次日晨起留取首次尿标本测定尿白蛋白/肌酐比率(urine albumin/ creatinine ratio, UACR),UACR 30~300 mg/g定义为MAU阳性.入院时采用美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale, NIHSS)评价卒中严重程度,出院时采用改良Rankin量表(modified Rankin Scale, mRS)评价功能转归,0~2分定义为转归良好.结果 共纳入244例急性缺血性卒中患者,其中53例(21.72%)MAU阳性,67例(27.50%)转归不良.单变量分析显示,MAU阳性组患者年龄、基线NIHSS评分、收缩压、空腹血糖、球蛋白、D-二聚体、白细胞计数、中性粒细胞以及缺血性心脏病构成比显著高于MAU阴性组(P均<0.05).转归不良组基线NIHSS评分、空腹血糖、纤维蛋白原、间接胆红素、直接胆红素、C反应蛋白、D-二聚体、白细胞计数、中性粒细胞以及MAU阳性患者构成比显著高于转归良好组(P均<0.05).多变量logistic回归分析显示,MAU[优势比(odds ratio, OR)1.520,95%可信区间(confidence interval, CI)1.151~1.794;P=0.031]、基线NIHSS评分(OR 1.570,95% CI 1.357~1.808;P<0.001)是急性缺血性卒中患者短期转归不良的独立危险因素.结论 急性缺血性卒中患者的MAU发生率较高,MAU阳性可作为急性缺血性卒中患者短期转归不良的独立预测指标之一.     

The baseline NIHSS score in female and male patients and short-time outcome: a study in young ischemic stroke

The NIH Stroke Scale (NIHSS) may not appropriately assess the spectrum of young sex-related stroke neurologic deficits. We determined the cutoff baseline NIHSS score that predicts independent daily life activity at discharge in young male versus female ischemic strokes. We conducted this study in 1,451 young Chinese adults with acute cerebral ischemic stroke as determined by the modified Rankin Scale (mRS) at discharge. The main outcome measures included a composite favorable outcome (defined as a mRS score of 0 or 2) and poor outcome (defined as a mRS score of 3 or 6) at discharge. Bivariate logistic regression analyses were used to determine the risk factors of outcome at discharge in male and female patients respectively, receiver operating characteristic (ROC) curves and calculated the area under the ROC curve with 95 % CIs. P < 0.05 was considered significant. Stepwise logistic regression analysis confirmed the risk factors of outcome included: diabetes mellitus, hyperlipidemia, stroke subtype and baseline NIHSS score in male patient; atrial fibrillation, stroke subtype and baseline NIHSS score in female patients. The optimal cutoff score of the baseline NIHSS was ≤4 for female patients with stroke, the optimal cutoff score of the baseline NIHSS was ≤6 for male patients with stroke. The cutoff score of the baseline NIHSS for a favorable outcome at discharge was relatively low in young female patients compared to male patients. These results need further confirmation in larger contemporary datasets.     

Significance of elevated blood pressure and its management on the short-term outcome of patients with acute ischemic stroke

BACKGROUND: The objectives of this study were to characterize blood pressure (BP) in acute ischemic stroke and to determine its relationship with short-term functional outcome. METHODS: We examined 24-h BP recordings in 434 patients with ischemic stroke (lacunar stroke [LS], n = 205; non-lacunar stroke [NLS], n = 229) and in 178 normotensive subjects. Stroke severity was evaluated by the National Institutes of Health Stroke Scale (NIHSS). Patients found to be hypertensive on BP recordings on day 1 were given captopril or amlodipine. The primary outcome was both moderate-to-severe disability (Rankin scale scores 4 to 6) on day 7 or death during hospital stay. RESULTS: Patients with LS and NLS had significantly higher systolic BP (SBP) and diastolic BP levels than control subjects. On day 1, patients with NLS showed significantly higher NIHSS scores, SBP, and heart rate (HR) levels than LS patients. In the multivariate analysis, combined death or dependency was associated with NIHSS score (odds ratio [OR] = 1.08 per 1-point increase, 95% confidence interval [CI] = 1.04 to 1.13), 24-h SBP >160 mm Hg (OR = 2.35, 95% CI = 1.10 to 5.52), and plasma glucose levels >125 mg/dL on admission (OR = 1.88, 95% CI =1.03 to 3.57), whereas a decrease in SBP on day 7 (OR = 0.46, 95% CI = 0.24 to 0.88) was associated with better short-term outcome. CONCLUSIONS: At presentation, NLS patients showed higher BP levels than LS patients. Moderate reductions in BP during the first week after admission were associated with short-term functional improvement in patients with acute ischemic stroke.     

轻型缺血性卒中患者转归不良的预测因素：前瞻性队列研究

目的 探讨轻型缺血性卒中患者的功能转归并明确其转归不良的危险因素.方法 前瞻性纳入发病后72 h内就诊的轻型缺血性卒中患者,根据发病后90 d时改良Rankin量表（modified Rankin Scale,mRS）评分将患者分为转归不良组（mRS评分＞2分）和转归良好组（mRS评分0～2分）.采用单变量分析和多变量logistic回归分析对人口统计学资料、血管危险因素、临床资料、实验室检查资料、影像学资料和随访资料进行比较和分析,明确轻型缺血性卒中转归不良的危险因素.结果 共纳入253例轻型缺血性卒中患者,其中71例（28.1％）转归不良.单变量分析显示,转归不良组年龄（=2.037,P=0.043）、基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分（U=4 610.000,P=0.000）、基线mRS评分（U=5 723.000,P=0.000）以及既往缺血性卒中史（x2 =4.950,P=0.026）、有症状大血管重度狭窄或闭塞（x2=49.037,P=0.000）、大动脉粥样硬化型卒中（x2=34.359,P=0.000）、早期神经功能恶化（x2=45.804,P=0.000）、并发肺炎（x2=12.121,P=0.000）以及缺血性卒中复发（x2=14.305,P=0.000）的患者比例显著性高于转归良好组.多变量logistic回归分析显示,高龄[优势比（odds ratio,OR）1.049,95％可信区间（confidence interval,CI）1.012 ～1.086;P=0.008]、基线mRS评分较高（OR 2.130,95％ CI 1.212～3.743;P=0.009）、基线NIHSS评分较高（OR 1.532,95％ CI 1.064 ～2.206;P=0.022）、有症状大血管重度狭窄或闭塞（OR 7.569,95％ CI 3.497～ 16.380;P=0.000）、早期神经功能恶化（OR 7.369,95％ CI2.648～20.510;P =0.000）和缺血性卒中复发（OR 10.450,95％ CI 3.071 ～35.564;P=0.000）是转归不良的独立危险因素.结论 超过1/4的轻型缺血性卒中患者转归不良,高龄、基线mRS评分较高、基线NIHSS评分较高、有症状大血管重度狭窄或闭塞、早期神经功能恶化以及缺血性卒中复发是其?     

血清前白蛋白和白蛋白与不同年龄段急性缺血性卒中患者短期转归的相关性

目的 探讨不同年龄段急性缺血性卒中患者血清前白蛋白和白蛋白水平与短期转归的相关性.方法 前瞻性连续纳入发病48 h内入院的急性缺血性卒中患者.在发病后14 d应用改良Rankin量表评估功能转归情况,0～2分定义为转归良好.根据患者年龄分为中青年组(＜60岁)和老年组(≥60岁).比较总体患者以及不同年龄段患者转归良好组与转归不良组的人口统计学、基线临床资料和实验室检查结果.应用多变量logistic回归分析确定短期转归的独立影响因素.结果 共纳入急性缺血性卒中患者622例,其中男性402例(64.6％),女性220例(35.4％);中青年组206例(33.1％),老年组416例(66.9％);转归良好310例(49.8％),转归不良312例(50.2％).转归良好组男性、老年、高脂血症、糖尿病、既往卒中或短暂性脑缺血发作(transient ischemic attack,TIA)史的患者构成比以及年龄、体重指数、前白蛋白、白蛋白、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆红素、直接胆红素、间接胆红素、尿素氮和尿酸水平与转归不良组差异有统计学意义(P均＜0.05).多变量logistic回归分析显示,女性[优势比(odds ratio,OR)1.522,95％可信区间(confidence interval,CI)1.023 ～ 2.266;P=0.038]、糖尿病(OR 1.789,95％ CI1.171 ～2.735;P=0.007)以及低密度脂蛋白胆固醇(OR 1.251,95％ CI 1.017～ 1.539;P=0.034)、总胆红素(OR1.054,95％ CI1.029～1.081;P＜0.001)、尿素氮(OR 1.245,95％ CI1.100～1.409;P=0.001)和基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(OR 2.854,95％ CI1.027～3.628;P=0.019)较高为转归不良的独立危险因素,而前白蛋白(OR 0.798,95％ CI0.633～0.979;P =0.034)和白蛋白(OR 0.741,95％ CI0.693～0.988;P=0.020)较高为转归良好的独立预测因素.在中青年患者中,转归良好组糖尿病和小动脉闭塞的患者构成比以及年龄、三酰甘油和高密度脂蛋白胆固醇水平与转归不良组差异有统计学意义(P均＜ 0.05);多变量logistic回归分析显示,糖尿病(OR 2.343,95％ CI 1.127 ～4.871;P=0.023)和基线NIHSS评分较高(OR 2.041,95％ CI1.304～4.125;P=0.027)为转归不良的独立危险因素,而高密度脂蛋白胆固醇较高(OR0.742,95％ CI0.639 ～0.937;P=0.044)为转归良好的独立预测因素.在老年患者中,转归良好组男性、既往卒中或TIA史、心源性栓塞的患者构成比以及前白蛋白、低密度脂蛋白胆固醇、总胆红素、直接胆红素、间接胆红素和尿酸水平与转归不良组差异有统计学意义(P均＜0.05);多变量logistic回归分析显示,糖尿病(OR 2.797,95％ CI1.153 ～4.756;P=0.039)、基线NIHSS评分较高(OR 2.586,95％ CI.033 ～3.435;P=0.035)和低密度脂蛋白胆固醇较高(OR1.304,95％ CI1.027 ～1.656;P=0.029)为转归不良的独立危险因素,而前白蛋白较高为转归良好的独立预测因素(OR0.795,95％ CI0.691 ～0.998;P=0.002).结论 前白蛋白和白蛋白是急性缺血性卒中患者短期转归良好的独立预测因素.血清前白蛋白在老年人群(≥60岁)中的保护作用更为明显.     

血压变异性与急性缺血性卒中患者早期神经功能恶化的相关性

目的 探讨早期血压变异性与急性缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)的相关性.方法 前瞻性收集住院治疗的急性缺血性卒中患者.连续记录入组患者入院72 h内的血压值,计算收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)的平均值(mean)、最大值(maximum,max)、极差(differences between the maximum and minimum,max-min)、标准差(standard deviation,SD)和变异系数(coefficient of variation,CV).END定义为美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)最高时的评分较基线增加≥2分.采用多变量logistic回归分析在校正混杂因素后确定不同血压变异性参数与急性缺血性卒中后END的独立相关性.结果 共纳入128例急性缺血性卒中患者,其中男性75例,女性53例;平均年龄(63.30±11.82)岁.经过标准治疗,35例(27.34％)患者在入院72 h内发生END.END患者与非END患者年龄、性别、糖尿病、基线NIHSS评分、C反应蛋白以及SBPmax、SBPmax.mm、SBPsD、SBPCv、DBPmax、DBPmax-min、DBPsD和DBPCV的差异有统计学意义(P＜0.05).多变量logistic回归分析表明,血压变异性指标中的SBPmax--min[优势比(odds ratio,OR)1.040,95％可信区间(confidence interval,CI)1.014 ～1.067]、SBPsD(OR 1.191,95％ CI 1.052～1.347)、SBPCv(OR 1.317,95％ CI1.100 ～1.578)、DBPmax-min(OR 1.076,95％ CI1.018 ～1.138)、DBPSD(OR 1.508,95％ CI1.128～2.016)和DBPCv(OR 1.338,95％ CI1.093 ～1.638)是急性缺血性卒中患者发生END的独立危险因素.结论 急性缺血性卒中患者72 h内血压变异性与END显著相关.     

急性缺血性脑卒中患者中国缺血性卒中亚型分型与早期神经功能恶化的关系

目的探讨中国缺血性卒中亚型(Chinese ischemic stroke subclassification,CISS)分型与早期神经功能恶化(END)的关系。方法连续收集2017年6月~2018年12月常州市第二人民医院神经内科住院的老年急性缺血性脑卒中患者157例,按照CISS分型标准分为大动脉粥样硬化型78例,心源性脑卒中16例,穿支动脉疾病63例。根据END定义分为END组86例,非END组71例,比较2组一般临床指标。所有患者采用美国国立卫生研究院卒中量表(NIHSS)评分评估神经功能缺损程度,END定义为入院后72h内NIHSS评分较基线增加≥2分。采用多因素logistic回归分析END的危险因素。结果与非END组比较,END组入院NIHSS评分明显高于非END组[(4.7±2.9)分vs (3.0±2.2)分,P=0.000]。2组CISS分型比较,差异有统计学意义(P=0.014)。多因素logistic回归分析显示,入院NIHSS评分(OR=0.729,95%CI:0.621~0.857,P=0.000)、穿支动脉疾病(OR=3.399,95%CI:1.603~7.208,P=0.001)是END的独立危险因素。结论入院NIHSS评分、穿支动脉疾病是急性缺血性脑卒中患者END的独立危险因素。     

急性缺血性卒中患者急性肾损伤的危险因素

目的 探讨缺血性卒中患者并发急性肾损伤(acute kidney injury, AKI)的危险因素.方法 回顾性纳入缺血性卒中患者,收集一般临床资料、血管危险因素、药物使用情况、卒中病因学分型、卒中严重程度和基线生化指标等.根据是否发生AKI分为并发AKI组和对照组.采用多变量logistic回归分析缺血性卒中患者发生AKI的独立危险因素.结果 共纳入214例缺血性卒中患者,其中32例(14.95%)发生AKI,182例(85.05%)未发生AKI.AKI组心力衰竭(62.50%对41.21%;χ2=4.998,P=0.025)、应用甘露醇(87.50%对43.96%;χ2=20.643,P<0.001)和呋塞米(87.50%对43.96%;χ2=20.643,P<0.001)、应用对比剂(37.50%对19.23%;χ2=5.300,P=0.021)和对比剂用量>200 ml(28.13%对9.89%;χ2=6.637,P=0.010)患者构成比以及NIHSS评分[(18.0±4.5)分对(8.0±3.2)分;t=15.249,P<0.001]、舒张压[(89.98±9.12)mmHg对(80.56±8.19)mmHg,1 mmHg=0.133 kPa;t=5.898,P<0.001]、空腹血糖[(10.54±4.31)mmol/L对(6.32±1.32)mmol/L;t=5.898,P<0.001]、血尿素氮水平[(11.21±2.13)mmol/L对(7.98±2.34)mmol/L;t=7.293,P<0.001]、动脉血乳酸浓度[(3.98±0.12)mmol/L对(0.91±0.25)mmol/L;t=68.003,P<0.001]均显著高于非AKI组.多变量logistic回归分析示,在校正各种混杂因素后,NIHSS评分较高[优势比(odds ratio, OR) 1.910,95%可信区间(confidence interval, CI) 1.517~6.012;P=0.024]、舒张压较高(OR 1.816,95% CI 1.652~3.876;P=0.018)、动脉血乳酸浓度(OR 1.553,95% CI 1.256~1.763;P=0.019)、应用脱水剂(甘露醇:OR 3.765,95% CI 2.081~9.658,P=0.017;呋塞米:OR 5.329,95% CI 3.085~8.763,P=0.010)、应用对比剂(OR 2.097,95% CI 1.364~2.456;P=0.031)以及对比剂>200 ml(OR 3.294,95% CI 1.464~2.786;P=0.021)是缺血性卒中患者AKI的独立危险因素.结论 NIHSS评分、舒张压、动脉血乳酸浓度、应用甘露醇和呋塞米以及应用对比剂和对比剂剂量>200 ml与缺血性卒中患者AKI独立相关.     

出血性转化对急性缺血性卒中患者转归的影响

目的 探讨出血性转化(hemorrhagic transformation,HT)对急性缺血性卒中预后的影响.方法 根据CT和(或)MRI所见将101例急性缺血性卒中患者分为无HT的脑梗死(无HT)、出血性脑梗死(hemorrbagic infarction,HI)和脑实质血肿(parenchymal hematoma,PH).应用改良Rankin量表评分(modified Rankin Scale,mRS)评价发病3个月时的临床转归,mRS≤2分定义为转归良好.采用多变量logistic回归分析确定影响急性缺血性卒中患者转归的预测因素.结果 101例急性缺血性卒中患者中,53例无HT,44例为HI,4例为PH.HI(OR=0.07,95%CI0.01～0.30;P=0.001)、年龄＜65岁(OR=52.94,95%CI9.12～307.27;P＜0.001)、NIHSS评分＜15分(OR=0.63,95%CI0.50～0.78;P＜0.001)是急性缺血性卒中患者预后良好的独立预测因素.结论 HI是急性缺血性卒中患者发病3个月时转归良好的独立预测因素之一.     

血清尿酸、胆红素水平与急性缺血性卒中患者近期转归的相关性

目的：探讨基线尿酸水平及胆红素水平与急性缺血性卒中患者短期转归的关系。方法收集缺血性卒中患者的临床资料,包括入院时血清尿酸和胆红素水平、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分、出院时或第14天时改良 Rankin 量表(modified Rankin Scale, mRS)评分(0~2分定义为转归良好,>2分定义为转归不良)。结果共纳入急性缺血性卒中患者162例,转归良好组114例,转归不良组48例。2组之间糖尿病(51．75%对75．00%;χ2=7．526,P =0．006)、既往卒中或短暂性脑缺血发作( transient ischemic attack, TIA)史(18．42%对50．00%;χ2=17．790, P <0．001)的患者构成比以及基线舒张压[(87．061±12．245)mmHg 对(82．375±10．949)mmHg,1 mmHg =0．133 kPa;t =2．293,P =0．023]、高密度脂蛋白胆固醇[(1．604±0．299)mmol/L 对(1．265±0．206)mmol/L; t =3．227, P =0．002]、空腹血糖[(2．875±0．438)mmol/L 对(8．160±0．592)mmol/L; t =-4．761, P <0．001)]、尿酸[(289．365±77．168)μmol/L 对(248．206±66．206)μmol/L; t =3．111, P =0．002]、总胆红素[(14．673±2．213)μmol/L 对(10．395±2．714)μmol/L; t =3．779, P <0．001]、直接胆红素[(6．036±1．392)μmol/L 对(4．956±1．379)μmol/L; t =2．088, P =0．038]、间接胆红素[(8．634±2．307)μmol/L 对(5．439±1．223)μmol/L;t =4．219,P <0．001]水平存在显著差异。多变量 logistic回归分析显示,既往卒中或 TIA 史[优势比(odds ratio, OR)3．751,95%可信区间(confidence interval, CI)1．395~10．091;P =0．009]和基线 NIHSS 评分(OR 2．723,95% CI 1．093~6．783;P =0．031)是缺血性卒中转归不良的独立危险因素,而尿酸(OR 0．357,95% CI 0．141~0．900;P =0．029)、高密度脂蛋白胆固醇(OR 0．262,95% CI 0．079~0．870;P =0．029)和间接胆红素(OR 0．117,95% CI 0．025~0．539;P =0．006)与转归良好独立相关。结论基线尿酸和间接胆红素水平增高是急性缺血性卒中患者转归良好的有利因素。     

静脉溶栓联合血管内治疗对急性中重症脑梗死患者预后的影响因素分析

目的研究急性中重症脑梗死患者静脉溶栓联合血管内介入治疗预后的影响因素。方法回顾性分析2013年9月至2015年12月在上海长海医院脑血管病中心采用静脉溶栓联合血管内介入治疗的急性中重症脑梗死患者179例的临床资料,均为发病4.5 h内采用静脉溶栓联合至少血管内介入治疗的1种方式(动脉溶栓、机械取栓、支架置入)。根据患者治疗后3个月改良Rankin量表(mRS)评分,将mRS≤2分作为预后良好组(71例),3≤mRS≤6分作为预后不良组(108例)。分析两组的临床资料,包括年龄、性别、既往史、治疗前及治疗后即刻美国国立卫生研究院卒中量表(NIHSS)、Alberta卒中早期CT评分(ASPECTS)等,并进一步行多因素Logistic回归分析预后的影响因素。结果预后良好率为39.7%(71/179)。预后良好组与不良组间年龄、病前1周短暂性脑缺血发作史、NIHSS评分和溶栓前ASPECTS评分的差异均有统计学意义[分别为:(62±14)岁比(71±11)岁,8.4%(6/71)比1.9%(2/108),(16±6)分比(19±6)分,(9.5±1.0)分比(8.5±1.9)分,均P0.05],其余差异均无统计学意义(均P0.05)。预后良好组与不良组间治疗后即刻NIHSS评分、24 h颅内出血转化率、脑实质出血率差异均有统计学意义[(10±3)分比(15±7)分,7.0%(5/71)比28.7%(31/108),0比12.0%(13/108),均P0.01]。多因素Logistic回归分析显示:年龄(OR=1.047,95%CI:1.014~1.081,P=0.005)、入院时ASPECTS评分(OR=0.382,95%CI:0.233~0.627,P0.01)、治疗后即刻NIHSS评分(OR=1.121,95%CI:1.050~1.196,P=0.001)为中重度脑梗死静脉溶栓联合血管内介入治疗预后的影响因素。结论年龄和治疗后即刻NIHSS评分为中重度脑梗死静脉溶栓联合血管内介入治疗预后的独立危险因素,年龄越大、治疗后即刻NIHSS评分越高,中重度脑梗死静脉溶栓联合血管内介入治疗的预后越差;入院时ASPECTS评分越高,对预后的保护性越强。     

Non-neurological complications of acute stroke: frequency and influence on clinical outcome

Understanding the nature and clinical relevance of non-neurological complications is crucial to provide an appropriate management to patients with acute stroke. The aims of this study in patients with acute stroke were to assess the in-hospital frequency of non-neurological complications and the correlation between these complications and adverse outcome (death or disability) at 3?months. Patients with acute ischemic or hemorrhagic stroke admitted to the Stroke Unit of the University of Perugia were included in a prospective cohort study. Pre-defined non-neurological complications were considered for study purposes. Study outcomes were 3-month death and composite of death and disability. Stroke was defined as not disabling (mRS 0-2) or disabling (mRS 3-5) or leading to death (mRS 6). Multiple logistic regression analysis was used to identify predictors for study outcomes. 1,101 consecutive patients (mean age 72.2?±?13.1?years; 57.1% males; 926 ischemic and 175 hemorrhagic) were included in the study; 338 patients (30.7%) experienced at least one non-neurological complication. 269 patients (24.4%) had fever, 210 patients (19.1%) infection in one or more sites, 86 patients (7.8%) venous thromboembolism (VTE) and 34 patients (3.0%) myocardial infarction. At 3?months, 511 patients (46.4%) were disabled and 123 had died (11.2%). Regression logistic analysis found that: (1) age (OR 1.06 for 1 added year; 95% CI 1.03-1.08), NIHSS score on admission (OR 1.31 for 1 added point; 95% CI 1.25-1.38), current smoking (OR 1.92; 95% CI 1.08-3.39), infection in any site (OR 4.13; 95% CI 1.51-11.28) and VTE (OR 6.03; 95% CI 1.44-25.11) were associated with death and/or disability (mRS?≥?3) and that (2) age (OR 1.06 for 1 added year; 95% CI 1.02-1.09), high NIHSS score on admission (OR 1.21 for 1 added point; 95% CI 1.15-1.27), male gender (OR 1.93; 95% CI 1.04-3.62), fever (OR 2.29; 95% CI 1.08-4.86) and myocardial infarction (OR 6.57; 95% CI 2.30-18.74) were associated with increased mortality. In conclusions, patients with acute stroke are at high risk of non-neurological complications, such as fever with or without infections, venous thromboembolism and myocardial infarction. Non-neurological complications are associated with increased long-term disability and death.     

血清糖化血红蛋白水平与急性脑梗死早期神经功能恶化的相关性分析

目的探讨血清糖化血红蛋白(Hb A1c)水平对急性脑梗死患者早期神经功能恶化(END)的预测价值。方法回顾性连续纳入2014年6月至2016年1月于宿迁市人民医院神经内科住院,且起病至入院时间间隔3 d的缺血性卒中急性期患者。入院当天采用美国国立卫生研究院卒中量表(NIHSS)对所有患者行神经功能缺损情况评估,入院7 d内多次对患者神经功能缺损症状进行复评,任意1次评分较入院时增加≥2分定义为END。对符合入组和排除标准的226例患者按急性脑梗死后是否发生END分为END组50例(22.1%)和非END组176例(77.9%)。采用单因素分析组间各因素差异,多因素Logistic回归分析血清Hb A1c水平与END的相关性。结果与非END组相比,END组患者年龄、糖尿病患病率、NIHSS评分、超敏C反应蛋白水平、ASPECT评分0~7分患者比例及血清Hb Alc水平均明显升高,差异有统计学意义(均P0.05)。Logistic回归分析结果示,超敏C反应蛋白和血清Hb A1c水平升高是急性脑梗死END的独立危险因素(OR值分别为1.048、1.809,95%CI分别为1.008~1.089、1.429~2.292;P值分别为0.018、0.002)。结论血清Hb A1c水平升高是急性脑梗死END的危险因素,对END具有一定预测价值。     

Prediction of cerebrovascular event risk following myocardial infarction

IntroductionPatients with coronary artery disease (CAD) are at increased risk of stroke. The aim of this study was to analyze the prognostic accuracy of selected clinical and laboratory variables in stroke risk prediction following discharge after myocardial infarction (MI).MethodsWe analyzed 404 consecutive patients (aged 68.1±13.7 years; 63.4% male; 37.4% with diabetes) without previous stroke who were discharged in sinus rhythm after being admitted for MI. The following data were collected: cardiovascular risk factors, admission blood glucose (BG), HbA1c, creatinine, peak troponin levels; glomerular filtration rate (GFR) by the MDRD formula; maximum Killip class; GRACE score for in-hospital and 6-month mortality; and extent of CAD. Patients were followed for two years and each variable was tested as a possible predictor of cerebrovascular events (stroke or transient ischemic attack [TIA]).ResultsDuring follow-up, 27 patients were admitted for stroke or TIA. The presence of diabetes, hypertension, dyslipidemia and previously known CAD, type of MI (STEMI vs NSTEMI) and extent of CAD did not predict cerebrovascular risk. The following variables were associated with higher stroke risk: GFR <60 ml/min/m² (p=0.029, OR 2.65, 95% CI 1.07-6.55); maximum Killip class >1 (p=0.025, OR 2.71, 95% CI 1.10-6.69); GRACE in-hospital mortality >180 (p=0.001, OR 4.09, 95% CI 1.64-10.22); admission BG >140 mg/dl (p=0.001, OR 5.74, 95% CI 1.87-17.58); GRACE 6-month mortality >150 (p=0.001, OR 4.50, 95% CI 1.80-6.27); and peak troponin >42 ng/ml (p=0.032, OR 2.64, 95% CI 1.06-6.59). Logistic regression analysis produced a model with the predictors GRACE 6-month mortality >150 (OR 3.26; p=0.014) and admission BG >7.7 mmol/l (OR 4.09; p=0.017) that fi tted the data well (Hosmer-Lemeshow: p=0.916).Discussion/conclusionsIn patients with MI, variables known to be predictors of in-hospital mortality, including admission BG, renal function, acute heart failure and GRACE score, were found to be useful predictors of stroke during 2-year follow-up. While both GRACE score for 6-month mortality >150 and admission BG >7.7 mmol/l were independent predictors of stroke, CV risk factors, previously known CAD, and extent of CAD assessed by coronary angiography did not improve stroke risk prediction. This study highlights the need for even more aggressive secondary prevention in patients most at risk.     

急性脑梗死进展发生的相关危险因素分析

目的探讨急性脑梗死早期进展发生的相关危险因素。方法回顾性分析2012年1月—2013年12月东南大学附属中大医院神经内科收治的急性脑梗死患者446例。神经功能恶化(ND)定义为住院72 h内任一时刻复评美国国立卫生研究卒中量表(NIHSS)评分较入院基线NIHSS评分增加2分(ND2)或增加4分(ND4)。将患者分为ND2组(n=107)和非ND2组(n=339),或ND4组(n=62)和非ND4组(n=384)。比较不同组间患者的一般人口学、脑血管病危险因素、影像学以及血液学资料的差异。结果 446例患者中,107例(24.0%)诊断为ND2,62例(13.9%)诊断为ND4。单因素分析结果显示,ND2患者和非ND2患者间住院时间、年龄、基线NIHSS评分、入院基线收缩压、责任动脉闭塞以及血液学检查中的白细胞、空腹血糖和C反应蛋白水平差异均有统计学意义(均P0.05);ND4患者和非ND4患者间性别、年龄、心房颤动、基线NIHSS评分、入院基线收缩压、责任动脉闭塞以及血液C反应蛋白水平的差异均有统计学意义(均P0.05)。校正混杂因素后,Logistic回归分析结果显示,基线NIHSS评分(OR=1.114,95%CI:1.0481~1.185,P=0.001)、C反应蛋白(OR=1.014,95%CI:1.004~1.024,P=0.004)、责任动脉闭塞(OR=2.303,95%CI:1.152~4.606,P=0.018)与ND2独立相关;而年龄(OR=1.040,95%CI:1.011~1.070,P=0.006)、收缩压(OR=1.015,95%CI:1.003~1.027,P=0.018)、C反应蛋白(OR=1.016,95%CI:1.005~1.026,P=0.003)、责任动脉闭塞(OR=2.845,95%CI:1.291~2.269,P=0.009)与ND4独立相关。结论急性脑梗死患者早期发生ND与患者年龄、卒中严重程度、基线收缩压、C反应蛋白以及责任动脉闭塞关系密切。临床诊治中,及时完善上述指标的检测有助于鉴别出早期易于进展恶化的急性脑梗死患者。     

A case control study between diabetic and non-diabetic subjects with ischemic stroke.

AIM: The clinical and prognostic profile of diabetic stroke patients is still an unclarified topic. The aim of the present study is to compare clinical features and risk factor profile in diabetics and in non-diabetics affected by acute ischemic stroke. METHODS: We have included 98 diabetics and 102 matched non-diabetic subjects affected by acute ischemic stroke and matched by age (+/-3 years) and gender. We determined the Scandinavian Stroke Scale (SSS) on admission and the Rankin disability scale on discharge and after a 6 months follow-up. Ischemic stroke has been classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. We anamnestically evaluated the presence of hypertension, hypercholesterolemia, any records of transient ischemic attack, and stroke. Using conditional logistic regression analysis, we calculated adjusted odds ratio (OR) and 95% confidence interval (CI). RESULTS: Diabetes was associated with lacunar ischemic stroke subtype (OR 3.89, 95% CI 2.23-6.8), with a record of hypertension (OR 2.53, 95% CI 1.48-4.32), and with a better SSS score at admission (OR 0.58, 95% CI 0.36-0.96). The association of diabetes with lacunar stroke remained significant also after adjustment for hypertension (adjusted OR 3.37, 95% CI 1.9-5.99) or for large artery atherosclerotic and cardioembolic stroke subtypes (adjusted OR 2.69, 95% CI 1.08-6.69). CONCLUSIONS: Our study shows some significant differences in acute ischemic stroke among diabetics in comparison with non-diabetics (higher frequency of hypertension, higher prevalence of lacunar stroke subtype, lower neurological deficit at admission in diabetics).     

影响青岛地区急性缺血性卒中患者溶栓治疗的因素

目的 明确青岛地区缺血性脑血管病患者的溶栓率,并分析影响溶栓治疗的原因,探讨其影响因素.方法 制定统一的青岛市卒中诊治现状调查表,回顾性连续收集2008年10月1日至2009年10月31日就诊于青岛市、县两级具有溶栓条件的11家医院神经内科的急性卒中住院患者,进行面对面问卷调查,收集其临床资料,分析影响溶栓治疗的因素.结果 实际调查缺血性脑血管病患者864例,仅10例患者接受溶栓治疗,溶栓率为1.16%,4.5 h治疗时间窗内的溶栓率为6.33%.Logistic回归分析显示,除溶栓禁忌证外,影响急性缺血性卒中患者溶栓治疗的因素还包括就诊医院级别(OR=0.061,95% Cl0.006～0.703,P=0.040)和就诊时美国国立卫生研究院卒中量表评分(OR=0.810,95%CI0.729～0.900,P=0.000).结论 青岛地区缺血性脑血管病患者的溶栓率偏低;除溶栓禁忌证外,影响急性缺血性卒中患者溶栓治疗的因素还包括就诊医院级别和就诊时美国国立卫生研究院卒中量表评分.     

中性粒细胞与淋巴细胞比值对急性脑梗死患者预后的预测价值

目的探讨中性粒细胞与淋巴细胞比值(NLR)对急性脑梗死患者预后的预测价值。方法回顾性连续纳入2014年1月至2015年12月郑州大学第五附属医院神经内科住院的急性脑梗死患者307例,其中女80例,男227例。根据改良Rankin量表评分标准,分为预后良好组(195例)和预后不良组(112例)。记录入院时年龄、性别、既往病史、美国国立卫生研究院卒中量表(NIHSS)评分等资料,根据入院中性粒细胞计数与淋巴细胞计数计算出NLR值。采用Logistics回归分析急性脑梗死预后不良的影响因素,采用受试者工作特征(ROC)曲线评价入院时NLR水平对急性脑梗死患者预后不良的预测作用。结果 (1)与预后良好组比较,预后不良组患者年龄、复发性脑梗死发生率、入院时NIHSS评分、入院NLR水平均较高,组间差异均有统计学意义[(69±12)岁比(62±14)岁,25.0%(28/112)比14.4%(28/195),5.00(3.00,9.00)分比3.00(1.75,5.00)分,3.66(2.62,7.91)比2.47(1.94,3.40),均P0.05],其余基线资料和临床特征的组间差异均无统计学意义(均P0.05)。(2)多因素Logistics回归分析结果显示,年龄、入院NIHSS评分及入院时NLR水平的升高,是预后不良的独立危险因素(OR值分别为1.030,1.148,1.427,95%CI分别为1.007~1.053,1.059~1.246,1.247~1.634,均P0.05)。(3)入院时NLR水平对急性脑梗死患者预后不良的诊断界值为2.84,其敏感度为69.6%,特异度为64.6%。结论入院时NLR水平增高对评估急性脑梗死患者预后不良具有一定的参考价值。     

胚胎型大脑后动脉与急性缺血性卒中患者梗死分布和卒中严重程度的相关性

目的 探讨胚胎型大脑后动脉(Fetal-type posterior cerebral artery, FTP)与急性缺血性卒中患者梗死分布和卒中严重程度的相关性.方法 回顾性纳入急性缺血性卒中患者.根据磁共振血管造影结果分为FTP组和非FTP组,前者进一步分为完全型FTP(complete FTP, cFTP)和部分型FTP(partial FTP, pFTP).根据弥散加权成像结果将梗死部位分为大脑前动脉(anterior cerebral artery, ACA)供血区、大脑中动脉(middle cerebral artery, MCA)供血区、大脑后动脉(posterior cerebral artery, PCA)供血区及椎基底动脉(vertebrobasilar artery, VBA)供血区.根据美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评价卒中严重程度,<8分定义为轻度卒中,≥8分定义为中重度卒中.多变量logistic回归分析确定FTP与梗死分布和卒中严重程度的相关性.结果 共纳入647例急性缺血性卒中患者,201例(31.1%)存在FTP,其中cFTP 162例(25.0%),pFTP 39例(6.0%).多变量logistic回归分析显示,cFTP和pFTP是MCA供血区梗死的独立危险因素[cFTP:优势比(odds ratio, OR)24.714,95%可信区间(confidence interval, CI)10.952~45.766,P<0.001;pFTP:OR 14.526,95% CI 6.832~25.931,P<0.001]和PCA供血区梗死的独立保护因素(cFTP:OR 0.214,95% CI 0.022~0.531,P<0.001;pFTP:OR 0.326,95% CI 0.018~0.739,P<0.001),同时也是急性缺血性卒中严重程度的独立危险因素(cFTP:OR 22.138,95% CI 12.492~64.067,P<0.001;cFTP:OR 19.510,95% CI 8.956~23.514,P<0.001).结论:cFTP和pFTP是MCA供血区梗死的独立危险因素和PCA供血区梗死的独立保护因素,同时也是中重度卒中的独立危险因素.FTP与急性缺血性卒中患者的梗死分布和卒中严重程度相关.     

Non-neurological complications of acute stroke: frequency and influence on clinical outcome

Understanding the nature and clinical relevance of non-neurological complications is crucial to provide an appropriate management to patients with acute stroke. The aims of this study in patients with acute stroke were to assess the in-hospital frequency of non-neurological complications and the correlation between these complications and adverse outcome (death or disability) at 3 months. Patients with acute ischemic or hemorrhagic stroke admitted to the Stroke Unit of the University of Perugia were included in a prospective cohort study. Pre-defined non-neurological complications were considered for study purposes. Study outcomes were 3-month death and composite of death and disability. Stroke was defined as not disabling (mRS 0–2) or disabling (mRS 3–5) or leading to death (mRS 6). Multiple logistic regression analysis was used to identify predictors for study outcomes. 1,101 consecutive patients (mean age 72.2 ± 13.1 years; 57.1% males; 926 ischemic and 175 hemorrhagic) were included in the study; 338 patients (30.7%) experienced at least one non-neurological complication. 269 patients (24.4%) had fever, 210 patients (19.1%) infection in one or more sites, 86 patients (7.8%) venous thromboembolism (VTE) and 34 patients (3.0%) myocardial infarction. At 3 months, 511 patients (46.4%) were disabled and 123 had died (11.2%). Regression logistic analysis found that: (1) age (OR 1.06 for 1 added year; 95% CI 1.03–1.08), NIHSS score on admission (OR 1.31 for 1 added point; 95% CI 1.25–1.38), current smoking (OR 1.92; 95% CI 1.08–3.39), infection in any site (OR 4.13; 95% CI 1.51–11.28) and VTE (OR 6.03; 95% CI 1.44–25.11) were associated with death and/or disability (mRS ≥ 3) and that (2) age (OR 1.06 for 1 added year; 95% CI 1.02–1.09), high NIHSS score on admission (OR 1.21 for 1 added point; 95% CI 1.15–1.27), male gender (OR 1.93; 95% CI 1.04–3.62), fever (OR 2.29; 95% CI 1.08–4.86) and myocardial infarction (OR 6.57; 95% CI 2.30–18.74) were associated with increased mortality. In conclusions, patients with acute stroke are at high risk of non-neurological complications, such as fever with or without infections, venous thromboembolism and myocardial infarction. Non-neurological complications are associated with increased long-term disability and death.