Assessment of the Main Fetal Cerebrovascular Areas by Ultrasound Color-Coded Doppler

The color flow mapping method makes it possible to identify small vessels presently not detected on B-mode imaging. The main cerebral arteries of normal human fetuses, anterior, middle, and posterior arteries, were investigated by color-coded Doppler in 45 normal pregnancies. The Pourcelot index R was calculated at different stages of the pregnancy. The values of R (anterior cerebral artery), R (middle cerebral artery), and R (posterior cerebral artery) were compared in each fetus. No significant differences were found when comparing all of the R (anterior cerebral artery) and R (middle cerebral artery) or the R (anterior cerebral artery) and R (middle cerebral artery) at the same gestational age. On the contrary, for each fetus, at any gestational age, the R (anterior cerebral artery) and the R (middle cerebral artery) indices were significantly different (P < 0.01); the index in the middle cerebral artery was higher than that of the anterior cerebral artery. The same difference was observed when comparing R (posterior cerebral artery) and R (middle cerebral artery). The index of the middle cerebral artery was significantly higher than that of the posterior cerebral artery (P < 0.001). On the other hand, no significant difference was found between R (anterior cerebral artery) and R (posterior cerebral artery) at any gestational age (P = 0.4).     

出血性脑梗死及其相关危险因素的临床分析

目的探讨出血性脑梗死的临床特点和危险因素。方法采用回顾性分析方法,将2003年1月~2006年1月收治的1 548例脑梗死患者分为出血性脑梗死组(52例)及对照组(1 496例),采用logistic回归模型分析出血性脑梗死的危险因素。结果出血性脑梗死占同期脑梗死患者的3.36%,脑栓塞、皮质梗死、大面积脑梗死、高血糖为出血性脑梗死的独立危险因素;抗凝、溶栓治疗不增加出血的危险性,但容易形成局部血肿,出血性脑梗死患者的预后优于对照组;结论脑栓塞、皮质梗死、大面积脑梗死、高血糖容易发生出血性脑梗死,出血性脑梗死患者的短期预后与原有梗死灶大小及部位有关,优于对照组,大量出血形成血肿预后不良。     

抗血小板治疗对伴脑出血史的脑梗死患者急性期及二级预防的安全性评价

目的 观察既往脑出血患者发生脑梗死后急性期及二级预防中使用抗栓药物的安全性.方法 择取符合入选条件的急性脑梗死患者554例,其中149例既往有脑出血史现首次发生脑梗死患者进入实验组,同期405例既往无脑出血史现发生脑梗死患者进入对照组,两组患者住院期间及出院后均给予持续抗栓治疗.记录住院期间及出院18个月内累计脑出血发生率.结果 住院期间实验组再发生脑出血7例,对照组16例;18个月内实验组累计再发生脑出血15例,对照组累计36例,观察期内两组均无因脑出血死亡病例.结论 既往脑出血患者发生脑梗死后,急性期及二级预防中使用抗栓药物不增加脑出血风险及病死率.     

脑出血与脑梗死患者血液中血小板活化因子的对比研究

目的　探讨脑出血与脑梗死患者血液中的血小板活化因子(PAF)的不同水平的变化。方法　用簿层层析法(TLC)测定了脑出血和脑梗死患者血液中PAF水平的不同变化。结果　脑梗死患者血液中PAF水平分别是急性期为(1 .5 2 1±0 .2 88)nmol/ml,恢复期为(1. 0 45±0 . 2 2 1 )nmol/ml,高于非脑血管病组的急性期(0 . 670±0 .1 79)nmol/ml和恢复期(0 . 661±0 . 1 72 )nmol/ml及健康对照组的急性期(0 . 71 4±0 . 2 1 2 )nmol/ml和恢复期(0 . 70 2±0. 2 0 1 )nmol/ml,有非常显著性差异(P <0 . 0 1 ) ;脑出血患者血液中PAF水平分别是急性期为(1 . 1 80±0 2 92 )nmol/ml,恢复期为(1 . 1 0 8±0 .2 95 )nmol/ml,也均高于非脑血管病组和健康对照组,有显著性差异。结论　提示PAF在脑血管病的发病过程中可能起重要作用。     

脑梗死患者死亡原因的探讨

目的探讨脑梗死患者死亡的原因。方法对1 457例脑梗死死亡患者的年龄、高血压、糖尿病、冠心病、心房颤动、血脂异常及并发症进行相关分析,并与脑梗死非死亡患者进行对照研究。结果脑梗死患者总病死率为2.68%,其中首次脑梗死的病死率1.10%,复发脑梗死的病死率9.35%,两者差异有显著性意义(P<0.01),复发性脑梗死病死率为初发脑梗死病死率的9倍。发病后2周内死亡占82.05%,死亡年龄65岁以上居多(占75.00%)。脑梗死死亡者多有高血压和(或)糖尿病,死亡前多有并发症(以肺部感染为主,脑梗死合并肺部感染等2种或以上并发症,是脑梗死的主要死亡原因)。结论高龄、高血压、冠心病、心房颤动、糖尿病和复发性脑梗死是脑梗死患者死亡的重要因素,并发症是导致脑梗死患者死亡的直接原因,并发症越多,脑梗死患者病死率越高。     

脑肿消方对缺血性中风急性期脑水肿作用的实验研究

目的观察脑肿消方对局灶性脑缺血大鼠脑水肿的影响,并初步探讨其作用机制.方法采用线栓法建立局灶性脑缺血模型,观察大鼠脑系数、脑含水量、全血黏度、红细胞聚集指数、脑组织脂质过氧化物丙二醛(MDA)及超氧化物歧化酶(SOD)的含量变化.结果脑肿消方大、小剂量组及维脑路通组均可不同程度地降低脑系数和脑组织含水量,降低全血黏度及红细胞聚集指数,降低脑组织中MDA含量,升高SOD活性,以脑肿消方大剂量组作用最优,与模型组比较,有统计学意义(P＜0.05).结论脑肿消方对局灶性脑缺血大鼠脑水肿有防治作用,其机制可能与改善机体血流动力学和提高机体抗氧化能力有关.     

参芎嗪注射液对大鼠脑缺血损伤血液流变学、脑含水量的影响

目的复制脑缺血大鼠模型,研究参芎嗪注射液对实验性脑缺血大鼠的干预作用。方法通过线栓法复制大鼠脑缺血模型,设立假手术组、模型组、川芎嗪注射液组、参芎嗪注射液组,观察各组治疗前后血液流变学、脑含水量、脑指数的影响。结果参芎嗪注射液可改善血液流变学,降低脑含水量及脑指数,与模型组比较差异有统计学意义(P0.05或P0.01)。结论参芎嗪注射液可改善微循环、减轻脑水肿,对脑缺血损伤起到较好的保护作用。     

Thiobarbituric acid reactive substances and vitamin E in serum and cerebrospinal fluid from patients with cerebral apoplexy

Thiobarbituric acid (TBA) reactive substances in serum and cerebrospinal fluid from patients with cerebral apoplexy were determined and their relationship to this disease was studied. TBA reactants in serum were elevated in patients with cerebral apoplexy, but there was no difference between patients with brain tumor or other neurological disease and healthy persons. TBA reactants in cerebrospinal fluid in patients with cerebral aneurysm, cerebral arterial and venous anomalies or intracerebral hematoma, and its levels in patients with cerebral infarction or brain tumor were also higher than in healthy persons. Serum α-tocopherol levels were elevated in patients with cerebral infarction, but were relatively low in patients with cerebral aneurysm, cerebral arterial and venous anomalies or intracerebral hematoma. The reverse was the case with cerebrospinal fluid levels of α-tocopherol. That is, the sequence of decreasing level of α-tocopherol in cerebrospinal fluid was intracerebral hematoma, cerebral aneurysm, cerebral arterial and venous anomalies, and cerebral infarction. The levels of TBA reactive substances in patients with cerebral apoplexy showed a positive correlation between serum and cerebrospinal fluid, and the levels of α-tocopherol showed a similar correlation.     

脑囊虫病160例的CT分析

目的 :为正确诊断脑囊虫病及合理治疗提供依据。方法 :对 160例脑囊虫病 CT进行分析。结果 :根据 CT检查结果将脑囊虫病分为脑实质型、脑室型、脑膜型和混合型等 4型 ;其中脑实质型又分轻度、中度、重度 3类 ,轻度预后好 ,重度预后差。结论 :脑囊虫病病灶的部位和数量与病情的轻、重及预后有关。 CT检查对脑囊虫病的诊断具有重要价值。     

糖尿病脑梗塞与其他类型脑梗塞病人的脑血流量比较

目的观察糖尿病及高血压脑梗塞患者脑血流量的变化。方法９５例糖尿病合并高血压脑梗塞患者，６５例糖尿病脑梗塞和１００例单纯脑梗塞患者全部作１３３Ｘｅ吸入法测定脑血流量。结果高血压脑梗塞及糖尿病脑梗塞患者脑血流量较脑梗塞组明显下降（Ｐ＜０．０５），糖尿病合并高血压脑梗塞又较单纯糖尿病脑梗塞明显降低（Ｐ＜０．０５），血糖控制不良比血糖控制良好的脑梗塞患者下降更为明显，且预后差。结论糖尿病合并高血压进一步影响脑梗塞患者的脑血流量。     

Suzuki分级及异常代偿血管与成人烟雾病脑出血及缺血的关系

目的进一步探讨成人烟雾病患者脑出血及脑缺血事件的发生机制。方法对86例经全脑血管造影证实的成人烟雾病患者[脑出血52例(104个大脑半球,脑出血组),脑缺血34例(68个大脑半球,脑缺血组)]的临床资料进行回顾性分析,对Suzuki分级、烟雾样血管的丰富程度分期及颅内小动脉扩张不同者的脑出血及脑缺血发生率进行χ2检验及Mann-Whitney U检验。结果①两组Suzuki分级无显著差异,Mann-Whitney U检验Z=0.656、P=0.512;Suzuki分级Ⅲ～Ⅳ级者脑出血率显著高于脑缺血率(P<0.05)。②两组颅底烟雾样异常血管丰富程度分期有显著差异,Mann-Whitney U检验Z=3.909、P=0.000;其中2～4期者脑出血率显著高于脑缺血率(P<0.05)。③两组扩张小动脉无显著差异,Mann-Whitney U检验Z=1.183,P=0.237;同种血管扩张者脑出血率显著高于脑缺血率(P<0.05)。结论成人烟雾病患者脑出血及缺血发生与Suzuki分级无显著相关;烟雾样血管的丰富程度升高及颅内主要小动脉扩张预示脑出血事件发生的可能性大。     

脑梗死伴冠状动脉狭窄的患病率及相关因素研究

目的 探讨脑梗死患者冠状动脉(冠脉)狭窄的患病率及其相关因素.方法 112例患者脑血管造影后行冠脉造影检查,对临床资料和冠脉狭窄之间的关系进行多因素logistic回归分析.结果 112例患者中,冠脉狭窄患病率为46.4%;经脑血管造影证实的95例脑梗死患者中,冠脉狭窄患病率为51.6%.多元logistic回归分析表明,年龄、高血压、高血脂、脑动脉显著狭窄是冠脉狭窄的独立预测因素.结论 对于脑梗死患者,尤其是年龄≥65岁,合并高血压、高血脂、脑动脉显著狭窄,脑血管造影后应行心脏64排CT常规筛查,以便早期发现冠脉狭窄.     

进展型脑梗死血脂、血流变、血凝检测的临床意义

目的研究进展型脑梗死患者血脂、血流变、血凝指标的变化,探讨进展型脑梗死的发病机制,为其临床早期诊断和治疗提供依据。方法对比检测了72例进展型脑梗死患者与72例完全型脑梗死患者血浆凝血酶原时间、凝血酶时间、部分凝血活酶时间、纤维蛋白原水平和血脂、血液流变学的各项指标。结果与完全型脑梗死患者比较,进展型脑梗死患者的血浆凝血酶原时间、凝血酶时间、部分凝血活酶时间显著缩短,而纤维蛋白原水平显著升高(P<0.01、0.05);血总胆固醇、甘油三酯、低密度脂蛋白水平明显增高(P<0.01、0.05);全血粘度、全血还原黏度、红细胞聚集指数和红细胞变形指数均较完全型组明显升高(P<0.010、.05)。结论进展型脑梗死患者存在着明显的高凝血状态、血流变的异常和高脂血症。     

Cerebral blood flow and metabolism in hepatic cirrhosis before and after portacaval shunt operation

It has been demonstrated that cardiac output and pulmonary, gastroduodenal, pancreatic, and splenic blood flow increases after portacaval shunt operations. This report concerns a study of cerebral haemodynamics and metabolism in eight patients with cirrhosis of the liver, examined both before and after portacaval surgical anastomosis. The patients were fully alert and orientated to mental and neurological examination at all times.In each subject the cerebral blood flow, cerebral vascular resistance, cerebral metabolic rate of oxygen and of glucose, and glucose/oxygen quotient were determined.This investigation showed that a portacaval shunt operation is followed by a significant increase in the cerebral blood flow and a significant decrease in the cerebral vascular resistances. No important variation in the cerebral metabolic rate of oxygen was observed, but both the cerebral metabolic rate of glucose and the glucose: oxygen quotient showed significant increases.The presence of toxic substances which, shunting the liver, enter the general circulation could be the cause of the increased cerebral blood flow, while the increase in the cerebral metabolic rate of glucose could result from a greater cerebral detoxication, for example, the cerebral synthesis of glutamine.     

脑储备能力评价参数概述及对比

脑储备能力的减退是预示缺血性卒中发生的危险因素已得到证实，具有重要的临床意义。其评价参数多样，如脑血流量、脑血容量、平均通过时间、脑循环时间、临界关闭压、血管舒缩反应性、反应时间、氧摄取指数、脑氧代谢率等，但迄今尚没有统一的评价标准。本文就脑储备能力不同阶段的各评价参数及其临床意义作一综述。     

轻度大脑中动脉狭窄对认知功能影响的分析

目的探讨轻度大脑中动脉狭窄对认知功能的影响。方法选取健康体检者和住院患者121例,根据检查结果分为轻度大脑中动脉狭窄组(狭窄组)49例和对照组72例。收集受试者一般临床资料,6个月后随访,采用中文版蒙特利尔认知评估量表(MoCA)和日常生活活动能力量表(ADL)进行评估。结果与对照组比较,狭窄组MoCA总分[(21.33±4.53)分vs(24.13±4.61)分]、注意[(5.11±0.61)分vs(5.43±0.93)分]、语言[(1.75±0.53)分vs(2.21±0.88)分]、抽象[(1.38±0.41)分vs(1.61±0.66)分]、延迟回忆[(1.64±1.22)分vs(2.72±1.52)分]、定向力[(5.11±0.78)分vs(5.49±0.88)分]明显降低,差异有统计学意义(P<0.05)。与右侧狭窄比较,双侧和左侧狭窄患者语言能力评分明显降低(P<0.01);与左侧狭窄比较,双侧和右侧狭窄患者抽象能力评分明显降低(P<0.01)。结论轻度大脑中动脉狭窄影响患者认知功能,且表现在特定的几个领域。     

Abnormal platelet von willebrand factor (vWF) as a marker of abnormal function in megakaryocytic dysplasia

Recent progress in the measurements of the hemostatic markers enables us to assess the detailed profiles of hemostatic activation in various diseases. To evaluate the degree of hemostatic system activation in patients with cerebral thrombosis, detailed coagulation studies were performed in 28 patients with acute-phase cerebral thrombosis and in 36 with chronic-phase cerebral thrombosis, together with 6 with chronic-phase cerebral hemorrhage and 37 age-matched healthy volunteers. In both acute-phase and chronic-phase cerebral thrombosis, plasma levels of thrombin-antithrombin III complex, plasmin-α₂-plasmin inhibitor complex and D-dimer were significantly higher, and antithrombin III and protein C were significantly lower than those in the normal group. Plasma fibrinogen concentration was significantly higher in chronic-phase cerebral thrombosis than that in chronic-phase cerebral hemorrhage. No significant difference was found in these variables between acute-phase and chronic-phase cerebral thrombosis. In addition, there was no difference in these parameters between chronic phase cerebral hemorrhage and normal subjects. These findings indicate that a sustained activation of coagulation and fibrinolysis is present in cerebral thrombosis, and it might contribute to the pathogenesis of cerebral thrombosis.     

胰岛素对脑梗死小鼠梗死周围区血管直径和梗死体积的影响

目的：探讨胰岛素对脑梗死小鼠梗死周围区血管直径和脑梗死体积的影响。方法40只雄性 C57/BL6j 小鼠随机分为正常对照组（n =5）、脑梗死组（n =15）、脑胰岛素抵抗组（n =5）和脑胰岛素抵抗梗死组（n =15）。采用光化学法制作脑梗死模型,侧脑室注射链脲霉素建立脑胰岛素抵抗模型,双光子共聚焦显微镜在体评价小脑延髓池注射胰岛素20 min后梗死周围区血管直径的改变。脑梗死模型制作后立即经小脑延髓池给予人工脑脊液或胰岛素（10 ng/ml）,并于梗死后24 h评估胰岛素对脑梗死体积的影响。结果胰岛素对正常对照组小鼠各类脑血管直径均无显著影响,但能显著收缩脑胰岛素抵抗组和脑胰岛素抵抗梗死组梗死周围区脑动脉[分别为（－23.16±6.86）％和（－23.32±6.40）％; P 均<0.001]和穿支动脉[分别为（－15.20±5.51）％和（－16.40±4.27）％;P 均<0.001],对脑静脉直径无显著影响。脑梗死组与正常对照组以及脑胰岛素抵抗梗死组与脑胰岛素抵抗组胰岛素的血管活性效应均无显著差异。胰岛素可使脑梗死组脑梗死体积显著缩小[（9.0±1.0）mm3对（6.0±1.2）mm3;t =4.294,P =0.002]。而胰岛素治疗对胰岛素抵抗脑梗死组脑梗死体积无显著影响[（12.6±2.3）mm3对（11.6±1.7）mm3;t =0.782,P =0.456]。结论胰岛素能减轻正常小鼠缺血性脑损伤且不影响梗死周围区脑血管直径,但对脑胰岛素抵抗小鼠的神经保护作用并不明显,可能与其对梗死周围区的缩血管效应有关。     

Single-photon-emission computed tomography of the brain in the evaluation of cerebral lupus

We sought to determine whether single-photon-emission computed tomography (SPECT) of the brain is useful for detecting abnormalities of regional cerebral blood flow in patients with cerebral lupus. Twenty lupus patients with clinical evidence of cerebral involvement underwent SPECT and CT scanning of the brain, as well as clinical, expert neurologic, and serologic evaluation. Fifteen patients (75%) had a clear regional cerebral hypoperfusion. Seven of 8 patients (88%) who were ultimately thought to have active cerebral lupus had abnormal SPECT scan findings, while 8 of 12 patients (67%) who were ultimately thought not to have active cerebral lupus had abnormal SPECT scan findings. There was no correlation of SPECT findings with CT scan results, overall disease activity, or serologic findings. Regional cerebral blood flow measured by SPECT is often abnormal in patients with active cerebral lupus, but is also frequently abnormal in lupus patients with neuropsychiatric symptoms not attributable to cerebral lupus activity.     

Expression and significance of angiostatin,vascular endothelial growth factor and matrix metalloproteinase-9 in brain tissue of diabetic rats with ischemia reperfusion

Objective: To discuss the expression and significance of angiostatin, vascular endothelial growth factor and matrix metalloproteinase-9 in the brain tissue of diabetic rats with ischemia reperfusion. Methods: A total of 60 male Wistar rats were randomly divided into the normal group, sham group, diabetic cerebral infarction group and single cerebral infarction group according to the random number table, with 15 rats in each group. The high sucrose diet and intraperitoneal injection of streptozotocin were performed for the modeling of diabetic rats, while the thread-occlusion method was employed to build the model of cerebral ischemia reperfusion. The immunohistochemical staining was performed to detect the expression of angiostatin, vascular endothelial growth factor(VEGF) and matrix metalloproteinase-9(MMP-9) in the brain tissue. Results: The expression of angiostatin after the reperfusion in the brain tissue of rats in the single cerebral infarction group and diabetic cerebral infarction group was increased 6 h after the reperfusion, reached to the peak on 1 d and then decreased gradually. The expression of angiostatin in the diabetic cerebral infarction group 6 h, 1 d, 3 d and 7 d after the reperfusion was significantly higher than that in the single cerebral infarction group(P0.05). VEGF began to be increased 1 h after the reperfusion in the single cerebral infarction group and diabetic cerebral infarction group, reached to the peak at 6 h and then decreased gradually. The expression of VEGF in the diabetic cerebral infarction group at each time point after the reperfusion was significantly lower than that in the single cerebral infarction group(P0.05). MMP-9 began to be be increased 1 h after the reperfusion in the single cerebral infarction group and diabetic cerebral infarction group, reached to the peak on 1 d and then decreased gradually. The expression of MMP-9 in the diabetic cerebral infarction group at each time point after the reperfusion was significantly higher than that in the single cerebral infarction group(P0.05). Conclusions: The high glucose environment in which the diabetic cerebral infarction is occurred is to induce the formation of MMP-9 at first and then activate and increase the expression of angiostatin. Afterwards, the expression of VEGF is inhibited, resulting in the poor angiogenesis after cerebral infarction, which thus makes the injury of brain tissue after cerebral infarction even worse than the non-diabetes mellitus.