脑梗死颈动脉粥样硬化斑块形成的危险因素分析

目的:研究脑梗死颈动脉粥样硬化斑块形成的危险因素.方法:选取我院2018年2月至2021年6月期间收治的158例脑梗死患者,根据患者颈动脉超声检查示有无斑块形成将患者分为斑块组(92例)和无斑块组(66例).统计所有患者的年龄、体质量指数(Body Mass Index,BMI)、颈动脉内膜中层厚度(intima-media thickness,IMT)等一般资料.多元Logistic回归分析影响脑梗死颈动脉粥样硬化斑块形成的因素.结果:年龄、高血压病史、糖尿病病史、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(High density lipoprotein cholesterol,HDLC)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDLC)、吸烟史,饮酒史,IMT是影响脑梗死颈动脉粥样硬化斑块形成的单因素(P<0.05).年龄、高血压病史、高血糖病史、吸烟史以及IMT是影响脑梗死颈动脉粥样硬化斑块形成的独立危险因素(P<0.05).结论:通过评估颈动脉部超声相关参数,对脑梗死颈动脉粥样硬化斑块的形成有预测价值.     

彩色多普勒超声对颈动脉粥样硬化与脑梗死的相关性分析

目的探讨颈动脉粥样硬化与脑梗死的关系。方法应用彩色多普勒超声检测82例脑梗死患者和46例非脑梗死患者颈动脉内-中膜厚度（intima-media thickness,IMT）、斑块检出率、管腔狭窄率,并观察斑块性质。结果脑梗死组斑块检出率及颈动脉内膜厚度较对照组明显增加,两组比较差异有统计学意义（P〈0.01）,脑梗死组斑块检出率（70.7%）明显高于对照组（32.6%）;脑梗死组颈总动脉（CCA）内膜厚度（1.38±0.14）明显高于对照组（0.89±0.16）,脑梗死组颈内动脉（ICA）内膜厚度（1.16±0.27）明显高于对照组（0.78±0.17）。斑块多发生于颈动脉分叉处（44.4%）,以软斑块、溃疡斑块（59.2%）居多。结论颈动脉粥样硬化程度与脑梗死的发病关系密切,彩超评估颈动脉粥样硬化程度,对脑梗死的早期预防和治疗具有重要的临床价值。     

缺血性脑血管病与颈动脉粥样硬化斑块的超声探查

目的 了解缺血性脑血管病患者颈动脉粥样硬化斑块的发生情况。方法 对85例确诊为缺血性脑血管病患者行颈动脉彩超检查。结果 本组中62例（72．9％）有不同程度的动脉粥样硬化，这些斑块好发于颈动脉分叉处，以多发为主。结论 颈动脉粥样硬化斑块是缺血性脑血管病的主要栓子来源，斑块不稳定性，即斑块脆性是导致脑梗死的根本原因。颈动脉彩超检查及早发现斑块，对缺血性脑血管病的预防、指导治疗、疗效观察、估计预后及二级预防均有实用价值。     

脑梗死患者颈动脉超声与肺炎衣原体感染的相关性

目的 探讨脑梗死患者颈动脉粥样硬化、肺炎衣原体(cpn)感染的相关性.方法 对75例脑梗死患者(病例组)及56例健康体检者(对照组)进行颈动脉超声检测,观察颈动脉粥样硬化斑块的部位、数目、性质和颈动脉内径;并用微量免疫荧光标记法进行肺炎衣原体特异性IgG、IgM抗体检测.结果 病例组颈动脉粥样硬化斑块的发生率(79.3%)、颈总动脉(CCA)内膜-中层厚度(IMT)和CCA内径与对照组比较差异有极显著性(均P<0.01).脑梗死部位与出现斑块的颈动脉存在同侧相关性(P<0.01).病例组与对照组Cpn总感染率有显著差异(P<0.01).结论 脑梗死患者大多有颈动脉粥样硬化,与Cpn感染有关.     

老年人颈动脉粥样硬化与脑梗死的相关性研究

目的应用彩色多普勒超声检测颈动脉粥样硬化,并探讨其与脑梗死及相关危险因素的关系.方法以96例脑梗死组及80例非脑血管病对照组为研究对象,检测颈动脉内膜-中膜厚度(IMT)、颈动脉粥样硬化斑块、颈动脉狭窄程度.结果颈动脉IMT增厚发生率在脑梗死组为70.8%,对照组为40.0%;颈动脉软斑发生率在脑梗死组为42.7%,对照组为18.8%;颈动脉中重度狭窄发生率在脑梗死组为21.9%,对照组为8.8%;脑梗死组颈动脉IMT增厚、软斑、中重度狭窄发生率与对照组相比差异有显著性(p＜0.01;p＜0.01;p＜0.05).Logistic回归分析发现年龄、高血压、糖尿病、总胆固醇、甘油三脂是颈动脉粥样硬化的独立危险因素.结论老年人颈动脉粥样硬化与脑梗死的发病密切相关.     

阿托伐他汀（立普妥）治疗脑梗死患者颈动脉粥样硬化斑块

目的：探讨阿托伐他汀治疗脑梗死患者颈动脉粥样硬化斑块的治疗效果。方法随机抽取2009年~2011年进入我院治疗的患者90例,随机分为干预组和对照组。其中干预组中患者46例,对照组中患者44例。在入院和治疗6个月时对患者进行颈动脉超声检查,评估颈动脉粥样硬化斑块内膜中层的厚度[1](IMT)。结果在6个月后干预组中颈动脉斑块IMT的厚度明显缩小,对照组中厚度明显增加,两组治疗后与治疗前比较,差异有统计学意义(P<0.05)。结论阿托伐他汀具有良好的降脂作用,并且有助于减轻动脉粥样硬化的作用,对治疗脑梗死患者颈动脉粥样硬化斑块具有良好的效果。     

脑梗死病人的颈动脉超声分析

目的 探讨颈部血管病变与脑梗死的相关性。方法 自颈总动脉近心端开始,分别取其短轴和长轴切面,由近而远逐渐向远心端扫查,观察颈总动脉及其分又处、颈内动脉和椎动脉内-中膜厚度和形态、斑块及血流情况。结果 129例脑梗死患者中有110例共329支颈部动脉患有不同程度的硬化,100例共178支动脉有硬化斑块。13例14支动脉为中度至严重狭窄;3例3支颈内动脉为完全闭塞,不能引出血流频谱和血流色彩。结论 颈动脉粥样硬化所形成的颈动脉狭窄和斑块是缺血性脑病的病理基础,颈动脉粥样硬化附壁血栓脱落、斑块的破裂出血可以成为大片脑梗死或腔隙性脑梗死的主要原因。     

急性脑梗死患者颈动脉粥样硬化斑块形成与血清脂蛋白a、MMP-9、D-D水平相关研究

目的 分析急性脑梗死患者颈动脉粥样硬化斑块形成与血清脂蛋白a、MMP-9、D-D水平的相关性.方法 选择2019年1月至2020年12月间收治的150例急性脑梗死患者作为观察组,100例脑梗死但未见颈动脉粥样硬化斑块患者作为对照组;入组后检测患者血糖、血脂、脂蛋白a、MMP-9及D-D水平.结果 观察组血糖、TG、TC、HDL及LDL水平均明显高于对照组,且差异具有统计学意义(P<0.05);观察组脂蛋白a、MMP-9及D-D水平均明显高于对照组,且差异具有统计学意义(P<0.05);脂蛋白a、MMP-9及D-D三指标均呈现明显的两两线性相关关系,且具有统计学意义(P<0.05);脂蛋白a、MMP-9及D-D水平与颈动脉粥样硬化斑块形成呈显著正相关关系,且具有统计学意义(P<0.01);脂蛋白a、MMP-9及D-D水平是影响颈动脉粥样硬化斑块形成的独立性危险因素(P<0.05).结论 急性脑梗死患者颈动脉粥样硬化斑块形成与血清脂蛋白a、MMP-9、D-D水平呈显著性正相关关系.     

老年人颈动脉粥样硬化与脑梗死的相关性研究

目的应用彩色多普勒超声检测颈动脉粥样硬化，并探讨其与脑梗死及相关危险因素的关系．方法以96例脑梗死组及80例非脑血管病对照组为研究对象，检测颈动脉内膜-中膜厚度（IMT）、颈动脉粥样硬化斑块、颈动脉狭窄程度．结果颈动脉IMT增厚发生率在脑梗死组为70．8％，对照组为40．0％；颈动脉软斑发生率在脑梗死组为42．7％，对照组为18．8％；颈动脉中重度狭窄发生率在脑梗死组为21．9％。对照组为8．8％；脑梗死组颈动脉IMT增厚、软斑、中重度狭窄发生率与对照组相比差异有显著性（P〈0．01；P〈0．01；P〈0．05）．Logistic回归分析发现年龄、高血压、糖尿病、总胆固醇、甘油三脂是颈动脉粥样硬化的独立危险因素．结论老年人颈动脉粥样硬化与脑梗死的发病密切相关．     

超声评价老年心血管病患者颈动脉粥样硬化的价值

探讨超声对老年心血管病患者颈动脉粥样硬化的评价价值。方法 在我院2017年7月~2018年6月收治的老年心血管疾病患者中随机抽取76例设为观察组,随机抽取同期于我院行健康体检的76例老年人设为对照组。两组受检者均进行颈部超声检查,比较两组受检者的颈部血管动脉粥样硬化斑块面积、斑块积分以及IMT值,VA、CCA以及ICA部位、血流量及脑血流量。结果 观察组患者的斑块面积、斑块积分以及IMT值均高于对照组（P＜0.05）;VA、CCA以及ICA部位的狭窄程度均较对照组严重（P＜0.05）;VA、CCA以及ICA部位的血流量与脑血流量均比对照组小（P＜0.05）。结论 超声评价老年心血管病患者颈动脉粥样硬化具有无创性、高效性以及操作简易等优点,可以掌握颈动脉粥样硬化疾病的不同状态,有利于老年患者病情发展与预后情况的判断,对临床工作有着重要指导作用。     

高压氧治疗对老年脑梗塞患者神经心理障碍改善作用的评价

探讨高压氧治疗对老年脑梗塞患者神经心理障碍的改善作用。方法 :采用Folstein简易精神状态检查法 (MMSE) ,修订韦氏成人智力量表 (WAIS -RC)和临床记忆量表 ,对一组老年脑梗塞患者用高压氧治疗前后进行测试。结果 :研究表明 :( 1)老年脑梗塞患者神经心理障碍常规药物治疗效果差 ,高压氧治疗可使其智能成绩明显提高 ;( 2 )合并高血压 ( >5年 )、糖尿病、高脂血症、脑萎缩以及脑梗塞发病次数≥ 2次者 ,其神经心理障碍更为显著。结论 :老年脑梗塞患者神经心理障碍较严重 ,合并症愈多尤甚 ;采用高压氧治疗有效 ,可做为改善老年脑梗塞患者神经心理障碍的治疗措施 ,值得在临床工作中推广应用     

Do cognitive complaints in euthymic bipolar patients reflect objective cognitive impairment?

BACKGROUND: In clinical practice, bipolar patients complain of cognitive deficits such as attentional or memory disturbances. The main aim of this study was to determine whether subjective cognitive complaints were associated with objective neuropsychological impairments. METHOD: Sixty euthymic bipolar patients were assessed through a neuropsychological battery. A structured clinical interview was used to determine subjective cognitive complaints in patients. Thirty healthy controls were also included in the study in order to compare the neuropsychological performance among groups. RESULTS: Bipolar patients with a higher number of episodes, especially the number of mixed episodes, longer duration of the illness and the onset of the illness at an earlier age showed more subjective complaints. Furthermore, bipolar patients with subjective complaints showed lower scores in several cognitive measures related to attention, memory and executive function compared with the control group. Nevertheless, patients without complaints also performed less well than controls in some neuropsychological measures. CONCLUSION: Bipolar patients who were aware of cognitive deficits were more chronic, had presented more previous episodes, especially mixed type, and their illness had started at an earlier age compared with patients who did not complain about cognitive problems. Moreover, patients with good cognitive insight also had a poorer social and occupational functioning as well as a poorer neuropsychological performance. However, the bipolar group without complaints also obtained lower scores in several tests compared with healthy controls. Cognitive status of bipolar patients should be routinely assessed, regardless of the patients awareness about their cognitive deficits.     

Stability and course of neuropsychological deficits in manic and depressed bipolar patients compared to patients with Major Depression

BACKGROUND: Neuropsychological functioning varies across different subgroups of patients with affective disorders; yet there have only been a few studies pointing out distinctive neuropsychological profiles and following-up possible changes in this functioning. The aim of this study was to compare neuropsychological functioning across remitted manic or depressed patients with bipolar disorder compared to remitted patients with Major Depression and to explore the course of their cognitive functioning. METHODS: 30 patients with Major Depression, 17 manic bipolar patients, and 22 depressed bipolar patients were assessed for memory, attention, and executive functions using the Auditory Verbal Learning Test (AVLT), the Modified Card Sorting Test (MCST), the Attention Network Test (ANT), and Stop-Signal Task. Neuropsychological assessment was performed at discharge and seven weeks after discharge. RESULTS: The three groups showed different neuropsychological performance at discharge. Regarding selective attention and speed of responding the manic bipolar patients displayed poorer performance than the other two groups. Furthermore, follow-up assessment revealed that although all patient groups demonstrated an overall improvement, some deficits (especially in executive functions) remain. Manic bipolar patients showed again the worst performance. Depressed bipolar patients, however, were not observed to show a poorer outcome than depressed unipolar patients. CONCLUSIONS: This study provides further evidence for distinct neuropsychological functioning in patients with affective disorders depending on their state of illness. Furthermore, it supports the hypothesis that especially manic bipolar patients stay impaired in certain cognitive functions after remission. These findings may be of clinical relevance regarding treatment and prevention programs and emphasize the need of further research investigating stability and course of patients with mood disorders.     

脑梗死患者急性期-康复期认知变化与脑MRI分析

血管性痴呆是医学研究的热点 ,关于血管性痴呆和脑ＣＴ的研究报告并不少见 ,但脑梗死急性期-康复期认知变化与ＭＲＩ的分析尚少报告。由于脑梗死无疑是血管性痴呆的主要原因 ,而且随着人口老龄化 ,伴有弥漫性、混杂性脑病变的急性脑梗死病人增多 ,急性期脑ＭＲＩ发现在认知障碍中的作用 ,以及在康复过程中与认知改变的相关性 ,有待研究探讨。现将我们的观察分析报告如下。1　资料和方法1.1　研究对象1999年 4月至 2 0 0 1年 4月在我院神经内科住院的浦东地区急性脑梗死患者 10 1例 ,男 5 4例 ,女4 7例 ,年龄 5 0～ 83岁 ,平均 6 7.2 7± 8.4…     

老年无症状性脑梗塞的神经心理学研究

目的：确定老年无症状性脑梗塞（SCI）对于记忆、空间构象、逻辑思维、情感等多方面的影响。方法：应用韦氏记忆量表（WMS）、老年抑郁量表（GDS）、视觉保持测验（VRT）,对61名老年SCI患者的神经心理学改变进行了测量。结果：老年SCI组和对照组WMS测试结果记忆商（MQ)明显降低,其错误分明显提高,老年SCI组情绪抑郁人数也明显高于对照组。结论：老年SCI病人记忆能力、视觉空间能力、注意能力均明显下降,尤以短时记忆、视觉记忆为著。     

康复护理干预对老年脑梗塞患者认知及 预后功能的影响

目的 观察康复护理干预对老年脑梗塞患者认知及预后功能的影响。方法 选取2017年1月~2018年1月我院接诊的脑梗塞患者76例,按照患者入院的先后顺序将其分成两组,对比组给予传统护理,试验组给予康复护理干预。结果 试验组日常生活功能评分为（70.76±22.65）分,高于对比组的（43.85±21.68）分,试验组护理满意度为94.74%,高于对比组的78.95%,差异均有统计学意义（P＜0.05）;试验组神经功能缺损评分为（8.77±6.55）分,低于对比组的（15.67±6.84）分,差异有统计学意义（P＜0.05）。结论 老年脑梗塞患者选择康复护理干预辅助治疗,可有效帮助患者提高日常生活能力,使得患者的神经功能得到良好的恢复。     

大面积脑梗死患者早期血清胆碱酯酶活性检测的临床意义

目的通过检测105例大面积脑梗死患者发病后24h内血清胆碱酯酶（CHE）的活性，探讨其与病情严重程度及预后的关系。方法对脑梗死患者和正常对照组进行血清CHE活性的测定。分别应用NIHSS评分（美国国立卫生研究院卒中量表）及mRS评分（改良Rankin评分）对大面积脑梗死患者在入院时及3个月后的神经功能缺损程度进行评分。结果大面积脑梗死组的血清CHE活性为（2568±427）U／L，对照A组（非大面积脑梗死组）为（6320±689）U／L，对照B组（正常对照组）为（6252±314）U／L，大面积脑梗死组与后两组比较差异有统计学意义（P〈0．001）。大面积脑梗死患者发病24h内血清CHE活性与NIHSS评分呈负相关（rs=0．19，P〈0．01），与mRS评分呈负相关（rs=-0．24，P〈0．01）。Logistic回归分析显示，最终进入logistic回归模型的大面积脑梗死预后不良的危险因素包括发病后24h内血清CHE的活性。结论大面积脑梗死患者早期血清CHE活性与病情严重程度及预后密切相关，可作为大面积脑梗死患者预后的参考指标之一。     

评价ABCD2评分+颈动脉硬化程度评分预测短暂性脑缺血发作后早期（7 d）卒中风险价值

目的：探讨采用ABCD2评分联合颈动脉硬化程度评分预测短暂性脑缺血发作后早期(7 d)进展为急性脑梗死的风险,并与ABCD2评分方法进行比较。方法：回顾160例首发症状为颈内动脉系统短暂性脑缺血发作患者,均进行ABCD2评分和颈动脉硬化程度评分,并对联合评分法和两种单独的评分方法进行统计分析,观察7 d内脑梗死的发生率,比较各种方法预测价值。结果：本研究160例短暂性脑缺血发作患者中一周内共有34例发生脑梗死,脑梗死的进展率为21.3%,ABCD2≥4分组7 d内脑梗死的发生率27.3%,明显高于ABCD2~4分组(P<0.05)。颈动脉硬化程度评分为2分组患者7 d内脑梗死的发生率为42%,高于0~1分组(P<0.05)。ABCD2评分联合颈动脉硬化程度评分预测短暂性脑缺血患者7 d内脑梗死发生的敏感度、特异度、准确度、阳性预测值及阴性预测值分别为94.1%、90.5%、91.3%、72.7%、98.3%,均高于两者的单一评分。预测7 d内脑梗死的发生风险时：ABCD2评分联合颈动脉硬化程度评分曲线下面积为0.874,大于ABCD2评分的0.817和颈动脉硬化评分的0.739。结论：ABCD2评分联合颈动脉硬化程度评分对短暂性脑缺血发作后短期进展为脑梗死的预测价值高于ABCD2评分方法,并可能成为一种新的短暂性脑缺血发作患者危险分层工具和预测转归的有效手段。     

The effect of initial serum neuron-specific enolase level on clinical outcome in acute carotid artery territory infarction

The prediction of functional outcome in patients with acute cerebral infarction depends on many factors. Various techniques have been applied to predict severity and outcome after cerebral infarction. Neuron-specific enolase (NSE) is a component of a specific brain enzyme and a useful marker of brain injury. We evaluated the relation between initial serum NSE level and short- and long-term clinical outcome in 59 patients with acute cerebral infarction and in 38 age-matched healthy controls. Serum NSE levels were determined in patients with carotid artery (CA) territory cerebral infarction within 24 hours of onset. Brain MRI was performed four to seven days after stroke. Patients were divided into two groups: large CA territory infarction with a lesion extending cortex (cortex group), and small subcortical CA territory infarction (subcortical group) with a lesion confined to the subcortical white matter. We compared the initial serum NSE levels of the two groups. National Institute of Health Stroke Scale (NIHSS) was determined at admission and seven days after onset and the modified Rankin's scale was used at the 3 months follow-up after onset. Serum NSE levels were significantly elevated in patients with acute cerebral infarction compared with the normal controls (13.88 +/- 5.47 ng/dl vs. 8.15 +/- 1.53 ng/dl, p < 0.05). The initial (< 24 h) serum NSE level was higher in the cortical group than in the subcortical group (16.68 +/- 5.70 ng/dl vs. 10.98 +/- 3.34 ng/dl, p < 0.05). NIHSS on admission and on the 7th day correlated with the initial serum NSE level (p < 0.05), as were more severe functional outcomes, as determined 3 months after onset (p < 0.05). This study shows that initial serum NSE level may be a useful marker for severity in acute ischemic stroke, and that it may be well correlated with short-term and long-term functional outcomes.     

Antihypertensive treatment with cerebral hemodynamics monitoring by ultrasonography in elderly hypertensives without a history of stroke may prevent or slow down cognitive decline. A pending issue

The role of the antihypertensive therapy in preventing cognitive disorders in elderly persons without a history of stroke is still a matter of debate. This article focuses on the pathogenesis of vascular cognitive disorders in hypertension and on the impact of antihypertensive treatment in their prevention. Cerebral white matter lesions, caused by small vessel disease and cerebral hypoperfusion, have been found in the majority of elderly hypertensives. They correlate with cognitive disorders, particularly impairments of attention and executive functions. Excessive blood pressure lowering in elderly patients with long-standing hypertension below a certain critical level, may increase the risk of further cerebral hypoperfusion because of disrupted cerebral blood flow autoregulation. As a result, worsening of the cognitive functions could occur, especially in cases with additional vascular risk factors. Five randomized, placebo-controlled trials have focused on the efficacy of antihypertensive treatments in preventing cognitive impairments in elderly patients without a prior cerebrovascular disease. Four of them have not found positive effects. We suggest that repeated neuropsychological assessments and ultrasonography for evaluation of carotid atherosclerosis, as well as cerebral hemodynamics monitoring could adjust the antihypertensive therapy with the aim to decrease the risk of cerebral hypoperfusion and prevent or slow down cognitive decline in elderly hypertensives. Prospective studies are needed to confirm such a treatment strategy.