缺血性脑卒中中医研究进展

脑卒中(stroke)可分为缺血性脑卒中和出血性脑卒中,具有发病率、致残率、死亡率和复发率高等特点,严重威胁人类健康.而缺血性脑卒中是指各种原因引起的脑部血液供应障碍,使局部脑组织发生不可逆性损害,导致脑组织缺血、缺氧性坏死,出现一系列的急性临床症状,包括脑血栓形成和脑栓塞,本病占所有脑卒中的80%.目前有效的干预措施较少,故缺血性脑卒中的防治研究是我国脑卒中研究领域的重中之重.祖国的传统医学称脑卒中为中风,而中医药防治中风具有悠久的历史,积累了丰富的临床经验.现将缺血性卒中中医药研究概况做一概述.     

缺血性脑卒中病因研究进展

缺血性脑卒中属于祖国医学的"中风"范畴,起病急骤,证见多端,变化迅速与风善行数变的特征相似,又称脑梗死。临床表现以猝然昏仆、不省人事或突然发生口眼歪斜、半身不遂、舌强语蹇、智力障碍为主要特征。缺血性脑卒中是严重危害人类健康及生命的常见病、多发病。因此深入的探讨缺血性脑卒中的发病机理,寻求其病因,提前预防,减少该病的发生,对于防治缺血性脑卒中有着重要     

血尿酸水平与缺血性脑卒中的相关性分析

目的探讨血尿酸水平与缺血性脑卒中(CIS)的相关性。方法采用回顾性队列研究方法,选择在我院就医的83例首发CIS患者(CIS组)和85例健康志愿者(对照组)作为观察对象,收集观察对象一般资料以及入院24 h内的血尿酸(UA)和三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及血糖(Glu)等检测结果,并对结果进行统计分析。结果 CIS组患者合并高血压、糖尿病以及吸烟者比例明显高于对照组,血TC、LDL-C水平均明显高于对照组;CIS组患者血UA水平(362.9±59.3)μmol/L明显高于对照组(307.5±56.6)μmol/L。Logistic回归分析的结果显示,血UA和糖尿病、高血压及LDL-C水平是CIS发生的独立危险因素。结论血UA水平与CIS呈明显正相关,是导致CIS的独立危险因素。     

非对称性二甲基精氨酸水平与缺血性脑卒中的相关性

目的 探讨非对称性二甲基精氨酸(asymmetricaldimethylarginine,ADMA)对缺血性脑卒中诊断及病情判断的临床价值.方法 选取88例缺血性脑卒中患者,采用欧洲卒中量表(ESS)进行神经功能缺损评分分为轻度卒中组(31例)、中度卒中组(39例)和重度卒中组(18例).另选30名年龄、性别构成比与患者组差异无统计学意义的健康志愿者为对照组,分别用高效液相色谱联合质谱法测定血浆中ADMA的水平,分析血浆ADMA水平在对照组和缺血性脑卒中各亚组之间的相关性.结果 对照组、轻度卒中组、中度卒中组和重度卒中组的血浆ADMA水平(±s,μmol/L)分别为:1.0±0.10,2.90±0.30,4.82±0.21及6.61±0.23.与对照组血浆ADMA水平比较,患者组各亚组ADMA水平明显升高,其差异有统计学意义(P<0.05);轻度卒中组与中度和重度卒中组的差异有统计学意义(P<0.05);重度组与中度卒中组的差异有统计学意义(P<0.05),与轻度卒中组的差异有统计学显著性意义(P<0.001).结论 血浆ADMA水平与缺血性脑卒中的发病及病变严重程度相关,检测血浆ADMA水平的变化,对缺血性脑卒中的诊断和病情判断、指导治疗有一定的帮助.     

半乳糖凝集素3与急性缺血性脑卒中的相关性研究

目的 探讨半乳糖凝集素3 （galectin-3,gal-3）与急性缺血性脑卒中的关系及临床意义.方法 收集急性缺血性脑卒中患者165例为患者组,同期健康体检中心无脑卒中病史的健康体检者100例为对照组,采用酶联免疫吸附法（ELISA）检测gal-3,行头颅核磁共振检查计算脑梗死体积大小,按美国国立卫生研究所中风量表（NIHSS评分）进行神经功能缺损程度评估.结果 对照组血清gal-3水平为5.18±1.56 μg/L,患者组为14.57±3.35 μg/L,差异有统计学意义（t=23.517,P＜0.01）;不同梗死体积gal-3水平随脑梗死体积增加而呈递增趋势差异有统计学意义（F=130.86,P＜0.01）.Spearman相关分析显示脑梗死体积与血清gal-3水平正相关（r3=0.927,P＜0.01）;不同神经缺损程度gal-3水平随神经缺损程度增加而呈递增趋势,差异有统计学意义（F=126.53,P＜0.01）.Spearman相关分析显示神经缺损程度与血清gal-3水平正相关（r3=0.872,P＜0.01）.结论 急性缺血性脑卒中患者gal-3水平显著升高,其升高程度与脑梗死体积相关,与神经功能缺损程度相关.     

睡眠时间与缺血性脑卒中发生风险的相关性研究

目的:研究缺血性脑卒中发生风险与睡眠时间的相关性.方法:选取2019年6月至2020年6月雷州市人民医院收治的缺血性脑卒中患者58例作为观察组,并选取同期门诊健康查体者58例作为对照组.观察分析2组的睡眠时间和缺血性脑卒中发生风险与睡眠时间的相关性.结果:经Logistic回归分析,影响缺血性脑卒中的因素包括年龄、性别...     

胰岛素抵抗与缺血性脑卒中的相关性

缺血性脑卒中作为临床常见病、多发病已受到广泛重视。近年来,胰岛素抵抗作为脑梗死的独立危险因素,国内外许多学者对胰岛素抵抗与脑梗死的关系进行了探讨。本文就缺血性脑卒中与IR相关性加以概述。     

颅多普勒在急性缺血性脑卒中的应用

早期溶栓无疑是缺血性脑卒中治疗的重大进展之一，但严格的适应证限制了其应用，实际上绝大部分缺血性卒中患者并不适合溶栓治疗，对于这些患者如何选择有针对性的治疗方案，仍是一个未解问题。我们对这类急性缺血性卒中患者进行早期颅多普勒（TCD）检查，通过血流方向、速度、搏动指数（PI）等脑部动脉血流动力学参数推断患者的病理基础和发病机制，进行早期病理分型和个体化治疗，防止脑卒中进展。     

缺血性脑卒中与阻塞性睡眠呼吸暂停综合征的临床相关性研究

目的研究缺血性脑卒中与阻塞性睡眠呼吸暂停综合征(OSAS)的临床相关性。方法选取我院神经内科收治的缺血性脑卒中患者70例,分为伴发OSAS患者组(A组)31例和非OSAS的患者组(B组)39例。比较两组患者超敏C反应蛋白(hs-CRP)、同型半胱氨酸(HCY)、纤维蛋白原(Fg)水平、颈动脉内-中膜厚度(IMT)及斑块发生率。结果A组hs-CRP、HCY、Fg水平、颈动脉IMT及斑块发生率明显高于B组(P<0.05)。结论 OSAS是导致缺血性脑卒中的独立危险因素,炎症反应、高HCY血症、凝血异常等改变及其所致的动脉粥样硬化可能是OSAS导致缺血性脑卒中的机制。     

血清Klotho蛋白水平与缺血性脑卒中致血管性痴呆的相关性

目的 探讨血清Klotho蛋白水平与缺血性脑卒中致血管性痴呆(VD)的相关性.方法 选取2017年2月至2018年1月我院收治的126例缺血性脑卒中患者作为研究对象.所有患者在发病后3个月复诊,分为血管性痴呆(痴呆组)和非痴呆组,痴呆组60例,男性36例,女性24例,非痴呆组66例,男性38例,女性28例.观察两组患者...     

Genetic variation in fibrinogen; its relationship to fibrinogen levels and the risk of myocardial infarction and ischemic stroke

Summary.  Background: Confounding by common causes and reverse causation have been proposed as explanations for the association between high fibrinogen levels and cardiovascular disease. Genetic variants can alter fibrinogen characteristics and are not subject to these problems. Objectives: To determine the fibrinogen plasma levels for genotypic variants in fibrinogen-Aα (FGA Thr312Ala) and fibrinogen-Bβ (FGB − 455G/A), and whether these variants are associated with arterial thrombosis. Methods: Fibrinogen genotypes were determined in a population-based case–control study including women aged 18–50 years; 218 cases with myocardial infarction, 192 cases with ischemic stroke, and 769 healthy controls. Fibrinogen levels were determined in the control population. Results: The FGB − 455G/A variant increased plasma fibrinogen levels, whereas the FGA Thr312Ala variant lowered plasma fibrinogen levels, albeit to a modest extent. The risk of ischemic stroke was altered when the homozygote minor allele was compared with the homozygote major allele. The FGA Thr312Ala single-nucleotide polymorphism (SNP) was associated with a decrease in risk [odds ratio (OR) 0.43; 95% confidence interval (CI) 0.21–0.87], whereas the FGB − 455G/A SNP might have increased the risk (OR 1.76; 95% CI  0.7–4.03). The risk of myocardial infarction was not altered for either SNP (FGA Thr312Ala, OR 0.98, 95% CI  0.40–2.40; FGB − 455G/A, OR 0.98, 95% CI  0.40–2.40). Conclusions: With the genetic variations as markers of plasma fibrinogen levels alterations, thereby ruling out confounding and reverse causation, our results suggest that plasma fibrinogen levels could play a more pronounced role as risk factors for ischemic stroke than for myocardial infarction.     

Overexpression of sirtuin 2 and its association with prognosis in acute ischemic stroke patients

BackgroundThis study aimed to investigate the correlation of sirtuin 2 (SIRT2) with acute ischemic stroke (AIS) risk, severity, inflammation, and prognosis.MethodsA hundred and sixty‐four first episode AIS patients and 164 age and gender matched non‐AIS patients with high‐stroke‐risk factors (controls) were enrolled. Peripheral blood was collected and serum was separated for SIRT2 and pro‐inflammatory cytokines detection by enzyme‐linked immunosorbent assay. AIS patients were continually followed up to 36 months or death, then recurrence‐free survival (RFS) and overall survival (OS) were calculated.ResultsSerum SIRT2 expression was increased in AIS patients compared to controls (p < 0.001), then receiver operative characteristic curve disclosed that the serum SIRT2 expression could differentiate AIS patients from controls with a good area under curve of 0.890 (95%CI: 0.854–0.926), a sensitivity of 78.7% and a specificity of 91.5% at the best cut‐off point. Serum SIRT2 expression was positively correlated with National Institute of Health stroke scale score (p < 0.001), serum tumor necrosis factor‐α (p < 0.001), interleukin (IL)‐6 (p = 0.012) and IL‐17 (p < 0.001) expressions in AIS patients. In addition, serum SIRT2 expression was elevated in recurrent/dead AIS patients compared to non‐recurrent/dead AIS patients (p = 0.025), and was also increased in dead AIS patients compared to survivors (p = 0.006). Moreover, RFS (p = 0.029) and OS (p = 0.049) were both worse in AIS patients with SIRT2 high expression compared to AIS patients with SIRT2 low expression.ConclusionSIRT2 may serve as a marker for AIS risk and prognosis in clinical practice.     

Fibrinogen gene variation and ischemic stroke

Summary.  Background : Plasma fibrinogen level and fibrin clot structure are heritable traits that may be of importance in the pathogenesis of ischemic stroke. Objectives : To investigate associations between variation in the fibrinogen gamma (FGG), alpha (FGA) and beta (FGB) genes, fibrinogen level, and ischemic stroke. Methods : The Sahlgrenska Academy Study on Ischemic Stroke comprises 600 cases and 600 matched population controls. Stroke subtypes were defined according to TOAST criteria. Plasma fibrinogen level was measured by an automated clot-rate assay. Eight tagging single nucleotide polymorphisms (SNPs) were selected to capture genetic variation in the FGA, FGG, and FGB genes. Results:  Plasma fibrinogen was independently associated with overall ischemic stroke and all subtypes, both in the acute stage ( P  < 0.001) and at three-month follow-up ( P  < 0.05). SNPs belonged to two haplotype blocks, one containing the FGB gene and the other the FGG and FGA genes. FGB haplotypes were associated with fibrinogen level ( P  < 0.01), but not with ischemic stroke. In contrast, FGG/FGA haplotypes showed independent association to ischemic stroke but not to fibrinogen level. In an additive model with the most common FGG/FGA haplotype (A1) as reference, the adjusted odds ratios of ischemic stroke were 1.4 [95% confidence interval (95% CI) 1.1–1.8], P  < 0.01, 1.4 (95% CI 1.0–1.8), P  < 0.05, and 1.5 (95% CI 1.0–2.1), P  < 0.05 for the A2, A3, and A4 FGG/FGA haplotypes, respectively. Conclusion:  FGG/FGA haplotypes show association to ischemic stroke. This association is independent of fibrinogen level, thus suggesting that the association between ischemic stroke and variation at the FGG/FGA genes is mediated by qualitative rather than quantitative effects on fibrin(ogen).     

SARS-CoV-2 infection and its association with thrombosis and ischemic stroke: a review

This review of current literature provides background to the COVID-19 pandemic, as well as an examination of potential pathophysiologic mechanisms behind development of thrombosis and ischemic stroke related to COVID-19. SARS-CoV-2 infection is well-documented to cause severe pneumonia, however, thrombosis and thrombotic complications, such as ischemic stroke, have also been documented in a variety of patient demographics. SARS-CoV-2 infection is known to cause a significant inflammatory response, as well as invasion of vascular endothelial cells, resulting in endothelial dysfunction. These factors, coupled with imbalance of ACE2 and RAS axis interactions, have been shown to create a prothrombotic environment, favoring thromboembolic events. Ischemic stroke is a severe complication of COVID-19 and may be a presenting symptom in some patients.     

A comprehensive association analysis between homocysteine metabolic pathway gene methylation and ischemic stroke in a Chinese hypertensive population

BackgroundIschemic stroke (IS) is a serious global health burden. In order to improve our understanding of the risk factors associated with IS, we investigated the combined effect of the methylation of five genes related to the metabolism of homocysteine on developing IS.MethodsQuantitative methylation‐specific PCR was used to measure the levels of promoter methylation in hypertensive and stroke patients. The cutoff value calculated by the maximum Youden index was used to classify the levels of gene methylation as hypomethylation and hypermethylation. Logistic regression was used to explore the relationship between gene methylation and IS.ResultsThe methylation levels of the genes encoding methylenetetrahydrofolate dehydrogenase 1 [MTHFD1], cystathionine β‐synthase [CBS], and dihydrofolate reductase [DHFR] in hypertensive patients were higher than those in stroke patients (all p < 0.01). MTHFD1 hypermethylation, CBS hypermethylation, and DHFR hypermethylation were protective factors for stroke after adjustment for confounding factors. Compared with individuals carrying none of the biomarkers, the ORs [95% CIs] for stroke of those with 1 and 2 elevated biomarkers were 4.068 [1.670–9.913] and 15.345 [6.198–37.994] after adjustment for confounding factors. The participants with a larger number of biomarkers had an increased risk of stroke (p for trend <0.001). For the combination biomarkers, the area under the curve of the receiver operating characteristic was 0.716.ConclusionA significant linear relationship between the number of elevated biomarkers and the risk of stroke has been observed, suggesting that elevations of these biomarkers could be used for potentially predicting the disease.     

Metabolic syndrome and its association with ischemic cerebrovascular disease

Metabolic syndrome (MS) is the term that encompasses metabolic risk factors that may lead to atherosclerotic cardiovascular disease. This study was undertaken to investigate the prevalence of MS in patients with ischemic cerebrovascular disease (CVD), according to National Cholesterol Education Program/Adult Treatment Panel III (ATP III) criteria. A total of 40 patients who were referred to the emergency department and given a diagnosis of CVD were included in this study. Detailed medical histories, physical examination findings, heights, weights, and waist circumferences of patients were recorded. Fasting blood glucose levels and lipid profiles of patients were evaluated. Those with hypertension, diabetes, or hyperlipidemia were regarded as meeting at least 1 of the ATP III criteria. Study results were compared, especially between females and males. In all, 55% of patients were female, and 70% were older than 65 y. Blood pressure over 130/85 mm Hg was assessed in 60% of patients. Among female patients, 81.8% had a waist circumference greater than 88 cm; 50% of male patients had a waist circumference over 102 cm. A fasting blood glucose level above 110 mg/dL was identified in 57.5% of patients. Serum triglyceride levels in 30% of patients were above 150 mg/dL. It was noted that 33.3% of male patients had a high-density lipoprotein (HDL) level below 40 mg/dL, and in 68.2% of female patients, an HDL level below 50 mg/dL was recorded. According to these findings, 14 of 22 female patients (64%) and 13 of 18 male patients (72%) were identified as having MS. High rates of stroke associated with MS reveal the importance of forthcoming preventive approaches.     

Lack of association between genetic variations in the KALRN region and ischemic stroke

Objectives

To investigate whether KALRN gene variation is associated with ischemic stroke (IS).

Design and methods

Associations to overall IS and IS subtypes were investigated in SAHLSIS, which comprises 844 patients with IS and 668 controls.

Results

Associations between KALRN SNPs and overall IS and cardioembolic stroke were detected. Associations for overall IS were investigated in two additional Swedish samples, but could not be replicated.

Conclusion

KALRN gene variation is not associated with overall IS.     

结局指标在缺血性脑卒中病人康复护理路径中的应用研究

[目的]运用护理结局指标构建缺血性脑卒中病人康复护理路径,为护士在临床服务全过程中提供标准化的语言链接和可供度量的尺度,同时培养临床护士发现、思考、解决问题的能力,也为病人在临床就医体验提供规范化、连续性、科学化的护理服务模式。[方法]通过病例回顾性研究和文献研究,由2名研究者独立提取护理记录的相关概念、归类到缺血性脑卒中46项核心护理结局。[结果]最终10项护理结局中有33个结局指标差异具有统计学意义(P<0.01),包括上肢肌力、下肢肌力、爬楼梯的耐受性、以有效的步态行走、慢走、中速行走、走、平衡、协调、步态、表现正常的能力水平、显示完成日常任务的能力、表现出适当的修饰和卫生、括约肌伸缩性、排便时肌肉的伸缩性、排便无须辅助措施、如厕、沐浴、走路、吞咽测试的结果、对食物的容受、吞咽不适、音质变化、正确使用支持器械、采取正确推重物的技巧、表现出肌力良好、充足的液体摄入、排尿模式、意识的尿意、说道感到焦虑、血压升高、说道恐慌感、恐慌感。[结论]以护理结局指标为导向构建的缺血性脑卒中病人康复护理路径,可为病人在临床就医体验提供规范化、连续性、科学化的护理服务模式,提高医护工作的水平。     

MS基因A2756G多态性位点与青年缺血性脑卒中相关性研究

目的 研究人体MS基因A2756G多态性与青年缺血性脑卒中的遗传相关性。方法 采用限制性内切酶片段长度多态性方法（PCR-RFLP），对98例脑卒中病人和116例健康人的MS2756多态性位点进行检测。结果病例组A等位基因纯合子（A／A）、杂合子（A／G）和G等位基因纯合子基因型（G／G）所占比例分别为77．55％，18．37％和4．08％。对照组A／A纯合子、A／G杂合子和G／G纯合子基因型比例分别为79.31％，15．52％和5．17％。两组无显著性差异（X^2=0．41，P〉0．05）。ORAA／GG=1．23；ORA／G=1．02。结论 汉族人群MSA2756G位点多态性与青年缺血性脑卒中无明显相关性。