急性脑梗死患者血清铁蛋白含量变化的临床意义

目的 探讨急性脑梗死患者血清铁蛋白（SF）含量变化的临床意义.方法 选择发病24 h内脑梗死患者72例,入院第1天及第3天分别进行血清铁蛋白测定,并进行神经功能缺损程度评分,同时选择72例健康者作为对照,比较急性脑梗死患者与健康者SF水平变化、不同严重程度脑梗死SF水平变化、进展性脑梗死及非进展性脑梗死不同时期SF水平变化.结果 急性脑梗死组SF水平较健康对照组显著增高（P〈0.001）;重型脑梗死组SF水平较轻、中型脑梗死组显著增高（P〈0.001）;进展性脑梗死组入院第3天SF水平较入院第1天显著增高（P〈0.001）,非进展性脑梗死组入院第3天SF水平较入院第1天比较增高无显著差别（P〉0.05）.结论 检测急性脑梗死患者SF水平对判断病情及评估预后有重要临床价值.     

急性进展性前循环脑梗死患者血清铁蛋白检测的临床意义

目的探讨急性进展性前循环脑梗死患者血清铁蛋白检测的临床意义。方法选择我院神经内科住院治疗的急性前循环脑梗死患者261例,按照病情分为进展组(98例)和非进展组(163例),于入院后的第1、3、7天空腹下采集静脉血应用放射免疫法检测铁蛋白水平,采用重复数据测量方法分析两组铁蛋白水平在不同检测时间的临床意义。结果进展组第1、3、7天铁蛋白分别为191.2±35.0、282.5±32.1、142.0±30.1,明显高于非进展组(94.2±26.7、99.7±48.2、83.2±15.4);与第1天铁蛋白水平比较,第2天明显上升,第7天下降并低于第1天,差异均有统计学意义(P0.05)。线性趋势卡方检验显示,铁蛋白水平呈现上升趋势时,急性进展性前循环脑梗死上升趋势,发生危险度亦不断增高;脑梗死面积越大,则铁蛋白水平越高,差异均有统计学意义(P0.01)。结论血清铁蛋白可作为急性进展性前循环脑梗死的预测指标,随着早期铁蛋白水平升高,发生急性进展性前循环脑梗死的危险性增强。     

脑梗死早期血清铁蛋白水平变化的临床意义

目的探讨脑梗死早期血清铁蛋白水平变化的临床意义。方法根据斯堪的纳维亚卒中量表(SSS)评分将642例急性脑死患者分为进展性脑梗死(PS)组(94例)和非PS(NPS)组(548例),检测两组患者发病24 h内血清铁蛋白水平,并与对照组比较。结果 PS组血清铁蛋白水平[(325.67±98.34)μg/L]显著高于NPS组[(236.19±84.12)μg/L](P<0.01);此两组亦显著高于对照组[(150.99±65.42)μg/L](均P<0.01)。结论脑梗死早期血清铁蛋白水平显著升高的患者可能为PS。     

脑梗死急性期血清铁蛋白和心肌酶谱水平的变化及其临床意义

目的　探讨脑梗死患者急性期血清铁蛋白、心肌酶谱水平的变化及其临床意义。方法　检测30例脑梗死急性期(发病7d内)患者(脑梗死组)的血清铁蛋白、心肌酶谱[天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、α- 羟丁酸脱氢酶(α- HBDH)、肌酸激酶(CK)、心肌型肌酸激酶同工酶(CK MB) ],并与正常对照组比较。结果　脑梗死组血清铁蛋白浓度明显高于正常对照组(P<0. 001),血清AST、LDH、а- HBDH、CK水平均高于正常对照组(P<0. 05~0 .001)。结论　脑梗死患者急性期存在明显的血清铁蛋白及心肌酶谱水平升高,观察其变化有助于对病情的判断。     

血清铁蛋白水平对急性缺血性脑卒中患者出血转化的预测价值

目的探讨血清铁蛋白水平对急性缺血性脑卒中患者发生出血转化(HT)的预测价值。方法 189例急性缺血性脑卒中患者根据CT复查结果分为HT组和非HT(non-HT)组,同时将HT组分为出血性梗死(HI)亚组和脑实质血肿(PH)亚组。采用ELISA法检测患者发病48 h内血清铁蛋白水平,比较各组血清铁蛋白水平,评估其对HT的预测意义。结果 CT结果显示,189例急性缺血性脑卒中患者中发生HT者87例(46%),其中HI 66例、PH 21例。HT组血清铁蛋白水平[(175.49±109.09)ng/m L]明显高于non-HT组[(117.25±78.42)ng/m L](P0.01)。PH亚组血清铁蛋白水平[(245.18±103.63)ng/m L]明显高于HI亚组[(153.31±101.84)ng/m L](P0.01)。多因素Logistic回归分析显示,血清铁蛋白水平升高是急性缺血性脑卒中患者发生HT的独立危险因素(OR=1.004,95%CI:1.000~1.008,P=0.029),同时也是发生PH的独立危险因素(OR=1.006,95%CI:1.001~1.011,P=0.021)。血清铁蛋白水平预测急性缺血性脑卒中患者发生HT和PH的ROC曲线下面积分别为0.687(95%CI:0.611~0.763,P0.001)、0.782(95%CI:0.652~0.913,P0.001),预测值分别为131.5 ng/ml、182.0 ng/ml。结论血清铁蛋白水平升高是急性缺血性脑卒中患者发生HT、PH的独立危险因素。血清铁蛋白水平对急性缺血性脑卒中患者发生HT具有预测价值。     

急性脑梗死患者血清钠的变化

目的探讨急性脑血管疾病脑梗死患者外周血清钠的变化及其与病情轻重之间的关系。方法用美国康仁644电解质自动分析仪检测患者住院后次日清晨空腹血清钠，以血钠〈135mmol／L为低血钠；〉145mmol／L为高血钠；135-145mmol／L为正常。结果240例急性脑梗死患者41例低血钠，23例高血钠，其余176例血钠基本正常。结论急性脑梗死患者有血清钠的变化，低血钠对脑梗死恢复不利。     

血清铁蛋白在急性脑血管病中的作用

脑卒中已成为威胁人类健康的主要疾病之一 ,具有发病率高、死亡率高及致残率高的特点 ,给社会和家庭带来沉重负担。血清铁蛋白与脑血管病的关系国内未见报道 ,我们对铁蛋白在急性脑血管病中的作用和相互关系等方面进行了初步探讨。材料和方法研究对象　对 96例急性脑卒中患者按全国第四届脑血管病学会通过的脑卒中患者神经功能缺损评分标准 (1995 )进行评分 ,并按评分分为两组 ,即分值 >15分组和分值 <15分组。并且以上病例符合第四届全国脑血管病学会修正的诊断标准。全部患者经ＣＴ和ＭＲＩ认定为出血或梗死。其中评分值 <15分组为 2 7例 …     

急性脑梗死患者血清钠的变化

目的探讨急性脑血管疾病脑梗死患者外周血清钠的变化及其与病情轻重之间的关系。方法用美国康仁644电解质自动分析仪检测患者住院后次日清晨空腹血清钠,以血钠<135mmol/L为低血钠;>145mmol/L为高血钠;135～145mmol/L为正常。结果240例急性脑梗死患者41例低血钠,23例高血钠,其余176例血钠基本正常。结论急性脑梗死患者有血清钠的变化,低血钠对脑梗死恢复不利。     

高分辨磁共振对急性脑梗死患者的颅内动脉评估

目的 通过高分辨磁共振对急性脑梗死患者的颅内动脉评估,探索脑梗死的病因。方法 纳入2017年6月-2018年6月西安交通大学第二附属医院神经内科收治的发病1 w,且完成高分辨磁共振等血管检查的急性脑梗死患者52例,收集其年龄、性别、血糖、血脂、血压、吸烟史、同型半胱氨酸资料,根据DWI弥散受限部位,通过头部MRA确定责任血管,对责任血管应用3. 0T高分辨磁共振进行扫描。根据高分辨磁共振扫描结果分为斑块阳性组和斑块阴性组,比较两组临床资料。将斑块阳性组分为前循环组和后循环组,比较两组斑块分布特点,管壁体积百分比,血管重塑指数是否有统计学差异。结果 共纳入52例急性脑梗死患者,其中经高分辨MR发现责任血管斑块阳性组34例,斑块阴性组18例。斑块阴性组中:脑动脉夹层9例(颈内动脉夹层4例,椎动脉夹层4例,基底动脉夹层1例),烟雾病2例,血管炎1例,血管无异常组6例。本研究中经高分辨MR发现的斑块阳性组中头部MRA正常者11例(11/34),头部MRA提示管腔狭窄及闭塞者23例(23/34)。斑块阳性组与斑块阴性组在高血压(P=0. 02)及年龄(P=0. 02)比较有统计学差异。动脉斑块阳性组中前循环组12例(均为大脑中动脉);后循环组22例(基底动脉19例,椎动脉3例),前循环组与后循环组两组间在斑块分布特点(P=0. 68)、管壁体积百分比(P=0. 18)、血管重塑指数(P=0. 41)比较均无统计学差异。结论 联合高分辨磁共振对于急性脑梗死患者颅内动脉的评估有助于脑梗死病因判断。前后循环在斑块的分布、管壁体积百分比、血管重塑指数方面比较无统计学差异。     

急性脑梗死患者血清NSE分析

目的探讨急性脑梗死(ACI)患者血清中神经元特异性烯醇化酶(NSE)水平及其与脑梗死面积大小的关系。方法对210例ACI患者按脑梗死面积大小进行分组,采用双抗体夹心ELISA法进行血清NSE水平测定。结果ACI患者各亚组间血清NSE水平有显著性差异(F值=16.2,P0.05),且与梗死灶体积呈显著正相关(r=0.72,P0.05)。结论ACI患者血清NSE水平可反应ACI患者的脑梗死状态,对判断病情和预后有重要价值。     

前列腺癌相关脑梗死的发病特点

目的 探讨前列腺癌相关脑梗死的发病特点。方法 收集2003年1月-2015年12月在广西医科大学第一附属院住院治疗的前列腺癌合并脑梗死患者的临床表现、实验室及器械检查等资料。结果 本研究共筛查前列腺癌患者2 584例,其中符合前列腺癌合并脑梗死的患者共有34例(1.31%),平均年龄(61.60±6.28)岁。入选的患者中无脑卒中危险因素21例(61.76%)。血液学检查发现D-二聚体水平升高22例(64.71%),总前列腺特异性抗原(Total prostate specific antigen,T-PSA)水平异常升高(>100 ng/mL )19例(55.88%),头颅MRI显示脑内单一梗死灶8例(23.52%),出现累及多个动脉供血区的2个或2个以上梗死灶26例(76.47%),脑梗死发生30 d多数患者预后不良,其中4例(11.77%)死亡。结论 前列腺癌相关脑梗死的患者以缺少常见的脑卒中危险因素、血清D-二聚体水平升高以及T-PSA异常升高、一次发病出现累及多血管分布区的多发性梗死灶以及预后不良等为特点,其发生机制可能与患者血液的凝固性升高有关。     

Status epilepticus in acute ischemic stroke

Stroke is one of the most frequent causes of acute symptomatic status epilepticus. The aim of this study was to investigate the electroclinical features of status epilepticus in acute ischemic stroke.Nine consecutively admitted patients with status epilepticus during ischemic stroke were examined: five of them had convulsive unilateral or generalized status epilepticus for from 24 hours to 9 days after a large hemispheric infarction, always associated with EEG epileptiform abnormalities; the remaining four had focal motor status epilepticus during the first 24 hours after a small cortical or subcortical infarction, and showed no clear EEG changes. Status epilepticus in acute ischemic stroke may have two distinct electroclinical patterns of different prognostic significance.

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Sommario L'infarto cerebrale rappresenta una delle cause più frequenti dello stato di male epilettico sintomatico. Nel nostro studio abbiamo analizzato le caratteristische elettrocliniche dello stato epilettico in pazienti con ictus ischemico cerebrale.Abbiamo studiato nove pazienti con stato epilettico in corso di ictus ischemico. Dei quali, cinque hanno resentato uno stato epilettico convulsivo generalizzato, esordito in un intervallo di tempo compreso tra 24 ore 3 9 giorni dalla comparsa di un vasto infarto cerebrale. Dal punto di vista elettroencefalografico, erano sempre presenti anomalie epilettiformi. Quattro pazienti hanno presentato uno stato di male parziale motorio, esordito 24 ore dopo un infarto corticale o sttocorticale di modeste dimensioni. In questo case le manifestazioni cliniche non erano associate ad evidenti anomalie elettroencefalografiche.Sulla base della nostra osservazione riteniamo che lo stato di male epilettico in corso di ictus ischemico sia caratterizzato da due tipi di pattern elettroclinici con decorso e significato prognostico differenti.

     

Cost of acute ischemic and hemorrhagic stroke in Turkey

Objective

The aim of this study is to examine the direct medical costs and outcomes of patients with stroke.

Material and methods

The records of the patients admitted with ischemic and hemorrhagic stroke to the University of Trakya, School of Medicine, Department of Neurology were reviewed retrospectively in year 2007. Direct medical costs (total costs, radiological, laboratory, medicine, and other) were calculated, additionally cost per life saved and per life-year saved were calculated for stroke patients.

Results

The study group consisted of 328 patients (169 male/159 female) and mean age was 66.5 ± 12.4 years. Length of hospital stay was 10.7 ± 7.5 days. Mortality rate was 20.4% and the mRS score of the patients was 3.2 ± 2.1. The average cost of stroke was US$ 1677 ± 2964 (29.9% medicine, 19.9% laboratory, 12.8% neuroimaging, and 38% beds and staff). Cost per life saved and per life-year saved were US$ 2108 and US$ 1070, respectively.

Conclusion

This is the first study in order to determine direct medical cost of stroke in Turkey, therefore, it may be guideline for disease-cost management of stroke.     

急性缺血性卒中患者血清白蛋白水平对早期预后的影响

目的探讨缺血性卒中患者入院时血清白蛋白水平对脑卒中早期预后,包括神经功能缺损、日常生活能力以及死亡率的影响.同时分析导致低血清白蛋白的危险因素.方法收集发病7 d以内的缺血性脑卒中患者,记录包括各种危险因素在内的病史、体征以及住院过程中死亡等情况.在入院和出院时均采用欧洲卒中评分(European Stroke Scale,ESS)和Barthel生活指数(BarthelIndex,BI)进行临床神经功能和生活自理能力的评定,所有患者均在入院后48h内检查血清白蛋白水平.采用出院时的ESS和BI作为评价患者早期预后的主要指标.结果219例缺血性脑卒中患者入选,29例(13.2%)患者发现血清白蛋白低于35g/L.入院时血清白蛋白低于35g/L的患者ESS明显低于正常白蛋白组(50.93us70.04,P＜0.001),出院时ESS和BI两组之间亦有明显差异(52.66vs 75.48,P＜0.001;42.34 vs 73.78,P＜0.001),出院时两组患者死亡率亦不同(10.3%vs4.2%),但无统计学意义(P=0.159).Logistic回归分析发现年龄、入院距发病时间、吞咽困难和意识障碍是影响患者血清白蛋白水平的独立因素.结论脑卒中患者入院时低血清白蛋白可能导致患者的早期神经功能差,生活能力低,死亡率高,是影响患者早期预后的独立危险因素.引起血清白蛋白降低的主要因素包括年龄、入院距发病时间、吞咽困难和意识障碍.因此,对缺血性脑卒中患者的营养状况应给予相应的关注.     

缺血性脑卒中超早期选择性动脉溶栓治疗

目的评价超早期选择性脑动脉溶栓疗法(SIT)对急性缺血性脑卒中的疗效及安全性.方法32例急性缺血性脑卒中患者起病至溶栓时间介于1～6小时.尿激酶用量87.66±17.63万单位.溶栓前先用微导丝通过血栓到达血栓远端,导丝撤出后,将导管置于靶血管闭塞点或患侧颈内动脉进行溶栓治疗.结果颈内动脉闭塞12例,3例完全再通,2例部分再通.大脑中动脉闭塞20例,19例完全再通.治疗后3个月神经功能恢复率为81%(26/32).4例合并无症状性脑出血均痊愈.血管再闭塞1例(经重复造影证实).结论超早期SIT治疗可使闭塞血管再通.溶栓后并发无症状性脑出血患者临床可恢复正常.SIT是目前治疗急性缺血性脑卒中有效的治疗手段.     

低温治疗急性缺血性卒中的研究进展

脑血管病作为神经系统的常见病及多发病,是目前导致人类死亡的三大主要疾病之一,也是第一大致残性疾病.缺血性卒中是脑血管病最常见的类型,约占脑血管病的70％.在现有的诸多治疗手段中,低温是有效的神经保护措施.自20世纪50年代低温的神经保护作用被发现以来,其已被提出用于外伤性脑损伤、卒中、心脏停搏性脑病、新生儿缺血缺氧性脑病、肝性脑病、脊髓损伤及动脉瘤手术等多个领域.本文根据近年来文献报道,就低温在急性缺血性卒中治疗中的研究进展进行综述,以期为开展低温的临床应用提供依据.     

缺血性脑卒中急性期的抗血小板治疗

血小板粘附、激活和聚集是栓塞性疾病的主要环节,缺血性脑卒中急性期的抗血小板治疗也因此扮演了极为重要的角色。近年来,随着实验室水平的提高以及多项大型临床试验结果的揭盲,人们对抗血小板药物有了更深一步的了解。本文就各种抗血小板药物、相关实验室研究以及临床试验进行综述。     

Thrombolytic therapy in acute ischemic stroke in Asia: The first prospective evaluation

OBJECTIVE: Intravenous thrombolytic therapy has been widely recommended as a standard treatment for acute ischemic stroke in most clinical practice guidelines. However, the experience in Asia is still limited. We report the first prospective case series of thrombolytic therapy in a developing Asian country. PATIENTS AND METHODS: Consecutive patients with acute ischemic stroke who presented within 3 h of onset were screened under stroke fast track program. Those who were eligible were treated with intravenous recombinant tissue plasminogen activator (rt-PA). General and neurological examinations together with the National Institute of Health stroke scale (NHISS) and modified Rankin scale (MRS) were recorded prior to and after the treatment at 1 h, 24 h, on discharge and at 3 months. Hemorrhagic brain lesion and death within 3 months were also recorded. RESULTS: Thirty-four patients or 2.1% of patients with acute stroke received intravenous thrombolysis. The mean pretreatment NIHSS was 18.8 and the majority of patients had stroke in the middle cerebral artery territory. The mean door-to-needle time was 72.6 min (ranged 20-150 min). Major neurological improvement, defined as improving of the NIHSS >8 points or NIHSS of 0 points at 24 h, was observed in 17 patients (50%). Intracerebral hemorrhage was detected in four cases (11.8%), two of them were symptomatic (5.9%) and one was fatal. CONCLUSION: Intravenous thrombolysis can be given in patients with acute stroke in our population. Our cases were more severe than other studies. However, half of them experienced major neurological improvement. The risk of hemorrhagic brain lesion is not much higher than previously reported.     

Role of magnesium sulfate in neuroprotection in acute ischemic stroke

Aims:

To study the effect of intravenous magnesium sulfate infusion on clinical outcome of patients of acute stroke.

Materials and Methods:

Sixty consecutive cases of acute ischemic stroke hospitalised within 24 h of an episode of stroke were taken as subjects. All subjects underwent a computed tomography head, and those found to have evidence of bleed/space-occupying lesions were excluded from the study. The subjects taken up for the study were divided into two groups of 30 subjects each. Both the groups received the standard protocol management for acute ischemic stroke. Subjects of Group 1 additionally received intravenous magnesium sulfate as initial 4 g bolus dose over 15 min followed by 16 g as slow infusion over the next 24 h. In all the subjects of the two study groups, serum magnesium levels were estimated at the time of admission (Day 0), Day 1 and Day 2 of hospitalization using an atomic absorption spectrometer.

Statistical Analysis Used:

Scandinavian stroke scores were calculated on Day 3, day of discharge and Day 28. Paired t-test was employed for comparison of stroke scores on Day 3, day of discharge and Day 28 within the same group and the unpaired t-test was used for the intergroup comparison, i.e. comparison of stroke scores of control group with corresponding stroke scores of magnesium group.

Results:

Comparison of stroke scores on Day 3 and day of discharge, on the day of discharge and Day 28 and on Day 3 and Day 28 in the magnesium group produced a t-value of 5.000 and P <0.001, which was highly significant. However, the comparison of the mean stroke scores between the magnesium and the control groups on Day 3, day of discharge and Day 28 yielded a P-value of >0.05, which was not significant.

Conclusions:

The study failed to document a statistical significant stroke recovery in spite of achieving a significant rise in serum magnesium level, more than that necessary for neuroprotection, with an intravenous magnesium sulfate regime.     

疏血通对急性缺血性脑卒中的临床疗效研究

目的 评价疏血通在急性缺血性脑卒中的临床疗效.方法 选择急性缺血性脑卒中患者196例,按随机数字表法分为治疗组(98例)和对照组(98例),分别在入院时及治疗后2周进行神经功能缺损评分、认知功能障碍评估及临床结局评定,并用经颅多普勒监测治疗前后脑血流量变化.结果 治疗组神经功能及临床结局改善及明显改善率明显高于对照组,而恶化病例明显减少.2组治疗后认知功能障碍评分均较治疗前明显改善,差异有统计学意义(P＜0.05),其中治疗组改善更显著.治疗后2组脑血流量较治疗前明显增加,差异有统计学意义(P＜0.05),其中治疗组改善更显著.结论 疏血通治疗急性缺血性脑卒中疗效显著,值得推广应用.

Abstract：

Objective To evaluate the therapeutic effect of Shuxuetong injection on acute ischemic stroke. Methods One hundred and ninety-six patients with acute ischemic stroke were randomly divided into Shuxuetong injection treatment group (n=98) and control group (n=98). The neurological deficiency scores, scores of cognitive dysfunction and clinical outcomes were evaluated; and the cerebral blood flow were evaluated by Doppler before treatment and 2 weeks after the therapy.Results The improvement of neurological function and clinical outcomes in the Shuxuetong injection treatment group was more obvious as compared with that in the control group and the improvement rate of patients in the treatment group was higher than that in the controls; Patients in the Shuxuetong injection treatment group enjoyed less worsening than the controls. The cognitive dysfunction 2 weeks after the therapy were significantly improved as compared with those before treatment (P＜0.05); and the cerebral blood flow after the treatment was significantly increased as compared with that before the treatment (P＜0.05); these improvements in the Shuxuetong injection treatment group were much obvious as compared with those in the controls. Conclusion Shuxuetong is effective in treating cerebral ischemic patients.