Anticardiolipin response and its association with infections in young and middle-aged patients with cerebral infarction

ABSTRACT- Antibodies binding to solid-phase cardiolipin (anticardiolipin antibodies, ACA), which are closely associated with lupus anticoagulant activity, have been found in patients with thrombosis. ACA are often seen also in patients after acute infections. To study further our recent observation on the association between infection and cerebral infarction in young and middle-aged patients we measured anticardiolipin response (IgG, IgM, IgA) in paired sera from 54 consecutive patients with cerebral infarction under 50 years of age and in 54 community controls matched for sex and age. An elevated IgG-class ACA level or a significant change in level as observed in 2 serial samples occurred in 15 (28%) patients, but in only 4 (7%) controls ( P < 0.02). These ACA levels were only slightly elevated, and there were no patients with levels approaching values commonly seen in lupus anticoagulant-positive patients. Neither were there any patients with systemic lupus erythematosus (SLE) as an underlying disease. The combination of IgG-class ACA positivity and preceding probable bacterial infection (based on clinical, cultural or serologic data) was found in 10 patients (18%) but in only 2 controls (4%) ( P < 0.05). There were no significant differences in IgM- or IgA-class ACA between the patients and their controls. These results suggest that IgG-class ACA response associated with preceding probable bacterial infection is more common in patients with cerebral infarction than in their community controls. However, slightly elevated ACA are probably only indirect indicators of preceding infection and not directly involved in the pathogenesis of thrombosis itself.     

The arterial lesions underlying cerebral infarction

The arterial lesions underlying cerebral infarction were reviewed by studying the pathological materials in the National Cardiovascular Center. The major clinical cate-gories of arterial lesion (i.e. atherothrombotic, cardio-embolic and lacunar strokes) were reviewed. Arterial lesions underlying striatocapsular infarction were reviewed separately. In order to analyze the mechanisms of the development of cerebral infarction, full postmortem ex-amination of patients dying shortly after the onset of stroke is necessary. Therefore, arterial lesions observed in acute stroke patients were the topic of this review. Two mech-anisms are responsible for atherothrombotic stroke: re-duced perfusion due to obstructive changes in the arteries and embolism. Cardioembolic stroke includes a special clinicopathological entity, cerebral infarction associated with non-bacterial thrombotic endocarditis. The mechan-isms of development of lacunar stroke are not studied sufficiently because the analysis of arterial lesions respons-ible for lacunes requires meticulous effort to examine serial sections of specially prepared specimens. Embolism of the middle cerebral artery (MCA) and abnormalities of the internal carotid artery (ICA) and MCA are responsible for striatocapsular infarction. The author emphasizes the need for postmortem examination of stroke patients, especially those dying shortly after the onset of stroke.     

Epidemiology of stroke in Lund-Orup, Sweden, 1983–85

The incidence of stroke in the hospital district of Lund-Orup (total population 200,191), the local uptake area of the University Hospital, Lund, was studied. Between January 1, 1983 and December 31, 1985, there were 1054 cases of first stroke. Age adjusted (to Swedish Dec 1983 population) incidence rates were 221.2 for males, 195.8 for females, and 208.3 for total population (per 100,000 and year). Case-fatality ratio by 30 days was 17.5%. Atherothrombotic infarction was the most common subtype (58.4%), followed in frequency by cardiac embolism (30.6%), intracerebral hemorrhage (8.3%) and subarachnoid hemorrhage (2.7%). The most important change in the distribution of subtypes with age was an increase in the proportion of cardiac embolism from 13% in the youngest to 44% in the oldest age groups. The present study underscores the importance of careful determination of subtypes of stroke in future epidemiological studies.     

Long-term outcome of cerebral infarction in young adults

OBJECTIVES: We analysed the long-term outcome of 232 young adults aged 15-49 years with first-ever cerebral infarction in 1988-1997 in western Norway. MATERIAL AND METHODS: Mortality, recurrence, epilepsy, functional state as evaluated by modified Rankin scale (mRS), and employment were analysed at follow-up (mean time 5.7 years). RESULTS: Twenty-three (9.9%) patients had died. Recurrence occurred in 9.9%, and post-stroke seizures developed in 10.5%. Recurrence was associated with diabetes mellitus (P = 0.005). Favourable functional outcome (mRS = 2) was found in 77.9%. The functional outcome was better in posterior than anterior circulation infarctions (P = 0.011). Unfavourable functional outcome (mRS > 2) was associated with diabetes mellitus (P = 0.001) and severity of neurological deficits on admission for the index stroke (P < 0.001). Only 58.3% were employed at follow-up. CONCLUSION: This population-based study shows that, although the majority had favourable functional outcome, cerebral infarction had major long-term impact on young adults as evaluated by mortality, recurrence and employment status.     

抗心磷脂抗体与脑梗死关系的研究

目的探讨抗心磷脂抗体(ACA)与脑梗死(C I)的关系。方法应用酶联免疫吸附(ELISA)法检测137例C I患者发病后第1 d、第1周、第2周、第3周、第4周末时血清ACA阳性率,并与短暂性脑缺血发作(TIA)组、脑出血(ICH)组及正常对照组比较。结果C I组ACA阳性率(64.9%)明显高于TIA组(24.6%)、ICH组(33.6%)、正常对照组(17.6%)(均P<0.01);C I组ACA阳性率随病程进展逐渐下降,第1周末与第2周、第3周、第4周末比较差异均有显著性(P<0.05~0.01);C I组中≤50岁患者ACA阳性率明显高于>50岁患者(P<0.01),ACA阳性者3年内再发C I明显高于阴性者(P<0.01)。结论C I患者急性期ACA阳性率高,尤其是≤50岁的患者;随病程演变CAC阳性率逐渐降低,ACA阳性者3年内复发率高。     

青年隐源性脑梗死的临床特点

目的 对临床诊断为隐源性脑梗死的29例年龄在45岁以下的患者进行临床特点分析.方法 回顾性分析29例青年隐源性脑卒中患者的临床特点,包括性别组成,首发症状,影像学所见,治疗后转归及并发症,并进行为期3 a随访.结果 青年隐源性脑卒中多以单个病灶为主,累及基底节和皮层多见; 1 a复发1例(3.4%),2 a复发3例(1...     

载脂蛋白E基因多态性与中青年动脉粥样硬化性脑梗塞的关系

目的 探讨载脂蛋白Ｅ基因多态性与中青年动脉粥样硬化性脑梗塞的关系。方法 应用聚合酶链反应－限制性长度多态性技术,检测４３例中青年动脉粥样硬化性脑梗塞患者的ａｐｏＥ基因型,并与６０名同龄健康对照组比较。同时检测血脂,脂蛋白及部分载脂蛋白。结果 中青年ＡＣＩ组ａｐｏＥ基因ε３／４的频率为３０．２％,明显高于对照组。     

血清血管生成素1水平与急性脑梗死严重程度的相关性

目的 探讨患者血清血管生成素1(Ang-1)水平与急性脑梗死的严重程度的相关性,为临床早期病情评估提供依据.方法 收集西安市第九医院诊断为急性脑梗死的患者为病例组,同时收集本院同期体检中心的健康体检者为对照组.收集所有研究对象的一般临床资料,并测定血清Ang-1水平.病例组分别根据美国国立卫生研究院脑卒中量表(NIHSS)评分及MRI最大梗死直径分组.比较病例组与对照组一般临床资料的差异.采用Logistic回归分析病例组的发病危险因素.通过ROC曲线评估血清Ang-1水平的诊断价值.采用Spearman相关分析脑梗死严重程度与Ang-1的相关性.结果 病例组患者的吸烟史、高血压病史、糖尿病史及心房纤颤病史的比例高于对照组,而血清Ang-1水平低于对照组,差异有统计学意义(P<0.05).Logistic回归分析显示,糖尿病史及血清Ang-1水平是急性脑梗死的危险因素(P<0.05).ROC曲线分析显示血清Ang-1水平在诊断急性脑梗死患者时的曲线下面积为0.791(95%CI=0.751~0.830).NIHSS评分为轻度、中度及重度组患者的血清Ang-1水平分别为(1.65±0.22)ng/ml,(1.45±0.24)ng/ml和(1.26±0.27)ng/ml,差异有统计学意义(F=47.940,P<0.01).MRI显示大梗死、中梗死及小梗死组患者的血清Ang-1水平分别为(1.38±0.23)ng/ml,(1.49±0.30)ng/ml和(1.71±0.23)ng/ml,差异有统计学意义(F=40.911,P<0.01).Spearman相关性分析显示急性脑梗死患者入院时NIHSS评分及MRI梗死最大直径与血清Ang-1水平均呈负相关(r=-0.498,-0.459;P<0.01).结论 脑梗死患者的血清Ang-1水平下降,并与脑梗死的严重程度密切相关.     

偏头痛与青年人脑梗死的关系

目的 调查偏头痛与青年人脑梗死的关系.方法 青年脑梗死患者40例,正常对照组40例.仔细调查高血压、糖尿病、心脏病、吸烟、饮酒、偏头痛等危险因素在两组中的分布情况,并进行统计学分析.结果 青年人脑梗死组伴高血压、糖尿病、心脏疾病合并房颤、偏头痛、有先兆的偏头痛的比例明显高于正常对照组(P均＜0.05).青年女性脑梗死患者与正常对照组比较,偏头痛、有先兆的偏头痛的比例较高,具有统计学差异(P均＜0.05).青年男性脑梗死患者与正常对照组比较,合并偏头痛、有先兆的偏头痛的比例均无统计学差异(P均＞0.05).多因素条件Logistic回归分析,高血压病史、有先兆的偏头痛与青年女性脑梗死发病关系最为密切,OR值分别为34.997(95％ CI 3.084～397.124)、17.552(95％CI 1.372～224.586).结论 偏头痛,尤其是有先兆的偏头痛是青年女性脑梗死的独立危险因素.     

急性脑梗死及其并发多脏器功能障碍综合征患者血清C反应蛋白水平的变化

目的　探讨急性脑梗死 (ACI)及其并发多脏器功能障碍综合征 (MODS)患者血清C反应蛋白(CRP)水平的变化及与MODS发生率的关系。方法　采用免疫透射比浊法测定 30名健康体检者 (正常对照组 )和 82例ACI患者血清CRP的含量 ,并对腔隙性脑梗死 (LCI)、急性单纯性脑梗死 (PACI)、ACI并发MODS患者的血清CRP水平进行比较。结果　ACI患者血清CRP水平与正常对照组比较显著升高 (P <0 0 1) ,PACI患者血清CRP水平显著高于LCI患者 ,ACI并发MODS患者又显著高于PACI患者 (均P <0 0 5 )。ACI患者MODS的发生率与血清CRP水平呈正相关 (r=0 94 ,P <0 0 5 )。结论　CRP与ACI及其并发MODS明显相关 ,血清CRP水平对判断ACI的预后是一个有效指标。     

急性脑梗死患者血清白细胞介素-18和基质金属蛋白酶-9水平及其临床意义

目的探讨急性脑梗死患者血清白细胞介素-18(IL-18)和基质金属蛋白酶-9(MMP-9)水平的变化及其临床意义。方法 53例急性脑梗死患者,根据脑梗死体积和临床神经功能缺损程度评分分组。采用酶联免疫吸附法(ELISA)检测血清IL-18和MMP-9水平并与正常对照组比较。应用SPSS 13.0版统计软件进行分析。结果急性脑梗死患者血清IL-18和MMP-9水平明显高于正常对照组(P<0.01),大梗死组患者血清IL-18和MMP-9水平高于小梗死组(P<0.05),患者血清IL-18和MMP-9水平与脑梗死体积呈正相关(P<0.05);轻型组、中型组、重型组患者血清IL-18和MMP-9水平依次升高,各组之间差异有统计学意义(P<0.05),患者血清IL-18和MMP-9水平与临床神经功能缺损程度评分呈正相关(P<0.05)。结论急性脑梗死患者血清IL-18和MMP-9水平升高;血清IL–18和MMP-9水平与脑梗死体积及临床神经功能缺损程度相关,检测其水平有助于判断急性脑梗死患者的病情及预后。     

Recurrence after first cerebral infarction in young adults

OBJECTIVE: We have investigated recurrence of stroke in a consecutive series of young adults, aged 16 to 45 years, after a first cerebral infarction. METHODS: From January 1, 1988 to December 31, 1996 we submitted those patients to a diagnostic protocol including angiographic, cardiological, and haematological investigations. The patients were followed at 6 month intervals up to December 31, 1998. RESULTS: We have evaluated and followed-up 135 patients, 71 men and 64 women, who were 3.99% of all the admitted stroke patients. At 12 months after stroke, 83 patients had returned to work, 40 patients were mildly to moderately handicapped, 4 were using a wheel-chair, and 8 had died. Follow-up was 26 to 123 months (mean 68.8). Recurrence of stroke, always of ischaemic nature, was seen in 15 patients (11.1%), 3 to 76 months after the first stroke (mean 27.4), for an annual incidence of 2.26%. Recurrence was significantly associated with Partial Anterior Circulation Syndrome and Haematological subtype of first stroke (respectively, P = 0.0209 and P = 0.0135, chi2 test), but not with age (< or = or > 35 years) or risk factors. Repetition of stroke was never fatal, but it caused heavy disability in 13 patients, 8 of whom had completely or nearly completely recovered after the first event. CONCLUSIONS: Our data suggest that recurrence of stroke is a major clinical problem also for the patients aged less than 45 years and that it might be more frequent with specific clinical syndromes and etiologic subtypes of first stroke.     

Cerebrovascular deaths before and after the appearance of oral contraceptives

The mortality of cerebrovascular diseases in Denmark was analysed for men and women 15-44 years of age, in a 14-year period before and after the appearance of oral contraceptives (OC) in 1966. 1,670 deaths were registered over 28 years, during which the female incidence of cerebrovascular deaths increased by 19% (P less than 0.025), while the male mortality was unchanged. Women showed a percentage increase in deaths from cerebral thromboembolic attacks (CTA) of 33%, men a fall of 14%. The increase of female CTA deaths was most pronounced in the young fertile group, the age group with a high OC use. A relative risk of CTA of 3.3-4.5 for OC users compared with non-users could explain the CTA trend difference between women and men. No other single risk factor responsible for the observed trends could be identified. Both women and men had a significant increase in the mortality of subarachnoidal hemorrhages, and a significant fall in the mortality of intracerebral hemorrhages.     

γ-谷氨酰转移酶与急性脑梗死的关系研究

目的探讨γ-谷氨酰转移酶(γ-GT)与急性脑梗死的关系,为急性脑梗死的防治提供参考。方法本研究采用回顾性分析,纳入急性脑梗死患者131例,对照组随机选取健康体检人群108例。收集基线资料及血液检测指标,对所收集的数据均进行统计分析。结果急性脑梗死组患者性别、吸烟、饮酒、高血压、糖尿病、冠心病、γ-GT水平高于对照组,差异均有统计学意义(P 0. 05)。吸烟(OR=3. 286,P=0. 001)、高血压(OR=6. 072,P=0. 000)、糖尿病(OR=2. 046,P=0. 043)和γ-GT (OR=1. 027,P=0. 002)为急性脑梗死的危险因素。γ-GT水平的曲线下面积AUC为0. 686(95%CI 0. 617～0. 754,P 0. 05)。结论血清γ-GT是急性脑梗死的危险因素,γ-GT水平对急性脑梗死的发生具有一定预测作用。     

大脑中脑动脉供血区急性脑梗死病灶类型与进展性脑梗死的关系

目的 探讨大脑中动脉供血区急性脑梗死病灶类型及其与进展性脑梗死的关系.方法 回顾性分析140例大脑中动脉供血区急性脑梗死患者病历资料及脑MRI、DWI、MRA影像资料,其中进展组71例,非进展组69例.结果 2组脑梗死类型均可见流域性脑梗死、分水岭脑梗死、纹状体内囊梗死、腔隙性梗死,进展组以分水岭脑梗死(45.1%)、纹状体内囊梗死(46.5%)为主,非进展组以流域性脑梗死(44.9%)为主,2组脑梗死病灶类型比较,差异有统计学意义(χ2=24.829,P<0.01).结论 大脑中动脉供血区急性分水岭脑梗死、纹状体内囊梗死易表现为进展性脑梗死.     

血清超敏C反应蛋白与急性脑梗死的相关性研究

目的探讨血清超敏C反应蛋白(hsCRP)水平与急性脑梗死病情严重程度及危险因素的关系。方法采用全自动生化分析仪测定186例动脉粥样硬化性血栓性脑梗死(ACI)及155例腔隙性脑梗死(LI)患者的血清hsCRP、血糖、血脂等指标,并与329名健康者进行对照。同时对急性脑梗死患者血清hsCRP水平与病情进行相关分析。结果ACI组和LI组的hsCRP水平显著高于正常对照组(均P<0.05);hsCRP水平与急性脑梗死患者神经功能缺损程度相关(P<0.05);hsCRP水平与ACI组年龄、舒张压、血糖、三酰甘油水平呈正相关(r=0.261、0.222、0.261、0.166,均P<0.05),与LI组患者的年龄、收缩压、血糖、总胆固醇水平呈正相关(r=0.294、0.456、0.245、0.402,均P<0.05),与高密度脂蛋白水平负相关(r=-0.371,P<0.05)。结论hsCRP水平与急性脑梗死的病情严重程度明显相关;并与其危险因素相关。     

Changes in serum interleukin-33 levels in patients with acute cerebral infarction

Inflammation is widely considered to be involved in the pathogenesis of cerebral ischemic injury. The balance between inflammatory and anti-inflammatory factors significantly affects the prognosis of patients with cerebral infarction. Interleukin-33 (IL-33), a newly identified member of the interkeukin-1 superfamily, has been found to play very important roles in the inflammation of several human diseases including asthma, inflammatory bowel disease, and central nervous system inflammation. To our knowledge its role in the pathology of acute cerebral infarction has not yet been reported. In this study, we demonstrated that serum IL-33 levels were significantly increased in patients with acute cerebral infarction compared to control patients without acute cerebral infarction. Furthermore, serum IL-33 levels increased with the infarction volume. Our study suggests that IL-33 may be involved in the pathogenesis and/or progression of acute cerebral infarction.     

血清组织蛋白酶S胱抑素C与急性动脉粥样硬化性脑梗死相关性分析

目的探讨急性动脉粥样硬化性脑梗死患者血清组织蛋白酶S(Cathepsin S,Cat S)和胱抑素C(Cystatin C,Cys C)水平的变化及临床意义。方法对336例急性脑梗死患者进行血清Cat S和Cys C检测,并与114例正常健康人作比较。结果急性动脉粥样硬化性脑梗死组患者与正常对照组进行比较,血清Cat S明显增高,而Cys C降低,差异均有统计学意义(P0.05)。结论急性动脉粥样硬化性脑梗死患者血清Cat S与Cys C水平密切相关。     

Review of long-term mortality and vascular morbidity amongst young adults with cerebral infarction

The incidence of cerebral infarction amongst patients <45 years ranges from 3.4 to 11.3 per 100 000. Aetiology of cerebral infarction is more heterogeneous amongst young patients than amongst older patients including frequent dissection of neck vessels. Because of longer expected survival, prognosis is of special importance amongst younger patients. Average annual long-term mortality rate after the first year of cerebral infarction ranges from 0.6% to 1.8% and is about 10 times higher than amongst matched controls. Long-term mortality is associated with cardiac embolism and atherosclerosis, whilst dissection of neck vessels is associated with low long-term mortality. Average annual long-term recurrence rate of cerebral infarction ranges from 0.3% to 1.7% after the first year. Recurrence of cerebral infarction and other vascular events is highly associated with traditional risk factors including smoking, diabetes mellitus and symptomatic atherosclerosis. Dissection of neck vessel is associated with low long-term mortality rate and low recurrence rate of cerebral infarction. Tailoring secondary preventive treatment according to aetiology and risk factors suggests better prognosis.