大动脉炎所致的脑缺血的治疗

目的　探讨由大动脉炎所致的脑缺血的外科治疗.方法　本文报导了我们自1984年6月至1999年9月治疗93例因头臂型大动脉炎(TA)所致脑缺血的临床经验.其中，男性10例,女性83例,升主动脉－腋动脉或锁骨下动脉－颈动脉搭桥47例；锁骨下动脉－颈动脉搭桥7例；经皮腔内球囊成形（PTA）5例；合并支架置放术1例.结果　显效30.3％，有效34.9％，改善21.2％，无效4.6％，死亡9.0％；平均48个月随访疗效分别为：30.6％，38.8％，16.3％，4.1％和2.0％；复发8.2％.结论　当脑供血不足时，于病情相对稳定阶段，应以积极正确的方法予以治疗.如有可能，PTA可作为首选，但术后易复发.据我们的经验，颈部四血管阻塞性病变在造影时多不能显示远端流出道.但升主动脉－颈动脉搭桥在绝大多数情况下是可行的.然而，术后脑组织再灌注损伤至今仍未能完全解决.     

Management of cerebral ischemia due to Takayasu’s arteritis

Objective To explore the management of cerebral ischemia caused by Takayasu’s arteritis. Methods Ninety-three cases treated from June 1984 to September 1999 at the General Post & Telecom Hospital, the Sir Run Run Shaw Hospital, the First Af filiated Hospital of Zhejiang University, the Second Medical College of Beijing University, Beijing An Zhen Hospital, and the Beijing Union Medical College Hosp ital, including 10 men and 83 women, were reviewed.Of the 93 cases, bypasses f rom the ascending aorta to the axillary or subclavian artery and from graft to t he carotid artery were performed in 47 cases.Subclavian to carotid bypass was performed in six cases.Percutaneous transluminal angioplasty (PTA) was used in five cases and stenting in one.Results Marked improvement was achieved in 30.3%, fair in 34.9%, improvement in 21.2 %, unchanged in 4.6%, and death in 9.0% before discharge; 30.6%, 38.8%, 16 .3%, 4.1%, and 2.0% respectively during a mean follow-up of 48 months, and r ecurrence requiring revision in 8.2%.Conclusion Patients with occlusive lesions of all four cervical arteries always have severe cerebral ischemia and their distal runoff is always unvisualised by angiography . However, we found by exploration that the internal carotid artery is patent in all but one patient. Therefore, an ascending aorta to carotid bypass is feasib le in most instances, and this can and should be done when the cerebral perfusio n is jeopardized at a time when the patient is in a stable or relatively stable condition. Unfortunately, the cerebral re-perfusion syndrome is still a serious and not completely solved problem.     

多发性大动脉炎的多层螺旋CT诊断

目的分析总结多发性大动脉炎(TA)的多层螺旋CT检查方法及CT征象,提高TA的CT诊断水平。方法回顾性分析20例TA的多层螺旋CT检查资料,总结CT检查方法及CT表现并结合文献进行分析讨论。结果按照Lupi-Herrea分类法,包括I型5例,Ⅱ型3例,Ⅲ型12例。受累血管48支。CT表现包括:受累血管管壁增厚48支、管腔狭窄46支、闭塞2支,2例并有血管瘤样扩张。结论正确选择多层螺旋CT检查方法,能够为TA的正确诊断提供可靠信息。     

多发性大动脉炎颈动脉受累的彩色多谱勒超声分析(附20例报告)

目的 研究多发性大动脉炎颈动脉受累的彩超特征。方法 回顾性分析20例多发性大动脉炎累及颈动脉的彩超表现，测量内膜-中层厚度，观察病变分布和血流情况。结果 20例多发性大动脉炎32支颈总动脉受累，表现为内膜-中层弥漫性或节段性环行增厚，15支颈总动脉狭窄，6支闭塞，3支扩张；9支颈外动脉可见反向血流，提示颈总动脉严重狭窄或闭塞。结论 多发性大动脉炎颈总动脉受累彩超有特征性改变，彩超对TA的诊断和随访有重要意义。     

短暂性脑缺血发作发展至脑梗死危险因素分析

目的探讨短暂性脑缺血发作（TIA）发展至脑梗死的危险因素。方法对144例TIA患者的临床资料进行分析。结果144例患者中50例（34，7％）发生了脑梗死；其中椎一基底动脉系统TIA20例中11例（55．O％）发生脑梗死；颈内动脉系统TIA118例中37例（31．4％）发生脑梗死；两个系统脑梗死的发生率差异有显著性（P〈0．05），78％的脑梗死发生在TIA后1h内，5例死于脑梗死；TIA发作持续〉30min、24h内〉3次发作以及首次发作后24h或发作〉5次开始治疗的患者发生脑梗死的危险性显著增高（P〈0，05～0，01），发生脑梗死的TIA患者血压、血糖、血胆固醇显著增高（均P〈0，05）。结论患者TIA发作持续久、次数多、未及时治疗，尤其伴有高血压、高血糖、高脂血症者短期内发生脑梗死的危险性较高。     

短暂性脑缺血发作进展为脑梗死危险因素分析

目的:探讨短暂性脑缺血发作(TIA)进展为脑梗死的危险因素。方法:选取129例TIA患者,其中32例在6个月内最终进展为脑梗死(脑梗死组),97例病情未进展(TIA组);对2组临床资料进行对比,并将所得数据进行统计学分析。结果:脑梗死组有高血压史、颈动脉不稳定斑块、糖尿病史、发作持续时间≥30 min和发作次数≥3次,均高于TIA组(P<0.05～P<0.01)。2组患者性别、有无吸烟史和有无冠心病史差异均无统计学意义(P>0.05)。脑梗死组患者年龄大于TIA组(P<0.05)。而2组患者空腹血糖、三酰甘油、胆固醇、低密度脂蛋白和血尿酸水平差异均无统计学意义(P>0.05)。结论:TIA发作持续时间长、发作次数多,尤其有高血压病、糖尿病、高龄、颈动脉不稳定斑块者短期内进展为脑梗死的危险性较高。     

梓醇对大鼠慢性脑缺血白质损伤的保护作用

目的 初步探讨梓醇对慢性脑缺血所致白质损伤的保护作用及机制.方法 成年雄性Wistar大鼠24只,分为4组:假手术组,缺血组,生理盐水组和梓醇组.通过结扎大鼠双侧颈总动脉建立慢性脑缺血模型,同时腹腔注射5 mg/kg 梓醇或生理盐水予以治疗,每天1次,连续10 d.术后30 d处死,然后利用卢卡斯快蓝(luxol fast blue, LFB)染色法和免疫组织化学技术分别观察梓醇对脑白质髓鞘以及髓鞘碱性蛋白(myelin basic protein,MBP)、腺瘤性息肉蛋白(adenomatus polyposis coli,APC(CC-1)和星形胶质纤维酸性蛋白(glial fibrillary acidity protein,GFAP)表达的影响.结果 与假手术组比较,在缺血组和生理盐水组,LFB染色变浅[(37 259.6±6 626.6)、(36 554.4±7 865.7) vs (90 470.5±5 004.6)],MBP表达下降[(24 016.5±3 794.8)、(23 923.6±4 605.1) vs (65 055.4±6 839.9)],CC-1阳性的少突胶质细胞(oligodendrocytes,Ols)减少[(33.0±9.6)、(32.0±9.8) vs (100.0±11.2)],GFAP阳性的星形胶质细胞增多[(52.0±7.4)、(50.0±9.4) vs (14.0±6.6)],均有显著差异(P<0.01);梓醇治疗后能显著地减轻白质损伤,它能使LFB染色加深(86 687.6±6 619.1),MBP表达升高(61 604.5±6 319.9), CC-1阳性细胞数增加(91.0±8.4),GFAP阳性细胞数减少(17.0±7.8),与生理盐水组比较均有显著差异(P<0.01).结论 梓醇可通过抑制星形胶质细胞的增生进而抑制炎症反应来保护慢性脑缺血所致的白质损伤.     

Coronary and peripheral vascular occlusion due to rheumatoid arteritis

A case of severe progressive rheumatoid arteritis leading to bilateral lower limb amputation and death from myocardial infarction is described.     

巨细胞动脉炎与脑卒中

1概述 巨细胞动脉炎(GCA)特征性的临床表现是颈外动脉分支和眼动脉的炎症及闭塞性改变所致.早在1890年由Hutchinso首先描述本病.1932年Horton进一步阐述本病表现.几年后被命名为颞动脉炎.但病变不局限于颞动脉,可以广泛性累及很多动脉.     

Cytological investigation of CSF in leptospiral cerebral arteritis

Summary Cytological investigation of CSF from 32 cases with leptospiral cerebral arteritis (LCA) was done with optical microscope, among which 6 were examined with SEM simultaneously. The results indicated that the cytological alterations in CSF of these patients were mainly due to a complicated reaction, in which lymphoid cell reaction was predominant. Using SEM, several types of cells with special surface architecture were demonstrated, such as bleb-like cells, uropod-like cells, bleb-uropod-like cells and hybrid-type monocytes. A special type of cells not reported previously was discovered and called crown-like cells by the authors. It is suggested that proliferation of immune competent cells exists in CSF. On the other hand, inflammatory cell reactions were also prominent in CSF, coincidently occurring with increase of immunoglobulin level in CSF in more than half of the patients. Considering the cytological and immunological changes in CSF and the features of the pathological lesion of the arteries involved together,we suggest that the pathogenesis of LCA is correlated with allergy and/or inflammation in CSF after leptospiral infection.     

Treatment of cerebral aneurysms associated with Takayasu arteritis

Takayasu arteritis (TA) is a chronic inflammatory disease of the large elastic arteries that primarilyaffects the aorta and its major branches,resulting in luminal stenosis and aneurysmal changes in the large vessels.1 Cerebral aneurysms and accompanying subarachnoid hemorrhage (SAH) are rare;no case from China has been reported.We herein report two cases of TA with cerebral aneurysms that were successfully treated with coil embolization.     

Treatment of cerebral aneurysms associated with Takayasu arteritis

Takayasu arteritis (TA) is a chronic inflammatory disease of the large elastic arteries that primarily affects the aorta and its major branches, resulting in luminal stenosis and aneurysmal changes in the large vessels [1,2]. Cerebral aneurysms and accompanying subarachnoid hemorrhage (SAH) are rare; no cases from China have been reported. We herein report two cases of TA with cerebral aneurysms that were successfully treated with coil embolization. Hemodynamic stress plays an important role in the formation of the cerebral aneurysms associated with TA. Patients with both TA and hypertension should maintain their blood pressure at a proper level and regularly undergo cerebral artery angiography or computed tomographic angiography (CTA) to screen for cerebral aneurysms.     

MicroRNA and cerebral ischemia

MicroRNAs (miRNAs) are a class of highly conserved single-stranded RNA molecules that modulate gene translation. By targeting the mRNA of protein- coding genes, miRNAs play a critical role in neuronal differentiation, cell proliferation, apoptosis and metabolism. There are a lot of miRNAs in central nervous system, which are not only closely linked to development, differentiation and function of nerve cells, also play an important role in nerve lesions and dysfunction after cerebral ischemia. Specific miRNA through their own changes affect their target gene expression levels after focal cerebral ischemia, involving in the protection against apoptosis in neurons and regeneration after cerebral ischemia. A full understanding of the specific microRNA function and its underlying mechanism in the brain can provide a new strategy for the prevention, diagnosis, and treatment of ischemic cerebral injury at gene level.     

Transient cerebral ischemia.

Stroke is a major cause of disability and death in North America. About 30% to 40% of patients with stroke have had transient ischemic attacks (TIAs). The recognition and treatment of TIAs and possibly of asymptomatic stenoses of the carotid arteries may be beneficial in preventing stroke. We review the epidemiologic features, natural history, pathogenetic features, clinical presentation, methods of investigation and management of patients with TIAs.     

TCD在钩端螺旋体性脑动脉炎中的应用

目的：探讨钩端螺旋体脑动脉炎患者血液动力学改变。方法：分析６３例钩端螺旋体性脑动脉炎患者ＴＣＤ资料。结果：血管狭窄２３例（３６．５％）,血流速度增高２０例（３１．７％）,血管阻力增高１４例（２２．２％）,结论：钩端螺旋体性脑动脉炎ＴＣＤ特征是血管狭窄,阻力增高,血流速度增高或减低。     

建立大鼠全脑缺血模型制作的方法改进

目的改进全脑大鼠缺血再灌注模型的制作方法。方法48只成年的SD大鼠,四血管闭塞法制作全脑缺血再灌注模型,术中氨基甲酸乙酯麻醉,1ml的0．5mm无茵注射器针头阻断双侧椎动脉,无创动脉夹夹闭双侧颈总动脉,以苏木精一伊红（H．E）和TUNEL原位标记法检测海马回CA1区存活锥体细胞数。结果全脑缺血模型的成功率为80％,在缺血再灌注组从再灌注后3小时开始明显减少,随时间的延长,锥体细胞数越来越少,到48小时后降到观察时间点的最低数值,与假手术组比较,每一个时间点都有显著性差异（均P〈0．01）。结论改进后的四动脉阻断法,成功率高,继发性损伤脑干小,并发症少,无需特殊仪器,方法简便,可靠。     

多发性大动脉炎合并脑梗死研究进展

在中国脑梗死已成为第一大致死性疾病,具有高发病率、高死亡率、高致残率、高复发率等特点。近年来脑梗死的致病因素已成为研究热点,如高血压、高血脂等危险因素已被广泛接受并在一定程度上得到控制,然而15~45岁的青年脑梗死发病率仍逐年增加,对年轻患者身体、精神以及家庭造成致命打击,这迫切要求我们更深入地探讨脑梗死的发病机制。据报道约10%~20%大动脉炎患者可并发脑缺血发作,以引起多发性脑梗死以及中青年脑梗死为特点,是引起长期病态和过早死亡的主要因素。研究发现,大动脉炎合并脑梗死的早期诊断可有效降低青年脑梗死死亡率同时提高患者生活质量,相较于普通脑梗死患者治疗手段,多发性大动脉炎脑梗死更应该慎重选择精准治疗方案。本文参考近年来国内外大动脉炎并发脑梗死的研究进展,就该疾病的病理、诊断以及治疗进行深入探讨,以期为临床治疗提供依据。     

Leptospiral cerebral arteritis: Report of 4 autopsy cases

Summary This paper presents the autoptical findings of 4 cases of leptospiral cerebral arteritis involving predominantly large arteries at the base of the brain, especially the middle and anterior cerebral arteries. The main pathological change of this basal cerebral polyarteritis is a proliferative endarteritis which may be classified into three types: acute, chronic and oblitero-sclerous. Specific serological tests for leptospirosis were positive in two cases and in one of these two patients spirochetes were found while in the other, immuno-fluorescence positive substance was demonstrated in the involved cerebral arteries. These findings, together with the clinico-epidemiological data, strongly suggest that the cerebral arteritis in our cases should be the result from leptospirochetic infection.