急性缺血性脑卒中患者血清脂蛋白(a)水平及临床意义

目的研究急性缺血性脑卒中患者血清脂蛋白(a)水平及其与短期预后的关系。方法检测210 例急性缺血性脑卒中患者以及100 名性别和年龄匹配的健康人血清脂蛋白(a)水平。患者入院后行美国国立卫生研究院卒中量表(NIHSS)评定。出院时行改良Rankin 量表(mRS)评定。结果患者组血清脂蛋白(a)水平显著高于健康人(P<0.001)。调整其他危险因素后,血清脂蛋白(a)水平是mRS 的独立预测因素(P<0.001)。接受者操作特征曲线下面积分析,脂蛋白(a)和NIHSS 联合模型的预测准确度高于NIHSS 评分。结论急性缺血性脑卒中患者血清脂蛋白(a)水平升高。血清脂蛋白(a)水平是急性缺血性脑卒中短期预后的独立预测因素。     

血清25-羟基维生素D水平与急性缺血性脑卒中短期预后的关系

目的:探讨血清25-羟基维生素D[25-hydroxyvitamin D,25(OH)D]水平与急性缺血性脑卒中患者短期预后之间的关系。方法:连续收集2015年5月至11月于中国医科大学附属盛京医院神经内科住院治疗的急性缺血性脑卒中患者200例,收集临床资料,测定血清25(OH)D水平并进行入院美国国立卫生研究院卒中量表(NIH Stroke Scale,NIHSS)评分,发病90 d后随访,行改良Rank量表(Modified R ankin Scale,m R S)评分。根据血清25(OH)D水平、m R S评分分组,比较两组资料。结果:200例患者进入研究队列,90 d后失访13例,失访率为6.5%,94例(47%)患者发生预后不良事件。25(OH)缺乏组165例,年龄、脑血管病史、入院NIHSS评分、90 d m RS评分、胱抑素C水平、D-二聚体水平大于非缺乏组(P0.05);90 d预后不佳组94例,25(OH)D水平低于预后良好组,房颤、脑血管病史、D-二聚体、NIHSS评分高于预后良好组;多因素分析显示血清25(OH)D水平(OR=0.895,95%CI 0.840~0.953,P=0.001)、入院NIHSS评分(OR=1.811,95%CI 1.428~2.296,P0.001)与急性缺血性脑卒中短期预后密切相关。结论:血清25(OH)D水平是急性缺血性脑卒中短期预后的独立预测因子且是保护性因素。     

入院CTRP-9和急性缺血性脑卒中患者住院期间神经功能缺损相关性

目的:探讨入院时补体Cq1/肿瘤坏死因子相关蛋白9(CTRP-9)和急性缺血性脑卒中患者短期功能缺损的相关性。方法:选取2015-03—2015-09期间明确诊断为急性缺血性脑卒中患者120例作为研究对象。采用改良Rankin评分(mRS)评估出院时患者神经功能恢复情况,依据分值分为预后良好组和预后不良组。两组患者均采用采用酶联免疫吸附试验(ELISA)对血清CTRP-9含量进行检测。结果:两组患者基线情况比较,预后良好组年龄、房颤、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(Hs-CRP)均低于预后不良组,差异具有统计学意义(P<0.05),其余指标两组间比较,差异无统计学意义(P>0.05)。两组患者血清CTRP-9水平比较,预后良好组明显高于预后不良组[(236.3±21.9)ng/ml vs(204.2±19.3)ng/ml],差异具有统计学意义(P<0.01)。ROC曲线分析显示,CTRP-9预测急性缺血性脑卒中患者不良预后的曲线下面积是0.724(95%CI:0.650~0.798,P<0.01),CTRP-9预测急性缺血性脑卒中患者不良预后的最佳临床分界点为242.7ng/ml。单因素Logistic回归分析显示,年龄、高血压、2型糖尿病、房颤、总胆固醇(TC)、LDL-C、肌酐、Hs-CRP、美国国立卫生院卒中评估量表(NIHSS)评分和CTRP-9和急性缺血性脑卒中患者不良预后相关。多因素Logistic回归分析显示,高血压、房颤、LDL-C、肌酐、NIHSS评分和CTRP-9是急性缺血性脑卒中患者不良预后的独立危险因素。结论:CTRP-9对急性缺血性脑卒中患者住院期间神经功能缺损具有预测价值。     

血清白蛋白水平与急性缺血性脑卒中短期预后的相关性

目的:探讨入院时患者血清白蛋白水平和急性缺血性脑卒中短期预后之间的关系。方法:初次发病的急性缺血性脑卒中患者84例,采用美国国立卫生院卒中评估量表(NIHSS)对脑卒中严重程度进行评估,测定入院时血清白蛋白水平。随访30 d,采用改良Rankin量表(m RS)评定预后。结果:84例患者中,预后不良34例(40.5%),预后良好50例(59.5%)。与预后不良患者比较,预后良好患者的年龄、NIHSS评分、收缩压较低(P<0.01);白蛋白水平较高(P<0.05)。30 d随访中死亡14例(16.7%)。结论:急性缺血性脑卒中入院时患者血清白蛋白水平低与预后不良相关。     

Lp-PLA2与高血压患者发生缺血性脑卒中及预后的相关性分析

目的探讨血浆脂蛋白磷脂酶A2(Lp-PLA2)与高血压患者发生缺血性脑卒中及其与预后的相关性。方法选取2013年1月至2016年1月该院确诊的高血压患者88例,其中单纯性高血压患者34例,高血压合并缺血性脑卒中患者54例,检测患者Lp-PLA2水平。在入院第1天和第14天采用美国国立卫生研究院卒中量表(NIHSS)对患者脑卒中严重程度进行评分,根据NIHSS变化情况将高血压合并缺血性脑卒中患者分为预后良和预后差,并采用Logistics多元回归评价预后的独立预测因素。结果高血压合并缺血性脑卒中患者Lp-PLA2水平显著高于单纯性高血压患者,Lp-PLA2水平(OR=1.523,95%CI=1.323~1.657)和入院NIHSS评分(OR=3.275,95%CI=1.402~6.208)是缺血性脑卒中患者预后不良的独立预测因素。结论血清Lp-PLA2与高血压患者中缺血性脑卒中的发生与预后密切相关,可作为高血压患者缺血性脑卒中发生和预后的评价指标为临床治疗提供客观依据。     

视频脑电图在急性缺血性脑卒中患者近期预后评估中的应用

目的探讨视频脑电图(VEEG)在急性缺血性脑卒中患者预后评估中的价值。方法选取85例急性缺血性脑卒中患者为研究对象,均行床旁VEEG监测,收集患者的临床资料并采用改良Rankin量表(mRS)评估患者发病3个月后的预后情况。结果预后不良组患者的入院美国国立卫生研究院卒中量表(NIHSS)评分、大脑对称指数(BSI)、波形比率(DTABR)高于预后良好组,而VEEG分级中Ⅰ级+Ⅱ级的占比低于预后良好组,差异有统计学意义(P 0. 05或P 0. 01);VEEG分级、BSI和DTABR与入院NIHSS评分、mRS评分均呈显著正相关,且入院NIHSS评分与mRS评分亦呈显著正相关(P 0. 01)。受试者工作曲线(ROC)分析显示,BSI和DTABR评估预后的敏感性显著高于NIHSS评分。Logistic多因素回归分析发现,BSI和DTABR是脑卒中预后的独立影响因素,BSI和DTABR值越高,预后不良的风险越高。结论 VEEG的量化指标BSI和DTABR能够有效评估患者的预后改善情况,可以作为预后的独立预测指标。     

降钙素原和C反应蛋白与急性脑梗死患者短期预后的相关性研究

目的探讨急性脑梗死(ACI)患者血清降钙素原(PCT)、C反应蛋白(CRP)水平与短期脑功能恢复的相关性。方法以该院2013年1月至2014年12月收治的100例ACI患者及50例同期体检健康者为研究对象,分析入院时PCT、CRP、美国国立卫生研究院脑卒中量表(NIHSS)评分等与90d临床预后的相关性。结果不良转归患者最高NIHSS高于良好转归患者(P0.05)。不良转归患者入院PCT水平高于健康者和良好转归患者(P0.05)。受试者工作特征曲线分析显示,最高NIHSS对90d预后的预测价值较高,曲线下面积(AUC)为0.733,灵敏度为75.5%,特异度为77.2%;入院时PCT的AUC为0.841,灵敏度为87.0%,特异度为82.9%。最高NIHSS与入院时PCT呈正相关,而入院时PCT和NIHSS与90d改良Ranking量表(mRS)评分呈负相关(P0.05)。最高NIHSS(22.3分)和入院时PCT(2.5ng/mL)是90d预后不良的独立危险因素。结论ACI发病后早期血清PCT水平是评价患者90d临床预后的潜在预测因子。     

尿酸对溶栓治疗的急性缺血性脑卒中患者预后的影响

目的 探讨溶栓治疗的急性缺血性脑卒中患者入院时血清尿酸水平与短期预后的关系.方法 连续收录了84例溶栓治疗的急性缺血性脑卒中患者.记录其人口统计学特征,病情严重程度以及入院时血清尿酸水平.患者在随访90d时若出现死亡或残疾(改良Rankin评分,mRS≥2)则定义为预后不良.采用Logistic逐步回归模型对可能影响预后的因素进行分析.结果 预后良好的患者(mRS为0～1)血清尿酸水平要显著高于预后不良的患者(mRS为2～6).用逐步向前法进行多元Logistic回归分析发现,尿酸是影响患者短期预后的独立保护因素.ROC曲线提示,尿酸用来预测患者预后的准确性并不高,曲线下面积仅为0.680±0.058.Pearson相关性分析发现,尿酸与mRS评分呈负相关.结论 溶栓治疗的脑卒中患者的良好预后和血清尿酸水平升高有关,但仍需要有更大规模的临床试验进一步探索外源性的尿酸加上溶栓联合治疗脑卒中的安全性与有效性.     

血清尿酸水平对中青年急性缺血性卒中患者静脉溶栓治疗后转归的影响

目的:探讨血清尿酸水平对中青年急性缺血性卒中患者静脉溶栓治疗后转归的影响。方法:收集接受静脉溶栓治疗的中青年急性缺血性卒中患者96例的临床资料进行回顾性分析。根据入院美国国立卫生院脑卒中量表(NIHSS)评分和出院改良Rankin量表(mRS)评分将患者纳入预后良好组58例和预后不良组38例;再根据性别,将患者分为男性组44例和女性组52例。收集患者入院首次实验室检测结果,对不同组别的卒中的影响因素进行单因素分析,探究血清尿酸水平及性别对溶栓治疗后转归的影响。结果:预后良好组的糖尿病和卒中病史阳性患者比例低于预后不良组(P0.01或P0.05);血清尿酸水平高于预后不良组(P0.01);多因素的logistic回归分析结果显示,糖尿病史和入院NIHSS评分是影响中青年急性缺血性卒中溶栓患者预后的危险因素(P0.01),血清尿酸水平是其保护因素(P0.01)。男性组尿酸水平高于女性组(P0.05),其他指标差异无统计学意义(P0.05)。结论:较高的尿酸水平可能对中青年急性缺血性卒中患者(尤其是女性)静脉溶栓治疗后转归有益。     

升阳益气活络汤对老年急性缺血性脑卒中患者血清NO、MMP-9、Hs-CRP水平及生活能力的影响

目的探讨升阳益气活络汤对老年急性缺血性脑卒中患者血清因子超敏C反应蛋白(Hs-CRP)、基质金属蛋白酶-9(MMP-9)、一氧化氮(NO)及日常生活能力的影响。方法收集某院收治的急性缺血性脑卒中老年患者共81例,根据入院时间先后将患者分为两组,其中对照组40例予以西药常规治疗,实验组41例增加升阳益气活络汤治疗,治疗结束后对比两组患者血清因子NO、MMP-9、Hs-CRP水平、神经缺损功能评分(NIHSS)、日常生活活动能力(ADL)。结果治疗后实验组患者的NIHSS评分低于对照组,Barthel指数高于对照组(P<0.05);实验组的MMP-9、Hs-CRP血清因子水平低于对照组,NO高于对照组(P<0.05)。结论升阳益气活络汤有助于改善老年急性缺血性脑卒中患者的神经功能及ADL能力,并能调节MMP-9、Hs-CRP、NO等血清因子,减少患者进一步损伤。     

测定D-二聚体和超敏C-反应蛋白对急性脑梗死患者的临床意义

目的探讨脑梗死患者血中D-二聚体和超敏C-反应蛋白（Hs-CRP）含量变化与脑梗死发生的关系。方法测定64例急性脑梗死患者和50名健康对照者血清中D-二聚体和Hs-CRP含量,并进行比较,同时对急性脑梗死患者进行美国卫生研究院卒中量表（NIHSS）评分。结果急性脑梗死患者D-二聚体和Hs-CRP含量明显高于对照组（P〈0.05）;大面积脑梗死组中D-二聚体和Hs-CRP含量明显高于小面积组（P〈0.01）;但D-二聚体和Hs-CRP含量与脑梗死患者NIHSS评分无相关性。结论测定血中D-二聚体和Hs-CRP含量对急性脑梗死的临床分析有价值。     

Serum lipid levels and 3-month prognosis in Chinese patients with acute stroke

INTRODUCTION: The possible correlation between serum lipid levels and outcome after stroke is still controversial. Therefore we examined whether serum lipid levels at admission had any prognostic value in the 3-month outcome after stroke. METHODS: We performed a prospective, observational study of 649 patients with acute ischaemic stroke and intracerebral haemorrhagic stroke (ICH). Information on age, sex, history of arterial hypertension, diabetes mellitus, drinking, current smoking status, stroke type, Glasgow Coma Scale and Scandinavian Stroke Scale score, time from stroke onset, and presence of atrial fibrillation was obtained. Serum lipid levels were measured in blood samples taken from fasting patients 12 to 48 hours following ictus. Death and poor neurological outcome (Modified Rankin Scale score of >/=3 points) were defined as outcome events. A logistic regression model was performed to estimate the effect of the above variables on outcome after stroke. RESULTS: We found that the median levels of serum total cholesterol (TC), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) in good outcome patients with acute stroke were significantly higher (P<0.005) than those of poor outcome patients. The low levels of serum TC, TG and HDL-C (P<0.05) were independently related to increased 3-month poor outcome after acute ischaemic stroke and ICH. However, there was no significant relationship between LDL-C levels and 3-month outcome. CONCLUSION: The data from this study show that low levels of serum TC, TG and HDL-C are strong independent predictors of 3-month poor outcome in patients with acute ischaemic stroke and ICH.     

Application of retrievable Solitaire AB stents in the endovascular treatment of acute ischemic stroke

Purpose: Retrievable stents are widely used in acute ischemic stroke (AIS); however, the results remain unclear in Chinese patients. This study aimed to explore the usefulness of Solitaire AB stents in AIS.Materials and Methods: Seventy-three AIS patients treated with Solitaire AB stents for thrombectomy of large artery occlusion of anterior circulation in January 2014-June 2015 were retrospectively evaluated. Recanalization was assessed with the Thrombolysis In Cerebral Ischemia (TICI) scale. Clinical outcomes were assessed according to the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Operation-related complications were recorded. The main factors affecting successful recanalization with Solitaire AB were analyzed.Results: The 73 patients enrolled included 39 males and 34 females (median age of 59 [31-78] years); 77 Solitaire AB stents were used. The initial recanalization rate with Solitaire AB as the first thrombectomy method was 53.42% (39/73; recanalization group). Among the 34 patients with failed stent retrieval, 32 underwent other treatments; the final arterial recanalization rate was 89.04% (65/73). Perioperative embolization events and symptomatic intracranial hemorrhage (sICH) occurred in 5 and 8 patients, respectively. The mean NIHSS score was 9.12±3.86 one week after thrombectomy, significantly lower compared with admission values. In 31 patients (42.47%), NIHSS score decreased by >8. Good functional independence (mRS score≤2) was achieved in 39 patients (53.42%) at 90 days; 12 patients (16.44%) died. Compared with the recanalization group, the remaining patients showed lower AF and higher LAA percentages.Conclusion: Solitaire AB stents are useful in the endovascular treatment of AIS.     

多时相CT血管造影对急性缺血性脑卒中患者侧支循环评估价值及溶栓治疗指导作用

目的 探讨多时相CT血管造影(CTA)对急性缺血性脑卒中(AIS)患者侧支循环评估价值及溶栓治疗指导作用.方法 我院收治的AIS患者,选取其中接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的120例患者为研究对象.治疗前均给予多时相CTA检查,根据影像学检查结果及Alberta卒中项目早期CT评分(ASPECT...     

The relationship between mean flow velocity and functional and neurologic parameters of ischemic stroke patients undergoing rehabilitation

OBJECTIVE: To investigate the correlation between mean flow velocity (MFV) as measured by transcranial Doppler ultrasonography (TCD) and functional and neurologic impairment during inpatient rehabilitation after acute stroke. DESIGN: Prospective study comparing results of rehabilitation in patients with different TCD findings. SETTING: Acute neurologic rehabilitation department. PARTICIPANTS: Twenty-four consecutive patients admitted to a rehabilitation center with a diagnosis of a first ischemic stroke in the middle cerebral artery (MCA) territory. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Impairment as measured with the National Institutes of Health Stroke Scale (NIHSS) and disability as assessed with the FIM instrument. RESULTS: Normative or high blood-flow velocity in the MCA of the damaged hemisphere was associated on admission with higher FIM and lower NIHSS scores during 2 months of hospitalization. Absent or low flow velocity correlated with much worse functional and neurologic outcome, especially after 1 and 2 months of inpatient rehabilitation. Statistical correlation was found between MFV in the MCA of the damaged hemisphere, measured by admission TCD, and FIM score on admission and 1 month later. NIHSS scores during hospitalization also correlated with MFV in the MCA of the damaged hemisphere on admission and after 1 month. MFV in the MCA of the undamaged hemisphere 1 month after admission correlated negatively with FIM scores during inpatient rehabilitation. CONCLUSIONS: Our data showed a correlation between blood-flow velocity in the MCA of both hemispheres and the parameters of functional and neurologic status at different stages of acute inpatient rehabilitation after first ischemic stroke in MCA territory. Cerebral blood flow as measured by TCD can be an additional tool for monitoring the rehabilitation process after stroke.     

急性缺血性脑卒中静脉溶栓预后的多因素联合预测模型研究

目的:探讨通过建立多因素联合预测模型的方法预测急性缺血性脑卒中(AIS)患者使用阿替普酶静脉溶栓治疗后的远期临床预后.方法:通过使用回顾性研究的方法,分析118例接受阿替普酶静脉溶栓治疗的AIS患者的临床资料;通过溶栓后90 d的改良Rankin量表(mRS)分为预后良好组(mRS评分0～2分)和预后不良组(mRS评分...     

超敏cTnT与血栓-炎症因子的相关性及其对急性缺血性脑卒中神经功能结局的预测价值

目的 探讨急性缺血性脑卒中患者血清超敏心肌肌钙蛋白T（hs-cTnT）与血栓-炎症因子的相关性,以及发病后6 h的hs-cTnT在预测神经功能结局中的价值。方法 选择106例首发急性缺血性脑卒中患者,分别于患者发病后6 h内和72 h检测血清hs-cTnT、S100B蛋白、hs-CRP、单核细胞趋化蛋白-1（MCP-1）、血栓-炎症因子[包括组织型纤溶酶原激活物（t-PA）、可溶性CD40配体（sCD40L）和P-选择素]水平,并于入院时和发病后90 d,采用美国国立卫生研究院卒中量表（NIHSS）评分联合改良Rankin量表（mRS）评分对患者神经功能进行评估。根据患者发病后90 d的神经功能结局分为预后不良组和预后良好组,比较2组患者的各项指标,分析hs-cTnT与血栓-炎症因子的相关性,以及其对神经功能结局的预测价值。结果 纳入预后不良组62例,预后良好组44例。发病后6 h内,预后不良组血清hs-cTnT、hs-CRP、MCP-1、t-PA、sCD40L水平均高于预后良好组（P均< 0.05）。发病后72 h,预后不良组血清hs-cTnT、S100B、hs-CRP、sCD40L水平均低于预后良好组（P均< 0.05）。发病后6 h内和发病后72 h,血清hs-cTnT水平与发病后72 h的hs-CRP水平呈正相关（r = 0.585,P < 0.001;r = 0.599,P < 0.001）,与发病后6 h内t-PA水平呈正相关（r = 0.551,P = 0.001;r = 0.547,P = 0.002）,与发病后6 h内的MCP-1 水平呈正相关（r = 0.475,P = 0.014;r = 0.462,P = 0.015）。基线NIHSS 评分 ≥8分（OR = 2.656, 95% CI 1.009 ~ 6.995,P = 0.048）、发病后6 h内hs-cTnT（OR = 6.050,95% CI 2.352 ~ 15.560,P < 0.001）、 hs-CRP（OR = 7.294,95% CI 3.285 ~ 16.195,P < 0.001）、 MCP-1（OR = 1.349,95% CI 1.002 ~ 1.818,P = 0.049）、t-PA （OR = 1.007,95% CI 1.001 ~ 2.446,P = 0.004）是神经功能预后不良的危险因素。结论 急性缺血性脑卒中发病后6 h内的hs-cTnT升高是神经功能预后不良的预测因子,并且还与hs-CRP、t-PA和MCP-1的急性升高有关。     

Biomarkers in the prognostic evaluation of ischemic stroke: Is there benefit in the measurements of TREM-1 and TREM-2 in the acute phase?

Background and purposeTriggering receptors expressed on myeloid cells 1 and 2 (TREM-1 and TREM-2) are cell surface receptors important for modulation of microglia immune response. In this study, we evaluate serum levels of TREM-1 and TREM-2 as potential biomarkers in acute ischemic stroke (AIS).Material and methodsProspective cohort study of 50 patients with AIS admitted at our hospital. Serum TREM-1 and TREM-2 was evaluated within 24 h of the acute event and on the third and fifth days after the stroke. Neurological stroke severity and global disability were determined with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at the same three times and at the time of hospital discharge.ResultsTREM-1 and TREM-2 levels were elevated in stroke. TREM-1, but not TREM-2, exhibited correlations with NIHSS and mRS within 24 h (NIHSS and TREM-1: r_S = 0.31, p = 0.029; mRS and TREM-1: r_S = 0.32, p = 0.023). The serum level of TREM-1 within 24 h correlated with the neurological outcomes at hospital discharge (NIHSS and TREM-1: p = 0.021; mRS and TREM-1: p = 0.049). The serum concentrations of TREM-1 protein within 24 h after stroke was significantly higher in patients with poor outcome (mRS > 2) at hospital discharge (p = 0.021). After Exact Logistic Regression, large segmental stroke (O.R. = 4.14; 95CI = 1.07–16.09; p = 0.040) and initial sTREM levels (O.R. = 1.02; 95CI 1.00–1.04; p = 0.045) remained independent prognostic factors for AIS poor outcome (mRS > 2).ConclusionIn our study, TREM-1 and TREM-2 were significantly increased in AIS. Early elevation of TREM-1 correlated with stroke severity and it was an independent prognostic factor for stroke outcome.