中国大陆妊娠相关性脑卒中314例临床资料分析

目的：探讨中国大陆地区妊娠相关性脑卒中和蛛网膜下腔出血的危险因素及临床特点。方法：计算机检索中文生物医学数据库（CBMdisc）、万方数据库、维普数据库及中国知网数据库,检索年限均为2000年1月至2012年6月,对中国大陆地区已发表的与妊娠相关的脑卒中文献进行总结分析。结果：检索到18篇文献中314例符合纳入标准的病例。314例中脑出血179例,脑梗死110例,蛛网膜下腔出血25例。于妊娠晚期脑出血为102／179例,发病率为57．0％;妊娠中期脑梗死49／110例,发病率为44．5％;蛛网膜下腔出血25例,占总发病数的8．0％。子痢前期／子痫导致的脑出血42．4％（76／179例）;动脉瘤破裂导致的蛛网膜下腔出血56．0％（14／25例）;心源性栓塞导致的脑梗死29．1％（32／110例）。结论：妊娠相关性脑卒中好发于妊娠晚期及产褥期。脑梗死好发于妊娠中期,脑出血好发于妊娠晚期。脑出血常见病因为子痫前期／子痫,蛛网膜下腔出血常见病因为动脉瘤破裂（多发于妊娠晚期）,脑梗死则为心源性栓塞。     

缺血性脑卒中早期复发的临床特点和危险因素预测

目的：探讨缺血性脑卒中患者早期复发的临床特点和危险因素。方法：对594例缺血性脑卒中在30天内复发的22例患者进行了临床分析和病例－对照研究。结果：早期复发率为3．7％（22／594），其中脑血栓复发率为3．3％（18／552），脑栓塞复发率为9．5％（4／42）。72．73％（16／22）复发在原患侧，多为同类型脑卒中复发（86．36％，19／22）。经统计学分析发现高血压、TIA史与复发有显著关系（OR＝4．9，OR＝7．1），而缺血性心脏病、糖尿病、入院时高血糖、房颤、高血脂、吸烟、颈部血管斑块与复发无显著关系。结论：缺血性脑卒中早期复发多为同类型脑卒中、同部位的复发，高血压、TIA史可能为脑卒中早期复发的重要危险因素。     

脑卒中复发的危险因素分析

目的探讨影响脑卒中1年复发率的主要因素。方法登记我院2004-05～2006-07住院的首次卒中患者，前瞻性随访病后1年的复发情况，并登记影响卒中复发的各种可能因素，采用Logistic回归模型对这些因素进行分析。结果共纳入300例首次卒中患者，其中脑出血106例（35．5％），缺血性脑卒中194例（64．5％）。卒中1年的总体复发率为13．5％．其中脑梗死复发率为11．2％。脑出血复发率为17．3％。校正年龄和性别后，多因素分析显示房颤、糖尿病、高脂血症、高血压、吸烟是脑卒中复发的独立危险因素。结论脑卒中后1年复发率约为13．5％，应加强脑卒中患者房颤、糖尿病、高脂血症、高血压、吸烟的监测和预防．以减少卒中再发。     

广东省脑卒中流行病学调查

目的调查广东省居民脑卒中患病率、发病率、死亡率及主要危险因素状况。方法本研究是2013年中国脑卒中流行病学调查的一部分,采用多阶段分层整群抽样的方法,对样本人群进行逐户家访,共调查了广东省内6个监测点的16724名成年居民。脑卒中后至2013年8月31日仍幸存者被认为是患病病例,2012年9月1日至2013年8月31日一年内的首次发病者被认为是发病病例,死亡者被认为是死亡病例。结果16724名受调查者中,共有脑卒中患者155例,患病率为926.8/10万;一年内病例33例,发病率为197.3/10万;死亡病例10例,死亡率为59.8/10万。年龄标化后,患病率、发病率和死亡率分别为773.7/10万、168.6/10万和49.4/10万。男性脑卒中患病粗率为1081.1/10万,明显高于女性的777.2/10万,城市居民脑卒中患病粗率为1785.7/10万,明显高于农村居民的706.3/10万。共有130例(83.9%)患病病例在起病7 d内住院治疗。在155例患病病例中,脑梗死121例(78.1%),脑出血28例(18.1%),蛛网膜下腔出血2例(1.3%),不确定型4例(2.6%)。脑卒中患者中,99例合并高血压(63.9%)、36例合并血脂异常(23.2%),33例合并吸烟(21.9%)。结论广东省脑卒中患病率、发病率和死亡率高,城市地区的脑卒中负担比农村更重,流行病学状况值得高度重视。     

东莞市2004至2007年脑卒中发病率趋势及住院直接经济负担调查

目的了解东莞地区2004～2007年脑卒中流行病学发病趋势及住院直接经济负担。方法监测东莞地区2004至2007年脑卒中的发病情况、住院相关经济指标及影响因素。结果东莞地区脑卒中的平均发病密度为142．5／10万人年,4年来脑卒中的标准化发病率有逐年升高趋势,平均每年增长7．9％。脑卒中患者平均住院日16．6d,平均住院费用为11715．5元,脑卒中亚型（P〈0．001）、平均住院时间（P〈0．001）和预后（P〈0．001）是影响平均住院费用的主要因素。结论东莞市脑卒中发病率有逐年上升的趋势,缩短住院时间可能是减轻住院经济负担的合理途径。     

手术后脑梗死(附18例分析)

目的 探讨手术后并发脑梗死的发病情况，临床表现，可能的发病机制及防治方法。方法 收集我院1996～2001年手术后并发脑梗死的资料并进行回顾性分析。结果 老年患手术后并发脑梗死的居多，颅脑手术后并发脑梗死的占本组病人的44．4％(8／18)，高血压脑出血行开颅血肿清除术后并发脑梗死的占本组病人的27．8％(5／18)和占本院同期行该手术病人的7．4％(5／68)，髋关节置换术后脑梗死占本组病人的16．7％(3／18)和占同期该手术病人的3．1％(3／97)。结论 老年病人尤其是高血压脑出血行开颅血肿清除术及髋关节置换术的是术后并发脑梗死的高危人群，术后要密切观察，发现意识改变、神经定位征，要及时行影像学检查，术后注意补充血容量。     

北京市和上海市抽样人群脑卒中发病率和危险因素暴露水平比较

目的：对北京和上海两城市抽样人群的脑卒中发病率及危险因素暴露情况进行比较和分析,为脑卒中预防提供参考。方法：在北京市石景山区和上海市奉贤区以整群抽样方法抽取人群中年龄≥40岁者为目标人群（北京2910名,上海5244名）。设计统一的调查表格,对目标人群进行基线调查,并进行脑循环动力学检测,此后随访脑卒中的发病情况。比较和分析两城市脑卒中发病率、危险因素及脑循环动力学综合积分的差异。结果：北京市和上海市高血压病、心脏病、糖尿病、血脂异常、脑卒中家族史、肥胖、吸烟、饮酒因素的暴露率分别为34．64％和21．09％、23．16％和5．53％、10．79％和2．38％、23．02％和2．59％、28．63％和7．70％、26．74％和4．27％、36．8％和33．6％、36．9％和18．5％,地区间各因素暴露率的差异有统计学意义（P〈O．01）。脑卒中发病密度分别为6．29‰和N2．51‰。男女组间各危险因素暴露率、脑循环动力学积分值及脑卒中发病率差异均有统计学意义（P〈0．01）。结论：北京市高血压、心脏病、糖尿病、血脂异常等脑卒中危险冈素暴露率、脑循环动力学损害及脑卒中发病率均显著高于上海市。脑循环动力学损害可能是影响脑卒中发病的重要因素。     

上海市社区人群干预前后脑卒中发病率的变化

目的：探索在社区人群中降低脑卒中发病率的有效措施。方法：在“八五”“九五”期间，在上海市静安区的两个街道约9万人群中开展社区脑血管病综合性防治研究。结果：经过9年干预，干预社区脑卒中总发病率呈波动性下降，2000年干预社区脑卒中发病率为130．2／10万，与1991年相比下降了25．8％，而监测社区脑卒中总发病率呈波动性上升，2000年监测社区脑卒中发病率为187．4％／10万，与1991年同组相比上升了13．2％，1996－2000年脑卒中平均发病率与同组的1991－1995年相比，干预社区下降了13．0％，而监测社区上升了11．0％，干预社区不同年龄性别人群的发病率变化趋势与程度不一致，其中以75－84岁人群下降最为明显，结论：以开展健康教育和积极控制高血压，糖尿病为主的综合干预措施对降低脑座中的发病率效果明显。     

兔脑栓塞后不同时间溶栓治疗的疗效及安全性研究

通过兔颈内动脉梗塞模型评价不同时间给予UK溶栓治疗的疗效和安全性。发现栓塞后0．5、2、4、6h溶栓治疗组与相应的对照组的梗塞灶占半球的百分率分别为2．60±1.40％／38．36±4．01％（P＜0．001）、11．96±3．12％／38．10±3．43％（P＜0．001）、27．13±5．95％／39．06±4．02％（P＜O．01）、38．220±498％／37.77±3．18％（P＞0．05）。栓塞后0．5、2h溶栓治疗组未见脑出血．4、6h组部分动物见脑出血。提示兔脑栓塞后早期给予UK治疗可缩小脑梗塞体积,减少脑损害;过迟溶栓治疗不能缩小梗塞灶,且有增加脑出血的危险。     

代谢综合征在脑卒中患者中患病状况的分析

目的研究代谢综合征在脑卒中患者中的患病状况。方法研究对象为390例初发脑卒中患者,对照组为400例年龄、性别匹配者,研究总结代谢综合征及其危险因素的患病率,经Logistic回归分析其对脑卒中的危险性。结果代谢综合征的现患率在脑卒中组高于对照组。代谢综合征的现患率在脑卒中病例组为28.3%,对照组为9.8%,差异有显著意义。腔隙性脑梗死、脑梗死和脑出血的代谢综合征现患率分别为26.0%、29.5%和27.3%。Logistic回归分析显示代谢综合征是脑卒中的独立危险因素。结论代谢综合征在脑卒中患者中患病率较正常人群高,是脑卒中的独立危险因素。     

缺血性脑卒中复发与阿司匹林抵抗的相关性研究

目的观察缺血性脑梗死初发以及复发患者阿司匹林(ASP)疗效,探讨缺血性脑梗死复发与阿司匹林抵抗(AR)的关系,并对复发患者的危险因素进行相关性分析。方法采用回顾性研究方法,将急性缺血性脑梗死患者分为初发组和复发组,复发组入院后即行血栓弹力图(TEG)检测,初发组规律服用ASP后1 m进行TEG检测,比较初发组及复发组AR发生率。并对患者生化指标、TOAST分型及危险因素等进行Logistic回归分析,探讨缺血性脑梗死复发的临床相关因素。结果初发组AR发生率为28.57%;复发组AR发生率为56.76%。复发组AR明显高于初发组(P0.01)。糖尿病、冠心病在复发组出现率高(P0.05);年龄、性别、吸烟、饮酒、高血压、高脂血症、动脉粥样硬化型、BMI、TG、CHOL、LDL、HDL、HCY及hs-CRP的水平两组差异无显著性(P0.05)。对P0.1危险因素的Logistic回归分析示AR、糖尿病与缺血性脑梗死复发明显相关。结论 AR能显著增加缺血性脑梗死复发风险;糖尿病增加缺血性脑梗死复发风险。     

Risk factors and subtype analysis of acute ischemic stroke

Background and Purpose: Stroke risk factors and subtypes were examined for associations with mortality and recurrence rate in Taiwanese patients with first-ever and recurrent stroke. Methods: This study examined patients with initial and recurrent stroke from 2003 to 2005 for risk factors, demographic data, Bamford subtypes and transient ischemic attack. Results: One thousand and twenty-one patients with 1,085 stroke episodes were recruited. Significant factors associated with recurrent stroke were hyperlipidemia, atrial fibrillation and smoking. A significant incidence of lacunar infarction was noted in the patient population (37.82% in all patients; 41.02% in first stroke vs. 35.67% in recurrent stroke patients). Patients with diabetes mellitus were more likely to have lacunar rather than total anterior circulation infarction (TACI) or partial anterior circulation infarction (PACI). Hyperlipidemia was more often attributable to lacunar stroke than PACI. Atrial fibrillation was significantly associated with nonlacunar infarcts, TACI and PACI but not lacunar stroke. Conclusions: The incidence of lacunar infarction was significantly higher in initial rather than recurrent stroke patients. Diabetes mellitus or hyperlipidemia was highly associated with lacunar infarction. Atrial fibrillation was associated with nonlacunar infarction in Taiwan, similar to the result of White and Black populations in the UK.     

Comparison of Prediction Models based on Risk Factors and Retinal Characteristics Associated with Recurrence One Year after Ischemic Stroke

Objectives: To develop risk estimation models for 1-year ischemic stroke recurrence using clinical risk factors and retinal characteristics. Methods: From June 2017 to January 2019, 332 patients with first-ever ischemic stroke were enrolled and followed up in the Shenzhen Traditional Chinese Medicine hospital in China. The primary endpoint was defined as fatal or recurrent stroke after 1 year of the index stroke. Clinical risk factors and retinal characteristics were identified by multivariate logistic models. Results: The multivariate logistic model with only clinical risk factors showed that Cerebral Atherosclerosis (OR 1.68, 95%CI: 1.000-2.81), white matter lesions (OR 3.61, 95%CI: 2.18-5.98), and Cardiac disease (OR 1.88, 95%CI: 1.02-3.46) were statistically significantly associated with higher stroke recurrence risk. The sensitivity and specificity of this model were 69.1% and 68.4% respectively. The multivariate logistic model with only retinal characteristics showed that central retinal venule equivalent (OR .34, 95%CI: .14-.83), hemorrhage (OR .6, 95%CI: .41-.88), exudate (OR 1.64, 95%CI: 1.16-2.32), central retinal artery equivalent (OR 2.95, 95%CI: 1.23-7.08), and Aangle (OR 0.8, 95%CI: .61-1.004) were statistically significantly associated with stroke recurrence. The sensitivity and specificity of the model were 62.0% and 64.4% respectively. The multivariate logistic model with both clinical risk factors and retinal characteristics showed that cerebral atherosclerosis (OR 1.74, 95%CI: 1.020-2.981), white matter lesions (OR 3.65, 95%CI: 2.17-6.13), cardiac disease (OR 1.99, 95%CI: 1.06-3.74), hemorrhage (OR .68, 95%CI: .49-.96), exudate (OR 1.65, 95%CI: 1.16-2.36) were independent risk factors of stroke recurrence. The sensitivity and specificity of the model were 72.5% and 70.7% respectively. Conclusions: Combining the traditional risk factors of stroke with the retinal vessels characteristics to establish the recurrent cerebral infarction prediction model may improve the accuracy of the prediction.     

血清碱性磷酸酶水平与轻型脑梗死患者卒中复发相关性研究

目的 探讨血清碱性磷酸酶（alkaline phosphatase，ALP）水平与轻型脑梗死患者卒中复发相关性。 方法 通过西安脑卒中数据库，纳入西安市4所三级甲等医院2015年1-12月确诊的轻型脑梗死患者。 入院24 h内检测血清ALP水平，并按照四分位数分组法分为四组。研究的终点事件为患者1年内卒中复 发（包括脑梗死、脑出血、蛛网膜下腔出血）。采用多因素Logistic回归分析和曲线拟合评估血清ALP 水平与轻型脑梗死患者1年卒中复发的相关性。 结果 共纳入895例轻型脑梗死患者，平均年龄为63.52±12.31岁，男性572例（63.9%），入院NIHSS 评分中位数为2分，1年卒中复发为26例（2.9%）。多因素Logistic回归分析显示，血清ALP每升高1 U/L， 轻型脑梗死患者的1年卒中复发风险增加2%（OR 1.02，95%CI 1.01～1.04，P =0.030）；每升高10 U/L， 1年卒中复发风险增加19%（OR 1.19，95%CI 1.01～1.41，P =0.030）。高水平组（Q2、Q3与Q4组）与最低 水平组（Q1组）间的1年卒中复发风险差异均无统计学意义；四分组间1年卒中复发风险升高趋势无统 计学意义。 结论 血清ALP可能是轻型脑梗死患者1年卒中复发的影响因素。     

Seasonal variation in stroke incidence in Hisayama, Japan

We investigated seasonal variation in the incidence of cerebral stroke among the general population aged greater than or equal to 40 years in November of 1961 in Hisayama, Japan. During the 24-year follow-up period, 311 cases of cerebrovascular diseases occurred. The date or month of onset was determined in 308 cases, of which 51 were classified as intracerebral hemorrhage, 223 as cerebral infarction, and 27 as subarachnoid hemorrhage. We observed a significant seasonality in the incidence of all stroke (p less than 0.01), of intracerebral hemorrhage (p less than 0.05), and of cerebral infarction (p less than 0.01), whereas subarachnoid hemorrhage had no significant seasonal pattern. Subjects less than 64 years of age showed a significant seasonal variation in the incidence of both intracerebral hemorrhage (p less than 0.05) and cerebral infarction (p less than 0.01). A significant seasonal pattern for the incidence of intracerebral hemorrhage was also noted among persons with hypertension (p less than 0.05) or a high serum cholesterol level (p less than 0.05), whereas such a pattern for cerebral infarction was documented among normotensive persons (p less than 0.05) and those with a low serum cholesterol level (p less than 0.01). In addition, the incidences of intracerebral hemorrhage and cerebral infarction were negatively correlated with mean ambient temperature (p less than 0.01 and p less than 0.05, respectively), and all stroke and intracerebral hemorrhage in men were significantly related to intradiurnal temperature change (p less than 0.05 and p less than 0.01, respectively). The significance of the seasonal occurrence of stroke is discussed in relation to relevant risk factors.     

Secondary stroke prevention with apixaban in nonvalvular atrial fibrillation: A subgroup analysis of the STANDARD study

BackgroundData on independent risk factors for stroke recurrence in Japanese patients with nonvalvular atrial fibrillation are limited.MethodsWe performed a subgroup analysis of a postmarketing surveillance study of apixaban (STroke prevention ANticoagulant Drug Apixaban Real-world Data study) in Japanese patients with nonvalvular atrial fibrillation receiving oral apixaban (5 mg/2.5 mg twice daily) in routine clinical practice. Patients were categorized into primary and secondary prevention groups based on the absence or presence of a history of ischemic stroke/transient ischemic attack, respectively.ResultsPatients in the secondary prevention group (1101 of 6306 patients [17.5%] analyzed; mean observation period, 15.7 months) had a higher risk of ischemic stroke or hemorrhage than those in the primary prevention group. The incidence rates of major (3.92%/year vs 2.06%/year), intracranial (1.87%/year vs 0.55%/year), and cerebral (1.14%/year vs 0.37%/year) hemorrhage and effectiveness outcomes (ischemic stroke/systemic embolism/transient ischemic attack, 3.25%/year vs 0.57%/year) were significantly higher (all P < 0.001) in the secondary prevention group than in the primary prevention group. Multivariate analysis identified no independent risk factors in the secondary prevention group, while prior major bleeding, alcohol abuse, advanced age, male sex, lower body weight, higher serum creatinine, and antiplatelet drug use were identified as risk factors for major hemorrhage, and advanced age and antiplatelet drug use for effectiveness outcomes in the primary prevention group.ConclusionsAmong Japanese patients with nonvalvular atrial fibrillation who received apixaban, presence of a history of ischemic stroke/transient ischemic attack was associated with higher incidence rates of hemorrhage and thromboembolic events.     

急性卒中并发上消化道出血单中心初步调查结果

目的 调查急性卒中并发上消化道出血的发病情况。方法 选取北京天坛医院中国急性脑血管病事件登记（Registry of Acute Cerebrovascular Events in China,RACE-CHINA）的急性卒中住院患者,对其住院病史记录进行回顾性分析。结果 2007年8月至2008年7月,北京天坛医院RACE－CHINA共登记急性卒中患者1408例,确诊上消化道出血40例,急性卒中上消化道出血的发生率为2.84%,上消化道出血患者平均年龄63±9岁,脑出血患者上消化道出血的发生率略高于脑梗死和蛛网膜下腔出血患者（2.98%：2.75%,2.98%：2.84%）,意识障碍患者、脑出血量大者、椎基底动脉系统脑梗死更易发生上消化道出血。上消化道出血多发生在卒中后第1～2周,持续时间多在1周内。急性卒中总体死亡率为7.0%,出现上消化道出血后,卒中死亡率为30%。结论 上消化道出血是急性卒中的严重并发症,年龄、性别、卒中类型、出血量、意识状态等可能是其主要危险因素,临床上应高度重视,加强防治。     

2型糖尿病脑梗死临床分析

目的分析2型糖尿病脑梗死临床特点,为其防治提供依据。方法将糖尿病脑梗死50例与非糖尿病脑梗死50例进行危险因素、临床特点等比较。结果糖尿病组高血压发病率、血脂水平、进展性卒中比例及复发性脑梗死比例均高于非糖尿病组,差异有统计学意义(p<0.05),而发病年龄、神经功能缺损程度、脑梗死类型及部位无显著性差异。结论糖尿病脑梗死患者易合并高血压、高血脂等多种危险因素,病情容易进展,复发的风险高,而糖尿病对脑梗死类型、部位及病情轻重无明显影响。     

Stroke registry in Malm?, Sweden.

BACKGROUND AND PURPOSE: A stroke registry covering the city of Malm?, Sweden (population 232,000) was started in January of 1989 to prospectively follow up stroke incidence, recurrence, and fatality rates. METHODS: Patients with presumed stroke were interviewed within 1 week after admission to the hospital, and their medical records were examined. Continuous validation against hospital diagnosis showed well over 90% of all stroke cases in Malm? to have been included. RESULTS: Incidence rates per 100,000 residents were 300 for all stroke events and 225 for first-ever stroke, lower than those reported from other studies. The distribution of stroke diagnostic categories was 3% subarachnoid hemorrhage, 10% intracerebral hemorrhage, 50% cerebral infarction, and 38% unspecified stroke. The diagnosis was based on computed tomography in 51% of first-ever stroke cases. Median age was 73.1 years for men and 79.7 years for women. Incidence rates for all stroke diagnostic categories except subarachnoid hemorrhage increased with age. Prior stroke, hypertension, smoking, atrial fibrillation, and diabetes mellitus were major risk factors for all stroke events. The presenting symptoms were hemiparesis in 74%, speech disorder in 49%, and clouded consciousness in 19% of the patients. The overall case-fatality rate at 30 days was 15%; the rate for intracerebral hemorrhage was 37% and that for cerebral infarction was 10%. CONCLUSIONS: Our findings confirm the value of a stroke registry for stroke epidemiology purposes and as a tool for specific stroke research.     

Epidemiology of cerebrovascular disease in Tartu, Estonia, USSR, 1970 through 1973.

This study was undertaken to establish the incidence and mortality for various types of cerebrovascular disease in the population of Tartu. All medical records for this population were reviewed for the period 1970 through 1973, and those with a diagnosis of brain infarction, transient ischemic attacks, cerebral hemorrhage or subarachnoid hemorrhage were identified. Only the first stroke was considered when determining incidence. A total of 786 cases were included in the study. Without cases of transient ischemic attacks, the number was 667 (e.g., cases of stroke). Cerebral infarction accounted for 80% of all strokes, cerebral hemorrhage for 13.5% and subarachnoid hemorrhage for 6.5%. The incidence rate for stroke was higher for men than for women and significantly increased in each older age group. The rate for all persons was 184 per 100,000 population per year. The incidence of transient ischemic attacks was 33 per 100,000 population per year. The mortality rate for stroke for this population was 98/100,000 per year. The data on incidence of stroke and its type, its dependence on age and sex, and mortality rate are close to the corresponding data reported from other countries.