Efficacy and safety of transcutaneous auricular vagus nerve stimulation combined with conventional rehabilitation training in acute stroke patients: a randomized controlled trial conducted for 1 year involving 60 patients

Transcutaneous auricular vagus nerve stimulation(ta-VNS)is a novel noninvasive treat-ment for stroke that directly stimulates the peripheral auricular branch of the vagus nerve.There have been recent reports that ta-VNS combined with conventional rehabilitation training promotes the recovery of neurological function of patients with acute stroke.However,these were small-sample-sized studies on the recovery of neurological function in patients after percutaneous vagus nerve stimulation in the subacute and chronic phases after stroke.This double-blinded randomized controlled trial involved 60 acute ischemic or hemorrhagic stroke patients aged 18-80 years who received treatment in the Second Affiliated Hospital of Chongqing Medical University.The subjects were randomly assigned to receive ta-VNS or sham ta-VNS combined with conventional rehabilitation training.The follow-up results over 1 year revealed that ta-VNS combined with conventional rehabilitation training greatly improved the recovery of motor and sensory functions and emotional responses compared with sham ta-VNS combined with conventional rehabilitation training.There were no obvious side effects.These findings suggest that ta-VNS combined with conventional rehabilitation training for the treatment of acute ischemic or hemorrhagic stroke patients is safe and effective.     

Skeletal muscle-derived cells repair peripheral nerve defects in mice

Skeletal muscle-derived cells have strong secretory function,while skeletal muscle-derived stem cells,which are included in muscle-derived cells,can differentiate into Schwann cell-like cells and other cell types.However,the effect of muscle-derived cells on peripheral nerve defects has not been reported.In this study,5-mm-long nerve defects were created in the right sciatic nerves of mice to construct a peripheral nerve defect model.Adult female C57BL/6 mice were randomly divided into four groups.For the muscle-derived cell group,muscle-derived cells were injected into the catheter after the cut nerve ends were bridged with a polyurethane catheter.For external oblique muscle-fabricated nerve conduit and polyurethane groups,an external oblique muscle-fabricated nerve conduit or polyurethane catheter was used to bridge the cut nerve ends,respectively.For the sham group,the sciatic nerves on the right side were separated but not excised.At 8 and 12 weeks post-surgery,distributions of axons and myelin sheaths were observed,and the nerve diameter was calculated using immunofluorescence staining.The number,diameter,and thickness of myelinated nerve fibers were detected by toluidine blue staining and transmission electron microscopy.Muscle fiber area ratios were calculated by Masson’s trichrome staining of gastrocnemius muscle sections.Sciatic functional index was recorded using walking footprint analysis at 4,8,and 12 weeks after operation.The results showed that,at 8 and 12 weeks after surgery,myelin sheaths and axons of regenerating nerves were evenly distributed in the muscle-derived cell group.The number,diameter,and myelin sheath thickness of myelinated nerve fibers,as well as gastrocnemius muscle wet weight and muscle area ratio,were significantly higher in the muscle-derived cell group compared with the polyurethane group.At 4,8,and 12 weeks post-surgery,sciatic functional index was notably increased in the muscle-derived cell group compared with the polyurethane group.These criteria of the muscle-derived cell group were not significantly different from the external oblique muscle-fabricated nerve conduit group.Collectively,these data suggest that muscle-derived cells effectively accelerated peripheral nerve regeneration.This study was approved by the Animal Ethics Committee of Plastic Surgery Hospital,Chinese Academy of Medical Sciences(approval No.040)on September 28,2016.     

Magnet-targeted delivery of bone marrow-derived mesenchymal stem cells improves therapeutic efficacy following hypoxic-ischemic brain injury

hypoxicischemic brain injury;however,the therapeutic efficacy of bone marrow-derived mesenchymal stem cells largely depends on the number of cells that are successfully transferred to the target.Magnet-targeted drug delivery systems can use a specific magnetic field to attract the drug to the target site,increasing the drug concentration.In this study,we found that the double-labeling using superparamagnetic iron oxide nanoparticle and poly-L-lysine(SPIO-PLL)of bone marrow-derived mesenchymal stem cells had no effect on cell survival but decreased cell proliferation 48 hours after labeling.Rat models of hypoxic-ischemic brain injury were established by ligating the left common carotid artery.One day after modeling,intraventricular and caudal vein injections of 1×105 SPIO-PLL-labeled bone marrow-derived mesenchymal stem cells were performed.Twenty-four hours after the intraventricular injection,magnets were fixed to the left side of the rats’heads for 2 hours.Intravoxel incoherent motion magnetic resonance imaging revealed that the perfusion fraction and the diffusion coefficient of rat brain tissue were significantly increased in rats treated with SPIO-PLL-labeled cells through intraventricular injection combined with magnetic guidance,compared with those treated with SPIO-PLL-labeled cells through intraventricular or tail vein injections without magnetic guidance.Hematoxylin-eosin and terminal deoxynucleotidyl transferase dUTP nick-end labeling(TUNEL)staining revealed that in rats treated with SPIO-PLL-labeled cells through intraventricular injection under magnetic guidance,cerebral edema was alleviated,and apoptosis was decreased.These findings suggest that targeted magnetic guidance can be used to improve the therapeutic efficacy of bone marrow-derived mesenchymal stem cell transplantation for hypoxic-ischemic brain injury.This study was approved by the Animal Care and Use Committee of The Second Hospital of Dalian Medical University,China(approval No.2016-060)on March 2,2016.     

Baculoviral inhibitor of apoptosis protein repeat-containing protein 3 delays early Wallerian degeneration after sciatic nerve injury

Wallerian degeneration is a complex biological process that occurs after nerve injury,and involves nerve degeneration and regeneration.Schwann cells play a crucial role in the cellular and molecular events of Wallerian degeneration of the peripheral nervous system.However,Wallerian degeneration regulating nerve injury and repair remains largely unknown,especially the early response.We have previously reported some key regulators of Wallerian degeneration after sciatic nerve injury.Baculoviral inhibitor of apoptosis protein repeat-containing protein 3(BIRC3)is an important factor that regulates apoptosis-inhibiting protein.In this study,we established rat models of right sciatic nerve injury.In vitro Schwann cell models were also established and subjected to gene transfection to inhibit and overexpress BIRC3.The data indicated that BIRC3 expression was significantly up-regulated after sciatic nerve injury.Both BIRC3 upregulation and downregulation affected the migration,proliferation and apoptosis of Schwan cells and affected the expression of related factors through activating c-fos and ERK signal pathway.Inhibition of BIRC3 delayed early Wallerian degeneration through inhibiting the apoptosis of Schwann cells after sciatic nerve injury.These findings suggest that BIRC3 plays an important role in peripheral nerve injury repair and regeneration.The study was approved by the Institutional Animal Care and Use Committee of Nantong University,China(approval No.2019-nsfc004)on March 1,2019.     

Micro-computed tomography utility for estimation of intraparenchymal spinal cord cystic lesions in small animals

Precise assessment of spinal cord cystic lesions is crucial to formulate effective therapeutic strategies,yet histological assessment of the lesion remains the primary method despite numerous studies showing inconsistent results regarding estimation of lesion size via histology.On the other hand,despite numerous advances in micro-computed tomography(micro-CT)imaging and analysis that have allowed precise measurements of lesion size,there is not enough published data on its application to estimate intraspinal lesion size in laboratory animal models.This work attempts to show that micro-CT can be valuable for spinal cord injury research by demonstrating accurate estimation of syrinx size and compares between micro-CT and traditional histological analysis.We used a post-traumatic syringomyelia rat model to compare micro-CT analysis to conventional histological analysis.The study showed that micro-CT can detect lesions within the spinal cord very similar to histology.Importantly,micro-CT appears to provide more accurate estimates of the lesions with more measures(e.g.,surface area),can detect compounds within the cord,and can be done with the tissue of interest(spinal cord)intact.In summary,the experimental work presented here provides one of the first investigations of the use of micro-CT for estimating the size of intraparenchymal cysts and detecting materials within the spinal cord.All animal procedures were approved by the University of Akron Institutional Animal Care and Use Committee(IACUC)(protocol#LRE 16-05-09 approved on May 14,2016).     

Assessment of structural brain changes in patients with type 2 diabetes mellitus using the MRI-based brain atrophy and lesion index

Patients with type 2 diabetes mellitus(T2 DM) often have cognitive impairment and structural brain abnormalities.The magnetic resonance imaging(MRI)-based brain atrophy and lesion index can be used to evaluate common brain changes and their correlation with cognitive function,and can therefore also be used to reflect whole-brain structural changes related to T2 DM.A total of 136 participants(64 men and 72 women,aged 55–86 years) were recruited for our study between January 2014 and December 2016.All participants underwent MRI and Mini-Mental State Examination assessment(including 42 healthy control,38 T2 DM without cognitive impairment,26 with cognitive impairment but without T2 DM,and 30 T2 DM with cognitive impairment participants).The total and sub-category brain atrophy and lesion index scores in patients with T2 DM with cognitive impairment were higher than those in healthy controls.Differences in the brain atrophy and lesion index of gray matter lesions and subcortical dilated perivascular spaces were found between non-T2 DM patients with cognitive impairment and patients with T2 DM and cognitive impairment.After adjusting for age,the brain atrophy and lesion index retained its capacity to identify patients with T2 DM with cognitive impairment.These findings suggest that the brain atrophy and lesion index,based on T1-weighted and T2-weighted imaging,is of clinical value for identifying patients with T2 DM and cognitive impairment.Gray matter lesions and subcortical dilated perivascular spaces may be potential diagnostic markers of T2 DM that is complicated by cognitive impairment.This study was approved by the Medical Ethics Committee of University of South China(approval No.USC20131109003) on November 9,2013,and was retrospectively registered with the Chinese Clinical Trial Registry(registration No.Chi CTR1900024150) on June 27,2019.     

Diffusion tensor imaging reveals brain structure changes in dogs after spinal cord injury

Based on the Wallerian degeneration in the spinal cord pathways, the changes in synaptic connections, and the spinal cord-related cellular responses that alter the cellular structure of the brain, we presumed that brain diffusion tensor imaging(DTI) parameters may change after spinal cord injury. However, the dynamic changes in DTI parameters remain unclear. We established a Beagle dog model of T10 spinal cord contusion and performed DTI of the injured spinal cord. We found dynamic changes in DT...     

Association between inflammatory bowel diseases and Parkinson's disease: systematic review and meta-analysis

Growing evidence suggests that there are similar pathological mechanisms and closely related pathogenic risk factors for inflammatory bowel disease(IBD) and Parkinson's disease(PD). However, the epidemiological features of these two diseases are different. This review systematically evaluated the relationship between inflammatory bowel diseases and Parkinson's disease risk. We searched Pub Med, Embase, and Cochrane databases to retrieve observational studies of IBD and PD published from inception to October 2019. Nine observational studies, involving 12,177,520 patients, were included in the final analysis. None of the studies had Newcastle–Ottawa Scale scores that suggested a high risk of bias. After adjusting for confounders and excluding heterogeneous studies, the overall risk of PD was significantly higher in IBD patients than in the general population(adjusted risk ratio [RR] = 1.24, 95% confidence interval [CI]: 1.15–1.34, P < 0.001). A metaanalysis of the temporal relationship revealed that the incidence of IBD was significantly increased before(adjusted hazard ratio [HR] = 1.26, 95% CI: 1.18–1.35, P < 0.001) and after(adjusted RR = 1.40, 95% CI: 1.20–1.80, P < 0.001) PD diagnosis. After excluding a heterogeneous study, the pooled risk of PD development in patients with ulcerative colitis(adjusted HR = 1.25, 95% CI: 1.13–1.38, P < 0.001) or Crohn's disease(adjusted HR = 1.33, 95% CI: 1.21–1.45, P < 0.01) was significantly increased. Subgroup analysis revealed no significant differences in risk between men(adjusted HR = 1.23, 95% CI: 1.10–1.39) and women(adjusted HR = 1.26, 95% CI: 1.10–1.43);however, older(> 65 years old) IBD patients(adjusted HR = 1.32, 95% CI: 1.17–1.48) may have a higher risk than younger(≤ 65 years old) patients(adjusted HR = 1.24, 95% CI: 1.08–1.42). Patients with IBD who were not treated with anti-tumor necrosis factor-α or azathioprine had significantly higher PD risk(adjusted HR = 1.6, 95% CI: 1.2–2.2). Thus, our meta-analysis indicates a certain correlation between IBD and PD, and suggests that IBD may moderately increase PD risk regardless of sex, especially in patients over 65 years of age. Moreover, early anti-inflammatory therapies for IBD might reduce the risk of developing PD. Our findings suggest an urgent need for an individualized screening strategy for patients with IBD. However, most studies included in this paper were observational, and more randomized controlled trials are needed to confirm the precise association between IBD and PD.     

Cerebral dopamine neurotrophic factor transfection in dopamine neurons using neurotensin-polyplex nanoparticles reverses 6-hydroxydopamine-induced nigrostriatal neurodegeneration

Overexpression of neurotrophic factors in nigral dopamine neurons is a promising approach to reverse neurodegeneration of the nigrostriatal dopamine system,a hallmark in Parkinson's disease.The human cerebral dopamine neurotrophic factor(h CDNF)has recently emerged as a strong candidate for Parkinson's disease therapy.This study shows that h CDNF expression in dopamine neurons using the neurotensinpolyplex nanoparticle system reverses 6-hydroxydopamine-induced morphological,biochemical,and behavioral alterations.Three independent electron microscopy techniques showed that the neurotensin-polyplex nanoparticles containing the h CDNF gene,ranging in size from 20 to 150 nm,enabled the expression of a secretable h CDNF in vitro.Their injection in the substantia nigra compacta on day 21 after the 6-hydroxydopamine lesion resulted in detectable h CDNF in dopamine neurons,whose levels remained constant throughout the study in the substantia nigra compacta and striatum.Compared with the lesioned group,tyrosine hydroxylase-positive(TH⁺)nigral cell population and TH+fiber density rose in the substantia nigra compacta and striatum after h CDNF transfection.An increase inβIII-tubulin and growth-associated protein 43 phospho-S41(GAP43 p)followed TH⁺cell recovery,as well as dopamine and its catabolite levels.Partial reversal(80%)of drugactivated circling behavior and full recovery of spontaneous motor and non-motor behavior were achieved.Brain-derived neurotrophic factor recovery in dopamine neurons that also occurred suggests its participation in the neurotrophic effects.These findings support the potential of nanoparticle-mediated h CDNF gene delivery to develop a disease-modifying treatment against Parkinson's disease.The Institutional Animal Care and Use Committee of Centro de Investigación y de Estudios Avanzados approved our experimental procedures for animal use(authorization No.162-15)on June 9,2019.     

优化溶栓流程对轻型急性缺血性卒中院内延误及预后的影响

目的分析优化溶栓流程对轻型急性缺血性卒中患者院内延误及预后的影响。方法回顾性收集秦皇岛市第一医院2015年7月-2017年6月行静脉溶栓治疗的轻型缺血性卒中患者资料。按照流程优化时间前后,分为优化组和对照组。比较两组入院到溶栓时间(door to needle time,DNT)、溶栓后7 d NIHSS评分和溶栓后3个月mRS评分。结果共纳入57例轻型缺血性卒中患者,平均年龄61.7±5.4岁,男性44例(77.2%)。其中对照组24例,优化组33例。两组患者一般资料比较差异无统计学意义。与对照组比较,优化组DNT缩短(68.7±19.1 vs 88.8±23.1 min,P=0.001),DNT≤60 min的患者比例更高(42.4%vs 12.5%,P=0.015);溶栓治疗后3个月mRS评分更低[0(0～0.5)vs 0.5(0～2),P=0.017],良好预后(mRS评分≤1分)患者比例更高(87.9%vs 62.5%,P=0.024)。结论优化溶栓流程可以缩短轻型急性缺血性卒中患者的DNT,提高DNT≤60 min达标率,改善患者3个月预后。     

丁苯酞联合阿替普酶治疗缺血性卒中临床疗效的观察性研究

目的 探讨丁苯酞联合阿替普酶静脉溶栓治疗缺血性卒中的临床疗效及安全性。 方法 回顾性分析青岛大学附属烟台毓璜顶医院急性缺血性卒中行静脉溶栓患者205例的队列，其 中联合治疗组（阿替普酶+丁苯酞组）112例，阿替普酶组93例。分析两组患者溶栓后即刻及14 d后 NIHSS评分，90 d的mRS评分，并分析不同急性卒中治疗低分子肝素试验（Trial of Org 10 172 in Acute Stroke Treatment，TOAST）分型中的临床疗效。同时分析溶栓后14 d症状性颅内出血及死亡情况。 结果 ①溶栓后两组NIHSS评分差异无统计学意义。溶栓后14 d联合治疗组NIHSS评分低于阿替普 酶组，差异有统计学意义（[ 4.82±0.44）分 vs（6.40±0.66）分，P=0.041]。联合治疗组90 d预后良好 率高于阿替普酶组，差异有统计学意义（72.3% vs 55.9%，P =0.014）；其中LAA亚型中联合治疗组患 者NI HSS评分（P =0.023）及预后良好率（P =0.045）均高于阿替普酶组，差异有统计学意义。②治疗 后90 d两组死亡率及14 d颅内出血率差异无统计学意义。③多因素回归分析结果显示丁苯酞是改善 缺血性卒中溶栓患者预后的保护因素（OR 0.425，95%CI 0.216～0.835，P =0.013）；年龄＞60岁（OR 2.233，95%CI 1.047～4.766，P =0.038）、入院时收缩压＞160 mm Hg（OR 2.295，95%CI 1.126～4.679， P =0.022）、溶栓前NIHSS评分＞10分（OR 9.354，95%CI 4.049～21.610，P＜0.001）是预后的独立危险 因素。 结论 丁苯酞联合阿替普酶静脉溶栓治疗缺血性卒中患者能改善90 d临床预后，对LAA患者可能更 有效。     

不同严重程度缺血性卒中患者静脉溶栓后失语改善情况分析

目的 比较不同严重程度急性缺血性卒中（acute ischemic stroke,AIS）患者rt-PA静脉溶栓后失语改 善的比例及程度。 方法 回顾性分析2015年4月-2017年3月在郑州人民医院神经内科卒中中心连续入院接受rt-PA静 脉溶栓治疗的AIS患者360例,根据NIHSS评分分为NIHSS评分≤8分组和NIHSS评分＞8分组。收集两组 患者的年龄、性别、高血压病史、糖尿病病史、心脏病病史、吸烟饮酒史、LDL-C、发病至溶栓时间等 基线资料。比较两组患者溶栓24 h后神经功能显著好转、失语改善的比例差异,并比较两组失语改 善程度的差异。 结果 共计纳入伴有失语的AIS患者158例,其中NIHSS评分≤8分患者49例,NIHSS评分＞8分患者109 例,两组基线资料及溶栓24 h后神经功能显著好转等指标差异无统计学意义;NIHSS评分≤8分组溶 栓24 h后失语改善比例高于NIHSS评分＞8分组（67.3% vs 45.9%,P =0.021）,NIHSS评分≤8分组失语 完全改善比例高于NIHSS评分＞8分组（69.7% vs 44.0%,P =0.021）。 结论 伴有失语的AIS患者rt-PA静脉溶栓24 h后,NIHSS评分≤8分患者失语改善比例高于NIHSS评分 ＞8分患者。     

应用移动卒中单元对急性缺血性卒中院前静脉溶栓的初步探索

目的 大多数急性缺血性卒中患者难以在发病早期接受静脉溶栓治疗,而移动卒中单元（mobile stroke unit,MSU）的应用将静脉溶栓治疗从院内提到院前。本研究初步探讨中国首台MSU在急性卒中 患者院前静脉溶栓中的作用。 方法 回顾性分析荥阳市人民医院卒中中心2018年11月-2019年4月期间应用MSU进行院前静脉溶 栓的患者（MSU溶栓组）和使用传统救护车转运至院内静脉溶栓的患者（常规溶栓组）的临床资料。 观察终点包括主要时间指标从呼叫至溶栓时间、从发病至溶栓时间;疗效指标为90 d良好预后（mRS 评分≤2分）率;安全性指标包括溶栓后48 h内症状性颅内出血及随访90 d内的全因死亡。比较静脉 溶栓患者应用两种治疗模式的终点差异。 结果 MSU溶栓组共计14例患者接受了院外静脉溶栓,同时期常规溶栓组有24例患者在院内进行了 静脉溶栓治疗。与常规溶栓组相比,MSU溶栓组呼叫至溶栓时间（59 min vs 92 mi n,P =0.001）、发病 至溶栓时间（73 min vs 114 mi n,P =0.002）均较短。两组的90 d良好预后率（79% vs 67%,P =0.488） 和安全性指标均未见统计学差异。 结论 基于MSU的急性缺血性卒中院前溶栓可以显著缩短患者从发病至溶栓时间及呼叫至溶栓时 间,但对于急性卒中的救治疗效仍需要多中心前瞻性研究进一步验证。     

高龄急性轻型缺血性卒中早期阿替普酶静脉溶栓疗效观察

目的 探讨高龄轻型缺血性卒中3 h内行阿替普酶静脉溶栓治疗的疗效及安全性。 方法 将我院2015年10月-2017年10月连续收治入院的发病3 h内48例高龄急性轻型缺血性卒中患者 随机分为阿替普酶静脉溶栓组24例和未溶栓组24例。比较两组患者入院时的一般情况,基线美国 国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NHISS）评分,治疗24 h后颅内出 血转化率,治疗后90 d改良Rankin量表（modified Rankin Scale,mRS）评分及90 d病死率。 结果 阿替普酶静脉溶栓组和未溶栓组患者一般临床资料、基线NIHSS评分比较,差异无统计学意 义。阿替普酶静脉溶栓组和未溶栓组治疗24 h后颅内出血转化率分别为4.17%和0（P =1.000）,两组 90 d病死率均为4.17%（P =1.000）,阿替普酶静脉溶栓组及未溶栓组90 d mRS评分为0～2分的比率 分别为83.33%和54.17%（P =0.029）。 结论 早期阿替普酶静脉溶栓治疗高龄急性轻型缺血性卒中不增加急性期颅内出血转化的风险, 可以改善高龄轻型缺血性卒中患者预后,不增加病死率。     

急性缺血性卒中静脉溶栓桥接血管内治疗的疗效和安全性

目的 观察rt-PA静脉溶栓桥接血管内治疗急性缺血性卒中的临床疗效和安全性。 方法 回顾性纳入2017年1-12月郑州市第一人民医院神经重症科收治的前循环急性缺血性卒中患 者,按rt-PA静脉溶栓后是否桥接血管内治疗分为单纯静脉溶栓组和桥接治疗组。主要疗效结局为治 疗后3个月mRS评分,次要疗效结局为24 h、3 d和30 d的NI HSS评分。安全性结局为2 d症状性颅内出血及 其他部位出血、10 d全因死亡。 结果 共入组56例患者,平均年龄60.77±12.72岁,男性35例（62.5%）。单纯静脉溶栓组39例,桥接 治疗组17例。桥接治疗组3个月mRS评分≤2分比例高于单纯静脉溶栓组（88.2% vs 56.4%,P =0.021）。 两组治疗后24 h、3 d和30 d NIHSS评分差异无统计学意义。两组2 d症状性颅内出血率及其他部位出血 率、10 d全因死亡率差异无统计学意义。 结论 rt-PA静脉溶栓桥接血管内治疗可改善急性缺血性卒中患者3个月预后。     

脑小血管病总负荷评分与静脉溶栓治疗急性缺血性卒中患者1年预后相关性研究

目的 探讨脑小血管病（cerebral small vessel disease，CSVD）总负荷评分与急性缺血性卒中（acute ischemic stroke，AIS）患者静脉溶栓后1年预后的关系。 方法 前瞻性连续纳入2017年1月-2018年12月于深圳市人民医院神经内科住院并接受rt-PA静脉溶 栓治疗的AIS患者，根据MRI评估CSVD负荷并计算CSVD总负荷评分。使用mRS量表评估患者发病1年的 神经功能预后，利用多因素Logistic回归分析确定CSVD的总负荷与1年的神经功能预后之间的关系，利 用ROC曲线分析CSVD总负荷评分对不良预后的预测价值及最佳界值。 结果 最终入组135例静脉溶栓的AIS患者，平均年龄为61.56±12.64岁，CVSD总负荷评分0分者17例 （12.59%），1分者44例（32.59%），2分者38例（28.15%），3分者30例（22.22%），4分者6例（4.44%）。 多因素分析发现溶栓前NIHSS评分（OR 1.615，95%CI 1.209～2.157，P =0.001）、CSVD总负荷评分（OR 1.570，95%CI 1.095～4.094，P =0.026）为AIS静脉溶栓患者1年功能预后的独立影响因素。CSVD总负 荷预测静脉溶栓后1年不良预后的ROC曲线下面积（area under the ROC curve，AUC）为0.735（95%CI 0.641～0.828），最佳界值为2.5分；溶栓前NIHSS评分的AUC为0.773（95%CI 0.684～0.862），最佳界 值为6.5分。 结论 CSVD总负荷评分及溶栓前NIHSS评分为AIS患者静脉溶栓治疗1年功能预后不良的可靠预测指 标，有助于临床评估静脉溶栓患者长期预后。     

急性缺血性卒中患者脑小血管病总负荷与静脉溶栓治疗转归的关系研究

目的 探讨急性缺血性卒中（acute ischemic stroke,AIS）患者脑小血管病（cerebral small vessel disease,CSVD）总体负荷与静脉溶栓治疗转归的关系。 方法 回顾性纳入2012年3月-2018年1月于同济大学附属同济医院神经内科接受静脉溶栓治疗的 AIS患者,根据头颅MRI评估CSVD总体负荷（CSVD总负荷评分）,在发病后90 d时采用mRS量表评估患 者预后,良好预后定义为mRS评分≤2分。使用多因素Logistic回归分析AIS静脉溶栓患者90 d预后不良 （mRS评分≥3分）及住院期间并发症（住院期间新发的肺部感染、消化道出血和泌尿道感染）的独立 影响因素。 结果 最终纳入178例患者,平均年龄62.3±10.5岁,其中男性125例（70.2%）。90 d预后良好患者 共128例（71.9%）。多因素分析显示：糖尿病（OR 2.919,95%CI 1.044～8.162,P =0.041）,吸烟（OR 7.752,95%CI 2.300～26.192,P =0.001）,心房颤动（OR 6.553,95%CI 1.733～24.785,P =0.006）,基线 NIHSS评分（每增加1分：OR 1.354,95%CI 1.224～1.497,P＜0.001）,CSVD总负荷评分≥3分（OR 3.787, 95%CI 1.127～12.728,P =0.031）是AIS患者静脉溶栓90 d预后不良的独立危险因素。基线NIHSS评分 （每增加1分：OR 1.266,95%CI 1.163～1.377,P＜0.001）及CSVD总负荷评分≥3分（OR 4.643,95%CI 1.562～13.801,P =0.006）是AIS静脉溶栓患者住院期间并发症的独立危险因素。 结论 CSVD总负荷评分≥3分是静脉溶栓患者90 d不良预后的独立危险因素。     

单核细胞与高密度脂蛋白胆固醇比值与急性缺血性卒中静脉溶栓短期预后的关系

目的 探讨单核细胞与HDL-C比值（monocyte-to-HDL cholesterol ratio,MHR）与急性缺血性卒中 （acute ischemic stroke,AIS）静脉溶栓短期预后的关系。 方法 回顾性纳入2015年1月1日-2017年12月1日在郑州大学第一附属医院神经内科急诊接受静脉 溶栓治疗的AIS患者。患者预后通过90 d mRS来评估,良好预后定义为mRS评分≤2分。采用多因素 Logistic回归分析MHR及其他基线资料与90 d预后的关系,应用ROC曲线评价MHR对预后的预测价值。 结果 共纳入281例患者,平均年龄59.54±12.49岁,男性183例（65.1%）,良好预后223例（79.4%）。 多因素Logistic回归分析显示,高龄（OR 1.03,95%CI 1.01～1.06,P =0.013）、溶栓前NI HSS评分高（OR 1.31,95%CI 1.17～1.44,P＜0.001）和高MHR（OR 2.39,95%CI 1.10～5.25,P =0.028）是AIS静脉溶栓患 者90 d不良预后的独立影响因素。亚组分析显示,高MHR（OR 5.15,95%CI 1.28～20.77,P =0.021）是 大动脉粥样硬化型AIS静脉溶栓90 d不良预后的独立影响因素。ROC曲线分析显示,MHR预测预后不良 的最佳界值为0.48,其敏感度和特异度分别为79.41%和58.33%。 结论 MHR是AIS尤其大动脉粥样硬化型静脉溶栓短期预后的独立影响因素。     

红细胞分布宽度与急性缺血性卒中静脉溶栓患者发病严重程度及预后的关系研究

目的 探讨红细胞分布宽度（red blood cell distribution width,RDW）与急性缺血性卒中（acute ischemic stroke,AIS）静脉溶栓患者发病严重程度及预后的关系。 方法 回顾性分析2016年1月-2019年5月于同济大学附属杨浦医院神经内科接受阿替普酶静脉溶 栓治疗的急性缺血性卒中患者的临床资料。将发病后3个月的mRS评分≥2分定义为预后不良。根据 RDW四分位数将患者分为四组,分析RDW与患者入院时NIHSS评分的相关性,多因素Logistic回归分析预 后不良的独立影响因素,绘制ROC曲线分析RDW对溶栓患者预后不良的预测价值。 结果 最终共纳入363例患者,男性232例（63.9%）,年龄34～95岁,平均71.15±12.42岁。207 例（57.0%）预后良好,156例（43.0%）预后不良。①RDW与入院时NI HSS评分呈正相关（ρ=0.224, P <0.001）;②多因素Logi sti c回归分析显示既往卒中史（OR 2.257,95%CI 1.302～3.914,P =0.004）, 入院时NI HSS评分较高（OR 1.145,95%CI 1.084～1.209,P ＜0.001）,基线收缩压高（OR 1.015, 95%CI 1.005～1.024,P =0.002）,高龄（OR 1.023,95%CI 1.002～1.044,P =0.030）和RDW较高（OR 1.308,95%CI 1.072～1.694,P =0.011）是溶栓患者3个月预后不良的独立危险因素;③RDW预测溶栓 患者预后不良的ROC曲线下面积是0.618（95%CI 0.561～0.676,P＜0.001）,最佳界值为12.75%,敏感 度为65.4%,特异度为55.1%。 结论 RDW与AIS溶栓患者入院时的卒中严重程度呈正相关,是3个月预后不良的独立危险因素,对 预后具有一定的预测价值。