法舒地尔对糖尿病脑梗死患者血脂及血液流变学的影响

目的探讨急性脑梗死合并糖尿病患者法舒地尔治疗对血脂及血液流变学的影响,为急性脑血管病的预防和治疗提供可靠的依据。方法采用全自动血液黏度仪检测血黏度,全自动生化分析仪检测甘油三酯、胆固醇。结果急性脑梗死合并糖尿病患者血黏度及血脂水平明显高于正常对照组,脑梗死伴糖尿病患者血液黏度及血脂高于单纯脑梗死组,法舒地尔治疗能够降低脑梗死合并2型糖尿病患者血黏度,同时对血脂也有作用。结论急性脑梗死疾病发生过程中,血黏度及血脂异常为重要发病因素,且糖尿病患者存在血黏度增高、血脂代谢异常,加重脑血管病的发生,法舒地尔在治疗急性脑梗死及脑梗死合并2型糖尿病中能明显降低血黏度及血脂,在脑梗死合并2型糖尿病患者中具有治疗作用。     

2型糖尿病并脑梗死患者血清尿酸和血脂水平改变

目的探讨2型糖尿病患者血清尿酸及血脂水平与脑梗死的关系。方法随机选择188例病人,分为2型糖尿病合并脑梗死组和单纯脑梗死组,另选81例健康体检者,测定各组患者的血清尿酸及血脂水平,并进行分析。结果2型糖尿病合并脑梗死患者血清尿酸及血脂(CHOL、TG、LDL)水平明显升高(P<0.01)。结论高尿酸血症及高脂血症是2型糖尿病并发脑梗死的主要危险因素。     

2型糖尿病并脑梗死患者血清尿酸和血脂水平改变

目的探讨2型糖尿病患者血清尿酸及血脂水平与脑梗死的关系。方法随机选择188例病人，分为2型糖尿病合并脑梗死组和单纯脑梗死组，另选81例健康体检者，测定各组患者的血清尿酸及血脂水平，并进行分析。结果2型糖尿病合并脑梗死患者血清尿酸及血脂（CHOL、TG、LDL）水平明显升高（P〈0．01）。结论高尿酸血症及高脂血症是2型糖尿病并发脑梗死的主要危险因素。     

脑梗死合并2型糖尿病患者梗死特点及血清学分析

目的探讨合并2型糖尿病的脑梗死患者梗死特点及血清生化指标变化。方法选取2017-05—2018-04在河南大学第一附属医院进行诊治的120例脑梗死患者,根据是否合并2型糖尿病分为A组(脑梗死合并2型糖尿病)和B组(脑梗死未合并2型糖尿病),每组60例。比较2组患者的病情、血脂及血清UA、TNF?α、ADPN、hs-CRP、Hcy水平。结果 A组患者大面积梗死、腔隙性梗死、多发性梗死、再发性梗死的比例均明显高于B组,2组比较差异有统计学意义(P0.05);A组患者的尿酸以及血脂水平均明显高于B组,2组比较差异均具有统计学意义(P0.05);A组患者的TNF?α、Hcy、Hs-CRP水平均明显高于B组,而ADPN水平明显低于B组,2组比较差异均具有统计学意义(P0.05)。结论合并2型糖尿病的脑梗死患者其梗死病情以及预后与患者的血糖水平均有密切关系,因此尽早地控制血糖及血脂水平,对于脑梗死的治疗和预后具有重要的促进作用。     

血糖水平对2型糖尿病合并脑梗死患者预后影响的临床分析

目的探讨血糖水平对2型糖尿病合并脑梗死患者预后的影响。方法117例2型糖尿病合并脑梗死患者分为A、B、C 3组进行预后分析。结果空腹血糖在<16.7mmol/L范围内时(A组和B组),血糖水平与疗效间无明显关系,但随着血糖水平的逐渐增高(C组≥16.7mmol/L),2型糖尿病合并脑梗死患者的疗效呈显著下降。结论2型糖尿病合并脑梗死患者的预后随血糖升高而加重。     

糖尿病并发脑梗死患者脂质的过氧化及对氧磷酯酶活性的变化

目的 探讨2型糖尿病患者及并发脑梗死时体内脂质过氧化物含量及血清对氧磷酯酶-1(PON1)活性的变化及两者之间的关系。方法测定2型糖尿病无并发症组,合并脑梗死组和正常对照组PON1活性,丙二醛(MDA)含量及血脂水平。结果 2型糖尿病组血清PON1活性显著降低,丙二醛含量明显增高,合并脑梗死时PON1活性下降更明显,而丙二醛含量更高,PON1活性与丙二醛含量呈负相关。结论 2型糖尿病患者脂质过氧化物产生增多,血清PON1活性降低促进脑梗死的发生。     

糖尿病并脑梗死36例治疗体会

目的探讨2型糖尿病合并脑梗死的临床特点,提高临床早期诊断及治疗的效果。方法回顾性分析36例糖尿病合并脑梗死患者诊疗资料,并与同期36例非糖尿病性脑梗死患者的治疗资料进行对比。结果 糖尿病合并脑梗死患者的血脂紊乱及血压异常发生率、梗死面积均明显增高,且治疗效果差。与非糖尿病性脑梗死患者对比,2组间差异有统计学意义（P〈0.05）。结论 糖尿病并脑梗死的发生和预后主要与血糖、高血压、脂质代谢紊乱、高凝状态长期损害关系密切,控制血糖、血压、血脂及早期诊断等综合措施,对提高糖尿病性脑梗死早期干预和治疗效果具有积极意义。     

糖尿病并发脑梗死患者脂质的过氧化及对氧磷酯酶活性的变化

目的探讨2型糖尿病患者及并发脑梗死时体内脂质过氧化物含量及血清对氧磷酯酶-1(PON1)活性的变化及两者之间的关系。方法测定2型糖尿病无并发症组，合并脑梗死组和正常对照组PON1活性，丙二醛(MDA)含量及血脂水平。结果2型糖尿病组血清PON1活性显著降低，丙二醛含量明显增高，合并脑梗死时PON1活性下降更明显，而丙二醛含量更高，PON1活性与丙二醛含量呈负相关。结论2型糖尿病患者脂质过氧化物产生增多，血清PON1活性降低促进脑梗死的发生。     

血浆同型半胱氨酸水平与老年2型糖尿病合并脑梗死的相关性分析

目的研究血浆同型半胱氨酸(Hcy)水平与老年2型糖尿病合并脑梗死患者的关系。方法选择我院住院的老年2型糖尿病合并脑梗死患者53例(观察组),单纯老年2型糖尿病患者38例(对照组),检测血浆Hcy水平、空腹血糖、糖化血红蛋白及各项血脂指标,研究其相关性。结果在2组患者血糖糖化血红蛋白的均控制相对良好的情况下,观察组血脂、血浆同型半胱氨酸水平明显高于对照组,2组比较差异有统计学意义(P<0.05)。结论 Hcy是老年2型糖尿病合并脑梗死患者的重要危险因素之一。     

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。     

Risk factors for progressive ischemic stroke——A retrospective analysis

BACKGROUND: Progressive ischemic stroke has higher fatality rate and disability rate than common cerebral infarction, thus it is very significant to investigate the early predicting factors related to the occurrence of progressive ischemic stroke, the potential pathological mechanism and the risk factors of early intervention for preventing the occurrence of progressive ischemic stroke and ameliorating its outcome. OBJECTIVE: To analyze the possible related risk factors in patients with progressive ishcemic stroke, so as to provide reference for the prevention and treatment of progressive ishcemic stroke. DESIGN: A retrospective analysis. SETTING: Department of Neurology, General Hospital of Beijing Coal Mining Group. PARTICIPANTS: Totally 280 patients with progressive ischemic stroke were selected from the Department of Neurology, General Hospital of Beijing Coal Mining Group from March 2002 to June 2006, including 192 males and 88 females, with a mean age of (62±7) years old. They were all accorded with the diagnostic standards for cerebral infarction set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1995, and confired by CT or MRI, admitted within 24 hours after attack, and the neurological defect progressed gradually or aggravated in gradients within 72 hours after attack, and the aggravation of neurological defect was defined as the neurological deficit score decreased by more than 2 points. Meanwhile, 200 inpatients with non-progressive ischemic stroke (135 males and 65 females) were selected as the control group. METHODS: After admission, a univariate analysis of variance was conducted using the factors of blood pressure, history of diabetes mellitus, fever, leukocytosis, levels of blood lipids, fibrinogen, blood glucose and plasma homocysteine, cerebral arterial stenosis, and CT symptoms of early infarction, and the significant factors were involved in the multivariate non-conditional Logistic regression analysis. MAIN OUTCOME MEASURES: Results of the univariate analysis of variance of the factors related to progressive ischemic stroke; Results of the multivariate regression analysis. RESULTS: All the 480 patients were involved in the analysis of results. ① Results of the univariate analysis variance: There were significantly more patients with fever, leukocytosis, history of diabetes mellitus, cerebral arterial stenosis and CT symptoms of early infarction in the progressive ischemic stroke group than in the control group (P < 0.01); The levels of blood glucose and fibrinogen in the progressive ischemic stroke group were significantly higher than those in the control group, while the level of blood pressure was significantly lower than that in the control group (P < 0.05–0.01). ② Results of the multivariate Logistic regression analysis: The independent predicting factors for progressive ischemic stroke were history of diabetes mellitus, fever, leukocytosis, cerebral arterial stenosis, CT symptoms of early infarction, blood glucose and blood pressure (OR =2.61, 2.96, 3.79, 1.03, 3.57, 2.68, 95% CI 0.92–3.59, P < 0.05–0.01). CONCLUSION: History of diabetes mellitus, fever, leukocytosis, levels of blood pressure, blood glucose, cerebral arterial stenosis and CT symptoms of early infarction are the risk factors for progress ischemic stroke     

急性脑梗死合并2型糖尿病患者血清Caveolin-1的水平变化及其与早期神经功能恶化的关系

目的 探讨急性脑梗死合并2型糖尿病患者血清陷窝蛋白-1(Caveolin-1)的水平变化及其与早期神经功能恶化(END)的关系。方法 选择2018年1月-2019年12月本院收治的急性脑梗死合并2型糖尿病患者、急性脑梗死患者、2型糖尿病患者、健康志愿者,检测血清Caveolin-1的水平,评价急性脑梗死合并2型糖尿病患者的END,采用Logistic回归分析END的影响因素,采用ROC曲线分析Caveolin-1水平对END的预测价值。结果 急性脑梗死合并2型糖尿病组患者的血清Caveolin-1水平高于急性脑梗死组、2型糖尿病组、对照组(P<0.05); 急性脑梗死合并2型糖尿病组END患者的Caveolin-1水平、女性比例、入院时NIHSS评分、起病至入院时间、糖化血红蛋白、随机血糖、hs-CRP水平均高于非END患者(P<0.05); logistics回归分析显示,Caveolin-1水平增高、女性、糖化血红蛋白水平增高及入院时NIHSS评分增加是急性脑梗死合并2型糖尿病组患者END的危险因素(P<0.05); ROC曲线分析显示,血清Caveolin-1对急性脑梗死合并2型糖尿病患者的END具有预测价值,最佳截点为34.95 ng/mL。结论 血清Caveolin-1水平升高是急性脑梗死合并2型糖尿病患者END的危险因素,且对END具有预测价值。     

急性脑梗死患者氯吡格雷抵抗的相关因素研究

目的 探讨急性脑梗死患者氯吡格雷抵抗(clopidogrel resisitance,CR)的相关因素。方法 收集急性脑梗死患者100例,入院后连续口服氯吡格雷7 d后空腹抽取肘静脉血,用血栓弹力图(thromboelastograms,TEG)测得二磷酸腺苷(adenosine diphosphate,ADP)受体途径诱导的血小板抑制率,将患者分为氯吡格雷抵抗组(CR)和氯吡格雷敏感组(clopidogrel sensitivity,CS); 根据2组患者的临床检测水平和Logistic回归分析引起CR的因素。结果 31例患者出现氯吡格雷抵抗,发生率为31%。单因素分析发现并发2型糖尿病、LDL-C水平、空腹血糖水平(FPG)差异明显(P<0.05)。多因素Logistic回归分析发现,2型糖尿病(OR=13.198,P<0.05)、LDL-C水平(OR=0.349,P<0.05)是引起CR的独立危险因素。结论 部分急性脑梗死患者会出现氯吡格雷抵抗,2型糖尿病、LDL-C水平是其独立危险因素。     

Blood flow velocities of cerebral arteries in lacunar infarction and other ischemic strokes

Blood flow velocity is an important determinant of vascular hemodynamics. The aim of the present study was to determine the mean flow velocities (MFVs) of cerebral arteries in patients with ischemic stroke, comparing lacunar and nonlacunar infarctions. 388 consecutive patients were examined for lacunar infarction, other subtypes of ischemic stroke, and the presence of underlying internal carotid artery steno-occlusion (ICS). MFVs were measured using transcranial Doppler along the full segments of each cerebral artery including both right and left middle cerebral arteries, basilar artery, and both of the vertebral arteries. The patients were categorized into two major groups: lacunar infarction, and nonlacunar infarction with or without underlying ICS. The characteristics of patients with lacunar infarction (n=83, 21.4%) were significantly different from those with nonlacunar infarctions: younger age, lower prevalence of type 2 diabetes, and lower concentration of plasma total homocysteine. The patients with lacunar infarction had lower MFVs in cerebral arteries than the patients with nonlacunar infarctions, especially in the posterior circulation vessels such as the basilar artery and both vertebral arteries. Different hemodynamics might be pathophysiologically associated with the lacunar infarction, compared with the other subtypes of ischemic stroke.     

Changing cerebral blood flow velocity by transcranial Doppler during head up tilt in patients with diabetes mellitus

ObjectiveDiabetes mellitus is an independent risk factor for poor prognosis in patients with ischemic stroke. It is known that diabetes mellitus directly affects cerebral vasculature as a secondary, long-term complication of cerebral circulation, and causes cerebral blood flow abnormalities. The abnormalities of cerebral autoregulation also poorly affects the prognosis of ischemic stroke. In this study, we aimed to show the cerebral autoregulation with transcranial Doppler (TCD) ultrasound in diabetic patients with autonomic nervous system abnormalities, determined with electrophysiological studies.Material and methodTwenty healthy controls and 39 patients, who had at least 2 years of diabetes mellitus, were evaluated (age ranges: 42–75 years). The patients were divided into two groups according to sympathetic skin response and R–R interval variation studies: (1) patients with autonomic neuropathy; (2) patients without autonomic neuropathy. Blood flow velocities were measured during supine position and after the patients were raised upright position on head up tilt table. Arterial blood pressures and heart rates were also evaluated.ResultsMean blood flow velocities of diabetic patients with autonomic neuropathy were found more decreased at 90 s after the patients were raised upright position.DiscussionAutonomic neuropathy due to diabetes mellitus affects cerebral autoregulation, and by this way cerebral perfusion loses protection against hemodynamical changes.     

糖尿病并脑梗死患者氧化型低密度脂蛋白检测及临床意义

目的 通过检测合并糖尿病的急性脑梗死患者血浆中氧化型低密度脂蛋白（ox-LDL）水平,探讨其与病灶特点、病情轻重、临床转归的关系.方法 选择发病48 h内的急性脑梗死患者124例,其中合并糖尿病组64例,无糖尿病组60例.选择同期住院的其他类型缺血性脑血管病（TIA及眩晕症）患者71例为对照组.所有患者均采用国内统一试剂盒进行ox-LDL水平测定.结果 脑梗死合并糖尿病组ox-LDL水平明显高于无糖尿病组及对照组,差异有统计学意义（P〈0.05）;合并糖尿病组腔隙性梗死比例相对较高,且与无糖尿病组相比,病情进展率、重型比例高,临床转归较差.结论 糖尿病并急性脑梗死患者ox-LDI水平显著增高,且与脑梗死病情进展及病情轻重相关.     

糖尿病脑梗死及非糖尿病高血压脑梗死患者的临床研究

目的 探讨糖尿病脑梗死与非糖尿病高血压脑梗死患者的临床特点.方法 糖尿病并发脑梗死患者85例,其中糖尿病高血压脑梗死组57例,糖尿病正常血压脑梗死组28例;同期住院的无糖尿病高血压脑梗死组40例;正常对照组40例.观察血压、血糖、血脂、肾功能及预后.结果 高血压脑梗死组的舒张压(DBP)及平均动脉压(MAP)明显高于糖...     

2型糖尿病合并脑梗死患者颈动脉、血脂及血浆纤维蛋白原的变化

目的 探讨2型糖球病合并脑梗死（DC1）患者颈动脉、血脂及血浆纤维蛋白原（Fg）的变化。方法 对58例DC1患者（DC1组）及36例非糖尿病不合并脑梗死患者（对照组）进行颈动脉超声检测，观察颈动脉粥样硬化斑块的部位、数目、性质和颈动脉内径；并作血糖、血脂和Fg含量测定。结果 DC1组颈动脉粥样硬化斑块的发生率（79．3％）、颈总动脉（CCA）内膜-中层厚度（1MT）和CCA内径与对照组比较差异有极显著性（均P〈0．01），斑块发生部化以CCA分叉处及颈内动脉（ICA）入口和起始处最多（86．0％）；以软斑为主（62．5％）。脑梗死部位与出现斑块的颈动脉存在同侧相关性（P〈0．01）。DC1组血糖、总胆固醇、三酰甘油及Fg较对照组显著增高（均P〈0．01）。结论 DC1患者大多有颈动脉粥样硬化及血脂、血糖、Fg水平异常，对糖尿病患者颈动脉粥样硬化斑块和血脂、血糖等异常进行早期干预，对预防脑梗死的发生有重要临床意义。     

脑梗死急性期血压变化特点及其与进展性脑梗死的关系

目的 观察脑梗死急性期血压变化特点,探讨其与进展性脑梗死的关系。方法 收集2013年7月～2014年4月本院收治的急性脑梗死患者129例。采用斯堪地那维亚卒中量表(Scandinavian Stroke Scale,SSS)评估病情是否发生进展,监测患者发病后72 h内的血压,分析血压变化特点及其与进展性脑梗死的关系。结果 脑梗死发病72 h内血压呈逐渐降低趋势。进展组患者高血压病史患病率显著高于非进展组,且各时段平均血压也显著高于非进展组。无高血压病史的患者各时段平均血压进展组显著高于非进展组,而有高血压病史的患者各时段平均血压2组比较无显著差异。结论 脑梗死急性期血压呈自发性下降。对于无高血压病史的患者急性期血压增高与进展性脑梗死有关,而对有高血压病史的患者急性期血压增高或许有保护作用。     

青年烟雾病患者的卒中类型及危险因素分析

目的 探索青年烟雾病患者的卒中类型及临床特征,分析青年烟雾病患者发生卒中的危险因素。 方法 回顾性纳入2020年1月-2021年12月解放军总医院第五医学中心收治的青年（18～45岁）卒中型烟雾病患者,将患者分为出血性卒中组和缺血性卒中组进行亚型分析,对比不同卒中类型患者的临床及影像学特征。并以同期未发生卒中的烟雾病患者作为对照组,应用多因素logistic回归分析青年烟雾病患者发生出血性或缺血性卒中的危险因素。 结果 共入组108例卒中型烟雾病患者,其中出血性卒中22例（20.4%）,缺血性卒中86例（79.6%）。出血性卒中组中脑室出血12例（54.5%）,脑实质出血7例（31.8%）,蛛网膜下腔出血3例（13.6%）。缺血性卒中组中大动脉梗死型21例（24.4%）,血流动力学梗死36例（41.9%）,穿支动脉梗死29例（33.7%）。出血性卒中组与缺血性卒中组性别和合并动脉瘤者比例的差异有统计学意义。无卒中对照组共104例,多因素logistic回归分析结果显示,合并动脉瘤（OR?10.569,95%CI?1.524～73.274,P=0.017）为青年烟雾病患者发生出血性卒中的独立危险因素;增龄（OR?1.058,95%CI?1.004～1.115,P=0.034）、合并糖尿病（OR?4.005,95%CI?1.766～9.080,P=0.001）、高铃木分期（OR?1.363,95%CI 1.037～1.793,P=0.027）为青年烟雾病患者发生缺血性卒中的独立危险因素。 结论 青年烟雾病患者的卒中类型以缺血性卒中为主。血流动力学梗死和脑室出血分别是缺血性卒中和出血性卒中的主要类型。增龄、高铃木分期、合并糖尿病和颅内动脉瘤是引起青年烟雾病患者卒中的独立危险因素。