血管生成素1与急性缺血性脑卒中患者短期预后的相关性

目的探讨血管生成素1与急性缺血性脑卒中患者短期预后的相关性。方法选取2017年12月至2018年12月湖北省恩施土家族苗族自治州中心医院脑病科,接受治疗的急性缺血性脑卒中患者100例,检测患者入院第2天外周血中血管生成素1水平。按照3个月后改良Rankin量表评分(mRS评分)将患者分为预后良好组(0～2分)和预后不良组(3～6分)。ROC曲线被用于评估血管生成素1对预后不良诊断价值,观察血管生成素1与急性缺血性脑卒中患者短期预后的相关性。结果共32例患者预后不良。预后不良组患者血糖、甘油三酯水平,合并心房颤动比例、脑卒中史、治疗前美国国立研究院卒中量表(NIHSS)评分高于预后良好组,血管生成素1水平低于预后良好组,差异有统计学意义(P <0.05)。血管生成素1诊断短期预后不良的最佳临界点为3.02 ng/mL,灵敏度为63.2%,特异度为78.4%。ROC曲线下面积为0.74。溶栓前血糖、甘油三酯、血管生成素1、治疗前NIHSS评分是急性缺血性脑卒中患者短期预后不良的独立影响因素(OR=1.654、1.549、1.224、2.777,均P <0.05)。结论急性缺血性脑卒中患者血管生成素1降低者预后不良,血管生成素1或可作为急性缺血性脑卒中短期预后不良的预测指标。     

新疆地区青年人群血浆同型半胱氨酸水平与急性缺血性脑卒中的关系

目的]探讨新疆地区青年人群血浆同型半胱氨酸水平与急性缺血性脑卒中的关系。[方法]选取2019年1月—2020年12月在新疆医科大学第一附属医院神经内科住院的青年急性缺血性脑卒中患者186例作为观察组,随机选取同期住院的非心脑血管疾病患者180例作为对照组。观察组患者根据入院时美国国立卫生研究院卒中量表评分分为轻度神经功能损伤组、中度神经功能损伤组和重度神经功能损伤组;根据颈动脉内膜中膜厚度分为正常内膜组、内膜增厚组、斑块形成组和颈动脉狭窄组;参照14天时改良Rankin量表评分分为短期预后良好组和短期预后不良组。比较各组的临床资料及实验室结果,探究青年缺血性脑卒中发生、颈动脉粥样硬化和短期不良预后的危险因素。[结果]青年急性缺血性脑卒中患者血浆同型半胱氨酸水平明显高于对照组(P＜0.05);青年发生急性缺血性脑卒中的风险随着同型半胱氨酸水平升高而增加;中度、重度神经功能损伤组患者的血浆同型半胱氨酸水平均高于轻度神经功能损伤组患者(P＜0.05);同型半胱氨酸是青年急性缺血性脑卒中患者颈动脉粥样硬化(OR=34.194,95%CI:8.184～142.876)和短期不良预后(OR=388.547,95%CI:50.271～3 003.108)的危险因素;同型半胱氨酸预测青年急性缺血性脑卒中短期不良预后的曲线下面积为0.712(95%CI:0.616～0.807),其与白细胞联合预测时曲线下面积为0.831(95%CI:0.745～0.916)。[结论]血浆高同型半胱氨酸水平是新疆地区青年发生急性缺血性脑卒中、颈动脉粥样硬化及短期不良预后的危险因素,并对青年急性缺血性脑卒中患者的短期不良预后有一定的预测价值。     

血清白蛋白及球蛋白水平与急性缺血性脑卒中患者出院结局的关系

目的研究血清白蛋白(ALB)及球蛋白(GLB)水平与急性缺血性脑卒中患者出院结局的关系。方法以48例急性缺血性脑卒中患者为研究对象,问卷调查患者的人口学特征、生活方式、体格检查、疾病相关情况及入院时血清ALB和GLB水平。参照脑卒中量表(mRS)评估患者出院结局,将mRS<3分设为结局良好组,mRS≥3分设为结局不良组。比较两组患者的基本情况差异,并通过多因素非条件Logistic回归方法分析出院结局不良与血清ALB和GLB水平的相关性。结果结局不良组的年龄、复发、发病-入院时间、住院时间、NIHSS评分、SBP值、DBP值和血脂异常比例均高于结局良好组患者,而其血清ALB水平低于结局良好组(P<0.05);回归分析显示,血清ALB<39.8 g/L是患者出院结局不良的危险因素,经调整后发生结局不良的危险性是高水平ALB>43.2 g/L者的3.117倍(P<0.05),而未发现ALB水平为39.8~43.2 g/L与出院结局不良的相关性(P>0.05)。同时,研究未发现不同水平血清GLB与出院结局不良的相关性(P>0.05)。结论血清ALB水平是急性缺血性脑卒中患者出院结局的影响因素,低水平血清ALB可增加患者出院结局不良的发生风险。     

微量白蛋白尿与急性缺血性卒中患者短期转归的相关性

目的 探讨尿微量白蛋白(microalbuminuria, MAU)与急性缺血性卒中患者短期转归的关系.方法 前瞻性纳入住院治疗的连续急性缺血性卒中患者.入院后次日晨起留取首次尿标本测定尿白蛋白/肌酐比率(urine albumin/ creatinine ratio, UACR),UACR 30~300 mg/g定义为MAU阳性.入院时采用美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale, NIHSS)评价卒中严重程度,出院时采用改良Rankin量表(modified Rankin Scale, mRS)评价功能转归,0~2分定义为转归良好.结果 共纳入244例急性缺血性卒中患者,其中53例(21.72%)MAU阳性,67例(27.50%)转归不良.单变量分析显示,MAU阳性组患者年龄、基线NIHSS评分、收缩压、空腹血糖、球蛋白、D-二聚体、白细胞计数、中性粒细胞以及缺血性心脏病构成比显著高于MAU阴性组(P均<0.05).转归不良组基线NIHSS评分、空腹血糖、纤维蛋白原、间接胆红素、直接胆红素、C反应蛋白、D-二聚体、白细胞计数、中性粒细胞以及MAU阳性患者构成比显著高于转归良好组(P均<0.05).多变量logistic回归分析显示,MAU[优势比(odds ratio, OR)1.520,95%可信区间(confidence interval, CI)1.151~1.794;P=0.031]、基线NIHSS评分(OR 1.570,95% CI 1.357~1.808;P<0.001)是急性缺血性卒中患者短期转归不良的独立危险因素.结论 急性缺血性卒中患者的MAU发生率较高,MAU阳性可作为急性缺血性卒中患者短期转归不良的独立预测指标之一.     

入院时血尿素水平与溶栓治疗的老年急性缺血性脑卒中患者短期临床预后的关系

目的探讨入院时血尿素水平与溶栓治疗的老年急性缺血性脑卒中患者短期临床预后的关系。方法回顾性收集在我院接受重组组织型纤溶酶原激活剂静脉溶栓治疗的老年急性缺血性脑卒中患者192例。在溶栓治疗后(90±3)d应用改良的Rankin量表(mRS)评分进行神经功能预后评定,mRS评分0~2分为临床预后良好,mRS评分3~6分为临床预后不良。采用logistic回归分析计算血尿素水平与临床预后不良的关系。结果单因素logistic回归分析显示:心房颤动、血尿素、美国国立卫生研究院卒中量表(NIHSS)评分与不良临床预后相关;小动脉闭塞性脑卒中和原因不明缺血性脑卒中发生不良预后的风险相对较低。多因素logistic回归分析显示:血尿素(OR=1.309,95%CI:1.080~1.587,P=0.006)、NIHSS评分(OR=1.321,95%CI:1.205~1.447,P=0.000)、心房颤动(OR=3.782,95%CI:1.384~10.335,P=0.010)是不良临床预后的独立危险因素。结论入院时血尿素水平是溶栓治疗的老年急性缺血性脑卒中患者90d不良临床预后的独立危险因素。     

急性缺血性脑卒中患者血清微小RNA-590水平变化及意义

目的]探究急性缺血性脑卒中(AIS)患者血清微小RNA-590(miR-590)水平变化及与预后的关系。[方法]选取2019年2月—2020年10月接受静脉溶栓和动脉取栓治疗的176例AIS患者作为研究对象,根据治疗后90天的改良Rankin量表(mRS)评分将其分为预后良好组(n＝123;mRS评分0～2分)、预后不良组(n＝53;mRS评分3～6分)。用实时荧光定量PCR法检测AIS患者血清miR-590水平;用受试者工作特征(ROC)曲线评价miR-590预判AIS预后的价值;用Logistic回归分析AIS预后的风险因素。[结果]预后不良组的年龄、男性占比、糖尿病史占比、空腹血糖(FPG)、总胆固醇(TC)、美国国立卫生研究院卒中量表(NIHSS)评分和入院至溶栓时间(DNT)均高于预后良好组(P＜0.05)。按1∶1进行倾向性评分匹配后,治疗前预后不良组的miR-590相对水平低于预后良好组,预后不良组和预后良好组的治疗后miR-590相对水平均高于治疗前,治疗后预后不良组的miR-590相对水平升高程度高于预后良好组,差异均有统计学意义(P＜0.05)。治疗前miR-590预判AIS预后的ROC曲线下面积为0.793,高于miR-590差值(治疗前和治疗后血清miR-590相对水平的差值)(P＜0.001)。Logistic回归分析结果显示FPG、TC、NIHSS评分和DNT是AIS预后的独立危险因素(P＜0.05),治疗前血清miR-590水平是AIS预后的独立保护因素(P＜0.001)。[结论]AIS患者静脉溶栓和动脉取栓治疗前血清miR-590水平低与AIS预后不良有关。     

老年急性缺血性脑卒中病人心踝指数与血管内皮生长因子、D-二聚体水平的相关性研究

目的探讨60岁以上老年人急性缺血性脑卒中病人心踝血管指数(CAVI)与血清血管内皮生长因子(VEGF)、D-二聚体的相关性。方法选取老年急性脑卒中病人62例为脑卒中组,同期60名老年健康体检者为对照组。采用动脉硬化检测仪(福田VS1000)检测CAVI,用双抗体夹心ELISA法分别检测两组病人血清中VEGF和D-二聚体的含量。结果心踝血管指数脑卒中组与对照组比较,差异有统计学意义(P0.05);脑卒中组血清VEGF和D-二聚体水平与对照组比较,差异有统计学意义(P0.05);相关因素分析脑卒中组病人CAVI与VEGF、D-二聚体呈显著正相关(分别为r=0.539,P0.01;r=0.562,P0.01)。结论老年急性脑卒中病人CAVI与VEGF、D-二聚体水平明显增高,呈显著正相关性,CAVI测量对判断老年急性缺血性脑卒中病人动脉硬化程度及预后有一定的临床指导意义。     

尿酸与急性缺血性脑卒中患者病情严重程度和预后的相关性研究

目的探讨血尿酸水平与急性缺血性脑卒中患者入院时病情严重程度和短期预后的关系。方法选择急性缺血性脑卒中患者496例,根据血尿酸水平分为高尿酸组119例,正常尿酸组377例。收集人口统计学信息、生活方式、疾病史、入院时尿酸水平等,评估患者入院时及出院时临床神经功能。以尿酸274、338和411mmol/L为截取点比较不同血尿酸水平患者短期预后的差异。结果高尿酸组尿酸、神经功能好转率明显高于正常尿酸组[(438.30±80.24)mmol/L vs(274.50±84.82)mmol/L,P=0.000;(62.00±22.00)%vs(57.00±15.00)%,P=0.005],出院时美国国立卫生研究院卒中量表评分明显低于正常尿酸组[(4.80±2.21)分vs(5.60±3.58)分,P=0.022]。与尿酸≥412μmol/L患者比较,尿酸≤274μmol/L患者预后不良明显升高(45.2%vs 29.6%,P<0.05)。结论血尿酸水平与急性缺血性脑卒中患者入院时病情严重程度无相关性,血尿酸水平升高有助于缺血性脑卒中早期神经功能恢复,提示高尿酸水平对急性缺血性脑卒中具有一定的保护作用。     

尿酸与急性缺血性脑卒中早期预后关系的研究

目的探讨血清尿酸与急性缺血性脑卒中早期预后的关系。方法选择2015年3月～2016年3月西安交通大学第一附属医院神经内科连续住院治疗的急性缺血性脑卒中患者421例,根据出院时预后情况分为预后良好组232例[改良的Rankin评分(modified Rankin scale,mRS)0～2分],预后不良组189例(mRS 3～6分)。采集整理患者入院时人口学信息、血管相关危险因素、尿酸等实验室指标、影像学资料及疾病相关临床指标,包括美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分。对2组患者上述临床特点进行比较,并通过非条件logistic回归分析尿酸与急性缺血性脑卒中早期预后的关系。结果预后不良组心房颤动、收缩压、TC、LDL、尿素、NIHSS评分、脑梗死位于大脑前动脉及大脑中动脉、住院时间、死亡和出院mRS评分明显高于预后良好组,尿酸和格拉斯哥昏迷评分明显低于预后良好组,差异有统计学意义(P0.05,P0.01)。非条件logistic回归分析显示,收缩压、NIHSS评分和尿酸为急性缺血性脑卒中患者预后不良的主要因素(OR=1.017,95%CI:1.003～1.031,P=0.018;OR=1.274,95%CI:1.178～1.378,P=0.000;OR=0.993,95%CI:0.989～0.996,P=0.000)。结论血清低尿酸可能与急性缺血性脑卒中早期预后不良相关。     

血浆D-二聚体水平与急性脑梗死患者的预后相关性分析

目的分析血浆D-二聚体水平与急性脑梗死患者的预后之间的相关性。方法将我院收治的41例急性脑梗死患者纳入本次研究,于发病后1d测量41例患者的脑梗死面积,根据患者脑组织梗死面积将患者分为大面积梗死组和非大面积梗死组,对比两组患者血浆D-二聚体水平。于41例患者发病后1d、1周、2周进行血浆D-二聚体检测,根据发病后2周的检测结果将41例患者分为高水平组(血浆D-二聚体水平明显升高)和对照组(血浆D-二聚体水平正常或轻微升高),应用改良Rankin量表(mRS)评价两组患者的预后。结果大面积梗死组的血浆D-二聚体水平高于非大面积梗死组(P0.05)。41例患者发病后1周的血浆D-二聚体水平高于发病后1d和发病后2周(P0.05)。高水平组患者的m RS评分高于对照组(P0.05)。结论急性脑梗死患者发病后血浆D-二聚体水平明显升高,可作为评估患者预后的辅助指标。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.