MTHFR基因多态性检测对判断卒中患者再发预后的临床意义

目的 前瞻性观察N5、N10-亚甲基四氢叶酸还原酶(MTHFR)基因C677T多态性对缺血性卒中(IS)再发及死亡事件发生的影响,为进一步对IS综合干预提供有用情报.方法 检测245例IS患者及52例健康对照者空腹血浆同型半胱氨酸(Hcy)水平及MTHFR基因C677T多态性,并在5年内追踪观察患者IS再发及死亡事件的发生情况.结果 T/T纯合型IS再发率显著高于C/T杂合型和C/C野生型(P<0.05),C/T杂合型高于C/C野生型,但差异无显著性(P>0.05).各基因型之间随访脑梗死再发率、TIA再发率、多次再发患者比例、及死亡发生率差异均无显著性,但均为T/T纯合型高于C/T杂合型,后者高于C/C野生型.Logistic回归分析显示Hcy升高是再发IS的独立危险因素(OR为1.171,95%CI:1.118～1.227,P<0.01),而MTHFR基因C677T突变未进入回归模型.结论 血浆Hey水平升高与IS再发密切相关,MTHFR基因C677T突变导致血浆Hey水平升高,是再发IS遗传易感因素.

Abstract：

Objective To prospectively observe the possible effect of the gene C677T polymorphism of methylene tetrahydrofolate reduetase(MTHFR)on the recurrence of isehemie stroke(IS)and death events in hope for providing a new theoretical evidence for the therapy and the prophylaxis of IS.Methods We determined the free plasma homocysteine (Hey)and MTHFR gene C677T polymorphism of 245 patients with IS and 52 age and gender-matched healthy controls,then we observed the recurrence of IS and death events within a 5-years follow-period.Results The rate of recurrent IS of T/T genotype group was significantly higher than C/T and C/C genotype group(P<0.05),and that of C/T genotype group was higher than C/C genotype group,but the deference Was not statistically significant.The deference of the rate of recurrent cerebral infarction,TIA,the proportion of patients who suffered multiple recurrence,and the death rate among the 3 genotype groups Was not statistically significant(P>0.05),but the occurred rate of every kind of event in T/T genotype group was higher than C/T genotype group,and that of the latter Was higher than C/C genotype group.By forward stepwise logistic analysis,we found that Hey Was an independent risk factor of recurrent IS(OR=1.171;95%CI:1.118～1.227;P<0.01),but gene C677T mutation of MTHFR Was not in the regression model.Conclusions Hey is closely correlated with prognosis of recurrent IS.Gene C677T mutation of MTHFR can cause the rising of Hey and was susceptibility gene of recurrent IS.     

短暂脑缺血发作内源性H2S及CBS检测的意义

目的探讨短暂脑缺血发作（TIA）患者血清内源性硫化氢（H2S）表达水平及胱硫醚-γ-合酶（CBS）活性的变化及临床意义。方法采集60名TIA患者空腹静脉血标本,采用敏感硫电极法测定H2S血清浓度,采用Elisa试剂盒测定CBS活性,与30例健康成年人所测结果进行比较,并对不同预后的患者血清H2S表达水平及CBS活性进行对比分析。结果健康成人外周血内源性H2S表达水平及CBS活性低于TIA患者（P〈0．05）,在TAT患者中,进展为脑梗死患者外周血内源性H2S表达水平及CBS活性高于未进展为脑梗死的患者（P〈0．05）,差异具有统计学意义。结论TIA患者早期即可出现内源性H2S表达水平异常,CBS活性改变,内源性H2S较早地预测、估计TIA演变趋势,对估计病情,预测预后具有重要的临床意义。     

26例椎基底动脉系统短暂性脑缺血发作患者血管成形术后疗效观察

目的 评价椎基底动脉系统短暂性脑缺血发作(TIA)患者血管成形术后近期疗效.方法 回顾性分析26例椎基底动脉系统TIA行血管成型术患者,随访6～9个月,平均(7±0.25)月,就术后短期内临床疗效以及其影响因素进行分析.结果 对26例患者31条病变血管行了支架成形术,技术成功率为100%,狭窄率从术前(82.50±9.95)%降至术后(4.2±3.8)%,术中1例出现脑缺血发作,术后随访6～9个月,24例临床症状完全消失,有效率92.3%,2例症状再发,其中1例术后再狭窄与服抗血小板药物不规范有关.1例血压未控制正常.结论 血管成形术治疗椎基底动脉系统短暂性脑缺血发作的近期疗效令人满意,远期疗效仍有待于进一步临床研究.     

较大剂量阿司匹林联合低分子肝素钠治疗TIA频繁发作56例疗效观察

资料与方法 2004年2月～2005年8月应用较大剂量阿司匹林联合低分子肝素钠（IH—NM）治疗近期频繁发作TIA患者56例,男35例,女21例;年龄50～77岁,平均E14岁。颈内动脉系统TIA32例（肢体单侧无力、麻木20例,失语6例,一过性黑矇2例,Homer征交叉瘫2例,同向偏盲2例）,椎-基底动脉系统TIA24例（眩晕、共济失调19例,突然跌倒1例,短暂性全面性遗忘3例,一侧面部口周麻木及交叉感觉障碍1例）,TIA平均发作1～8次／日,病程3～78小时,平均26小时。     

Recessed elliptical-centric view-ordering for contrast-enhanced 3D MR angiography of the carotid arteries.

Fast arterial-venous transit in the carotid arteries requires accurate, reliable timing of the acquisition to the bolus transit to maximize arterial signal and minimize venous artifacts. The rising edge of the bolus is not utilized in conventional elliptical-centric view-ordering because the critical k-space center must be acquired with full arterial enhancement. In this study, a recessed elliptical-centric view-ordering scheme is introduced in which the k-space center is acquired a few seconds following scan initiation. The recessed view-ordering is shown to be more robust to timing errors than the conventional scheme in a study of 37 patients.     

1周内TIA对老年人首发脑梗死的保护作用

目的　探讨 1周内TIA对老年人首发脑梗死有无保护作用。方法　将首发脑梗死老年患者分为观察组 (病前 1周内有TIA)和对照组 (病前 1周内无TIA) ,观察意识障碍发生率、病死率、神经功能有缺损评分及脑血流量。结果　观察组意识障碍发生率、神经功能缺损评分低于对照组 ,而脑血流量高于对照组 ,且治疗一月后疗效好 ,但病死率无明显差别。结论　 1周内TIA对老年人首发脑梗死有保护作用。     

低分子肝素与阿司匹林防治短暂性脑缺血发作的疗效观察

阿司匹林作为预防和治疗缺血性脑卒中的药物，已被国内外医学界广泛认可。近年来，我们应用低分子肝素（抗栓灵）治疗TIA患者与阿司匹林（ASA）对照，取得了良好疗效。现报告如下。     

高频超声对TIA病人颈动脉的检测价值

目的 :探讨高频超声对TIA病人颈动脉的检测价值。方法 :应用高频超声检测 35例TIA病人及 33例健康对照组的颈总动脉、颈内动脉的构型和血流动力学变化。结果 :TIA病人的颈动脉内膜 -中层厚度明显增加 (P <0 .0 1) ;颈动脉斑块形成 2 8例 ,占 80 % ;颈动脉峰值流速和舒张末流速均降低 (P <0 .0 5 )。结论 :TIA病人颈动脉的高频超声检测对其诊治具有重要价值。     

Functional Imaging of Carotid Atheromatous Plaques

Atherosclerotic plaque rupture within the internal carotid artery is an important cause of transient ischemic attack (TIA) and stroke. Conventional imaging techniques such as ultrasound and angiography provide information about the structural consequences of such plaques in terms of luminal stenosis. Most clinical trials of carotid surgery and stenting and based on these imaging methods. Techniques aimed at imaging the biological 'functional' status of the plaque are now emerging. Most of these are based on the premise that inflammatory activity is an index of plaque stability. In this article we review potential imaging targets from the known molecular biological pathways of atherosclerosis. Both conventional imaging techniques and the newer methods are discussed. Recent data from position emission tomography (PET) imaging and from the use of superparamagnetic iron oxide particles with magnetic resonance (MR) imaging are shown.