新生儿缺氧缺血性脑病血清脂联素水平的变化及临床意义

目的探讨血清脂联素水平在新生儿缺氧缺血性脑病（HIE）患儿中的变化及其临床意义。方法应用ELISA法检测90例不同病变程度（轻度组30例,中度组30例,重度组30例）的HIE患儿和30例正常新生儿的血清脂联素水平,并对患儿组在治疗过程中进行血清脂联素水平的动态测定（分别于治疗第7天、第14天和第30天）。结果与对照组比较,HIE患儿的血清脂联素水平明显降低,且病变程度越重下降越明显,其中轻度组下降至（9.97±0.97）mg/L,中度组下降至（9.01±0.32）mg/L,重度组下降至（6.34±1.50）mg/L,差异均有统计学意义（P〈0.01）,不同病变程度组间有统计学意义（P〈0.01）。在治疗过程中,随病情的好转,血清脂联素水平有上升的趋势,在治疗第7天、第14天和第30天与第1天相比,脂联素水平持续上升（P〈0.01）,且在治疗第30天与对照组比较,轻度组与中度组与对照组无统计学意义（P〉0.05）,重度组与对照组比较仍有统计学意义（P〈0.05）。结论HIE患儿的血清脂联素水平与神经系统损伤程度和炎症存在状态呈明显的负相关,连续测定HIE患儿血清脂联素水平,对病情估计、用药指导、疗效观察和预后判断有重要的意义。     

太极拳运动对缺血性脑卒中高危人群的心肺功能影响研究进展

本文总结缺血性脑卒中的危险因素,分析太极拳对缺血性脑卒中高危人群心肺功能的影响机理,为今后社区开展脑卒中预防项目提供依据。     

急性缺血性脑卒中患者单核细胞/高密度脂蛋白胆固醇比值、脑侧支循环与神经功能缺损的关系研究

目的探讨急性缺血性脑卒中(AIS)患者机体中单核细胞/高密度脂蛋白胆固醇比值(MHR)、脑侧支循环与患者神经功能缺损的关系。方法选取2020年7月至2021年6月我院收治的急性缺血性脑卒中患者118例,按患者神经功能缺损程度分为轻度组53例、中度组38例、重度组27例,观察三组MHR、脑侧支循环情况,分析与患者神经功能缺损的关系。结果三组间单核细胞计数、MHR比较,重度组>中度组>轻度组,HDL-C、脑侧支循环评分比较,轻度组>中度组>重度组(P<0.05);单核细胞计数、MHR指标与神经功能缺损程度呈正相关,HDL-C水平、脑侧支循环评分与神经功能缺损程度呈负相关(P<0.05); MHR与脑侧支循环评分联合诊断轻中度和中重度神经功能缺损的曲线下面积分别为0.988、0.832,均高于MHR指标曲线下面积(P<0.05)。结论 MHR、脑侧支循环及神经功能缺损能有效反映AIS患者机体炎性反应、病灶区血流代偿能力,对预测患者神经功能缺损情况有一定的指导意义和价值。     

降纤酶治疗老年短暂脑缺血发作临床观察

目的观察降纤酶治疗老年短暂脑缺血发作的临床疗效。方法选择65岁以上的脑缺血发作患者,随机分为治疗组和对照组。治疗组在常规药物治疗基础上使用降纤酶20IU,以后隔日5IU／次。对照组给予口服阿斯匹林和维脑路通治疗7天,7天后和1年分别评价疗效。结果治疗组治愈率为81．54％,总有效率为93．85％。对照组治愈率为58．46％,总有效率为68．72％,两组比较有显著性差异（P〈0．01）。结论降纤酶治疗老年短暂脑缺血发作疗效确切,使用安全,无副作用。     

Association between Geriatric Nutritional Risk Index and Depression after Ischemic Stroke

Background: Malnutrition is associated with poor outcomes after stroke. However, the association between malnutrition and post-stroke depression (PSD) remains unelucidated. We aimed to explore the association between geriatric nutritional risk index (GNRI) and depression after ischemic stroke. Methods: In total, 344 patients with ischemic stroke were included in this analysis. The GNRI was calculated from serum albumin level, weight, and height at admission. Malnutrition was defined using the GNRI cutoff points. A lower GNRI score indicates an elevated nutritional risk. The outcome was depression, measured 14 days after ischemic stroke. Logistic regression models were used to estimate the association between the GNRI and risk of PSD. Results: A total of 22.9% developed PSD 14 days after stroke. The mean GNRI was 99.3 ± 6.0, and 53.8% of the patients had malnutrition. After adjusting for covariates, baseline malnutrition was not associated with risk of PSD (OR, 0.670; 95%CI, 0.370–1.213; p = 0.186). The restricted cubic splines revealed a U-shaped association between the GNRI and PSD. Compared to moderate GNRI, higher GNRI (OR, 2.368; 95%CI, 0.983–5.701; p = 0.085) or lower GNRI (OR, 2.226; 95%CI, 0.890–5.563; p = 0.087) did not significantly increase the risk of PSD. Conclusion: A low GNRI was not associated with an increased risk of depression after ischemic stroke.     

Evolution of ischemic stroke drug clinical trials in mainland China from 2005 to 2021

BackgroundTo assess the temporal changes in the characteristics of ischemic stroke drug clinical trials conducted in mainland China in 2005–2021.MethodsA statistical analysis of registered clinical trials on ischemic stroke was performed using the platform of the Center for Drug Evaluation of China National Medical Products Administration, the Chinese Clinical Trial Registry, and ClinicalTrials.gov websites.ResultsFrom January 1, 2005 to August 1, 2021, a total of 384 registered drug clinical trials on ischemic stroke were identified in mainland China. Over time, the number of trials gradually increased each year, with a significant growth in 2014, from 16 in 2013 to 42 in 2014. Phase IV trials (31.8%) accounted for the majority, followed by phase II (16.4%), phase I (10.9%), and phase III (8.6%). In terms of sponsorship, the proportion of investigator‐initiated trials (IITs) (60.7%) was higher than industry‐sponsored trials (ISTs) (39.3%). Additionally, trials involving traditional Chinese medicines (TCMs) (36.2%) accounted for the largest proportion, followed by trials involving antithrombotic therapy (19.5%) and cerebral protection agents (16.7%). Furthermore, over the past 17 years, the number of leading drug clinical trial units for ischemic stroke in mainland China has continuously increased. The leading principal units from Beijing, Shanghai, Guangdong, Jiangsu, and Liaoning accounted for the majority of the trials (67.4%).ConclusionIn the past 17 years, great progress has been made in the research and development (R&D) of drugs and clinical trials for ischemic stroke in mainland China. The most extensive progress was observed in TCMs, antithrombotic therapy, and cerebral protection agents. More clinical trials are needed to confirm whether the newly developed drugs can improve the clinical efficacy of ischemic stroke. Simultaneously, more pharmaceutical R&D efforts of innovative drugs are warranted.     

短暂性脑缺血发作中医证候量化诊断标准研究

目的：建立短暂性脑缺血发作中医证候量化诊断标准。方法：根据文献研究、专家咨询、临床流行病学调查获得短暂性脑缺血发作四诊信息。将493例临床患者随机分为运算组（370例）和考核组（123例）,以基于熵的复杂系统分划方法提取运算组患者症状信息,分析证候之间组合规律,确立症状对证候贡献度,以诊断性试验ROC曲线分析方法建立诊断阈值,并依据考核组数据对其进行前瞻性检验。结果：短暂性脑缺血发作存在以络气郁滞、络气虚滞、痰湿、血瘀、阴虚、火热等基本证候,分别确立了不同症状对证候诊断的贡献度,建立了诊断阈值,前瞻性检验显示其具有良好的灵敏度、特异度及符合率。结论：基于熵的复杂系统分划方法可用于中医证候的量化研究,建立的短暂性脑缺血发作量化诊断标准具有良好的诊断效能,为中医证候规范化及进一步开展络病与血管病变相关性研究奠定了基础。     

血清OX40L、Occludin与急性缺血性脑卒中患者病情程度及预后的相关性

目的 探讨急性缺血性脑卒中患者血清OX40配体(OX40L)、闭合蛋白(Occludin)的水平,分析其与患者病情严重程度及预后的关系。方法 选取2016年1月至2020年1月在该院接受治疗的135例急性缺血性脑卒中患者为观察组。另选取同期该院体检健康者100例为对照组。采用酶联免疫吸附试验检测血清OX40L、Occludin水平差异。患者出院后6个月采用改良Rankin量表(mRS)评估预后状况,并分为预后良好组93例(mRS评分≤2分)和预后不良组42例(mRS评分>2分)。采用多因素Logistic回归分析影响急性缺血性脑卒中患者预后不良的危险因素。结果 观察组血清OX40L、Occludin水平与对照组相比,差异有统计学意义(P<0.05)。急性缺血性脑卒中重度组血清OX40L、Occludin水平高于中度组、轻度组,中度组血清OX40L、Occludin水平高于轻度组,差异有统计学意义(P<0.05)。预后不良组血清OX40L、Occludin水平明显高于预后良好组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,美国国立卫生...     

“一键启动”流程优化在缩短急性缺血性脑卒中患者静脉溶栓时间中的应用

目的 探讨“一键启动”流程优化在缩短急性缺血性脑卒中患者静脉溶栓时间中的应用效果。方法 选择2020年1-12月笔者所在医院收治的急性缺血性脑卒中静脉溶栓患者86例为研究对象,其中2020年1-6月入院进行静脉溶栓的41例为对照组,2020年7-12月入院进行静脉溶栓的45例为观察组。对照组采用常规抢救流程,观察组采用“一键启动”流程优化进行干预。比较2组入院至见到神经内科医生的时间（door to physician,DTP）、入院至实验室检查出报告时间（door to laboratory,DTL）、入院至溶栓用药时间（door to needle time,DNT）、入院至完成CT检查的时间（door to imaging,DTI）、美国国立卫生研究院卒中量表（national institute of health stroke scale,NIHSS）评分与改良RANKIN量表（modified Rankin scale,MRS）评分。结果 观察组DTP、DTL、DTI、DNT均明显短于对照组（Z=-8.506,P<0.001;Z=-6.750,P<0.001;Z...     

APP17肽对缺氧缺血性脑病新生鼠皮质区GAP-43表达的影响

目的：观察APP（β—amyloid precursop protein,APP）17肽（APP695—319—335）肽段对缺氧缺血性脑病新生鼠皮质区GAP-43表达的影响。方法：将生后7d的新生大鼠随机分为假手术组、脑病组和APP17肽治疗组。采用一侧颈动脉结扎,然后放在缺氧仓内2h的方法制备缺氧缺血性脑病模型。应用免疫组化方法观察各组大鼠不同时期脑皮质GAP-43表达的变化。结果：免疫组化结果显示,脑病组较假手术组小鼠皮质区GAP-43免疫阳性细胞增加（P〈0．01）．治疗组较脑病组GAP-43免疫阳性细胞明显增多（P〈0．01）。结论：缺氧缺血性脑损伤后,皮质区GAP-43表达和合成增加,GAP-43的表达增加可能与神经元再生和轴突重塑有关,是脑缺氧缺血后神经细胞内源性代偿机制之一。APP17肽可能通过调节GAP-43的表达来增加神经细胞之间的突触联系,促进神经的生长起到营养神经的作用,从而改善缺氧缺血性脑病小鼠的预后。