急性非心源性缺血性脑卒中的病因分型与Essen卒中风险评分

目的Essen卒中风险评估（ESRS）体系可准确评估非心源性缺血性脑卒中（IS）复发的风险。而TOAST（Trial of Org 10172 in acute stroke treatment）分型则是目前应用最广泛的病因分型。本研究着眼于传统与改良的TOAST分型与ESRS的关系，从而间接了解非心源性IS的病因分型与复发风险的关系。方法①对连续纳入的非心源性IS患者行ESRS评估，将其分为低风险组（ESRS〈3分）和高风险组（ESRS≥3分）；②改良TOAST分型：动脉粥样硬化血栓形成（AT），小动脉病变（SAD），其他原因所致的缺血性脑卒中（SOD）及不明原因的缺血性脑卒中（SUD）。比较不同ESRS分值组之间TOAST分型的构成。结果纳入的316例非心源性IS患者中低风险组93例（29．4％），高风险组223例（70．6％），动脉粥样硬化性脑梗死患（以下简称AT）161例（50．9％），SAD68例（21．5％），SOD22例（7％），SUD65（20．6％）。不同ESRS分值组中不同病因分型的构成存在一定差异（P〈0．0001）。低风险组中AT较少（18／93VS161／316，P〈0．0001），SOD较多（18／93 vs 22／316，P=0．003），而高风险组中SOD相对少（4／225 vs 22／316，P=0．012）。高风险组中大动脉粥样硬化的比例并无明显高于低风险组的趋势（P〉0．05），小血管病变的比例也不明显低于低风险组（P〉0．05）。结论本研究提示①ESRS分值愈大则出现罕见病因IS的概率可能愈小，而尚不可认为出现动脉粥样硬化性IS的几率就愈大；②ESRS评分系统所包含的危险因素对于大小血管病变的影响可能是等同。     

骨髓增殖性肿瘤与缺血性卒中

【摘要】 骨髓增殖性肿瘤常出现血管并发症，最常累及脑血管，以缺血性卒中最为常见。骨髓增殖性肿瘤作为缺血性卒中的病因之一，其诊断与治疗不同于其他病因所致卒中。白细胞增多、JAK2V617F基因突变等相继被发现与缺血性卒中相关。本文对骨髓增殖性肿瘤伴缺血性卒中的发生、机制及防治的新进展进行综述。     

Risk prediction of cerebrovascular events with carotid plaque magnetic resonance analysis: A meta-analysis

Background and purpose

It is not conclusive that magnetic resonance (MR)-based carotid atherosclerotic plaque assessment identifies high-risk features associated with cerebrovascular events. We aimed to systematically summarize the association of MR imaging (MRI)-determined intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thinning/rupture of the fibrous cap (TRFC) with subsequent ischemic events.

Carotid webs and ischemic stroke: Experiences in a comprehensive stroke center

Background and purpose

Carotid webs are intraluminal filling defects at the carotid bulb which are considered rare, though possibly underappreciated entities with recent studies demonstrating a likely casual association with ischemic stroke. The purpose of the study is to describe our recent experience with clinical and imaging manifestations of carotid webs.

中风病急性期痰热证与MMP-1和MMP-3表达的影响＊

目的 研究缺血性中风病急性期痰热证与MMP-1和MMP-3表达的相关性，其相关性研究能否形成微观辨证的依据。方法 筛选发病7天内就诊于中国中医科学院西苑医院的缺血性中风痰热证患者45名，非痰热证44名，对每例患者分别作出痰湿证、气虚证、血瘀证、内风证、阴虚证和内火证的量化诊断，并用ELISA法检测血清中MMP1和MMP-3的含量。结果 痰热证组和非痰热证组MMP-1和MMP-3的表达均无明显差异。结论 MMP-1和MMP-3不能作为痰热证的微观指标，需进一步寻找微观指标对中风病痰热证证候诊断及疗效评价提供更加客观支持。     

血清神经元特异性烯醇化酶在缺血性脑卒中患者中的变化及意义

目的通过观察缺血性脑卒患者中血清神经元特异性烯醇化酶(NSE)的动态变化情况,探讨其对患者临床病情监测和预后评估的意义。方法选择2012年3月至2013年6月期间在我院住院治疗的缺血性脑卒患者65例为研究组,并选择同期在我院接受体检的健康者50例为对照组。采用酶联免疫吸附法测定两组患者血清神经元特异性烯醇化酶的动态变化水平。并分析患者血清NSE水平与患者脑损伤程度和预后的关系。结果研究组与对照组入院24h内血清NSE平均水平相比差异显著(t=7.29,P=0.001)。随后在2d、5d和第7d研究组患者血清NSE水平均显著高于对照组,并较24h时亦显著升高(t=21.81,18.56,9.13;P=0.000,0.000.0.001)。入院第2d,脑损伤病情中型重型组患者血清NSE水平与病情轻型组患者比较显著偏高(t=4.06,t=8.58,P=0.002,0.005)。预后不良组患者各时间血清NSE水平检测值均显著高于预后良好组(t=6.46,5.17,6.43,3.83,7.34;P0.05)。结论临床上可以将血清NSE的表达水平作为判断缺血性脑卒患者早期诊断的有力依据和评价预后的重要指标。     

应用计算机流体力学技术评估症状性颅内动脉狭窄患者卒中复发风险的研究

目的 评估基于计算机流体力学（computational fluid dynamics，CFD）技术的无创血流动力学参数与缺血性卒中复发之间的关系。      

Ischemic stroke in Morocco: Prehospital delay and associated factors

ObjectivesThis study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco.Patients and methodsAn observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department.ResultsA total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6 hours (IQR, 4–16). Multiple regression analysis showed that illiteracy (OR 38.58; CI_95%: 3.40–437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI_95%: 1.57–80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI_95%: 0.01–0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI_95%: 0.00–0.36), and direct admission without reference (OR 0.005; CI_95%: 0.00–0.07), were independently associated with late arrival (> 4.5 hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI_95%: 4.37–138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI_95%: 0.03–0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI_95%: 0.00–0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI_95%: 0.03–0.80), distance between 50 and 100 km (OR 10.16; CI_95%: 1.16–89.33), and direct admission without reference (OR 0.03; CI_95%: 0.00–0.14), were independently associated with late arrival (> 6 hours) of patients with acute ischemic stroke.ConclusionPatient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.