脑卒中吞咽障碍患者的焦虑状态评估

目的:探讨脑卒中吞咽障碍患者焦虑状态发生率.方法:选取神经内科脑卒中吞咽障碍患者132例为观察组,无吞咽障碍的脑卒中患者132例为对照组.2组患者均使用Zung焦虑自评量表(SAS)进行问卷调查,评估二组焦虑状态.结果:二组患者焦虑状态均高于中国常模标准,观察组焦虑状态发生率为86.36％,对照组为59.09％(P＜0.05),二者比较差异有统计学意义.结论:脑卒中吞咽障碍患者焦虑状态的发生率较高.应提前给予干预.     

静脉注射人脐血间充质干细胞对脑损伤神经生长因子的影响

目的 观察TBI后静脉注射人脐血间充质干细胞(CB-MSCs)对NGF、BDNF表达的影响,探讨其脑保护的作用机制.方法 清洁级健康雄性SD大鼠90只采用完全随机数字表法分为假手术组、损伤组和治疗组,每组30只.损伤组和治疗组采用改进的Feeney自由落体法制作大鼠TBI模型,假手术组只开骨窗,不撞击硬脑膜.治疗组尾静脉注入3×106个Brdu标记的CB-MSCs,损伤组及假手术组注入等体积的PBS液.在移植后3、7、14、21、28 d,采用HE染色、免疫组化染色、原位杂交法对TBI大鼠脑组织形态学变化、Brdu标记情况、NGF和BDNF表达情况进行检测.结果 假手术组仅有极少量的NGF、BDNF阳性表达细胞.损伤组表达明显增加,以损伤周边区最为明显,注射后14d达到高峰(NGFA值为8.35±1.07,BDNFA值为9.01±1.74),之后逐渐下降,但仍高于假手术组,差异有统计学意义(P＜0.05).治疗组表达趋势与损伤组相同,14d达高峰后,21 d、28 d阳性表达明显下降;各时间点均高于损伤组与假手术组,差异有统计学意义(P＜0.05).结论 在TBI中,静脉注射CB-MSCs可以增加损伤局部NGF、BDNF的分泌,改善局部微环境,促进神经元的修复.     

缺血性脑卒中复发危险因素分析及预测模型的构建

目的 探讨影响缺血性脑卒中复发的危险因素并建立Cox比例风险回归模型.方法 回顾性收集2008-2009年河北联合大学附属医院神经内科确诊的连续性初发缺血性脑卒中患者为研究对象,同时随访患者的复发情况,于2010年6月30日完成随访工作,应用Kaplan-Meier法进行复发率分析,应用Cox比例风险回归模型对影响患者复发的危险因素进行单因素和多因素分析,建立复发模型.结果 随访期间共79例患者复发,患者1年复发率为12.75%,2年复发率为18.87%,经Cox比例风险回归模型单因素及多因素分析显示,年龄(X1)(RR=1.025,95%CI:1.003～1.048)、高血压史(X2)(RR=1.976,95%CI:1.014～3.851)、家族卒中史(X3)(RR=2.647,95%CI:1.175～5.961)、总胆固醇(X4)(RR=1.485,95%CI:1.214～1.817)、ESRS评分(X5)(RR=1.327,95%CI:1.057～1.666)和病情进展(X6)(RR=1.889,95%CI:1.123～3.178)是影响患者复发的独立危险因素,建立复发模型的个体预后指数(PI)为0.025X1+0.681X2+0.973X3+0.395X4+0.283X5+0.63X6.PI值越小,复发危险性越低;PI值越大,复发危险性越高.结论 年龄、高血压史、家族卒中史、总胆固醇、ESRS评分和病情进展是缺血性脑卒中患者复发的独立危险因素,并成功建立复发模型及个体PI方程.

Abstract：

Objective To investigate the risk factors and establish the Cox' s regression model on the recurrence of ischemic stroke. Methods We retrospectively reviewed consecutive patients with ischemic stroke admitted to the Neurology Department of the Hebei United University Affiliated Hospital between January 1,2008 and December 31,2009. Cases had been followed since the onset of ischemic stroke. The follow-up program was finished in June 30, 2010. Kaplan-Meier methods were used to describe the recurrence rate. Monovariant and multivariate Cox' s proportional hazard regression model were used to analyze the risk factors associated to the episodes of recurrence.And then, a recurrence model was set up. Results During the period of follow-up program, 79 cases were relapsed,with the recurrence rates as 12.75% in one year and 18.87% in two years. Monovariant and multivariate Cox' s proportional hazard regression model showed that the independent risk factors that were associated with the recurrence appeared to be age (X1)(RR=1.025,95% CI: 1.003-1.048),history of hypertension (X2) (RR= 1.976, 95% CI: 1.014-3.851), history of family strokes (X3) (RR=2.647,95%CI: 1.175-5.961), total cholesterol amount (X4) (RR= 1.485,95%CI: 1.214-1.817), ESRS total scores (X5) (RR= 1.327,95%CI: 1.057-1.666) and progression of the disease (X6) (RR= 1.889,95%CI: 1.123-3.178). Personal prognosis index (PI) of the recurrence model was as follows: PI=0.025X1 + 0.681X2+ 0.973X3 + 0.395X4+ 0.283X5 + 0.636X6. The smaller the personal prognosis index was, the lower the recurrence risk appeared, while the bigger the personal prognosis index was, the higher the recurrence risk appeared. Conclusion Age, history of hypertension, total cholesterol amount, total scores of ESRS, together with the disease progression were the independent risk factors associated with the recurrence episodes of ischemic stroke. Both recurrence model and the personal prognosis index equation were successful constructed.     

高敏C反应蛋白与急性脑梗死患者病情严重程度相关性研究

摘要目的探讨急性脑梗死患者入院早期高敏c反应蛋白（hs—CRP）与临床病情严重程度的关系。方法连续收集发病时间〈24h急性脑梗死患者272例,应用自制调查表收集研究对象的基本信息和疾病史,检测入院后24h内hs—CRP水平,同时收集患者入院后1,7,14d的NIHSS评分、mRS评分作为患者临床病情严重程度的综合判定指标。应用相关分析进行hs～CRP与NIHSS评分、mRS评分的相关性分析,多因素Logistic逐步回归分析找出影响患者7dNIHSS评分、mRS评分的独立危险因素。结果hs—CRP与入院后1,7,14dNIHSS评分,入院后1,7,14dinRS评分高度相关（P〈0．001）。hs—CRP是影响7dNIHSS评分及1TIRS评分的共同危险因子。结论hs—CRP是急性脑梗死病情危重的独立危险因子。