急性缺血性脑卒中hsCRP水平变化与胰岛素抵抗的关系及预后观察

目的：通过比较在急性缺血性脑卒中胰岛素抵抗（IR）患者与非IR组中超敏C反应蛋白（hsCRP）的变化情况,进行相关的统计学分析,探讨其早期水平的变化是否会对急性脑卒中患者的病情预后产生影响。方法：建立研究人群的组别,描述研究人群的分布特征,设立参照及实验标准,进行各项研究指标的检测,以及患者完整的随访观察,收集相关全面,详细的临床研究资料,筛选有效及合格的信息,及时输入研究样本的资料。结果：根据研究统计分析,我们可以看出在血清中hsCRP的水平,并不随卒中后的时间推移有显著改变。具有危险因素的受试者,较阴性对照组,有更高的hsCRP水平。结论：我们发现hsCRP在急性缺血组IR中有较高表达,与患者不良终点事件的预后,有一定的线性相关性。     

NT-pro BNP 及D-二聚体水平变化对急性缺血性脑卒中患者预后的影响

目的:探讨急性缺血性脑卒中患者血浆B型脑钠肽前体(NT-proBNP)和D-二聚体水平与病情严重程度的关系。方法:选取2013年6月-2015年6月在我院接受治疗的急性缺血性脑卒中患者81例作为研究对象,另选取同期在我院接受健康体检的志愿者53例作为对照组。检测并比较两组血浆NT-proBNP及D-二聚体水平。结果:急性脑卒中患者血浆NT-proBNP与D-二聚体水平均显著高于对照组,差异具有统计学意义(P0.05)。大面积梗死的缺血性脑卒中患者血浆NT-proBNP及D-二聚体水平显著高于非大面积梗死患者,差异具有统计学意义(P0.05);NIHSS评分10的缺血性脑卒中患者血浆NT-proBNP及D-二聚体水平显著高于NIHSS评分≤10的患者,差异具有统计学意义(P0.05);有意识障碍的缺血性脑卒中患者血浆NT-proBNP及D-二聚体水平显著高于无意识障碍者,差异具有统计学意义(P0.05);随访结局为死亡的缺血性脑卒中患者血浆NT-proBNP及D-二聚体水平显著高于存活者,差异具有统计学意义(P0.05)。结论:NT-proBNP及D-二聚体水平可以反映急性缺血性脑卒中患者的病情,对脑卒中患者的病情评估及预后判断具有参考价值。     

血清超敏C-反应蛋白水平与急性缺血性脑卒中预后的关系

目的:探讨急性缺血性脑卒中患者血清超敏C-反应蛋白(hs-CRP)的水平对卒中后功能障碍的预测价值.方法:分别在发病后第1和7天,采用颗粒增强免疫透射比浊法对92例急性缺血性脑卒中患者检测血清hs-CRP水平,并选取40例健康受试者作为对照.随访并记录患者1月、3月和6月mRS评分.结果:①急性缺血性脑卒中患者血清hs-CRP水平较对照组显著升高.②急性缺血性卒中患者入院1d和7d血清hs-CRP水平与1月、3月和6月mRS评分,均有明显的相关性.与入院1d血清hs-CRP水平相比,入院7d血清hs-CRP水平与mRS评分相关性更好.③与无颈动脉粥样硬化危险因素的缺血性卒中患者相比,有颈动脉粥样硬化危险因素的缺血性卒中患者入院7d血清hs-CRP水平明显升高.结论:与入院1d血清hs-CRP水平相比,入院7d血清hs-CRP水平对卒中后功能障碍的预测价值更好.     

血清甘油三酯变化在急性缺血性脑卒中的临床意义

目的:探讨血清甘油三酯(TG)与急性缺血性脑卒中(AIS)早期预测之间的相关性.方法:我们收集了736例AIS患者.依据TG水平将患者分为5组.参照美国国立卫生研究院(为什么不参照我国的标准)卒中量表(NIHSS),将早期神经功能恶化(END)设定为≥4分,将新发症状开始一周后的早期临床改善(ECI)定为降低4分或以上.将各组内的END、ECI患者及两者都不是的患者进行比较.结果:高TG和低TG组患者发生END的风险显著高于正常组.高TG、低TG组以及临界组患者发生ECI的百分率显著低于正常组.多元回归分析显示高TG、低TG组以及临界组患者在END中的or值显著高于正常低值组(50-100 mg/dl).AIS患者的甘油三酯(TG)水平与预后不良呈非线性的J型相关,与良好预后呈反J形相关.结论:在AIS的早期高TG和低TG都是预后不良的危险因素.     

血清SHBG水平与妊娠期糖尿病胰岛素抵抗的关系研究

目的:探讨血清性激素结合球蛋白(SHBG)水平与妊娠期糖尿病(GDM)胰岛素抵抗(IR)的关系。方法:选择2015年3月~2016年1月在我院收治的90例GDM孕妇为观察组,选择同期健康体检孕妇45例为对照组,采用化学发光法检测两组孕妇的SHBG、胰岛素(INS)、C肽和游离睾酮(FT),糖化血红蛋白仪检测糖化血红蛋白(HbA1c),生化分析仪检测空腹血糖(FBG),并计算胰岛素抵抗指数(HOMA-IR)和敏感性指数(ISI),分析两组孕妇各指标的关系及其与两指数的相关性。结果:观察组孕妇空腹及餐后2h、3h的INS水平高于对照组,差异有统计学意义(P0.05)。观察组孕妇餐后1h和2h的C肽水平低于对照组,而餐后3h高于对照组,差异有统计学意义(P0.05)。观察组孕妇SHBG水平、ISI低于对照组,而HOMA-IR、FT、FBG和HbA1c水平高于对照组,差异有统计学意义(P0.05)。SHBG水平与FINS、C肽水平、HOMA-IR呈负相关,与ISI呈正相关,差异有统计学意义(P0.05)。结论:GDM孕妇胰岛素抵抗性和敏感性下降,血清SHBG水平降低且与INS水平、IR及敏感性相关,检测血清SHBG水平有助于了解GDM孕妇IR情况。     

急性缺血性脑卒中患者血清GAL3、CXCL12水平与病情严重程度和预后的关系研究

目的:探讨急性缺血性脑卒中(AIS)患者血清半乳糖凝集素3(GAL3)、血清趋化因子12(CXCL12)水平与病情严重程度和预后的关系。方法:选取成都市第五人民医院于2016年2月～2018年9月期间接收的AIS患者138例为观察组,另选取同期来该院行健康体检的志愿者60例为对照组。其中观察组根据美国国立卫生研究所中风量表(NIHSS)评分分为轻症组(n=42,4分),中症组(n=61,4～15分),重症组(n=35,15分),根据改良RABKIN量表(m RS)评分分为预后良好组(n=82)和预后不良组(n=56)。比较对照组、观察组的血清GAL3、CXCL12水平,分析不同NIHSS得分、不同预后的血清GAL3、CXCL12水平,采用Pearson相关性分析血清GAL3、CXCL12水平与NIHSS评分、m RS评分的相关性。结果:观察组血清GAL3、CXCL12水平均显著高于对照组,差异有统计学意义(P0.05)。重症组、中症组AIS患者血清GAL3、CXCL12水平高于轻症组,且重症组高于中症组,差异有统计学意义(P0.05)。预后不良组的AIS患者血清GAL3、CXCL12水平均高于预后良好组,差异有统计学意义(P0.05)。Pearson相关性分析结果可知,血清GAL3、CXCL12水平与NIHSS评分、m RS评分均呈正相关(P0.05)。结论:AIS患者的血清GAL3、CXCL12水平均异常升高,且其升高程度与AIS患者病情严重程度及预后息息相关。     

急性缺血性脑卒中患者入院时血浆BNP水平与梗死部位关系

目的:分析急性缺血性脑卒中患者入院时血浆脑钠肽(BNP)水平与缺血性脑卒中梗死部位的关系。方法:随机入选88例急性缺血性脑卒中患者,按梗死部位,将其分为前循环病灶组(66名)和后循环病灶组(22名)两组进行比较。测定入院时血浆脑钠肽(BNP)水平进行比较。两组脑卒中病人的危险因素血糖、糖化血红蛋白、血脂全套,肝肾功能分析对比,并将急性缺血性脑卒中患者梗死部位相关的多个变量采用单因素logistic回归分析。结果:前循环病灶组血浆脑利钠肽水平的中位数是225.90 pg/mL,四分位数间距为596.00 pg/mL;后循环病灶组的中位数是750.95 pg/mL,四分位数间距为907.00 pg/mL。后循环病灶组血浆脑利钠肽水平要显著高于前循环病灶组血浆脑利钠肽水平,两个部位间入院时的脑利钠肽水平有统计学差异(P=0.004)。通过入院时脑利钠肽水平与缺血性脑卒中梗死部位的关系的ROC曲线,得出截点299.50 pg/mL。入院时血浆脑利钠肽水平≥299.50 pg/mL可以作为后循环病灶组的预测指标,其敏感性72.72%,特异性62.12%。结论:急性缺血性脑卒中患者入院时血浆BNP水平可作为急性期区别前后循环脑梗死的预测因子。     

胰岛素抵抗与脂肪肝关系的研究

胰岛素抵抗(IR)是许多疾病的独立危险因素。胰岛素抵抗与脂肪代谢紊乱非常密切,研究发现它在脂肪肝的发生、发展过程中起了很大的作用。近年来,越来越多的人已经意识到脂肪肝与胰岛素抵抗之间的密切关系。在胰岛素抵抗与脂肪肝的研究中关于瘦素及瘦素抵抗在胰岛素抵抗及脂肪肝的关系中的作用是研究比较多的,本文主要介绍了胰岛素抵抗、脂肪肝的发生机制及瘦素、瘦素抵抗在其中的催化作用。     

急性缺血性脑卒中患者入院时血浆BNP水平与梗死部位关系

目的：分析急性缺血性脑卒中患者入院时血浆脑钠肽（BNP）水平与缺血性脑卒中梗死部位的关系。方法：随机入选88例急性缺血性脑卒中患者,按梗死部位,将其分为前循环病灶组（66名）和后循环病灶组（22名）两组进行比较。测定入院时血浆脑钠肽（BNP）水平进行比较。两组脑卒中病人的危险因素血糖、糖化血红蛋白、血脂全套,肝肾功能分析对比,并将急性缺血性脑卒中患者梗死部位相关的多个变量采用单因素logistic回归分析。结果：前循环病灶组血浆脑利钠肽水平的中位数是225.90 pg/mL,四分位数间距为596.00 pg/mL;后循环病灶组的中位数是750.95 pg/mL,四分位数间距为907.00 pg/mL。后循环病灶组血浆脑利钠肽水平要显著高于前循环病灶组血浆脑利钠肽水平,两个部位间入院时的脑利钠肽水平有统计学差异（P=0.004）。通过入院时脑利钠肽水平与缺血性脑卒中梗死部位的关系的ROC曲线,得出截点299.50 pg/mL。入院时血浆脑利钠肽水平≥299.50 pg/mL可以作为后循环病灶组的预测指标,其敏感性72.72%,特异性62.12%。结论：急性缺血性脑卒中患者入院时血浆BNP水平可作为急性期区别前后循环脑梗死的预测因子。     

胰岛素信号转导障碍与胰岛素抵抗的形成

胰岛素生理作用的发挥,起始于胰岛素与其受体的结合,并由此引起细胞内一系列信号转导,最终到达各效应器产生各种生理效应。胰岛素信号转导在胰岛素生理作用的发挥中起着至关重要的作用。胰岛素信号转导减弱或受阻,使得胰岛素生理作用减弱,导致胰岛素抵抗形成。本文综述了胰岛素信号转导失调在胰岛素抵抗形成中的作用。     

Aspirin Resistance in the Acute Stages of Acute Ischemic Stroke Is Associated with the Development of New Ischemic Lesions

Background

Aspirin is a primary antiplatelet agent for the secondary prevention of ischemic stroke. However, if aspirin fails to inhibit platelet function, as is expected in acute ischemic stroke (AIS), it may increase the rate of early clinical events. Therefore, we sought to determine whether aspirin resistance in the acute stage was associated with early radiological events, including new ischemic lesions (NILs).

Methods

This study was a single-center, prospective, observational study conducted between April 2012 and May 2013. Aspirin 300 mg was initially administered followed by maintenance doses of 100 mg daily. The acute aspirin reaction unit (aARU) was consistently measured after 3 hours of aspirin loading. An aARU value ≥550 IU was defined as biological aspirin resistance (BAR). NILs on follow-up diffusion-weighted imaging (DWI) were defined as lesions separate from index lesions, which were not detected on the initial DWI.

Results

A total of 367 patients were analyzed in this study. BAR in aARU was detected in 60 patients (16.3%). On follow-up DWI, 81 patients (22.1%) had NILs, which were frequently in the same territory as the index lesions (79%), pial infarcts (61.7%), and located within the cortex (59.3%). BAR was independently associated with NILs on follow-up DWI (adjusted OR 2.00, 95% CIs 1.01–3.96; p = 0.047).

Conclusion

In conclusion, BAR in aARU could be associated with NILs on follow-up DWI in AIS. Therefore, a further prospective study with a longer follow-up period is necessary to evaluate the clinical implications of aARU in AIS.     

Characteristics of Misclassified CT Perfusion Ischemic Core in Patients with Acute Ischemic Stroke

Background

CT perfusion (CTP) is used to estimate the extent of ischemic core and penumbra in patients with acute ischemic stroke. CTP reliability, however, is limited. This study aims to identify regions misclassified as ischemic core on CTP, using infarct on follow-up noncontrast CT. We aim to assess differences in volumetric and perfusion characteristics in these regions compared to areas that ended up as infarct on follow-up.

Materials and Methods

This study included 35 patients with >100 mm brain coverage CTP. CTP processing was performed using Philips software (IntelliSpace 7.0). Final infarct was automatically segmented on follow-up noncontrast CT and used as reference. CTP and follow-up noncontrast CT image data were registered. This allowed classification of ischemic lesion agreement (core on CTP: rMTT≥145%, aCBV<2.0 ml/100g and infarct on follow-up noncontrast CT) and misclassified ischemic core (core on CTP, not identified on follow-up noncontrast CT) regions. False discovery ratio (FDR), defined as misclassified ischemic core volume divided by total CTP ischemic core volume, was calculated. Absolute and relative CTP parameters (CBV, CBF, and MTT) were calculated for both misclassified CTP ischemic core and ischemic lesion agreement regions and compared using paired rank-sum tests.

Results

Median total CTP ischemic core volume was 49.7ml (IQR:29.9ml-132ml); median misclassified ischemic core volume was 30.4ml (IQR:20.9ml-77.0ml). Median FDR between patients was 62% (IQR:49%-80%). Median relative mean transit time was 243% (IQR:198%-289%) and 342% (IQR:249%-432%) for misclassified and ischemic lesion agreement regions, respectively. Median absolute cerebral blood volume was 1.59 (IQR:1.43–1.79) ml/100g (P<0.01) and 1.38 (IQR:1.15–1.49) ml/100g (P<0.01) for misclassified ischemic core and ischemic lesion agreement, respectively. All CTP parameter values differed significantly.

Conclusion

For all patients a considerable region of the CTP ischemic core is misclassified. CTP parameters significantly differed between ischemic lesion agreement and misclassified CTP ischemic core, suggesting that CTP analysis may benefit from revisions.     

Relationship between Blood Pressure and Outcomes in Acute Ischemic Stroke Patients Administered Lytic Medication in the TIMS-China Study

Objective

Increased blood pressure (BP) management following acute ischemic stroke (AIS) remains controversial. This study aimed to identify the association between BP and clinical outcomes in AIS patients administered lytic medication in the TIMS-China (thrombolysis implementation and monitor of acute ischemic stroke in China) database.

Methods

The sample comprised 1128 patients hospitalized within 4.5 hours (h) of AIS for intravenous recombinant tissue plasminogen activator (i.v. rt-PA) thrombolysis. Systolic BP (SBP) and diastolic BP (DBP) at baseline, 2 h and 24 h after treatment, and changes from baseline were analyzed. The study outcomes comprised a favorable outcome (modified Rankin Scale 0–1 at 90 days) and symptomatic intracerebral hemorrhage (SICH), analyzed using logistic regression, with low BP as the reference group.

Results

Lower BP (baseline, 2 h, and 24 h) was beneficial in AIS patients and significantly related to a favorable outcome (P<0.05). A substantial BP decrease at 24 h after rt-PA thrombolysis was significantly associated with a favorable outcome compared with a moderate BP decrease (P = 0.0298). A SBP >160 mmHg 2 h after rt-PA thrombolysis was significantly associated with SICH compared with a SBP <140 mmHg (P = 0.0238). An increase or no change (>25 mmHg) in SBP was significantly associated with SICH (P = 0.002) compared with a small SBP decrease (1–9 mmHg).

Conclusions

This study provides novel evidence that lower BP within the first 24 h is associated with a more favorable outcome and less frequent SICH in AIS patients administered lytic medication. Routine BP-lowering treatment should be considered in AIS patients following lytic medication.     

新发缺血性脑卒中患者实施单病种质量管理的预后评价

目的 调查分析上海市某三甲医院缺血性脑卒中单病种质量管理实施情况并评价其效果。方法 采用回顾性调查的方法,以NIHSS评分为疗效评价依据,对新发缺血性脑卒中单病种质量管理实施组和未实施组的预后情况进行分析评估。结果 在2组基线资料均衡的情况下,缺血性脑卒中单病种质量管理实施组的疗效显著优于未实施组,尤其是发病初始疾病严重程度一般者的疗效最好。结论 缺血性脑卒中单病种质量管理通过对诊疗过程的质量控制,规范了诊疗行为,改善了新发缺血性脑卒中患者的预后。     

The Relationship Between Serum Mannose-Binding Lectin Levels and Acute Ischemic Stroke Risk

Complement activation and inflammation have been suggested in the pathogenesis of stroke, mannose-binding lectin (MBL) were found to have roles during the process. The aim of this study was to investigate the relationship between acute ischemic stroke (AIS) and serum MBL levels in Chinese population. From January 1 to June 30 2013, all patients with first-ever AIS were recruited to participate in the study. Serum MBL levels and routine test were examined. The National Institutes of Health Stroke Scale (NIHSS) score was assessed on admission blinded to MBL levels. During the inclusion period, 148 patients with AIS were registered and completed study. The results indicated that the serum MBL levels were significantly (p < 0.0001) higher in acutely ischemic stroke patients as compared to normal controls [1,332; interquartile range (IQR) 996–2,134 μg/L and 897; IQR 678–1,100 μg/L, respectively]. There was a correlation between serum levels of MBL and NIHSS score [r (spearman) = 0.608, p < 0.0001). In multivariate analysis, serum MBL as a continuous variable was associated with an increased risk of AIS, after adjustment for above possible confounders (OR 1.002, 95 % CI 1.001–1.008; p < 0.0001). These results indicated that elevated MBL levels could be considered as an independent stroke risk factor in Chinese population, suggesting a role of MBL and the lectin pathway of complement activation in the pathogenesis of stroke.