Silent brain infarctions and leuko-araiosis in Chinese patients with first-ever acute lacunar strokes

We report on silent brain infarction (SBI) and leuko- araiosis (LA) of 23 patients with clinically diagnosed “first-ever” acute ischemic lacunar stroke. The lacunar syndromes were pure motor hemiparesis (10), pure sensory syndrome (2), ataxic hemiparesis (3), dysarthria clumsy hand syndrome (3), and sensory- motor deficit (5). Nineteen out of the 23 patients presented with completed strokes on arrival to the hospital, and 4 (17%) developed evolving-stroke within 24 hours of stroke onset. A lacune corresponded to the acute stroke could be found in all patients on brain magnetic resonance imaging (MRI), and in 18 (78%) on brain computed tomography (CT). MRI showed additional subclinical or asymptomatic “silent brain infarctions or lacunes” (SBI) in 19 (83%) of 23 patients, and leuko-araiosis (LA) of moderate to severe degree (> grade 2) was present in 61% of patients although dementia was absent. Hypertension is the risk factor in 78% of cases followed by diabetes mellitus, smoking, and elevated plasma cholesterol level. Independence of the types of lacunar syndromes, patients with hypertension and diabetes mellitus are associated with high grade LA. None with normal blood pressure and plasma glucose had grade 3 or grade 4 LA (p < 0.05). In conclusion, evolving-stroke occurs in one- fifth of patients with “first-ever” lacunar infarct within the first 24 hours of stroke onset. SBI was found in 83% of cases. Hypertension and diabetes mellitus are associated with additional SBI and high grade LA. The severity of leuko-araiosis per se dictates the cerebrovascular risks.

Effect of DF-521 on functional recovery of nerve defect in patients with acute brain infarction

Objective To observe the effect of DF 521 on acute brain infarction and its’ safety.Method Patients were randomly divided into DF 521 group and control group.Neurological defect scoring were done before and after treatment.Clinical effect was evaluated.Result Total effective rate was more favorable in DF 521 group than that in control group(P<0.01).Conclusion DF 521 is effective in treating brain infarction without inducing significant adverse effects.

Rehabilitation and functional prognosis of acute brain infarct complicated with depression

Objective To observe rehabilitation and functional prognosis of patients suffered from brain infarction of acute phase complicated by depression. Method We selected 38 cases of acute brain infarct complicated with depression disorder as depression group, 40 cases of non-depression patient admitted at the same period were selected as non depression group.Antidepressants drugs administration and rehabilitation therapy were performed.We evaluated patients according to functional independence measure(FIM)of Chinese edition. HAMD grading comparison was carried out in depression group. Result Before treatment,two groups score nearly the same,compared with pretreatment. After treatment,patients in depression group and non depression group showed significant improvement esp non-depression group (P<0.01).11 cases with severe depression in the depression showed no changes in FIM score before and after treatment. Conclusion Compared with non-depression patients,functional recovery of patients with depression following brain infarction of acute stage is much slower,especially for patients with severe depression.

CONTRAST STUDY ON CT AND BA IN DIAGNOSIS OF PATIENTS WITH ATHEROTHROMBOTIC BRAIN INFARCTION

Objectives: To explore applied value on CT and BA in diagnosis of patients with athero-thrombotic brain infarction. Methods :CT and BA were examined in 246 patients with atherothrombotic brain infarction. Results:The different change of CT and BA were showed in 246 patients with atherothrombotic brain infarction. Conclusions: There were separately different advantage and shortcoming in CT and BA in diagnosis of atherothrombotic brain infarction. The value of clinical application of BA was important in diagnosis of atherothrombotic brain infarction.

Electro-Acupuncture for Treatment of Dysequillibrium Due to Cerebellum or Brain Stem Infarction

The authors treated 26 cases of dysequillibrium due tocerebellum or brain stem infarction byelectro-acupuncture from Aug 2000 - April 2002. Theresults were quite satisfactory and reported as follows.

Anxiety Network of Brain Function in Patients with Acute Cerebral Infarction

Objective: To explore the characteristics of brain functional network with anxiety in patients with acute cerebral infarction. Methods: A total of 39 patients with acute cerebral infarction by cranial magnetic resonance examination were included, and all the patients were scored by the Hamilton Anxiety Scale. The anxiety scale is scored by a professional psychiatrist. There are a total of 14 items, including anxiety, nervousness, fear, insomnia, cognitive function, depressed mood, somatic anxiety, sensory system, etc. The total score ≥ 29 points may be severe;≥21 points, there must be obvious;≥14 points, there must be anxiety;a score of more than 7 may indicate anxiety. If the score is less than 7, there are no anxiety symptoms. All patients within 24 to 72 hours, complete the head examination magnetic resonance, computerized calculation of the DWI sequence images, according to the results of the calculation to superimpose the image of the lesion, image reconstruction in space, and carry out Binarization, defining the value of lesions as 1, and the value of non as 0. All lesions are superimposed into one image and integrated. The relationship between the lesions in this superimposed image and anxiety after cerebral infarction was analyzed. Results: The lesions were basically concentrated around the lateral ventricle, and they were mainly concentrated around the lateral ventricle. Conclusion: Patients with acute cerebral infarction in the lateral ventricle or basal ganglia are more prone to post-stroke anxiety. This has a certain evaluation value for the prognosis of future cerebral infarction, and has a certain understanding of the exploration of complications, and has a certain understanding of the exploration of complications.

Clinical study of recombinant human brain natriuretic peptide in patients with acute myocardial infarction complicating congestive heart failure

Objectives To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) on patients with acute myocardial infarction complicating congestive heart failure.Methods 40 patients with acute myocardial infarction complicated by congestive heart failure were randomly divided into control group and treatment group of 20 cases.The control group,15 cases of acute anterior myocardial infarction,5 cases of acute inferior wall myocardial infarction, 15 males and 5 females,aged 55-70 years,mean age 58±12 years;treated 16 cases of acute anterior myocardial infarction,4 cases of acute myocardial infarction,16 males and 4 females,aged 56-70 years,mean age 59±11 years;two groups of age,gender,severity of disease and vascular lesions no significant difference and comparable(P】0.05).Conventional group were given aspirin,clopidogrel, statins,Inotropic,diuretic and vasodilator therapy.In the con- ventional treatment group based on the use of recombinant human brain natriuretic peptide(new bios,Tibet Pharmaceutical Co.,Ltd.Chengdu Nuodikang biopharmaceutical production, usage:1.5μg/Kg intravenous injection(impact), then 0.0075μg-0.01μg/(kg·min)infusion rate).Continuous medication 72 h.The clinical symptoms observed for 3 days in patients before treatment and after treatment,heart rate,blood pressure and left ventricular ejection fraction (LVEF) and tumor necrosis factor(TNF-α),brain natriuretic peptide(BNP) levels were measured.Results In control group,8 cases markedly effect,5 cases effect and 7 cases no effect,the total effective rate was 65%;In treatment group,13 cases markedly effect,6 cases effect and 1 cases no effect,the total effective rate was 95%,compared with two groups P New bios treatment group significantly increased cardiac index(CI) in patients with heart failure and left ventricular ejection fraction(LVEF) than the control group(all P【0.05),further reduce the levels of tumor necrosis (TNF-α) and brain natriuretic peptide(BNP).Conclusions rh-BNP can improve symptoms and heart function,reduced plasma tumor necrosis factor(TNF-α) and BNP levels of acute myocardial infarction patients with congestive heart failure,the treatment safe and reliable.As small sample size observed,larger sample to be accumulated to further evaluate its efficacy and safety.

Silent Cerebral Infarctions in Type II Diabetes Mellitus Patients;Could Brain MRI Be a Routine Investigation?

Objective: To study the prevalence of silent cerebral infarction in Type II diabetes mellitus. Patients and Methods: The study was a prospective on 80 patients recruited from neurology, endocrine outpatient clinics. Patients were type II diabetics as described by the American Diabetes Association, 2011 criteria. All patients underwent full metabolic profiles to diagnose diabetes mellitus and MRI brain scans to detect cerebral infarction. Results: Silent cerebral infarctions were detected in 60% of patients (48/80 patients) predominately along periventricular white matter area and subcortical areas (Basal ganglia, Thalamus). Conclusion: Asymptomatic Type II diabetes mellitus patients could have vascular cerebral changes without neurological symptoms. MRI brain scans could be recommended as routine diagnosis (if possible) for early cerebral infarct detection in type II diabetic patients.

Effect of Transcranial Magnetic Stimulation on the Expression of c-Fos and Brain-derived Neurotrophic Factor of the Cerebral Cortex in Rats with Cerebral Infarct

The effect of transcranial magnetic stimulation （TMS） on the neurological functional recovery and expression of c-Fos and brain-derived neurotrophic factor （BDNF） of the cerebral cortex in rats with cerebral infarction was investigated. Cerebral infarction models were established by using left middle cerebral artery occlusion （MCAO） and were randomly divided into a model group （n=40） and a TMS group （n=40）. TMS treatment （2 times per day, 30 pulses per time） with a frequency of 0.5 Hz and magnetic field intensity of 1.33 Tesla was carried out in TMS group after MCAO. Modified neurological severity score （NSS） were recorded before and 1, 7, 14, 21, and 28 day（s） after MCAO. The expression of c-Fos and BDNF was immunohistochemically detected 1, 7, 14, 21, and 28 day（s） after infarction respectively. Our results showed that a significant recovery of NSS （P〈0.05） was found in animals treated by TMS on day 7, 14, 21, and 28 as compared with the animals in the model group. The positive expression of c-Fos and BDNF was detected in the cortex surrounding the infarction areas, while the expression of c-Fos and BDNF increased significantly in TMS treatment group in comparison with those in model group 7, 14, 21, and 28 days （P〈0.05） and 7 14, 21 days （P〈0.01） after infarction, respectively. It is concluded that TMS has therapeutic effect on cerebral infarction and this may have something to do with TMS＇s ability to promote the expression of c-Fos and BDNF of the cerebral cortex in rats with cerebral infarction.

EFFECT OF ACUPUNCTURE ON β-EP CONTENT IN THE BRAIN TISSUE OF RATS WITH ACUTE CEREBRAL INFARCTION

Objective: To study the mechanisms of acupuncture in treatment of acute cerebral infarction. Methods: 90 SD rats were randomly divided into normal control group (n=10), model group (n=40) and electroacupuncture (EA) group (n=40). Shuigou (GV 26), bilateral Neiguan (PC 6) and Zusanli (ST 36) were stimulated with EA for 20 min. Acute cerebral infarction (ACI) was produced by blocking blood flow of the cerebral middle artery. Changes of β EP content in the brain tissue after ACI and EA were detected by radioimmunoassay (RIA). Results: 24 hour after ACI, plasma β EP content increased significantly to 1120.41±33.79 ng/L from 401.72±266.47 ng/L before ACL. While after acupuncutre, the increased β EP content lowered evidently in comparison with that of model group but was close to that of normal group. Conclusion: Acupuncture may adjust the neuroendocrine disturbance in rats with acute cerebral infarction to minimize the injury of the brain tissue.

机械介入取栓术联合重组组织型纤溶酶原激活剂治疗急性脑梗死的疗效观察

目的观察机械介入取栓术联合重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)治疗急性脑梗死(ACI)的疗效。方法选取作者医院2020年1月至2021年12月收治的107例ACI患者作为回顾性队列研究对象,按治疗方法将患者分为rt-PA静脉溶栓组(以下简称对照组,n=49)和机械介入取栓术联合rt-PA静脉溶栓组(以下简称观察组,n=58)。比较两组患者临床疗效、血清炎症因子、血清脂蛋白相关磷脂酶A2(Lp-PLA2)、血清总超氧化物歧化酶(T-SOD)、血清锰超氧化物歧化酶(Mn-SOD)、血清血管内皮功能指标以及脑血流灌注水平的差异。结果观察组临床总有效率高于对照组(96.55%比81.63%;χ^(2)=5.179,P=0.023);观察组治疗后肿瘤坏死因子α(TNF-α)、白细胞介素-1α(IL-1α)、IL-1β、IL-6、C反应蛋白(CRP)、Lp-PLA2、内皮素-1(ET-1)和血管内皮生长因子(VEGF)水平显著低于对照组(P<0.05),而T-SOD、Mn-SOD、一氧化氮水平及脑血容量(CBV)和脑血流量(CBF)水平明显高于对照组(P<0.05)。结论机械介入取栓术联合rt-PA治疗能够有效改善ACI患者神经功能、炎症状态及Lp-PLA2、T-SOD、Mn-SOD水平,增强脑组织血流灌注及血管内皮功能,整体提高临床疗效。

急性脑梗死患者溶栓后网膜素1水平对早期神经功能恶化的评估价值

目的探讨急性脑梗死患者溶栓后外周血网膜素1表达对早期神经功能恶化(early neurological deterioration,END)的评估价值。方法选取2021年2月至2022年2月郴州市第一人民医院神经内科明确诊断为急性脑梗死并行溶栓治疗的患者210例,根据溶栓后网膜素1水平分为低水平组70例(网膜素1<150μg/L),中水平组70例(150μg/L≤网膜素1≤200μg/L),高水平组70例(网膜素1>200μg/L),比较3组END发生情况。采用Pearson相关性分析网膜素1与END的相关性,用Cox回归分析发生END的影响因素,ROC曲线分析网膜素1对END的预测价值。结果210例急性脑梗死患者发生END 60例(28.6%)。低水平组、中水平组、高水平组END发生率比较,差异有统计学意义(45.7%vs 25.7%vs 14.3%,P<0.01),其中高水平组END发生率明显低于低水平组和中水平组,差异有统计学意义(P<0.01)。Pearson相关性分析显示,网膜素1与END发生呈负相关(r=-0.635,P<0.05)。多因素Cox回归分析显示,发病至溶栓时间、糖尿病、白细胞计数、网膜素1与急性脑梗死患者溶栓后发生END独立相关(P<0.05,P<0.01)。ROC曲线分析显示,网膜素1预测END发生的截断值为162.36μg/L,曲线下面积为0.868(95%CI:0.811~0.925),敏感性和特异性分别为73.3%、88.0%。结论急性脑梗死患者溶栓后外周血网膜素1水平与END的发生密切关联,网膜素1可作为评估END发生的生物标志物。

急性脑梗死患者血清miR-16表达与并发抑郁的关系

目的:探讨急性脑梗死(ACI)患者血清微小核糖核酸-16(miR-16)表达与并发抑郁的关系。方法:选择自贡市第一人民医院神经内科2019年12月~2021年9月收治的189例ACI患者作为疾病组,另选择同期在本院体检的健康志愿者175例作为健康组,均采用定量实时聚合酶联反应(qRT-PCR)法检测血清miR-16表达。治疗后随访6个月,根据是否并发抑郁将ACI患者分为抑郁组(56例)和无抑郁组(133例),比较两组血清miR-16表达及一般资料。采用多因素Logistic回归分析ACI患者并发抑郁的影响因素。结果:疾病组血清miR-16表达[(13.24±2.41)比(5.76±1.02)]显著高于健康组(P<0.001)。随访6个月,189例ACI患者中抑郁发生率为29.63%。与无抑郁组比较,抑郁组血清miR-16表达[(12.75±2.23)比(14.42±2.68)]、入院时美国国立卫生研究院卒中量表(NIHSS)评分[(15.12±2.88)分比(18.23±3.42)分]和性格内向(38.35%比67.86%)、失语(43.61%比62.50%)占比均显著升高,BI评分[(56.24±9.89)分比(48.41±9.45)分]显著降低(P<0.05或<0.01)。多因素Logistic回归分析结果显示,血清miR-16表达(OR=3.071,95%CI 1.653~5.562,P<0.001)、性格内向(OR=4.623,95%CI 2.321~6.589,P=0.009)、失语(OR=3.854,95%CI 1.785~6.112,P<0.001)、入院时NIHSS评分(OR=4.354,95%CI 2.121~6.563,P<0.001)均是影响ACI患者并发抑郁的独立危险因素,而BI评分是其独立保护因素(OR=0.626,95%CI 0.335~0.914,P=0.017)。结论:ACI患者血清miR-16表达显著高于健康人群,其与性格内向、失语、入院时NIHSS评分、BI指数评分均是ACI患者并发抑郁的独立影响因素。

触珠蛋白和不对称二甲基精氨酸与急性脑梗死预后关系

目的探讨急性脑梗死(ACI)患者血清触珠蛋白(HP)和不对称二甲基精氨酸(ADMA)变化与静脉溶栓治疗后血管再通和预后不良的关系。方法回顾性选择2020年1月至2023年3月于巴彦淖尔市医院接受静脉溶栓治疗的ACI患者260例,根据心肌梗死溶栓试验分为血管再通组196例和血管未通组64例;治疗后90 d,应用改良的Rankin量表评分分为预后良好组159例和预后不良组101例。比较各组血清HP和ADMA水平,用logistic回归分析治疗后血管未通和预后不良的危险因素,用ROC曲线分析血清HP和ADMA水平对治疗后血管未通的预测价值和预后不良的诊断效能。结果血管未通组血清HP和ADMA水平显著高于血管再通组[(2.10±0.21)g/L vs(1.29±0.31)g/L,(1.68±0.19)μmol/L vs(0.69±0.11)μmol/L,P<0.01];HP和ADMA是ACI患者治疗后血管未通的危险因素(P<0.01);二者联合诊断血管未通的曲线下面积为0.869(95%CI:0.830~0.908)。预后不良组血清HP和ADMA水平显著高于预后良好组[(2.27±0.19)g/L vs(1.15±0.34)g/L,(1.72±0.21)μmol/L vs(0.64±0.10),P<0.01];HP和ADMA是治疗后预后不良的影响因素(P<0.01);二者联合诊断预后不良的曲线下面积为0.816(95%CI:0.768~0.865)。结论HP和ADMA在ACI静脉溶栓治疗后血管未通患者和预后不良患者血清中表达升高,二者联合可有效预测静脉溶栓治疗后血管未通和预后不良。

多模态MRI参数及PWI定量参数对脑梗死患者并发认知功能障碍的预测价值分析

目的:分析多模态MRI参数及灌注加权成像(PWI)定量参数对脑梗死(CI)患者并发认知功能障碍的预测价值。方法:2020年5月—2023年8月将我院收治的139例CI并发认知功能障碍患者作为认知功能障碍1组,70例CI并发认知功能障碍患者作为认知功能障碍2组,同期收治的148例单纯CI患者作为非认知功能障碍1组,75例单纯CI患者作为非认知功能障碍2组,其中认知功能障碍1组和非认知功能障碍1组联合作为建模组,认知功能障碍2组和非认知功能障碍2组联合作为验证组。统计4组一般资料、多模态MRI参数及PWI定量参数,分析CI患者并发认知功能障碍的影响因素,并构建相关的预测模型,分析预测模型对CI患者并发认知功能障碍的预测价值及多模态MRI参数及PWI定量参数对CI患者并发认知功能障碍的预测价值。结果:年龄及脑白质病变(WML)评分、相对平均通过时间(rMTT)、相对达峰时间(rTTP)较高均为CI并发认知功能障碍的独立危险因素(OR=2.044、1.669、1.480、1.626,P<0.05),进一步进行模型构建得出相关的预测模型,模型区分度ROC曲线显示,该模型在建模组和验证组中的曲线下面积(AUC)分别为0.878和0.781。WML评分、rMTT、rTTP联合预测CI患者并发认知功能障碍的AUC均高于三者单独检测(P<0.05)。结论:CI患者并发认知功能障碍的影响因素主要为年龄、WML评分、rMTT、rTTP,其中WML评分、rMTT、r TTP联合可有效提高对CI患者并发认知功能障碍的预测价值。

动态动脉硬化指数联合血清肿瘤坏死因子受体相关因子6、前蛋白转化酶枯草溶菌素9对急性分水岭脑梗死病人的预后价值

目的探究动态动脉硬化指数(AASI)联合血清肿瘤坏死因子受体相关因子6(TRAF6)、前蛋白转化酶枯草溶菌素9(PCSK9)对急性分水岭脑梗死(CWI)病人的预后价值。方法选取2019年8月至2021年8月保定市第二中心医院收治的96例急性CWI病人为研究组,另取同期体检健康者80例为对照组。收集病人一般临床资料,并对研究组和对照组的血清TRAF6、PCSK9水平及AASI进行检测;根据研究组病人预后情况将其分为预后良好组(67例)和预后不良组(29例),多因素logistic回归分析急性CWI病人预后的影响因素;绘制AASI与血清TRAF6、PCSK9对急性CWI病人预后评估的受试者操作特征曲线(ROC曲线)。结果研究组血清TRAF6(1.48±0.34)µg/L、PCSK9(97.25±14.25)µg/L水平及AASI(0.56±0.15)高于对照组(0.87±0.19)µg/L、(82.78±9.17)µg/L、(0.36±0.11)(P<0.05)。预后良好组与预后不良组年龄、美国国立卫生研究院卒中量表(NIHSS)评分、空腹血糖、狭窄程度及血管斑块性质差异有统计学意义(P<0.05)。预后不良组血清TRAF6(1.77±0.37)µg/L、PCSK9(104.82±17.93)µg/L水平及AASI(0.62±0.12)高于预后良好组(1.35±0.21)µg/L、(93.97±12.65)µg/L、0.53±0.09(P<0.05)。多因素logistic回归分析结果显示NIHSS评分、狭窄程度、血管斑块性质、AASI、血清TRAF6、PCSK9水平是急性CWI病人预后的影响因素(P<0.05)。AASI联合血清TRAF6、PCSK9预测急性CWI病人预后的AUC是0.92,灵敏度为93.10%,特异度为76.12%,Youden指数为0.69,优于AASI、TRAF6、PCSK9各自单独预测(P<0.05)。结论急性CWI病人血清TRAF6、PCSK9水平显著升高,联合AA-SI对病人的预后状况具有较高的预测效能,可为临床的合理干预和改善病人预后提供依据。

CTP参数与急性缺血性脑梗死侧支循环建立及介入治疗预后的相关性

目的 :探讨CT灌注(CTP)参数与急性缺血性脑梗死(AIS)侧支循环建立及介入治疗预后的相关性。方法 :选取2020年10月—2022年10月我院收治的82例AIS患者,以CT血管造影(CTA)作为诊断“金标准”,按照侧支循环建立状况分为良好组(15例)、一般组(38例)与不良组(29例)。所有患者均进行CTP检查,对比三组受试者CTP参数(脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)及达峰时间(TTP)),采用受试者工作特征(ROC)曲线分析上述CTP参数对AIS侧支循环的预测价值,并分析上述CTP参数与侧支循环建立分级的相关性;采用美国国立卫生研究院卒中量表(NIHSS)、改良Ranking量表(mRS)评分评估AIS患者介入治疗预后,用Pearson相关性分析CTP参数与预后的相关性。结果:CBV、CBF组间比较:良好组>一般组>不良组(P<0.05);MTT、TTP组间比较:良好组<一般组<不良组(P<0.05)。ROC曲线分析显示,CBV、CBF、MTT、TTP及联合检测对AIS侧支循环建立评估均有一定的效能(P<0.05),其曲线下面积分别为0.640、0.672、0.654、0.664、0.896,其中联合检测效能最高,敏感性为84.09%,特异性为92.11%。Spearman相关分析发现,CBV、CBF与侧支循环等级呈正相关(P<0.05),MTT、TTP与侧支循环等级呈负相关(P<0.05)。NIHSS、mRS评分组间比较:良好组<一般组<不良组(P<0.05);Pearson相关分析发现,AIS患者CBV、CBF与NIHSS、mRS评分呈负相关(P<0.05),MTT、TTP与NIHSS、mRS评分呈正相关(P<0.05)。结论:CTP参数中CBV、CBF与AIS患者侧支循环等级、介入治疗预后呈正相关,MTT、TTP与AIS患者侧支循环等级、介入治疗预后呈负相关,临床可通过CTP参数评估患者侧支循环建立情况以及介入治疗预后。

CT灌注成像低灌注强度比值对急性脑梗死预后预测价值

目的探析CT灌注成像低灌注强度比值(HIR)对急性脑梗死的预后预测价值。方法选取2023年5月至2024年4月福建中医药大学附属人民医院收治的80例急性脑梗死患者,按随访90 d行改良Rankin量表(mRS)评估结果将其划分为预后不良组(26例,mRS评分为3~5分)和预后良好组(54例,mRS评分为0~2分),对比组间各项资料差异,分析影响患者预后的因素,以及独立预测因素与预后的相关性。结果预后良好组入院NIHSS评分、侧支循环(CC)不丰富、HIR、相对低灌注区残余功能达峰时间(Tmax)均低于预后不良组(P<0.05),低灌注区相对脑血流量(rCBF)、相对血流容积(rCBV)均高于预后不良组(P<0.05);CC不丰富和HIR是发生预后不良的独立预测因素;CC不丰富、HIR与90 d mRS评分呈正相关;HIR及低灌注区rCBF、rCBV、rTmax对患者预后预测的曲线下面积(AUG)分别为0.982(0.925~0.997)、0.848(0.750~0.945)、0.851(0.756~0.946)、0.870(0.780~0.960),最佳截断值分别为0.41、0.56(ml·100 g^(-1)·min^(-1))、0.66(ml·100 g^(-1))、1.36 s,预测灵敏度、特异度均较高。结论CC不丰富和HIR是发生急性脑梗死预后不良的独立危险因素,运用CT灌注成像HIR对患者预后具有较高预测价值。

通脑饮治疗急性脑梗死的临床疗效及作用机制研究:基于网络药理学和分子对接技术

背景脑梗死是由各种原因引起的局部脑组织区域供血障碍,通脑饮为江苏省中医院治疗脑梗死的协定方,但具体作用机制尚不清楚。目的本研究旨在通过网络药理学和临床试验,解释通脑饮治疗脑梗死的机制。方法选取2019年1月—2020年6月江苏省中医院收治的199例脑梗死患者。根据随机数字表法,将患者分为对照组(97例)和试验组(102例)。两组均接受稳定型脑梗死的标准化治疗,试验组加用通脑饮治疗。治疗前和治疗2周时,两组均采用美国国立卫生研究院卒中量表(NIHSS)评估卒中引起的功能损害程度,采用改良Rankin量表(mRS)评估神经功能的恢复情况。从TCMSP和文献中筛选通脑饮的化学成分,选择生物利用度(OB)≥30%和药物相似性(DL)≥0.18要求的成分寻找该处方的有效成分。利用OMIM和GeneCards数据库分析通脑饮治疗脑梗死的分子靶点。在筛选出共同靶点后,用Cytoscape软件、String数据库分别绘制化合物和靶蛋白的网络图、构建蛋白相互作用(PPI)网络和基因本体论(GO)功能及京都基因和基因组百科全书(KEGG)信号通路富集分析。最后,进行分子对接实验,确定通脑饮治疗脑梗死的主要活性成分。结果治疗后,试验组NIHSS、mRS评分均低于对照组(P<0.05)。最终得到通脑饮活性成分60个,潜在靶点147个,疾病相关靶点5167个,药物与疾病的交集靶点121个。KEGG信号通路富集分析获得前列腺癌症、神经活性配体-受体相互作用、白介素(IL)-17信号通路、催乳素信号通路、PI3K-Akt信号通路、钙信号通路等。分子对接显示,通脑饮治疗脑卒中的主要活性成分β谷甾醇、山柰酚和胡萝卜素与核心蛋白雄激素受体(AR)有较好的结合性。结论通脑饮可能通过激活AR来治疗脑梗死。IL-17信号通路、PI3K-Akt信号通路和催乳素信号通路也是潜在的机制。

三维动脉自旋标记成像序列与弥散加权成像在急性脑梗死鉴别诊断中的价值研究

目的研究在急性脑梗死鉴别诊断中三维动脉自旋标记成像(3D-ASL)序列与弥散加权成像(DWI)的应用价值。方法选定本院2020年11月至2023年12月收治的108例高度疑似急性脑梗死患者,所有入院患者均接受磁共振成像(MRI)扫描,分析患者的3D-ASL、DWI图像表现,以临床综合诊断为金标准,评估3D-ASL序列与DWI的诊断效能。结果108例疑似患者临床综合诊断,确诊阳性100例,而3D-ASL序列确诊急性脑梗死者97例,DWI确诊急性脑梗死者78例,诊断符合率、灵敏度、特异度3D-ASL高于DWI(P<0.05);3D-ASL、DWI成像参数值对比,病灶侧局部脑血流量(rCBF)、表观弥散系数(ADC值)低于健侧,差异有统计学意义(P<0.05);急性期、亚急性期、慢性期患者三维D-ASL、DWI成像参数值对比差异有统计学意义(P<0.05)。结论在急性脑梗死鉴别诊断中,3D-ASL诊断符合率与灵敏度要高于DWI,可为临床提供一定的参考依据,有重要的参考价值。