Advances in arterial spin labeled cerebral perfusion imaging in cerebrovascular diseases

Cerebrovascular disease is a disease with high morbidity,disability and mortality rates,which seri-ously affects the daily life of patients and is a heavy burden on families and society.Arterial spin labeling(ASL)is a magnetic resonance imaging(MRI)technology that uses the magnetic labeling of hydrogen atoms in arterial blood as tracers to noninvasively evaluate brain blood flow.ASL does not require injection of an exogenous contrast agent,and has the advantages of no radiation,simplicity and low cost.In cerebrovascular diseases,ASL can evaluate the collateral cerebrovascular circulation and abnormal perfusion of brain tissue,which can provide a reliable basis for early diagnosis and clinical decision-making.This study reviewed ASL and its application in the diagnosis,treatment and prognosis of cerebrovascular diseases.

Risk factors and ankle brachial indexes in cerebral infarction combined with peripheral arterial disease

BACKGROUND: Ankle brachial index (ABI) is widely involved in researches and clinical application of peripheral vascular injury of patients with diabetes mellitus (DM); however, the application in cerebral infarction (CI) is rare. OBJECTIVE: To investigate the possible risk factor of cerebral infarction plus peripheral arterial disease (PAD), compare metabolic characteristics of patients who having CI plus PAD or only having CI, and understand the significance of ABI on screening and diagnosing CI plus PAD of lower limb. DESIGN: Contrast observation based on CI patients. SETTING: Department of Neurology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region. PARTICIPANTS: A total of 124 CI patients were selected from Department of Neurology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region from July 2005 to April 2006, including 72 males and 52 females aged from 45 to 88 years. All patients met the diagnostic criteria of cerebrovascular disease established by National Academic Conference of Cerebrovascular Diseases in 1995 and determined as cerebral infarction with MRI or CT examination. All patients provided informed consent. There were 46 cases (37.2%) with CI plus PAD and 78 cases (62.8%) only with CI. METHODS: Blood pressure of bilateral ankles and upper extremities was measured at plain clinostatism with DINAMAP blood pressure monitor (GE Company). The ratio between average systolic pressure of lateral ankle and average systolic pressure of both upper extremities was regarded as ABI. The normal ABI was equal to or more than 0.9. If ABI < 0.9 occurred at one side, patients were diagnosed as PAD. On the second morning after hospitalization, blood was collected to measure fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG2h), glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Among them, blood glucose, lipid and other biochemical markers were measured with enzyme chemistry assay and HbA1c was measured with HbA1c meter based on high liquid phase. Measurement data and enumeration data were compared with t test and Chi-square test, and multiple factors were dealt with Logistic regression analysis and multivariate linear regression analysis. MAIN OUTCOME MEASURES: Results of correlation between ABI and metabolic markers with multivariate linear regression analysis; risk factors of CI plus PAD with Logistic regression analysis; comparisons of metabolic markers between PAD and non-PAD patients. RESULTS: All 124 patients with acute CI were involved in the final analysis. ① Comparisons of metabolic markers: Levels of serum LDL-C and uric acid (UA) were higher of PAD patients than those of non-PAD patients (t =2.051 9, 3.339 1, P < 0.05); however, there were no significant differences among other metabolic markers (P > 0.05). ② Results of multivariate linear regression analysis: PBG2h, LDL-C and UA were obvious correlation with ABI of posterior tibial artery of lower limb and dorsal pedis artery (partial regression coefficient = -0.231 to -1.010, P < 0.05). ③ Risk factors of CI plus PAD with Logistic regression analysis: Age, smoking history, sum of CI focus (≥3) and LDL-C were independent risk factor of CI plus PAD (OR =1.524-5.422, P < 0.05-0.01). CONCLUSION: ① Levels of serum LDL-C and UA of patients with CI plus PAD are high. ② ABI of lower limbs is correlation with PBG2h, LDL-C and UA. In addition, measuring ABI is beneficial for early diagnosing PAD of lower limbs of patients who have poorly controlled blood glucose, abnormal lipid and poor renal function. ③ Age, LDL-C and sum of CI focus (≥3) are independent risk factors of CI plus PAD. It is of significance for screening non-PAD patients to evaluate risk degrees and prognosis and select therapeutic methods based on ABI measurement.

Significance of Cyclooxygenase-2 Elevation in Middle Cerebral Artery for Patients with Hemorrhagic Moyamoya Disease

The etiology and pathogenesis of moyamoya disease（MMD） remain elusive. Some inflammatory proteins, such as cyclooxygenase（COX）-2, are believed to be implicated in the development of MMD. So far, the relationship between COX-2 and MMD is poorly understood and reports on the intracranial vessels of MMD patients are scanty. In this study, tiny pieces of middle cerebral artery（MCA） and superficial temporal artery（STA） from 13 MMD patients were surgically harvested. The MCA and STA samples from 5 control patients were also collected by using the same technique. The expression of COX-2 was immunohistochemically detected and the average absorbance（A） of positively-stained areas was measured. High-level COX-2 expression was found in all layers of the MCA samples from all 5 hemorrhagic MMD patients, while positive but weak expression of COX-2 was observed only in the endothelial layer of the MCA samples from most ischemic MMD patients（6/8, 75%）. The average A values of COX-2 in the hemorrhagic MMD patients were substantially higher than those in their ischemic counterparts（t=4.632, P=0.001）. There was no significant difference in the COX-2 expression among the ＂gender＂ groups, or ＂radiographic grade＂ groups, or ＂lesion location＂ groups（P0.05 for all）. The COX-2 expression was detected neither in the MCA samples from the controls nor in all STA specimens. Our results suggested that COX-2 was up-regulated in the MCA of MMD patients, especially in hemorrhagic MMD patients. We are led to speculate that COX-2 may be involved in the pathogenesis of MMD and even contribute to the hemorrhagic stroke of MMD patients.

Histopathological Features of Middle Cerebral Artery and Superficial Temporal Artery from Patients with Moyamoya Disease and Enlightenments on Clinical Treatment

The histopathological features of the middle cerebral artery（MCA） and superficial temporal artery（STA） from moyamoya disease（MMD） and their relationships with gender,age,angiography stage were explored.The causes and the clinical significance of vasculopathy of STA were also discussed.The clinical data and specimens of MCA and STA from 30 MMD patients were collected.Twelve samples of MCA and STA from non-MMD patients served as control group.Histopathological examination was then performed by measuring the thickness of intima and media,and statistical analysis was conducted.The MCA and STA specimens from MMD group had apparently thicker intima and thinner media than those from the control group.There was no significant pathological difference between the hemorrhage group and non-hemorrhage group,and between the males and females in MMD patients.Neither the age nor the digital subtraction angiography（DSA） stage was correlated with the thickness of intima in MCA and STA.MMD is a systemic vascular disease involving both intracranial and extracranial vessels.Preoperative external carotid arteriography,especially super-selective arteriography of the STA,benefits the selection of donor vessel.

NOTCH3 Mutations and CADASIL Phenotype in Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

Background:The etiology of pulmonary arterial hypertension associated with congenital heart disease(PAHCHD)is complicated and the phenotype is heterogeneous.Genetic defects of NOTCH3 were associated withcerebral disease and pulmonary hypertension.However,the relationship between NOTCH3 mutations and theclinical phenotype has not been reported in CHD-PAH.Methods:We eventually enrolled 142 PAH-CHD patientsfrom Fuwai Hospital.Whole exome sequencing(WES)was performed to screen the rare deleterious variants ofNOTCH3 gene.Results:This PAH-CHD cohort included 43(30.3%)men and 99(69.7%)women with the meanage 29.8±10.9 years old.The pathogenic or likely pathogenic mutations of NOTCH3 were identified in five cases.Patients 2,5,8 and 11 carried the same NOTCH3 mutation c.1630C>T(pArg544Cys),which is the hot-spotmutation for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy(CADASIL).Patient 3 carried the NOTCH3 mutation p.Arg75Gln that has also been reported to be associatedwith the CADASIL.Patients 2,5,8,11 took the examination of the cerebral magnetic resonance imaging(MRI)and confirmed the phenotype of CADASIL.Conclusions:We first reported the NOTCH3 rare mutationsand CADASIL phenotypes in CHD-PAH patients.The NOTCH3 rare variants were with a relatively high positiverate and CADASIL phenotypes were likely enriched in PAH-CHD patients.The preoperative neurological examinationmight be recommended for PAH-CHD patients to determine the surgical contraindications and reduceintraoperative neurological complications.

Long-Term Prognosis and Predictive Risk Factors for Polyvascular Disease in Patients with Peripheral Arterial Disease

Background: The aim of the current study was to assess fifteen-year life expectancy, cardiovascular events, fate of the limb, and risk factors with or without polyvascular disease in patients with Peripheral Arterial Disease (PAD). Methods: We conducted a prospective cohort study in 1019 PAD patients. The endpoints were Cardiovascular or Cerebrovascular Death (CCVD), All-Cause Death (ACD), Major Adverse Cardiovascular Events (MACE), and Cardiovascular and/or Limb Events (CVLE). Results: The patients who died were 539 (52.9%) during follow-up periods. The rate of CCVD was 50.5% (n = 272). In multiple regression analysis, the number of affected arteries had correlations with estimated Glomerular Filtration Rate (eGFR), HDL-cholesterol, Ankle Brachial Pressure Index (ABI), and diabetes (p < 0.05). In multiple logistic analysis, PAD with Cerebrovascular Disease (CVD) was correlated with older age, ABI, eGFR, and atrial fibrillation (p < 0.05);PAD with Coronary Heart Disease (CHD) was correlated with younger age, eGFR, HDL-cholesterol, LDL- cholesterol, and diabetes (p < 0.05);and triple vascular disease (PAD with CVD and CHD) was correlated with ABI, eGFR, HDL-cholesterol, and diabetes (p < 0.05). The number of affected arteries had significant correlations with CCVD, ACD, MACE, and CVLE (p < 0.05). In Cox multivariate analyses, age, Critical Limb Ischemia (CLI), eGFR, albumin, C-Reactive Protein (CRP), Body Mass Index (BMI), CVD, and CHD were related to CCVD (p < 0.05);age, albumin, eGFR, CRP, BMI, CLI, and CVD were associated with ACD (p < 0.05);age, albumin, eGFR, CRP, CLI, CHD, and diabetes were associated with MACE (p < 0.05);age, ABI, albumin, eGFR, CRP, CLI, CHD, and diabetes were related to CVLE (p < 0.05). Statins improved all outcomes (p < 0.05). Conclusions: Polyvascular disease was independently associated with fifteen-year mortality, cardiovascular events, and the fate of the limb with diverse risk factors in PAD patients.

经桡动脉行PCI术联合术后伊伐布雷定对冠心病患者疗效及对冠脉再狭窄发生率、血清ET水平的影响

目的探讨经桡动脉行PCI术联合术后伊伐布雷定对冠心病患者疗效及对冠脉再狭窄发生率、血清内皮素(Endothelin,ET)水平的影响。方法选取2021年1月—2022年8月贵州省纳雍县人民医院经桡动脉行PCI术的120例冠心病患者为研究对象,按照随机数表法分为对照组和观察组,各60例。对照组术后给予常规治疗,观察组在此基础上联合伊伐布雷定治疗。比较两组患者的临床资料、手术指标、疗效(有效率、炎性反应、复发心绞痛率)、冠脉再狭窄发生率及血清ET水平。结果与对照组(76.67%)相比,观察组的治疗有效率(93.33%)更高,差异有统计学意义(χ^(2)=6.614,P<0.05);观察组的C-反应蛋白、白细胞计数、心绞痛复发率、冠脉再狭窄率、血清ET水平均低于对照组,差异有统计学意义(P均<0.05)。结论经桡动脉行PCI术联合术后伊伐布雷定能够提高冠心病患者的临床疗效,降低冠脉再狭窄发生率,降低血清ET水平。

Neuroprotective effect of penehyclidine hydrochloride on focal cerebral ischemia-reperfusion injury

Penehyclidine hydrochloride can promote microcirculation and reduce vascular permeability. However, the role of penehyclidine hydrochlodde in cerebral ischemia-reperfusion injury remains unclear. In this study, in vivo middle cerebral artery occlusion models were established in experimental rats, and penehyclidine hydrochloride pretreatment was given via intravenous injection prior to model establishment. Tetrazolium chloride, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling and immunohistochemical staining showed that, penehyclidine hydrochloride pretreatment markedly attenuated neuronal histopathological changes in the cortex, hippocampus and striatum, reduced infarction size, increased the expression level of BcI-2, decreased the expression level of caspase-3, and inhibited neuronal apoptosis in rats with cerebral ischemia-reperfusion injury. Xanthine oxidase and thiobarbituric acid chromogenic results showed that penehyclidine hydrochloride upregulated the activity of superoxide dismutase and downregulated the concentration of malondialdehyde in the ischemic cerebral cortex and hippocampus, as well as reduced the concentration of extracellular excitatory amino acids in rats with cerebral ischemia-reperfusion injury. In addition, penehyclidine hydrochloride inhibited the expression level of the NR1 subunit in hippocampal nerve cells in vitro following oxygen-glucose deprivation, as detected by PCR. Experimental findings indicate that penehyclidine hydrochloride attenuates neuronal apoptosis and oxidative stress injury after focal cerebral ischemia-reperfusion, thus exerting a neuroprotective effect.

Computer-aided differential diagnosis system for Alzheimer’s disease based on machine learning with functional and morphological image features in magnetic resonance imaging

Alzheimer’s disease (AD) is a dementing disorder and one of the major public health problems in countries with greater longevity. The cerebral cortical thickness and cerebral blood flow (CBF), which are considered as morphological and functional image features, respectively, could be decreased in specific cerebral regions of patients with dementia of Alzheimer type. Therefore, the aim of this study was to develop a computer-aided classification system for AD patients based on machine learning with the morphological and functional image features derived from a magnetic resonance (MR) imaging system. The cortical thicknesses in ten cerebral regions were derived as morphological features by using gradient vector trajectories in fuzzy membership images. Functional CBF maps were measured with an arterial spin labeling technique, and ten regional CBF values were obtained by registration between the CBF map and Talairach atlas using an affine transformation and a free form deformation. We applied two systems based on an arterial neural network (ANN) and a support vector machine (SVM), which were trained with 4 morphological and 6 functional image features, to 15 AD patients and 15 clinically normal (CN) subjects for classification of AD. The area under the receiver operating characteristic curve (AUC) values for the two systems based on the ANN and SVM with both image?features were 0.901 and 0.915, respectively. The AUC values for the ANN-and SVM-based systems with the morphological features were 0.710 and 0.660, respectively, and those with the functional features were 0.878 and 0.903, respectively. Our preliminary results suggest that the proposed method may have potential for assisting radiologists in the differential diagnosis of AD patients by using morphological and functional image features.

老年无症状颅内动脉延长扩张症与脑小血管病综合评分的相关性

目的探讨老年无症状颅内动脉延长扩张症(IADE)与脑小血管病(CSVD)综合评分的相关性。方法回顾性分析2019年1月至2021年12月北京医院神经内科门诊查体或就诊且完成3 T头部磁共振成像(MRI)平扫、头部磁共振血管造影(MRA)和头部磁敏感加权成像(SWI)的CSVD患者。通过影像学诊断IADE并进行CSVD综合评分。根据有无IADE,将所有患者分为IADE组与非IADE组;依据CSVD综合评分,将患者分为CSVD无-轻度组与中-重度组,分别比较各组患者的基线资料和影像学资料,采用多因素Logistic回归分析IADE与CSVD总负荷之间的关系。结果共纳入230例CSVD患者,其中IADE组86例、非IADE组144例,CSVD综合评分无-轻度组157例、中-重度组73例。与非IADE组相比,IADE组患者的脑梗死史〔16例(18.6%)比13例(9.0%)〕、口服抗血小板聚集药物〔45例(52.3%)比51(35.4%)〕及CSVD综合评分为中-重度的患者〔36例(41.9%)比37例(25.7%)〕比例更高(均P<0.05)。230例患者中,CSVD综合评分中-重度组IADE患者比例高于无-轻度组〔36例(49.3%)比50例(31.8%),χ2=6.495,P值=0.011〕。多因素Logistic回归分析显示年龄〔OR(95%CI)=1.777(1.124~2.808),P=0.014〕、脑梗死史〔OR(95%CI)=15.481(4.565~52.496),P<0.001〕、颅内外动脉狭窄/闭塞〔OR(95%CI)=0.961(1.003~6.804),P=0.049〕和IADE〔OR(95%CI)=0.037(0.879~2.563),P=0.037〕是中-重度CSVD综合评分的独立危险因素,血红蛋白(≥135.5 g/L)〔OR(95%CI)=0.283(0.114~0.701),P<0.01〕是中-重度CSVD综合评分的保护因素。结论CSVD伴IADE患者在颅内影像表现上全脑受损更明显,且IADE、脑梗死史及颅内动脉狭窄/闭塞是CSVD严重程度的独立危险因素。

血清KLF2、NOS3水平对大动脉粥样硬化型急性脑梗死患者的诊断及病情评估价值

[目的]探讨锌指样转录因子2(KLF2)、内皮型一氧化氮合酶3(NOS3)水平在大动脉粥样硬化(LAA)型急性脑梗死(ACI)患者诊断及病情评估中的价值。[方法]将150例LAA型ACI患者根据病情分为轻度组(n=36)、中度组(n=48)和重度组(n=66),另选取同期门诊健康体检者设为对照组(n=150)。比较各组血清KLF2、NOS3水平;ROC曲线分别分析血清KLF2、NOS3水平对LAA型ACI的诊断价值和对发生重度LAA型ACI的预测价值。[结果]LAA型ACI组患者血清KLF2、NOS3水平显著低于对照组(P<0.05)。轻、中、重度组LAA型ACI患者血清KLF2、NOS3水平依次显著降低(P<0.05)。血清KLF2、NOS3二者联合诊断LAA型ACI的AUC为0.858,灵敏度为73.33%,特异度为86.00%,优于KLF2、NOS3各自单独诊断(Z联合检测-KLF2=3.796,Z联合检测-NOS3=4.689,均P<0.001)。血清KLF2、NOS3二者联合预测发生重度LAA型ACI的AUC为0.878,灵敏度为77.27%,特异度为90.48%,优于KLF2、NOS3各自单独预测(Z联合检测-KLF2=2.401,P=0.016;Z联合检测-NOS3=3.070,P=0.002)。[结论]LAA型ACI患者血清KLF2、NOS3水平显著降低,且与病情严重程度显著负相关,二者联合应用对LAA型ACI诊断和病情预测具有较高的评估效能。

CSVD总负荷与大脑中动脉供血区单发皮质下小梗死早期神经功能恶化的相关性研究

目的探讨脑小血管病(CSVD)的磁共振成像(MRI)总负荷与大脑中动脉供血区单发皮质下小梗死(SSSI)患者发生早期神经功能恶化(END)之间的关系。方法收集2020年1月-2021年12月在河北医科大学第三医院神经内科经脑MRI证实为大脑中动脉供血区SSSI患者133例。独立评估了脑MRI中的假定血管源性腔隙、脑微出血、脑白质高信号(WMH)和血管周围间隙扩大的存在,整合各CSVD影像特征,进而确定CSVD总负荷。END定义为入院后72h内美国国立卫生研究院卒中量表(NIHSS)评分增加≥2分或是肌力单项评分增加≥1分。根据患者入院后神经功能缺损程度的进展情况,将患者分为END组和非END组。比较两组的基线资料、单一CSVD影像学标志物和CSVD总负荷。采用Logistic回归分析SSSI患者中CSVD总负荷与发生END的关系。根据梗死部位对SSSI患者进行亚组分析,采用Logistic回归分析CSVD总负荷在不同梗死部位的SSSI患者中与发生END的关系。结果133例SSSI患者,其中30例(22.6%)被诊断为END。END组出现假定血管源性腔隙、脑微出血的比例、脑室周围WMH及CSVD总负荷评分显著高于非END组(P<0.05)。Logistic回归分析显示,CSVD总负荷是SSSI患者卒中后发生END的独立危险因素(P<0.05)。亚组分析结果显示远端SSSI患者的CSVD总负荷与END之间存在显著相关性(P<0.05)。结论CSVD总负荷是大脑中动脉供血区SSSI患者卒中后发生END的独立危险因素,在远端梗死上相关性更显著。

MR动脉自旋标记成像技术在脑血管病及相关认知障碍疾病中的应用进展

动脉自旋标记(ASL)为无需对比剂的MR脑灌注成像技术,与金标准对比剂灌注成像具有良好的相关性。随着ASL在中枢神经系统重大疾病中的广泛应用,尤其是多延迟ASL、4D ASL和超选择单支血管标记技术在脑血管病及相关认知障碍疾病中的应用,大幅提升了ASL的应用效能。就ASL的技术进展及其在脑血管病和相关认知障碍疾病中的应用进行评述,以期在临床上进一步推广ASL新技术,为病人提供简便易行和经济的影像检查方法,为个体化诊断及治疗决策提供支持。

颅内动脉直径与脑小血管病患者认知功能的关系

目的探讨颅内动脉直径与脑小血管病(CSVD)患者认知功能之间可能存在的关系,以求为血管性认知功能障碍(VCI)患者的早期识别、诊断及预后提供新的思路。方法回顾性分析2022-01—2023-12在郑州大学第二附属医院及新郑市公立人民医院住院的151例CSVD患者,采用蒙特利尔认知量表(MoCA)评估受试者的认知功能情况,分为认知功能正常组88例和认知功能障碍组63例,使用3D-Slicer软件对患者原始MRI图像进行处理,得出颅内动脉重塑(BAR)评分。根据BAR评分将患者分为颅内大动脉直径缩窄组(58例)、颅内大动脉直径平均组(37例)、颅内大动脉直径扩张组(56例)。应用Logistic回归分析颅内动脉直径与认知功能障碍的关系,Pearson相关性分析颅内动脉直径与MoCA总分及MoCA各子项得分的关系。结果Logistic回归分析提示颅内动脉直径扩张(OR=1.214,95%CI:1.127~1.307,P<0.01)是认知功能障碍的危险因素。颅内动脉直径扩张与MoCA总分(r=-0.306,P<0.001)、视空间与执行功能(r=-0.237,P=0.003)、语言(r=-0.238,P=0.003)、抽象(r=-0.160,P=0.049)、延迟回忆(r=-0.180,P=0.027)、定向(r=-0.163,P=0.046)呈负相关。结论颅内动脉直径扩张是CSVD患者认知功能障碍的危险因素,颅内动脉直径扩张与MoCA校正后总分、视空间与执行功能、语言、抽象、延迟回忆、定向力呈负相关。

颞浅动脉-大脑中动脉搭桥术治疗闭塞性脑血管疾病的现状及研究进展

闭塞性脑血管疾病的发生与动脉粥样硬化引起的血管管腔闭塞有关,导致脑供血不足,继而出现神经功能障碍。脑血管搭桥术是临床上治疗闭塞性脑血管疾病的主要手段之一,患者经治疗后可改善患侧脑供血,因此近年来该治疗方法受到广泛关注。但目前对于脑血管搭桥术在治疗闭塞性脑血管疾病中的应用还存在诸多需要探讨的问题。本文就颞浅动脉-大脑中动脉(superficial temporal artery-middle cerebral artery,STA-MCA)搭桥术在治疗闭塞性脑血管疾病中的现状及研究进展进行综述,旨在为该治疗手段在临床上的应用提供参考。

受体动脉不同临时阻断策略在烟雾病颞浅动脉-大脑中动脉搭桥术中的应用比较

目的探讨颞浅动脉-大脑中动脉端侧吻合术中不同临时阻断技术的效果及可靠性。方法回顾性分析2015年1月—2023年4月南方医科大学南方医院神经外科收治的接受直接搭桥术治疗的烟雾病患者资料,根据临时阻断策略的不同将患者分为3组:①有垫片、多阻断夹阻断组(multi-clips+rubber pad group,M+R组);②无垫片、多阻断夹阻断组(multi-clips group,M组);③无垫片、单阻断夹阻断组(single-clip group,S组)。比较组间临时阻断时间、受体动脉切开后有无渗血、术中穿支血管损伤以及术后新发脑梗死情况。结果共355例患者、360个大脑半球纳入分析,按大脑半球统计患者360例,其中男性188例,女性172例,平均年龄为(43.8±0.7)岁。其中M+R组45例,M组191例,S组124例。3组平均阻断时间:M+R组为(37.9±9.8)min,M组为(20.9±9.0)min,S组为(11.0±3.5)min,组间差异有统计学意义(P<0.001)。阻断后受体动脉管腔内渗血以及术中穿支血管损伤发生率:M+R组为8.89%(阻断后受体动脉渗血4例),M组为14.66%(阻断后受体动脉渗血19例,术中穿支血管损伤8例,临时阻断部位有血栓形成1例),S组为5.65%(阻断后受体动脉渗血7例),组间差异无统计学意义(P>0.05)。术后新发脑梗死发生率差异无统计学意义(P>0.05)。结论单阻断夹阻断策略安全、有效,能显著缩短临时阻断时间,可以优先考虑作为颞浅动脉-大脑中动脉端侧吻合过程中的临时阻断策略。

冠脉重建术后患者康复运动对ET-1、NO和CGRP的影响

目的:观察康复运动治疗对冠心病患者冠脉重建术后内皮素(ET-1)、一氧化氮(NO)及降钙素基因相关肽(CGRP)水平的影响,以进一步探讨康复运动治疗对冠心病患者内皮功能的作用。方法:选择56例经皮冠状动脉腔内成形术(PTCA),10例冠脉搭桥术(CABG)后患者,按随机原则此66例患者被分配入康复运动治疗组和常规治疗组,每组33例。两组临床特征无统计学差异,有可比性。两组患者均给予相同的常规药物治疗,康复运动治疗组还接受12周康复运动治疗。观察疗程前后两组ET-1、NO及CGRP基因相关肽水平的变化。结果:康复运动治疗组12周疗程前、后ET-1、NO及CGRP水平均有显著性差异(P<0.05)。治疗后康复运动组与常规治疗组的ET-1、NO、CGRP水平均有显著性差异(P<0.05)。而常规治疗组疗程前、后ET-1、NO、CGRP水平均无显著性差异(P>0.05)。结论:康复运动治疗可以改善冠心病冠脉重建术后患者的血管内皮功能。

颞浅动脉-大脑中动脉分支吻合术治疗闭塞性脑血管疾病的临床效果

目的探讨颞浅动脉-大脑中动脉分支吻合术(STA-MCA)治疗闭塞性脑血管疾病的临床效果。方法纳入我院收治的74例闭塞性脑血管疾病患者,根据随机数字表法分为观察组与对照组,每组37例。对照组患者采用保守治疗,观察组患者采用STA-MCA治疗。术后随访3个月,观察2组治疗前和治疗后第3天、1个月、3个月的脑血流指标(大脑前动脉脑血流量、达峰时间),记录2组患者治疗前和治疗后第3天、1个月改良Rankin评分,统计治疗后血管重建情况和并发症发生情况。结果2组患者治疗后1个月、3个月的大脑前动脉脑血流量均提高,达峰时间均缩短,且观察组患者大脑前动脉脑血流量高于对照组,达峰时间短于对照组,差异有统计学意义(P<0.05)。与治疗前比较,2组患者治疗后1个月改良Rankin评分均降低,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组患者治疗后1个月血管重建为0级、1级的比例低于对照组,2级、3级比例高于对照组,差异均有统计学意义(P<0.05);观察组患者治疗后3个月血管重建为0级、1级比例低于对照组,3级比例高于对照组,差异均有统计学意义(P<0.05)。2组患者治疗后并发症总发生率比较,差异无统计学意义(P>0.05)。结论STA-MCA治疗闭塞性脑血管疾病的临床效果良好,有利于改善脑血流指标,促进神经功能恢复和血管重建,安全可靠。

动脉自旋标记成像观察帕金森病患者纹状体-丘脑-皮层环路的代谢网络连接属性

目的 从代谢网络连接的角度探讨帕金森病(Parkinson’s disease, PD)患者纹状体-丘脑-皮层(striatal-thalamo-cortical,STC)环路紊乱的影像学特征。材料与方法 采用动脉自旋标记成像技术,获取62名PD患者以及65名健康对照(healthy control,HC)受试者的脑血流量(cerebral blood flow, CBF)数据。基于CBF信息计算两组STC环路代谢网络的连接属性,包括种子点-连接、皮层-连接及模块-连接。随后使用置换检验分别进行三种网络连接的组间比较。结果 两组的年龄、性别、受教育程度及认知量表评分差异均无统计学意义(P>0.05)。相较于HC受试者,PD患者其种子点-连接值在双侧颞下回、双侧梭状回、双侧额中回、左侧枕中回以及右侧中央后回等脑区显著增高,而在双侧颞中回、左侧额直回、左侧颞上回、双侧额下回、双侧楔前叶、右侧辅助运动区以及双侧顶下回等脑区显著减低(P<0.05);其与感觉运动皮层存在显著增强的皮层-连接、而与运动皮层及顶-枕叶皮层存在显著减弱的皮层-连接(P<0.05);模块-连接于额叶模块与运动模块、感觉运动模块与顶-枕叶模块以及顶-枕叶模块与颞叶模块之间呈现显著升高;而于额叶模块与颞叶模块、运动模块与顶-枕叶模块以及感觉运动模块与颞叶模块之间呈现显著降低(P<0.05)。结论 PD患者存在代谢层面的神经网络紊乱,涉及到STC环路内以基底节区为枢纽的广泛性连接异常。

平均血小板体积和脑白质高信号对穿支动脉疾病型脑梗死早期神经功能恶化的预测价值

目的探讨平均血小板体积(MPV)和脑白质高信号(WMH)与穿支动脉疾病(PAD)型脑梗死患者早期神经功能恶化(END)的相关性。方法回顾性连续纳入2021年1月至2023年9月苏州市独墅湖医院神经内科收治的经头部MRI等检查诊断的PAD型脑梗死患者,按照入院后7 d内是否发生END分为END组和非END组。收集两组患者的人口学资料、临床资料,包括性别、年龄、体质量指数、高血压病、糖尿病、高脂血症、吸烟、早期(发病7 d内)是否合并肺部感染、入院美国国立卫生研究院卒中量表(NIHSS)评分、入院时收缩压、脑梗死部位(前、后循环供血区)及抗血小板聚集药物治疗方案(单抗、双抗)、白细胞计数、中性粒细胞/淋巴细胞比值、C反应蛋白、血小板计数、血小板压积、MPV、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸、同型半胱氨酸、糖化血红蛋白、D-二聚体及纤维蛋白原。根据头部MRI影像,按照改良Fazekas分级,将两组患者的WMH严重程度分为轻度负荷(改良Fazekas分级0~1级)和重度负荷(改良Fazekas分级2~3级)。采用单因素及多因素二元Logistic回归分析MPV和WMH程度与PAD型脑梗死患者发生END的相关性。结果共167例患者纳入本研究,其中END组40例,非END组127例,END发生率24.0%。单因素分析结果显示,END组患者的入院NIHSS评分、糖尿病、MPV以及WMH负荷程度均高于非END组,而血小板计数低于非END组(均P<0.05)。多因素Logistic回归分析显示,MPV和重度负荷WMH是PAD型脑梗死患者发生END的独立影响因素(OR值分别为1.460、2.549,95%CI值分别为1.066~2.000、1.161~5.595,P值分别为0.018、0.020)。受试者工作特征曲线显示,MPV水平及重度负荷WMH程度对PAD型脑梗死患者发生END均有预测价值,曲线下面积分别为0.704(95%CI:0.615~0.793,P=0.001)、0.616(95%CI:0.516~0.716,P=0.028)。结论MPV水平升高和重度负荷WMH是PAD型脑梗死患者发生END的独立影响因素,且MPV的预测价值较重度负荷WMH更高。