Influences of blood lipids on the occurrence and prognosis of hemorrhagic transformation after acute cerebral infarction: a case-control study of 732 patients

Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 st, 2015, and December 31 st, 2016, were retrospectively analyzed. Patients were divided into group A(without HT) and group B(HT). The outcomes were assessed after 3 months of disease onset using the modified Rankin Scale(m RS). An m RS score of 0–2 points indicated excellent prognosis, and an m RS score of 3–6 points indicated poor prognosis.Results: A total of 732 patients conformed to the inclusion criteria, including 628 in group A and 104 in group B. The incidence of HT was 14.2%, and the median onset time was 2 d(interquartile range, 1–7 d). The percentages of patients with large infarct size and cortex involvement in group B were 80.8% and 79.8%, respectively, which were both significantly higher than those in group A(28.7 and 33.4%, respectively). The incidence rate of atrial fibrillation(AF) in group B was significantly higher than that in group A(39.4% vs. 13.9%, P<0.001). The adjusted multivariate analysis results showed that large infarct size, cortex involvement and AF were independent risk factors of HT, while total cholesterol(TC) was a protective factor of HT(OR=0.359, 95% CI 0.136–0.944, P=0.038). With every 1 mmol/L reduction in normal TC levels, the risk of HT increased by 64.1%. The mortality and morbidity at 3 months in group B(21.2% and 76.7%, respectively) were both significantly higher than those in group A(8.0% and 42.8%, respectively). The adjusted multivariate analysis results showed that large infarct size(OR=12.178, 95% CI 5.390–27.516, P<0.001) was an independent risk factor of long-term unfavorable outcomes, whereas low-density lipoprotein cholesterol(LDL-C) was a protective factor(OR=0.538, 95% CI 0.300–0.964, P=0.037). With every 1 mmol/L reduction in normal LDL-C levels, the risk of an unfavorable outcome increased by 46.2%. Major therapies, including intravenous recombinant human tissue plasminogen activator(r TPA), intensive lipid-lowering statins and anti-platelets, were not significantly related to either HT or long-term, post-ACI poor prognosis.Conclusions: For patients with large infarct sizes, especially those with cortex involvement, AF, or lower levels of TC, the risk of HT might increase after ACI. The risk of a long-term unfavorable outcome in these patients might increase with a reduction in LDL-C.

Susceptibility gene for stroke or cerebral infarction in the Han population in Hunan Province of China

The scavenger receptor class B type I gene can protect against atherosclerosis; a mononucleotide polymorphism is associated with differences in blood lipid metabolism, postprandial serum lipid levels, insulin resistance, coronary artery disease and familial hyperlipidemia. In this study, the scavenger receptor class B type I gene exon 1 G4A gene polymorphism in atherosclerotic cerebral infarction patients, cerebral hemorrhage patients and normal controls was detected using the polymerase chain reaction-restriction fragment length polymorphism method. The results showed that the GA ＋ AA genotype frequency of scavenger receptor class B type I gene G4A in atherosclerotic cerebral infarction patients was similar to that in cerebral hemorrhage patients and normal controls; however, the A allele frequency was significantly lower than that in normal controls. The serum level of high-density lipoprotein cholesterol in patients with the scavenger receptor class B type I gene G4A GA ＋ AA genotype was significantly higher, while the serum level of low-density lipoprotein cholesterol was significantly lower than that in patients with the GG genotype, in both the atherosclerotic cerebral infarction and cerebral hemorrhage groups. The serum level of high-density lipoprotein cholesterol in patients with the scavenger receptor class B type I gene G4A GA ＋ AA genotype was significantly higher, while the serum levels of low-density lipoprotein cholesterol and total cholesterol were significantly lower than those in normal controls with the GG genotype. Our experimental results suggest that the G4A polymorphism of the scavenger receptor class B type I gene is a possible predisposing risk factor for atherosclerotic cerebral infarction, and that it has no association with cerebral hemorrhage in the Hart population in Hunan province of China. The A allele is possibly associated with the metabolism of high-density and low-density lipoprotein cholesterol.

Myocardial Infarction and Intracerebral Hemorrhage in a Chinese Population: Relationship with Lipoproteins and Adipokines

BACKGROUND: Adipokines and inflammatory factors play an important role in disease progression. Two cardiovascular diseases which have important contributions to mortality and morbidity in China are in-tracerebral hemorrhage (ICH) and myocardial infarction (MI). Acylation stimulating protein has been shown in North American populations to have strong associations with risk factors for MI. Complement C3 (C3) a component of the innate complement immune system is the precursor protein to ASP;C3 has been impli-cated in the pathogenesis of ICH. OBJECTIVE: In this case-control study we examined the association be-tween BMI, lipoproteins adiponectin, C3 and ASP) in a Chinese population. METHODS AND RESULTS: Three groups of subjects were studied: ICH group (N = 41), MI group (N = 60) and a control group (N = 44). There was no difference in BMI for either ICH or MI compared to controls (Control: 22.3 ± 0.3 kg/m2;ICH: 21.3 ± 0.4 vs MI: 22.5 ± 0.2, ICH and MI versus control pNS). The ICH group had lower LDL-C (Control: 3.21 ± 0.13 mmol/L;ICH: 2.54 ± 0.13;MI: 2.99 ± 0.13;ICH vs control p < 0.05), total cholesterol (Control: 5.06 ± 0.16 mmol/L;ICH: 4.40 ± 0.15;MI: 4.51 ± 0.14;ICH and MI vs control p < 0.05),, HDL-C (Control: 1.34 ± 0.05 mmol/L;ICH: 1.22 ± 0.06;MI: 0.95 ± 0.04;ICH and MI vs control p < 0.05), and C3 (Control: 2.58 ? 0.21 g/L;ICH: 1.85 ? 0.19;MI: 2.87 ? 0.16;ICH vs control p < 0.05), and higher TG (Control: 1.10 ± 0.07 mmol/L;ICH: 1.77 ± 0.17;MI: 1.61 ± 0.10, ICH and MI vs control p < 0.05), compared to the controls. The MI group had lower total cholesterol and HDL-C and higher TG and ASP (Control: 33.70 ? 2.07 nM;ICH: 35.10 ? 2.33;MI: 41.50 ? 1.81;MI vs control p < 0.05) compared to control. CONCLUSION: Chinese men and women who had an MI displayed elevated ASP unrelated to an increase in the precursor protein, C3. Chinese men and women with ICH had ASP levels similar to controls yet lower C3 suggesting that C3, and the regulation of C3 conversion to ASP may be important in ICH disease pathology.

Effects of Maixuekang Capsules Combined with Edaravone on Serum MMP-9, S-100β Protein Levels and Neurological Functions in Patients with Hemorrhagic Cerebral Infarction

OBJECTIVE: To investigate the effects of Maixuekang Capsules combined with edaravone on serum matrix metalloproteinase-9(MMP-9), S-100β protein levels and neurological functions in patients with hemorrhagic cerebral infarction. METHOSDS: A total of 76 patients with hemorrhagic cerebral infarction treated in the First Affiliated Hospital of Henan University of Science and Technology from January 2017 to May 2018 were selected and were randomly divided into treatment group and control group, with 38 patients in each group. The control group was given edaravone, and the treatment group was given Maixuekang Capsules on the basis of the control group. The clinical efficacy, serum MMP-9 and S-100β protein levels, neurological function recovery, activity of daily living and incidence rate of adverse reactions were compared between the 2 groups. RESULTS: The total effective rate of the treatment group was 92.11%, which was higher than 71.05% of the control group(P < 0.05); the National Institutes of Health Stroke Scale(NIHSS) score in the 2 groups decreased(P < 0.05), and the Activity of Daily Living Scale(ADL) score increased(P < 0.05), the improvement of the above 2 scores in the treatment group were better than those in the control group(P < 0.05); the level of MMP-9 was gradually decreasing in the 2 groups, on the 7th day, 14 th day after treatment, and the levels of MMP-9 decreased significantly(P < 0.05), and the treatment group was lower than the control group at all time points(P < 0.05); on the 3rd day after treatment, the levels of S-100β protein in the 2 groups increased significantly(P < 0.05); on the 7th day, 14 th day after treatment, the levels of S-100β protein in the two groups decreased significantly(P < 0.05), and the treatment group was significantly lower than the control group(P < 0.05); there was no significant difference in incidence rate of adverse reactions between 7.89% in the control group and 5.26% in the treatment group(P > 0.05). CONCLUSION: The combination of Maixuekang Capsules and edaravone is effective in treating hemorrhagic cerebral infarction, and it can significantly improve neurological function defect and daily living ability, reduce serum MMP-9 and S-100β protein levels, and has higher safety.

Ileal hemorrhagic infarction after carotid artery stenting:A case report and review of the literature

BACKGROUND Ileal hemorrhagic infarction after carotid artery stenting(CAS)is a fatal complication.The prognosis of ileal hemorrhagic infarction after CAS is very poor if not treated in a timely manner.We describe a rare case of ileal hemorrhagic infarction due to acute embolism of the mesenteric artery after CAS.CASE SUMMARY A 67-year-old man with acute ischemic stroke underwent CAS via the right femoral artery approach 21 d after intensive medical treatment.On the first day after surgery,the patient had abdominal distension and abdominal pain.Abdominal enhanced computed tomography revealed intestinal obstruction,severe stenosis of the superior mesenteric artery,and poor distal angiography.An exploratory laparotomy was performed,and pathological examination showed hemorrhagic ileal infarction.It was subsequently found that the patient had intestinal flatulence.With the guidance of an ultrasound scan,the patient underwent abdominal puncture,drainage,and catheterization.After 58 d of treatment,the patient was discharged from hospital with a National Institutes of Health Stroke Scale score of 2 points,and a Modified Rankin Scale score of 1 point.At the 6-mo follow-up,the patient had an excellent functional outcome without stroke or mesenteric ischemia.Furthermore,computed tomography angiography showed that the carotid stent was patent.CONCLUSION Ileal hemorrhagic infarction is a fatal complication after CAS,usually caused by mesenteric artery embolism.Thus,more attention should be paid to the complications of embolism in the vascular system as well as the nervous system after CAS,and the complications should be identified and treated as early as possible.

Study on risk factors of hemorrhagic transformation in patients with acute cerebral infarction after non thrombolysis

Objective:To study the risk factors of hemorrhagic transformation in patients with acute cerebral infarction and to analyze the risk factors.Methods: A total of 96 patients with acute cerebral infarction after the thrombolysis in our hospital from June 2016 to December 2017 were selected as the research object. And they were divided into bleeding group 48 cases and hemorrhage transformation group 48 cases according to whether with hemorrhage occurs transformation. Then the lipid metabolism, atrial fibrillation, history of smoking and drinking, history of hypertension and diabetes, blood pressure, treatment time after onset and infarction area of two groups were compared, and the relationship between those factors and the disease were analyzed by the multi-factor Logistic regression analysis.Results: The atrial fibrillation, history of smoking and drinking of two groups had significant differences;The hospital fasting plasma glucose and LDL-C level of two groups had significant differences;the treatment time after onset and infarction area of two groups had significant differences;The multi-factor Logistic regression analysis showed that atrial fibrillation, blood glucose on admission, LDL-C and large area of infarction are the factors affecting the risk of bleeding in patients with acute cerebral infarction transformation.Conclusion:Atrial fibrillation, blood glucose on admission, LDL-C, treatment time after onset and large area of infarction belongs to the patients with acute cerebral infarction after the thrombolysis transformation of bleeding risk factors.

High-resolution magnetic resonance imaging in the diagnosis and management of vertebral artery dissection:A case report

BACKGROUND Vertebral artery dissection(VAD)is a rare but life-threatening condition characterized by tearing of the intimal layer of the vertebral artery,leading to stenosis,occlusion or rupture.The clinical presentation of VAD can be heterogeneous,with common symptoms including headache,dizziness and balance problems.Timely diagnosis and treatment are crucial for favorable outcomes;however,VAD is often missed due to its variable clinical presentation and lack of robust diagnostic guidelines.High-resolution magnetic resonance imaging(HRMRI)has emerged as a reliable diagnostic tool for VAD,providing detailed visualization of vessel wall abnormalities.CASE SUMMARY A young male patient presented with an acute onset of severe headache,vomiting,and seizures,followed by altered consciousness.Imaging studies revealed bilateral VAD,basilar artery thrombosis,multiple brainstem and cerebellar infarcts,and subarachnoid hemorrhage.Digital subtraction angiography(DSA)revealed vertebral artery stenosis but failed to detect the dissection,potentially because intramural thrombosis obscured the VAD.In contrast,HRMRI confirmed the diagnosis by revealing specific signs of dissection.The patient was managed conservatively with antiplatelet therapy and other supportive measures,such as blood pressure control and pain management.After 5 mo of rehabilitation,the patient showed significant improvement in swallowing and limb strength.CONCLUSION HR-MRI can provide precise evidence for the identification of VAD.

醛化人“O”型红细胞的制备及其在兔出血症HA/HI试验中的应用

在兔出血症的检测和免疫监测中,血凝/血凝抑制试验(HA/HI)是常规有效的检测方法。针对人"O"型新鲜红细胞存在质脆易碎、保存期短的缺点,从醛化人的"O"型红细胞制备方法的优化、工作浓度、保存时间三个方面进行研究,并用于兔出血症的HA/HI试验,同时以新鲜的人"O"型红细胞作为对照。结果表明:经戊二醛-甲醛二次醛化的红细胞的醛化效果与只用戊二醛醛化的红细胞效果差异不显著,均优于甲醛醛化效果,且经戊二醛-甲醛二次醛化或戊二醛醛化后的红细胞不溶血,性质不变,易保存;在兔出血症HA/HI试验中,经戊二醛醛化人"O"型红细胞的试验效果与新鲜红细胞差异不大,结果稳定性好。

Study on Relationship between Anticardiolipin Antibody and Cerebrovascular Diseases

Summary: Serum anticardiolipin antibody (ACA) was measured in 91 patients with cerebral infarction (CI), 42 patients with cerebral hemorrhage (CH) and 30 healthy controls. The results showed that the ACA in CI and CH patients was significantly higher than in controls and IgG ACA was the most important isotype. Stroke in ACA positive group tended to be recurrent and of multi focuses. Positive rate of IgG ACA reached its peak within the first week after stroke onset. The results suggested that ACA was an independent risk factor in CI and CH and might be valuable in stroke prediction.

Apolipoprotein E gene polymorphism in cerebrovascular diseases of the Chinese Naxi populations from Yunnan province

Currently it is not well known whether apolipoprotein E （ApoE） is a genetic susceptibility factor for cerebrovascular diseases in the Chinese Naxi population. The present study detected and sequenced ApoE polymorphisms of 90 patients with cerebrovascular diseases （58 cases of cerebral infarction and 32 cases of intracerebral hemorrhage）, and 50 normal people of Naxi nationality from Yunnan province, China. The populations were used to analyze the relationship of ApoE polymorphisms with cerebral infarction and intracerebral hemorrhage. Results showed an association between ApoE gene polymorphism and the onset of cerebral infarction, and a possibility that the ε4 allele is a susceptibility locus for the risk of cerebral infarction. However, there was no evidence of a relationship between the ApoE gene polymorphism and cerebral hemorrhage.

HIF-1α、NLRP3、Adropin与高血压脑出血血肿清除术后并发脑梗死患者神经缺损的相关性

【目的】探讨缺氧诱导因子-1α(HIF-1α)、核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)、Adropin与高血压脑出血(HICH)血肿清除术后并发脑梗死患者神经缺损的相关性。【方法】回顾性分析2018年6月至2021年3月本院收治的151例HICH血肿清除术后并发脑梗死患者的临床资料,根据患者30 d预后情况将其分为不良组(n=34)和良好组(n=117)。比较两组基线资料、美国国立卫生研究院卒中量表(NIHSS)评分及术前、术后3 d血清HIF-1α、NLRP3、Adropin水平,应用Pearson分析HIF-1α、NLRP3、Adropin与NIHSS评分关系,采用受试者工作特征曲线(ROC曲线)分析HIF-1α、NLRP3、Adropin对不良预后预测价值。【结果】不良组血肿量高于良好组,入院时格拉斯哥昏迷评分(GCS)低于良好组(P<0.05)。与术前比较,两组术后3 d血清HIF-1α、NLRP3水平均升高,Adropin、NIHSS评分均降低,不良组术后3 d血清HIF-1α、NLRP3水平及NIHSS评分高于良好组,Adropin水平低于良好组(P<0.05)。Pearson相关性分析显示,HIF-1α、NLRP3与NIHSS评分呈正相关(r分别为0.550、0.659,均P<0.05),Adropin与NIHSS评分呈负相关(r=-0.679,P<0.05)。ROC曲线结果显示,术后3 d HIF-1α、NLRP3联合Adropin预测不良预后的AUC、敏感度、特异度最大。【结论】HIF-1α、NLRP3、Adropin与HICH血肿清除术后并发脑梗死患者神经缺损、预后情况有关,联合检测可作为预测患者预后的有效指标,为临床预防患者病情恶化及治疗提供参考依据。

A Study on Stroke in Young and Elderly in Rajiv Gandhi Government General Hospital, Chennai

Stroke is a devastating and disabling cerebrovascular disease with some amount of residual deficit leading onto economic loss. Recent Indian studies have shown a stroke prevalence rate of 471.58/100,000 population. This study was undertaken to analyse the clinical profile and to arrive at important factors contributing to stroke in 45 years group. This is a descriptive, retrospective cross—sectional study carried out on acute CVA patients, admitted to the I.I.M., RGGGH, Chennai. 150 patients were studied over a period of 3 months in the 2011. 20% of /= 45 years constituted our study population. 18.4% and 22.2% of males and females respectively were young stroke patients. Only 33.3% of patients were brought to the hospital within 6 hours. 90% patients had mild GCS score (>/=13/15) and presented with hemiplegia 76% and 18% had infarct and intracerebral hemorrhage(ICH) respectively. Risk factors: Type A personality (70.7%), Tobacco (60.7%) and Alcohol (44.7%) abuse, Systemic Hypertension (60.7%), Diabetes Mellitus (33.3%), Cardiac disorders (14%). Stroke was seen to be more common in >45 years but still young stroke carries paramount importance due to loss of productive years in these patients. Female predominance was seen in young stroke, with particular reference to puerperal period. Among the comorbid illness systemic hypertension followed by cardiac disorders had important contributing role in young strokes. Most of the patients with infarct and ICH were tobacco and alcohol abusers respectively. A holistic approach encompassing further research in factors involved in young stroke, public awareness, behavioural modification and comorbid medical illness management is the need for the hour.

120 CASES OF PSEUDOBULBAR PARALYSIS TREATED BY NEEDLING LIANQUAN AND CHIZE

Pseudobulbar paralysis is a clinical syndrome which is characterized essentially by symptoms of dyslalia and dysphagia, and caused by paralysis of the muscles controlled by medulla oblongata. Over the past ten years, we have treated the disease by

BNP和WBC等多指标检测对急性脑梗死与脑出血鉴别诊断的临床应用价值研究

目的探讨血浆B型钠尿肽(BNP)和血液白细胞计数(WBC)等多项实验室常规检查对急性脑梗死与脑出血鉴别诊断的临床应用价值。方法回顾性分析2023年1月至2023年12月于首都医科大学附属北京天坛医院住院患者急性脑梗死(1083例)和脑出血(1136例)的9项相关实验室检测结果,通过统计分析,探究其在急性脑梗死与脑出血鉴别诊断方面的临床意义。结果经单因素分析和多因素回归分析后显示,两组患者的BNP、WBC、凝血酶时间(TT)、血清葡萄糖(GLU)、天门冬氨酸氨基转移酶(AST)、肌酐(CREA)差异均有统计学意义(P值均<0.05),并进行联合诊断模型的构建,其诊断AUC=0.734,灵敏度为66.9%,特异性为68.9%,诊断模型为:Y=-0.002×BNP+0.203×WBC-0.032×TT-0.030×GLU+0.012×AST+0.004×CREA-1.419。结论联合BNP与WBC等多指标可有效地对急性脑梗死和脑出血进行鉴别诊断。

MTHFR基因多态性对脑梗死患者阿替普酶静脉溶栓后出血性转化的影响

目的分析亚甲基四氢叶酸还原酶(MTHFR)基因多态性对脑梗死患者阿替普酶静脉溶栓后出血性转化(HT)的影响。方法回顾性分析2020年7月—2023年7月在安徽医科大学附属阜阳人民医院接受治疗的120例脑梗死患者的临床资料。依据治疗后24~72 h HT发生情况分为HT组(15例)、无HT组(105例)。比较两组基线资料、MTHFR基因多态性、纤维蛋白原(Fib)、同型半胱氨酸(Hcy)。采用多因素一般Logistic回归模型分析脑梗死患者阿替普酶静脉溶栓后HT发生的危险因素。绘制受试者工作特征(ROC)曲线,分析入院时美国国立卫生院卒中量表(NIHSS)评分、Hcy预测脑梗死患者阿替普酶静脉溶栓后HT发生的价值。结果HT组心房颤动发生率、MTHFR基因型677CT占比、入院时NIHSS评分、Hcy水平均高于无HT组(P<0.05)。多因素一般Logistic回归分析结果显示:心房颤动史[OR=1.478(95%CI:1.126,1.940)]、入院时NIHSS评分升高[OR=1.656(95%CI:1.125,2.438)]、MTHFR基因型为677CT[OR=1.871/2.362(95%CI:1.052,3.328/1.081,4.652)]、Hcy水平升高[OR=2.149(95%CI:1.108,4.168)]均为脑梗死患者阿替普酶静脉溶栓后HT发生的危险因素(P<0.05)。ROC曲线分析结果显示,入院时NIHSS评分、Hcy均可预测脑梗死患者阿替普酶静脉溶栓后HT发生,其敏感性分别为80.0%(95%CI:0.765,0.883)、73.3%(95%CI:0.717,0.834),特异性分别为74.3%(95%CI:0.659,0.817)、74.3%(95%CI:0.824,0.931)。677CT型患者Hcy水平高于677CC、677TT型患者(P<0.05)。结论心房颤动、MTHFR基因型、入院时NIHSS评分、Hcy均为影响脑梗死患者阿替普酶静脉溶栓后HT发生的重要因素,临床应结合以上指标对高危患者进行重点筛查,尽早采取干预措施。

探讨NLR、PLR、hs-CRP、Hb、D-D与ACI非溶栓治疗后出血性转化的相关性分析

目的 探讨急性脑梗死患者(ACI)非溶栓治疗前血清中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、超敏C反应蛋白(hs-CRP)、血红蛋白(Hb)、D-二聚体(D-D)与治疗后出血性转化(HT)的相关性,以期为临床预防ACI非溶栓治疗后发生提供指导依据。方法 本研究病历组(设为转化组)共纳入80例样本,选取自2015年1月至2019年12月在吉林大学第一医院检验科接受非溶栓治疗后并出现HT的ACI患者,根据HT严重程度等级化分1级、2级、3级、4级,各严重程度患者分别为27例、22例、18例、13例。选取50例在接受非溶栓治疗后未出现HT的ACI患者作为对照(非转化组)。比较各组的血清NLR、PLR、hs-CRP、Hb、D-D表达水平差异,并通过Spearman秩相关检验分析NLR、PLR、hs-CRP、Hb、D-D与HT严重程度的相关性。并采用ROC曲线分析NLR、PLR、hsCRP、Hb、D-D对ACI患者HT的预测作用。结果 转化组的血清NLR、PLR、hs-CRP、D-D表达水平均高于非转化组,Hb的表达水平低于非转化组(均P<0.05)。1级、2级、3级、4级患者的血清NLR、PLR、hs-CRP、D-D表达水平依次上升,Hb表达水平依次降低,差异有统计学意义(P<0.05),且组间两两比较,差异有统计学意义(P<0.05)。ACI非溶栓治疗后HT严重程度与血清NLR、PLR、hs-CRP、D-D均呈正相关(r值分别为:0.729、0.692、0.601、0.578,均P<0.05),与Hb呈负相关(r值为:-0.678,P<0.05)。ROC曲线分析显示,NLR的AUC值为0.896[95%CI(0.737~0.962)]、PLR的AUC值为0.775 [95%CI(0.626~0.917)]、hs-CRP的AUC值为0.840 [95%CI(0.712~0.948)]、Hb的AUC值为0.782 [95%CI(0.493~0.914)]、D-D的AUC值为0.725 [95%CI(0.403~0.852)]。结论 ACI患者的NLR值、PLR值、hs-CRP、Hb、D-D表达水平与其在非溶栓治疗后发生HT存在相关性,临床上可将这些指标作为预测HT风险。

MRI在急性脑梗死患者血管内血栓切除术后颅内出血的预测价值

目的探讨MRI在急性脑梗死患者进行血管内血栓切除术(EVT)后颅内出血(ICH)的预测价值。方法回顾性分析接受EVT治疗的急性脑梗死患者67例,收集这些患者的弥散加权成像(DWI)、灌注加权成像(PWI)和DWI-PWI不匹配(DPM)的体积以及其他临床相关数据,ICH由非增强CT评估。采用多元logistic回归分析预测急性脑梗死患者治疗后的ICH。结果接受EVT后,ICH的患者空腹血糖[(11.96±1.93)mg/L与(13.26±1.73)mg/L]、HbA1c[(5.73±0.42)%与(6.21±0.49)%]、DWI梗死体积(51.23±41.32 ml与29.61±32.26ml)显著大于无ICH的患者(t=-7.693,P<0.001;t=6.135,P<0.001;t=-2.531,P=0.016)。多变量逻辑回归分析显示血糖[OR(95%CI):1.312(1.145~1.417),P<0.001]、HbA1c[OR(95%CI):38.847(7.216~201.753),P<0.001]以及DWI梗死体积[OR(95%CI):1.021(1.004~1.034),P=0.016]为预测急性脑梗死患者EVT术后ICH独立的预测因子。结论急性脑梗死患者行EVT治疗后,通过检测患者的空腹血糖、HbA1c和DWI梗死体积能够预测ICH的发生风险,从而对后续的临床治疗提供信息。

血清ESM-1、E-cad对ACI-LAA溶栓后HT的预测价值

目的 探讨血清内皮细胞特异性分子-1 (ESM-1)、E-钙黏连蛋白(E-cad)对大动脉粥样硬化型脑梗死(ACI-LAA)溶栓后出血转化(HT)的预测价值。方法 选取2020年1月至2022年12月新疆医科大学第一附属医院收治的110例ACI-LAA患者,根据是否发生HT分为HT组和non-HT组。对比两组基础资料及血清ESM-1、E-cad水平。采用ROC曲线分析ESM-1、E-cad预测ACI-LAA患者发生HT的价值。结果 HT组患者NIHSS评分高于non-HT组,梗死面积大于non-HT组(P <0.05),HT组患者血清ESM-1、E-cad水平也高于non-HT组(P<0.05)。Logistic回归分析显示,梗死面积大、NIHSS评分高、血清ESM-1和E-cad水平升高是ACI-LAA患者发生HT的危险因素(P<0.05)。ESM-1联合E-cad预测ACI-LAA患者发生HT的曲线下面积为0.859,预测灵敏度为84.6%,特异度为72.6%。结论 血清ESM-1和E-cad水平与ACI-LAA患者HT密切相关,可作为早期预测发生HT的参考指标。

1例心源性脑梗死后出血转化合并心肾综合征病人应用无创呼吸机治疗的护理

总结1例心源性脑梗死后出血转化合并心肾综合征病人应用无创呼吸机治疗的护理经验。护理要点:无创呼吸机辅助通气治疗的护理、液体及营养支持管理、静脉血栓的预防及处理、预防和控制感染、联合康复科制订渐进式康复方案、出院指导与随访。经过21 d的精心治疗和护理,病人病情稳定,顺利转回当地医院继续康复治疗。

急性脑卒中患者心脏电学改变研究

目的通过分析急性脑卒中患者心脏电学变化,探讨心电图评估急性脑卒中患者血压控制效果的临床价值。方法选取2023-06—2024-01郑州大学第二附属医院收治入院的急性脑卒中患者103例(脑出血50例,脑梗死53例)为研究组,原发性高血压患者61例为对照组,分析研究组临床资料和心电图特点,比较研究组和对照组的心电图改变。将研究组分为血压异常组和血压正常组,比较不同血压状态下脑出血和脑梗死患者心电图改变。结果急性脑卒中患者中脑出血患者年龄偏小,糖尿病占比高,入院收缩压/舒张压、血糖较高,差异有统计学意义(P<0.05)。脑卒中患者心电图异常率高于原发性高血压患者,以P波时限≥120 ms、P波双峰(峰间距>40 ms)、Macrua指数、左心室高电压、左心室肥大、快速性心律失常检出率较高,差异有统计学意义(P<0.05)。脑出血患者心电图异常率高于脑梗死患者,左心房/左心室肥大、心肌缺血比较差异有统计学意义(P<0.05)。血压异常的脑出血患者心电图异常率高于血压正常者,左心房/左心室肥大、心肌缺血比较差异有统计学意义(P<0.05)。血压异常的脑梗死患者快速性心律失常检出率高于血压正常者,差异有统计学意义(P<0.05)。结论急性脑卒中患者心电图异常率高,尤其高血压合并脑卒中患者心电图异常表现更加明显,心电图检查可作为诊断和评估急性脑卒中患者血压控制效果的重要依据。