Use of various CT imaging methods for diagnosis of acute ischemic cerebrovascular disease

Thirty-four patients with cerebral infarction and 18 patients with transient ischemic attack were examined by multi-slice spiral CT scan, CT perfusion imaging, and CT angiography within 6 hours after onset. By CT perfusion imaging, 29 cases in the cerebral infarction group and 10 cases in the transient ischemic attack group presented with abnormal blood flow perfusion, which corresponded to the clinical symptoms. By CT angiography, various degrees of vascular stenosis could be detected in 41 patients, including 33 in the cerebral infarction group and eight in the transient ischemic attack group. The incidence of intracranial artery stenosis was higher than that of extracranial artery stenosis. The intracranial artery stenosis was located predominantly in the middle cerebral artery and carotid artery siphon, while the extracranial artery stenosis occurred mainly in the bifurcation of the common carotid artery and the opening of the vertebral artery. There were 34 cases （83%） with convict vascular stenosis and perfusion abnormalities, and five cases （45%） with perfusion abnormalities but without convict vascular stenosis. The incidence of cerebral infarction in patients with National Institutes of Health Stroke Scale scores 〉 5 points during onset was significantly higher than that in patients with National Institutes of Health Stroke Scale scores 〈 5 points. These experimental findings indicate that the combined application of various CT imaging methods allows early diagnosis of acute ischemic cerebrovascular disease, which can comprehensively analyze the pathogenesis and severity of acute ischemic cerebrovascular disease at the morphological and functional levels.

Significance of ultrasound evaluation of carotid atherosclerotic plaque for diagnosing ischemic cerebrovascular disease

BACKGROUND： Carotid artery is the main source for craniocerebral blood supply. Its intimal plaque formation and arterial stenosis degree both are the risk factors for ischemic cerebrovascular disease.Therefore, the close relationship of carotid atherosclerotic plaque and ischemic cerebrovascular disease, and ultrasound evaluation of carotid atherosclerotic plaque have become the hot spot in studying ischemic cerebrovascular disease.OBJECTIVE： This study was to detect the degree of carotid atherosclerosis of ischemic cerebrovascular disease patients by ultrasonography, and to analyze the situation of carotid atherosclerosis and its relationship with clinic.DESIGN： Clinical randomized concurrent control experiment.SETTING： Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS： Totally 60 outpatients and inpatients with ischemic cerebrovascular disease, 42 males and 18 females, admitted to Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA between January 2006 and December 2006 were involved in the patient group. They met the diagnosis criteria of ischemic cerebrovascular disease constituted by the 4th Cerebrovascular Disease Conference in 1996, and were confirmed to suffer from ischemic cerebrovascular disease by skull CT and MRI. Another 20 subjects who received healthy examination concurrently in the same hospital, 12 males and 8 females, were involved in the control group. Informed consents of detected items were obtained from involved subjects.METHODS： The plaque thickness of mid portion, distal end and crotch of common carotid artery （CCA）,internal carotid artery （ICA）, external carotid artery （ECA） and vertebral artery （VA） of involved subjects,who received health examination was separately detected with color Doppler ultrasonograph （HDI-5000）.Then, total integral of plaque was calculated. The intima-media thickness （IMT） was measured with two-dimensional ultrasonography. The inner diameter stenosis degree of subjects who had plaque was measured. Blood flow parameters were recorded, and stenosis degree and plaque area were calculated. Blood flow volume of bilateral carotid artery and VA was separately measured with ultrasound equipment software,and brain blood flow volume was calculated.MAIN OUTCOME MEASURES： Atherosclerotic degree and blood flow volume of patients of two groups.RESULTS： Sixty patients with ischemic cerebrovascular disease and twenty subjects who received health examination participated in the final analysis. ①The IMT thickness, total plaque score, and total plaque area of patient group was significantly superior to that of control group, respectively（ t=5.216 - 10.158, P 〈 0.05 ）.② There were significant differences in the stenosis degree of CCA, ICA and VA between patient group and control group （t=6.720 - 12.816, P 〈 0.05 ） . ③ The blood flow volume of CCA, ICA, VA and brain of patient group was significantly lower than that of control group, respectively （t=2.872 - 10.860, P 〈 0.05）.CONCLUSION： Ischemic cerebrovascular disease patients have different degrees of changes in atherosclerosis and arterial blood flow.

Factors influencing ischemic cerebrovascular disease complicated by hyperhomocysteinemia

BACKGROUND： Hyperhomocysteinemia, as an important risk factor for ischemic cerebrovascular disease is receiving increasing attention. OBJECTIVE： To analyze whether differences of gender, age, cerebrovascular disease typing, and disease conditions exist when ischemic cerebrovascular disease occurs together with hyperhomocysteinemia. DESIGN： A controlled observation. SETTING： Department of Neurology, Tianjin Huanhu Hospital. PARTICIPANTS： A total of 601 acute ischemic cerebrovascular disease inpatients, comprising 386 males and 215 females, aged 33-90 years old, were admitted to the Department of Stroke, Tianjin Huanhu Hospital between August 2005 and April 2007, and were recruited for this study. All included patients consisted of 342 aged patients （≥ 60 years old） and 92 middle-aged and young patients （〈 60 years old）. Among these patients, 48 suffered from transient cerebral ischemic attack, 138 from lacunar cerebral infarction, 273 from atherosclerotic stroke, 38 from cardiogenic cerebral infarction, 44 from agnogenic ischemic stroke, and 6 from other factor-induced ischemic strokes. All included inpatients corresponded to the diagnosis criteria of acute ischemic cerebrovascular disease, formulated in the 4^th National Working Conference of Cerebrovascular Disease, and were confirmed as acute ischemic cerebral infarction by CT and/or MRI examinations. Informed consents of laboratory measurements were obtained from all subjects, and this study was approved by the Hospital＇s Ethics Committee. METHODS： Following admission, 2 mL venous blood was collected from each fasting patient on the third morning. Plasma homocysteine level was measured by an enzymatic cycling assay with a CX5 reader （Beckman, USA）. Plasma homocysteine levels ≥ 16μ mol/L were defined as hyperhomocysteinemia. Clinical neurological function deficit scoring was also performed for each ischemic stroke patient using Chinese stroke scales. Scores ranged from 0 45 （0-15： mild neurological function deficits, 16-30： moderate neurological deficits, and 31-45： severe neurological deficits）. The scores positively correlated with severity of stroke. MAIN OUTCOME MEASURES： Incidence of ischemic cerebrovascular disease patients complicated by hyperhomocysteinemia and the effects of patient age and gender; plasma homocysteine levels of each type of ischemic cerebrovascular disease; and effects of ischemic cerebrovascular disease conditions on plasma homocysteine levels. RESULTS： All 601 inpatients with acute ischemic cerebrovascular disease were included in the final analysis. The detection rate of homocysteine was significantly higher in aged patients than in middle-aged and young patients （ x^2 = 5.353 0, P 〈 0.05）. The incidence of hyperhomocysteinemia was significantly higher in male patients than in female patients （ x^2 = 9.484 4, P 〈 0.05）. There was no significant difference in the incidence of hyperhomocysteinemia among various types of ischemic cerebrovascular diseases （P 〉 0.05）. No significant difference in incidence of hyperhomocysteinemia existed between mild, moderate, and severe cerebrovascular disease patients （P 〉 0.05）. CONCLUSION： There is a greater chance of ischemic cerebrovascular disease complicated by hyperhomocysteinemia in older, male patients.

β-FIBRINOGEN PROMOTER -455 G/A(HaeIII)POLYMORPHISM PREDICTION OF PLASMA FIBRINOGEN BUT NOT OF ISCHEMIC CEREBROVASCULAR DISEASE

Objective The -455 G/A(HaeIII)polymorphism of β-fibrinogen gene influences levels of plasma fibrinogen. We further investigated whether it influences the risk of ischemic cerebrovascular disease. Methods We accumulated 134 acute ischemic cerebrovascular disease(ICVD)cases and compared their -455 G/A status with a control group(n = 166). The β-fibrinogen gene -455 G/A polymorphism was analyzed for all subjects by PCR-RFLP with the restrictive enzyme HaeIII. Results Plasma fibrinogen was higher in AA homozygous participants(341 mg/dL)than in partici-pants carrying the G allele: GA(290 mg/dL), GG(298 mg/dL)in the control group. Plasma fibrinogen was also higher in AA homozygous patients(353 mg/dL)than in cases carrying the G allele: GA(287 mg/dL), GG(302 mg/dL)in the ICVD group. However, there was no significant association between β-fibrinogen gene -455 G/A polymorphism and ICVD group. Conclusions Although a small effect cannot be excluded, β-fibrinogen gene -455 G/A polymor-phism is an independent predictor of plasma fibrinogen, but not of ischemic cerebrovascular disease.

Meta-analysis of 5, 10-methylenetetrahydrofolate reductase gene polymorphism as a risk factor for ischemic cerebrovascular disease in a Chinese Han population

OBJECTIVE： To assess whether 5, 10-methylenetetrahydrofolate reductase （MTHFR） gene polymorphism （TT genotype or T allele） is a risk factor for ischemic cerebrovascular disease （ICVD）. DATA SOURCES： MEDLINE and PubMed databases from September 1997 to December 2009 were searched for case-control studies that examined MTHFR genotype in human ICVD using ＂MTHFR, gene, polymorphism, and ischemic cerebrovascular disease＂ as search key words. STUDY SELECTION： Eighteen associated studies were identified. The methods used to collect relevant information factors were similar between case and control groups, and diagnosis of ischemic cerebrovascular disease was in accordance with Trial of ORG 10172 in Acute Stroke Treatment criteria classification, with some referring to European Stroke Diagnostic Criteria. Quality of all included studies was evaluated, and meta-analysis was conducted using RevMan4.2 software （Cochrane Collaboration, http：//www.cochrane-handbook.org） following strict screening. MAIN OUTCOME MEASURES： The correlation between MTHFR gene TT genotype or T allele and ICVD was determined. RESULTS： Eighteen studies involving 4 295 patients with ICVD and 6 169 control subjects were included for this meta-analysis. There was a significant difference in MTHFR gene TT genotype or T allele frequency （x^2 = 15.737, 9.186, P 〈 0.01） between ICVD cases and controls. In addition, six Chinese Han population studies were specially reviewed by meta-analysis. Results showed no significant difference between ICVD and control groups with regard to frequency of MTHFR gene TT genotype and T allele （x^2 = 1.076, 2.434, P 〉 0.05） in the Chinese Han population. CONCLUSION： Results from the present meta-analysis suggested that the MTHFR gene TT genotype or T allele is a risk factor for ICVD. However, the TT genotype or T allele is not a risk factor for ICVD in the Chinese Han population.

Genetic relationship between serum pregnancy-associated plasma protein-A gene polymorphism and ischemic cerebrovascular disease in a Northern Han Chinese population

The present study recruited 193 patients with ischemic cerebrovascular disease from Inpatient and Outpatient Departments at the Affiliated Hospital of Qingdao University Medical College, China from August 2008 to May 2010, as well as 120 healthy volunteers from the Medical Examination Center at the Affiliated Hospital of Qingdao University Medical College, China, who served as controls for this study. Patients and control subjects were from the Han population in northern China. Enzyme- linked immunosorbent assay analysis revealed increased levels of serum pregnancy-associated plasma protein-A （PAPP-A） in ischemic cerebrovascular disease patients compared with healthy controls. In addition, the patients exhibited greater frequency of genotype CC and C alleles in a missense A/C （Tyr/Ser） polymorphism （dbSNP： rs7020782） of exon 14 in the PAPP-A gene. Multiple-factor logistic regression analysis on correction of age, gender, history of smoking, hypertension, diabetes mellitus, hypercholesteremia, and ischemic stroke family history showed that the risk for ischemic cerebrovascular disease in the population without the A allele at the A/C genetic locus in exon 14 of the PAPP-A was 2-folds greater than the population expressing the A allele. These experimental findings suggested that ischemic cerebrovascular disease correlated with the C allele in exon 14 of PAPP-A. In addition, the A allele is likely a protective gene; individuals carrying the A allele were less prone to ischemic cerebrovascular disease compared with individuals without the A allele.

Effects of hypoxia-inducible factor 1 on ischemic cerebrovascular disease

Hypoxia-inducible factor 1, a nuclear transcription factor, is induced by hypoxia. Hypoxia-inducible factor 1, a heterodimeric DNA-binding protein, is composed of hypoxia-inducible factor 1α and hypoxia-inducible factor 1βsubunits, which are family members of the basic helix-loop-helix-PER, ARNT, SIM （PAS） protein. O2 concentration regulates hypoxia-inducible factor 1 activity via this subunit. Hypoxia-inducible factor 1α plays a major role in response to hypoxia and transcriptional activation, as well as in the target gene specificity of the DNA enhancer. Hypoxia-inducible factor 1β cannot be induced by hypoxia. This effect may be due to hypoxia-inducible factor 1 stability and activated conformation due to dimerization. Previous studies have shown that hypoxia-inducible factor 1 mRNA expression increases in the penumbra following ischemia/hypoxia. Hypoxia-inducible factor 1 plays an important role in brain tissue injury after ischemia by affecting a series of target genes, elevating tolerance to hypoxia, and ensuring survival of neural cells. This article summarizes the structure, function, expression, regulatory mechanisms, biological effects, and significance of hypoxia-inducible factor 1 in patients with ischemic cerebrovascular disease. As a transcriptional activator, hypoxia- inducible factor 1 plays a key role in hypoxic responses by stabilizing the internal environment. It also has been shown to regulate the expression of several genes. The regulatory effects of hypoxia-inducible factor 1 in patients with ischemic cerebrovascular disease have been described. The present review re-examined the concept of brain protection at the level of gene regulation.

Ischemic stroke susceptibility gene in a Northern Han Chinese population

Interleukin-18 gene promoter polymorphisms are potential risk factors for ischemic cerebrovascular disease, and the –607C allele may increase ischemic stroke risk in the Han Chinese population. In the present study, we recruited 291 patients with ischemic cerebrovascular disease from the Affiliated Hospital of Qingdao University Medical College, China, and 226 healthy controls. Both patients and controls were from the Han population in northern China. Immunoresonance scattering assays detected increased serum amyloid A protein, C-reactive protein, and interleukin-18 levels in ischemic cerebrovascular disease patients compared with healthy controls. Analysis of the –607C/A （rs1946518） polymorphism in the interleukin-18 gene promoter showed ischemic cerebrovascular disease patients exhibited increased frequencies of the CC genotype and C alleles than healthy controls. Genotype and allele frequencies of the interleukin-18 –137G/C （rs187238） polymorphism and the –13T/C （rs11024595） polymorphism in the 5＇-flanking region of serum amyloid A, showed no significant difference between the two groups. Multivariate logistic regression analysis on the interleukin-18 promoter A/C genetic locus, for correction of age, gender, history of smoking, hypertension, diabetes mellitus, hypercholesteremia, and an ischemic stroke family history, showed ischemic cerebrovascular disease risk in individuals without the A allele （C homozygotes） was 2.2-fold greater than in A allele carriers. Overall, our findings suggest that the –13T/C （rs11024595） polymorphism in the 5′-flanking region of serum amyloid A has no correlation with ischemic cerebrovascular disease, but the C allele of the –607C/A （rs1946518） polymorphism in the interleukin-18 promoter is a high-risk factor for ischemic cerebrovascular disease in the Han population of northern China. In addition, the A allele is likely a protective gene for ischemic cerebrovascular disease.

Angiotensinogen gene polymorphism and ischemic stroke in East Asians:A meta-analysis

OBJECTIVE： To investigate the association between angiotensinogen gene M235T polymorphism and ischemic stroke in East Asians. DATA RETRIEVAL： A computer-based online search was conducted in PubMed, Google scholar, China National Knowledge Infrastructure database between January 1990 and April 2012 for relevant studies. The key words were angiotensinogen or AGT, polymorphism or genetic and ischemic stroke or cerebral infarction. SELECTION CRITERIA： Case-controlled studies addressing the correlation between angiotensinogen gene M235T polymorphism and ischemic stroke in East Asians were included. The distribution of genotypes in the included studies was tested for Hardy-Weinberg equilibrium. Quality evaluation of the included studies was conducted by two physicians. Statistical analyses were carried out using Stata 12.0 software for meta-analysis. Heterogeneity tests, sensitivity analysis and publication bias were also conducted. MAIN OUTCOME MEASURES： The association between angiotensinogen gene M235T polymorphism and ischemic stroke risk in East Asians was assessed. RESULTS： Six relevant studies involving 891 patients with ischemic stroke and 727 controls were included in this meta-analysis. Results showed that there was a significant association between angiotensinogen gene M235T polymorphism and the risk of ischemic stroke in East Asians （T vs. M odds ratio （OR） = 1.54, 95% confidence interval （CI） = 1.10-2.16; TT vs. MM： OR = 2.24, 95%CI = 1.37-3.66; TT vs. MT： OR = 1.76, 95%CI = 1.41-2.20; MM ＋ MT vs. TT： OR = 0.57, 95%CI -= 0.46-0.70）. Sensitivity analysis confirmed that the study results were stable and reliable, with no publication bias. CONCLUSION： The angiotensinogen gene M235T polymorphism is associated with ischemic stroke in East Asians, and the TT genotype and T allele are risk factors for ischemic stroke.

Effects of aquatic exercise on depression and anxiety in ischemic stroke subjects

Background: Stroke ranks third and is the leading cause of permanent disability in western countries. Furthermore there are no treatments for the psychosocial effects of this pathology. Purpose: Analyse the effect of an aquatic exercise program in depression and trace and state anxiety in subjects who suffered an ischemic stroke. Methods: Two groups were analyzed: experimental group (EG) n = 15, 50.3 ± 9.1 years;control group (CG) n = 13, 52.5 ± 7.7 years. EG underwent a 12-week aquatic exercise program. Both groups were evaluated in pre and post- treatment using Beck Depression Inventory (BDI) and Trace State Anxiety Inventory (IDATE). Wilcoxon signed-rank and Mann-Whitney tests were used to compare moments and groups, respec- tively. Results: The BDI scores of aquatic activities were: pre-treatment, 17.4 ± 7.7 and 16.9 ± 8.6 for the EG and CG, respectively;post-treat- ment, 13.2 + 7.1 and 16.4 + 7.9 for the EG and CG, respectively. The IDATE scores for anxiety trace in strength training were: pre-treatment, 43.2 + 12.5 and 42.9 + 12.2 for the EG and CG, respec- tively;post-treatment, 39.7 + 7.1 and 42.6 + 12.1 for the EG and CG, respectively. The IDATE scores for anxiety state in strength training were: pre-treatment, 46.9 + 7.6 and 47.4 + 8.1 for the EG and CG, respectively;post-treatment, 44.4 + 7.9 and 47.5 + 8.0 for the EG and CG, respectively. Significant differences were found in pre and post-treatment values in the EG and between groups in the depression and trace and state anxiety levels in post-treatment (p Conclusions: Aquatic physical activity contributes to an improvement of the levels of depression and anxiety in people who suffered a stroke.

多元化教学模式在缺血性脑血管病介入进修医师培训中的应用探索

目的 探讨多元化教学模式在提高缺血性脑血管病介入诊疗进修医师培训质量和效率方面的应用。方法 选择2018年1月-2022年12月在南京大学医学院附属鼓楼医院神经内科接受脑血管介入培训的进修医师为研究对象,应用多元化教学模式,即将多种教学方法融合交叉的培训模式进行教学。采用问卷调查的形式对进修医师满意度及其在培训前后介入诊疗理论知识和实践操作能力进行评估。结果 共纳入55名进修医师,年龄32~50岁,其中男性51名(92.73%)。89.09%的进修医师对多元化教学模式非常满意;分别有83.64%和85.45%的进修医师认为多元化教学模式激发了学习兴趣和自主学习能力。经过多元化教学模式培训后,能够独立完成颅外支架置入治疗的进修医师显著增加(41.82%vs. 12.73%,P=0.002)。结论 多元化教学模式是提高缺血性脑血管病介入进修医师培训质量和效率的有效手段。

以问题为导向联合线上学习模式在缺血性脑血管病专业进修中的应用分析

目的探讨以问题为导向联合线上学习模式相比于非问题为导向的线下学习模式在缺血性脑血管病专业进修中的可行性及有效性。方法采取问卷调查法对2017年1月至2023年1月在首都医科大学宣武医院介入放射中心接受过系统培训的152名进修医师进行回访。根据进修时间以及学习模式的不同,将2017年1月至2020年1月进修方式为非问题为导向的线下学习模式的进修医师纳入非问题为导向组,将2020年2月至2023年1月进修方式为以问题为导向联合线上学习模式的进修医师纳入以问题为导向组。于培训结束时以及结束2个月后进行问卷调查。问卷内容包括:进修医师的性别、年龄,参与培训前已有的工作年限,参加进修培训的目的,培训时长,对培训的感受、建议和意见,培训结束后是否开展新手术(主要包括颅内外动脉支架置入术、颈动脉内膜切除术、杂交手术、动脉旁路移植术、急诊取栓术或其他)和培训结束后开展的新手术数量。结果(1)共发放问卷调查表152份,参与问卷调查并完成反馈者136名,其中4份问卷填写不全或填写错误,排除无效问卷后,剩余有效问卷调查表共132份,回收率和有效应答率分别为89.5%和97.1%。参与培训时,进修医师的年龄为25~44岁,平均(34±4)岁。医师的工作年限分布不等,>10年者占22.7%(30/132),>5~10年者占40.9%(54/132),0~5年者占36.4%(48/132)。不同工作年限者间是否开展新手术的比例差异有统计学意义(χ^(2)=2.501,P=0.012)。(2)参与以问题为导向和非问题为导向两种培训模式的人数分别为70人和62人。以问题为导向组中,希望通过培训学习新技术和提高手术能力的进修医师占88.6%(62/70),而在非问题为导向组中,该比例为87.1%(54/62),两组进修医师的进修培训目的差异无统计学意义(χ^(2)=0.067,P=0.796)。对培训体会进行分析显示,认为现有的培训形式合理和内容较为充实的进修医师占比为96.2%(127/132),以问题为导向组和非问题为导向组中比例分别为97.1%(68/70)和95.2%(59/62),两组差异无统计学意义(χ^(2)=0.354,P=0.552)。(3)经过培训后,以问题为导向组开展新手术的进修医师比例为80.0%(56/70),非问题为导向组的比例为66.1%(41/62),两组差异无统计学意义(χ^(2)=3.247,P=0.072)。在开展新手术的数量方面,以问题为导向组和非问题为导向组中,开展新手术数量≥30例的进修医师比例分别为70.0%(49/70)和46.8%(29/62),两组差异有统计学意义(χ^(2)=7.337,P=0.007)。(4)在非问题为导向组中,开展新手术例数≥30例的进修医师进修时长为3、6、12个月者分别占13.8%(4/29)、82.8%(24/29)、3.4%(1/29);在以问题为导向组中,开展新手术例数≥30例的进修医师进修时长为3、6、12个月者分别占4.1%(2/49)、57.1%(28/49)、38.8%(19/49),两组差异有统计学意义(χ^(2)=3.531,P<0.01)。结论以问题为导向联合线上学习模式有助于中青年神经外科医师的新手术开展以及增加开展的新手术数量,但需结合既往的工作年限和进修时长作为参考。

缺血性脑血管病患者血清β淀粉样蛋白和壳多糖酶3样蛋白1水平与颈动脉病变的关系

目的探讨缺血性脑血管病(ICD)患者血清β淀粉样蛋白(Aβ)和壳多糖酶3样蛋白1(CHI3L1)水平与颈动脉病变的关系。方法选取2019年1月—2023年5月沧州市中心医院ICD患者298例(ICD组)、健康体检者300名(对照组)。根据颈动脉内膜中层厚度(ITM)、斑块积分和颈动脉狭窄程度分别分组。收集所有研究对象一般资料,并检测血清Aβ、CHI3L1、糖化血红蛋白(Hb A1c)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平。采用偏相关分析评估血清Aβ、CHI3L1水平与颈动脉病变的相关性。结果ICD组血清TG、TC、LDL-C、Aβ和CHI3L1水平均高于对照组(P<0.01),其他指标2个组之间差异均无统计学意义(P>0.05)。内膜正常组、内膜增厚组、斑块形成组血清Aβ和CHI3L1水平依次升高(P<0.001)。轻度硬化组、中度硬化组和重度硬化组血清Aβ和CHI3L1水平依次升高(P<0.001)。轻度狭窄组、中度狭窄组和重度狭窄组血清Aβ、CHI3L1水平依次升高(P<0.001)。血清Aβ和CHI3L1水平与ITM、斑块积分和颈动脉狭窄程度均呈正相关(P<0.001)。结论ICD患者血清Aβ和CHI3L1水平升高,且与颈动脉病变密切相关,或可作为反映ICD患者颈动脉病变程度的指标。

CTA/CTP评估在缺血性脑血管病介入治疗中的应用

目的探讨CT血管成像(CTA)/CT灌注成像(CTP)在缺血性脑血管病介入治疗中的应用价值。方法选取2021年1月至2023年9月我院收治的200例缺血性脑血管病患者,均在入院后接受CTA及CTP检查,分析其影像资料,探究CTA及CTP缺血性脑血管病介入治疗中的应用价值。结果脑血容量(CBV)比较:缺血半暗带>健侧>梗死区(P<0.05);脑血流量(CBF)比较:健侧>缺血半暗带>梗死区(P<0.05);平均通过时间(MTT)、目标组织中浓度达峰时间(TTP)、目标组织中所有残余功能全部达峰时间(Tmax)比较:健侧<缺血半暗带<梗死区(P<0.05)。CTA检出左侧、右侧大脑中动脉(MCA)闭塞或狭窄分别59例(29.50%)、91例(45.50%),左侧、右侧颈内动脉(ICA)闭塞分别16例(8.00%)、12例(6.00%),双侧ICA狭窄为6例(3.00%);代偿分支血管显影基本满意129例(64.50%),显影不足71例(35.50),其余16例(8.00%)患者CTA影像资料显示无异常,敏感度为92.00%。预后不良组患侧CBV、CBF小于预后良好组,MTT、TTP、Tmax长于预后良好组,代偿血管建立比例低于预后良好组(P<0.05)。采用受试者工作特征曲线分析显示,CBV、CBF、MTT、TTP、Tmax对介入治疗预后均有一定的预测效能(P<0.05),其曲线下面积分别为0.839、0.815、0.673、0.713、0.710,其中CBV预测效能最高,敏感性为83.20%,特异性为73.33%。结论CTA/CTP可反映大脑、颈内动脉狭窄或闭塞、代偿分支建立情况,也可反映血流灌注情况,在介入治疗合理时机的判断方面可提供准确依据,提高患者预后。

缺血性脑血管病血清尿酸水平与颈动脉不稳定斑块关系

目的 探讨缺血性脑血管病血清尿酸水平与颈动脉不稳定斑块关系。方法 选择60例缺血性脑血管病患者,其中,短暂性脑缺血发作30例(短暂性脑缺血发作组);脑梗死30例(脑梗死组),测定两组患者的血清尿酸水平,分析缺血性脑血管病血清尿酸水平与颈动脉不稳定斑块的关系。结果 短暂性脑缺血发作组的血清尿酸水平显著低于脑梗死组(P<0.05)。Logtisic回归分析显示,血清尿酸水平升高是缺血性脑血管病患者斑块发生的危险因素(P<0.05)。随着斑块面积增大,血清尿酸水平升高(P<0.05)。结论 缺血性脑血管病血清尿酸水平与颈动脉不稳定斑块关系密切,血清尿酸水平是患者斑块发生的独立危险因素,通过早期监测血清尿酸水平,可更好地评估颈动脉斑块的不稳定性,为疾病早期诊治提供基础。

血管内支架植入术治疗缺血性脑血管病颈动脉狭窄患者的临床效果分析

目的观察血管内支架植入术治疗缺血性脑血管病(ICVD)颈动脉狭窄患者的临床效果。方法选取行ICVD治疗的患者83例分为观察组43例和对照组40例,比较2组患者的血流动力学指标和颈内动脉血管狭窄程度、神经标志物与血管内皮功能、神经功能缺损程度、临床疗效和不良反应。结果2组患者经治疗后的血管收缩期峰流速(PSV)、舒张末期流速(EDV)和血管狭窄程度均呈下降趋势,且对照组的PSV、EDV和血管狭窄程度下降幅度均小于观察组,差异有统计学意义(P<0.05);2组患者治疗后的正五聚蛋白-3(PTX-3)、神经元特异性烯醇化酶(NSE)均有降低,血管扩张功能(FMD)和血管内皮生长因子(VEGF)均有提升,且观察组的PTX-3、NSE低于对照组,VEGF、FMD高于对照组,差异有统计学意义(P<0.05);治疗后2组患者的美国国立卫生研究院脑卒中量表(NIHSS)和改良爱丁堡-斯堪的纳维亚评分(MESSS)均降低,且对照组NIHSS评分和MESSS降低幅度小于观察组;对照组的临床总有效率为80.00%,低于观察组的97.67%,差异有统计学意义(P<0.05);观察组和对照组的不良反应发生率分别为2.33%和22.50%,差异有统计学意义(P<0.05)。结论血管内支架植入术能够有效提高ICVD患者的临床疗效,减轻血管狭窄程度,改善患者的认知功能,且具有较高安全性。

Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease:beyond the cervicocephalic atherosclerosis?

Background:Asymptomatic coronary artery stenosis(ACAS)≥50%is common in patients with acute ischemic cerebrovascular disease(AICVD),which portends a poor cardiovascular and cerebrovascular prognosis.Identifying ACAS>50%early may optimize the clinical management and improve the outcomes of these high-risk AICVD patients.This study aimed to investigate whether aortic arch plaque(AAP),an early atherosclerotic manifestation of brain blood-supplying arteries,could be a predictor for ACAS>50%in AICVD.Methods:In this cross-sectional study,atherosclerosis of the coronary and brain blood-supplying arteries was simultaneously evaluated using one-step computed tomography angiography(CTA)in AICVD patients without coronary artery disease history.The patients were divided into ACAS≥50%and non-ACAS≥50%groups according to whether CTA showed stenosis≥50%in at least one coronary arterial segment.The AAP characteristics of CTA were depicted from aspects of thickness,extent,and complexity.Results:Among 118 analyzed patients with AICVD,29/118(24.6%)patients had ACAS≥50%,while AAPs were observed in 86/118(72.9%)patients.Increased AAP thickness per millimeter(adjusted odds ratio[OR]:1.56,95%confidence interval[CI]:1.18-2.05),severe-extent AAP(adjusted OR:13.66,95%CI:2.33-80.15),and presence of complex AAP(adjusted OR:7.27,95%CI:2.30-23.03)were associated with ACAS≥50%among patients with AICVD,independently of clinical demographics and cervicocephalic atherosclerotic stenosis.The combination of AAP thickness,extent,and complexity predicted ACAS≥50%with an area under the receiver-operating characteristic curve of 0.78(95%CI:0.70-0.85,P<0.001).All three AAP characteristics provided additional predictive power beyond cervical and intracranial atherosclerotic stenosis for ACAS≥50%in AICVD(all P<0.05).Conclusions:Thicker,severe-extent,and complex AAP were significant markers of the concomitant ACAS≥50%in AICVD,possibly superior to the indicative value of cervical and intracranial atherosclerotic stenosis.As an integral part of atherosclerosis of brain blood-supplying arteries,AAP should not be overlooked in predicting ACAS≥50%for patients with AICVD.

丁苯酞联合替格瑞洛对缺血性脑血管病患者的疗效

目的探讨丁苯酞联合替格瑞洛对缺血性脑血管病(ICD)患者的疗效及对心理状态、认知功能的影响。方法选取2020年1月至2022年1月新乡市中心医院收治的120例ICD患者为研究对象,并通过随机数字表法分为对照组(60例)、联合组(60例)。所有患者均接受常规治疗,对照组接受替格瑞洛治疗,联合组接受替格瑞洛联合丁苯酞治疗。治疗2周,对比两组疗效、心理状态、神经功能、认知功能、血清学指标[降钙素基因相关肽(CGRP)、同型半胱氨酸(Hcy)]及药物不良反应(ADR)情况。结果联合组总有效率为93.33%,较对照组的80.00%高(P<0.05);两组治疗2周后汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分、神经功能缺损(NDF)量表评分及血清Hcy水平均较治疗前低(P<0.05),联合组低于对照组(P<0.05);两组治疗2周后蒙特利尔认知功能评定表(MoCA)评分及血清CGRP水平均较治疗前高(P<0.05),联合组高于对照组(P<0.05);联合组、对照组ADR分别为8.33%、5.00%,组间比较差异无统计学意义(P>0.05)。结论对ICD患者应用丁苯酞联合替格瑞洛治疗,疗效较佳,可调节血清CGRP、Hcy水平,改善神经功能、认知功能,减轻负面心理,且ADR较少。

Plasma RANTES level is correlated with cardio-cerebral atherosclerosis burden in patients with ischemic cerebrovascular disease

Background::Regulated upon activation, normal T-cell expressed, and secreted (RANTES) is a chemokine actively involved in the initiation and progression of atherosclerosis (AS), which is the major cause of ischemic cerebrovascular disease (ICVD). This study aimed to determine the associations between circulating RANTES level and overall AS conditions of cardiac and cerebral vessel beds in patients with ICVD.Methods::Patients with ICVD admitted to the department of neurology of Xuanwu Hospital from April 1, 2019 to June 30, 2019 were prospectively enrolled in the study. Plasma RANTES level was measured by enzyme-linked immunosorbent assay to represent the circulating RANTES level. The integrated AS burden of the cervicocephalic and coronary arteries was examined using computed tomography angiography and reflected by "cardio-cerebral AS burden (CCAB)" as a continuous variable. Then, the relationship of plasma RANTES level and CCAB in patients with ICVD was analyzed by correlation analyses and general linear models.Results::A total of 40 patients with ICVD were included in the study. There was a significant positive correlation between CCAB and plasma RANTES level in ICVD ( r = 0.786, P < 0.001), independent of age, sex, acute or chronic phase of ICVD, and mono or dual antiplatelet therapy (adjusted B for ln RANTES, 12.063;95% confidence interval, 7.572-16.533). The association of plasma RANTES level with AS conditions (burden, severity, and extent) in single cardiac or cerebral vessel bed was similar to that with CCAB, but the correlation coefficient for CCAB was higher (increment ranged from 0.126 to 0.397). Conclusions::Plasma RANTES level was an independent indicator for the integrated AS burden of the cervicocephalic and coronary arteries in ICVD. Comprehensive evaluation of AS conditions using the novel continuous index CCAB might be important in revealing the systematic relationship between circulating RANTES and AS in patients with ICVD.

Advances in endovascular therapy for ischemic cerebrovascular diseases

Endovascular therapy for ischemic cerebrovascular diseases has developed rapidly in recent years. The latest clinical trials of acute ischemic stroke have shown promising results with the continued advancement of concepts, techniques, and materials. Mechanical thrombectomy is recommended in the treatment of acute ischemic stroke caused by large vessel occlusion of the anterior circulation, according to the guidelines updated in Europe, USA, and China. The long-term therapeutic efficacy of endovascular stenting for carotid artery stenosis has also been proved noninferior to that of carotid endarterectomy. However, the latest clinical trials have shown that the efficacy of stenting for intracranial artery and vertebral artery stenosis is inferior to that of medical treatment alone, which needs urgent attention through further development and studies.