Relationship of nocturnal concentrations of melatonin, gamma-aminobutyric acid and total antioxidants in peripheral blood with insomnia after stroke： study protocol for a prospective non-randomized controlled trial

Melatonin and gamma-aminobutyric acid（GABA） have been shown to regulate sleep. The nocturnal concentrations of melatonin, GABA and total antioxidants may relate to insomnia in stroke patients. In this prospective single-center non-randomized controlled clinical trial performed in the China Rehabilitation Research Center, we analyzed the relationship of nocturnal concentrations of melatonin, GABA and total antioxidants with insomnia after stroke. Patients during rehabilitation of stroke were recruited and assigned to the insomnia group or non-insomnia group. Simultaneously, persons without stroke or insomnia served as normal controls. Each group contained 25 cases. The primary outcome was nocturnal concentrations of melatonin, GABA and total antioxidants in peripheral blood. The secondary outcomes were Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Fatigue Severity Scale, Morningness-Eveningness Questionnaire（Chinese version）, and National Institute of Health Stroke Scale. The relationship of nocturnal concentrations of melatonin, GABA and total antioxidants with insomnia after stroke was analyzed and showed that they were lower in the insomnia group than in the non-insomnia group. The severity of stroke was higher in the insomnia group than in the non-insomnia group. Correlation analysis demonstrated that the nocturnal concentrations of melatonin and GABA were associated with insomnia after stroke. This trial was registered at Clinical Trials.gov, identifier： NCT03202121.

Predictors of short-term outcome in patients with acute middle cerebral artery occlusion: unsuitability of fluid-attenuated inversion recovery vascular hyperintensity scores

Fluid-attenuated inversion recovery （FLAIR） vascular hyperintensity （FVH） is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days （National Institutes of Health Stroke Scale） and 90 days （modified Rankin Scale） to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.

Major ozonated autohemotherapy promotes the recovery of upper limb motor function in patients with acute cerebral infarction

Major ozonated autohemotherapy is classically used in treating ischemic disorder of the lower limbs In the present study, we performed major ozonated autohemotherapy treatment in patients with acute cerebral infarction, and assessed outcomes according to the U.S. National Institutes of Health Stroke Score, Modified Rankin Scale, and transcranial magnetic stimulation motor-evoked potential. Compared with the control group, the clinical total effective rate and the cortical potential rise rate of the upper limbs were significantly higher, the central motor conduction time of upper limb was significantly shorter, and the upper limb motor-evoked potential amplitude was significantly increased, in the ozone group. In the ozone group, the National Institutes of Health Stroke Score was positively correlated with the central motor conduction time and the motor-evoked potential amplitude of the upper limb. Central motor conduction time and motor-evoked potential amplitude of the upper limb may be effective indicators of motor-evoked potentials to assess upper limb motor function in cerebral infarct patients. Furthermore, major ozonated autohemotherapy may promote motor function recovery of the upper limb in patients with acute cerebral infarction.

A Retrospective Study of Branch Atheromatous Disease： Analyses of Risk Factors and Prognosis

The theory of branch atheromatous disease（BAD） has been commonly underused in clinical practice and research since it was proposed in 1989. In this study, we sought to explore clinical characteristics of its substypes and biomarkers for prognosis of BAD. A total of 176 consecutive patients with BAD were classified into two groups： paramedianpontine artery group（PPA group, n=70） and lenticulostriate artery group（LSA group, n=106）. Bivariate analyses were used to explore the relationship between white matter hyperintensities（WMHs）, National Institutes of Health Stroke Scale（NIHSS） scores and prognosis evaluated by the modified Rank Scale（m RS） at 6th month after stroke. The differences in prevalence of diabetes mellitus and a history of ischemic heart disease were statistically significant between PPA group and LSA group（χ~2=8.255, P=0.004; χ~2=13.402, P〈0.001）. The bivariate analyses demonstrated a positive correlation between NIHSS and poor prognosis in patients with BAD and in the two subtype groups, and a positive correlation between WMHs and poor prognosis in the PPA group. It is concluded that a significantly higher prevalence of diabetes mellitus and a history of ischemic heart disease exist in the PPA group than in the LSA group. In addition, high grades of NIHSS scores imply poor prognosis in patients with BAD and in the two subtype groups. Moreover, WMHs are a positive predictor for poor prognosis in patients in the PPA group.

Efficacy of Guhong injection versus Butylphthalide injection for mild ischemic stroke: A multicenter controlled study

BACKGROUND Most studies on Guhong injection have involved a single center with a small sample size,and the level of clinical evidence is low.AIM To assess the safety and efficacy of Guhong injection for mild ischemic stroke(IS).METHODS A total of 399 IS patients treated at six hospitals from August 2018 to August 2019 were retrospectively analyzed.The patients were given Guhong injection(experimental group)or Butylphthalide injection(control group).Changes in National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS)scores were observed before treatment and at 1,2,and 3 wk after treatment in each group.The efficacy and safety of Guhong injection for IS were assessed.Other medications taken by the patients were confounding factors for efficacy assessment.These factors were controlled by propensity score matching,and the results were further analyzed based on the matching.RESULTS The marked response rates at three follow-up visits were 64.64%,74.7%,and 66.7%in the experimental group,and 48.26%,45.4%,and 22.2%in the control group.The marked response rates increased significantly in the experimental group compared with the control group(P<0.05).The overall response rate at the first visit(days 7±2)did not differ significantly between the two groups,but differed significantly at the second(days 14±2)and third visits(days 21±3)(P<0.05).The proportion of patients without any symptoms in the experimental group was significant different at the first visit(P<0.05),but not significantly different at the second visit.The two groups showed no significant difference in the baseline distribution of mRS scores.At the first and second visits,the change in mRS scores was-2 and-1 in the experimental and control groups,respectively,which were significantly different(P<0.05).After propensity score matching,the overall response rate and marked response rate were 97.29%and 100%in the experimental group(P>0.05)and 64.0%and 47.7%in the control group(P<0.05)at the first visit,respectively.The decreased NIHSS scores in the two groups were significant different(P<0.05).The overall response rate and marked response rate differed significantly between the two groups at the second visit(P<0.05).There was no significant difference in the incidence of adverse events between the two groups.No severe adverse events occurred in either group.CONCLUSION Guhong injection is safe and more effective than Butylphthalide injection for treatment of IS.

Cell-free mitochondrial DNA quantification in ischemic stroke patients for non-invasive and real-time monitoring of disease status

BACKGROUND Acute ischemic stroke(AIS)is one of the major causes of the continuous increasing rate of global mortality due to the lack of timely diagnosis,prognosis,and management.This study provides a primitive platform for non-invasive and cost-effective diagnosis and prognosis of patients with AIS using circulating cellfree mitochondrial DNA(cf-mtDNA)quantification and validation.AIM To evaluate the role of cf-mtDNA as s non-invasive,and affordable tool for realtime monitoring and prognosticating AIS patients at disease onset and during treatment.METHODS This study enrolled 88 participants including 44 patients with AIS and 44 healthy controls with almost similar mean age group at stroke onset,and at 24 h and 72 h of treatment.Peripheral blood samples were collected from each study participant and plasma was separated using centrifugation.The cf-mtDNA concentration was quantified using nanodrop reading and validated through real-time quantitative polymerase chain reaction(RT-qPCR)of NADH-ubiquinone oxidoreductase chain 1(ND1)relative transcript expression levels.RESULTS Comparative analysis of cf-mtDNA concentration in patients at disease onset showed significantly increased levels compared to control individuals for both nanodrop reading,as well as ND1 relative expression levels(P<0.0001).Intergroup analysis of cf-mtDNA concentration using nanodrop showed significantly reduced levels in patients at 72 h of treatment compared to onset(P<0.01).However,RT-qPCR analysis showed a significant reduction at 24 h and 72 h of treatment compared to the disease onset(P<0.001).The sensitivity and specificity were relatively higher for RT-qPCR than nanodrop-based cfmtDNA quantification.Correlation analysis of both cf-mtDNA concentration as well as ND1 relative expression with National Institute of Health Stroke Scale score at baseline showed a positive trend.CONCLUSION In summary,quantitative estimation of highly pure cf-mtDNA provides a simple,highly sensitive and specific,non-invasive,and affordable approach for real-time monitoring and prognosticating AIS patients at onset and during treatment.

Computed tomography perfusion and computed tomography angiography for prediction of clinical outcomes in ischemic stroke patients after thrombolysis

Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy of lesion location using imaging methods before treatment,with less attention to predictions of outcomes after thrombolysis.Thus,in the present study,we assessed the efficacy of combined computed tomography（CT） perfusion and CT angiography in predicting clinical outcomes after thrombolysis in ischemic stroke patients.The study included 52 patients who received both CT perfusion and CT angiography.Patients were grouped based on the following criteria to compare clinical outcomes：（1） thrombolytic and non-thrombolytic patients,（2） thrombolytic patients with CT angiography showing the presence or absence of a vascular stenosis,（3） thrombolytic patients with CT perfusion showing the presence or absence of hemodynamic mismatch,and（4） different CT angiography and CT perfusion results.Short-term outcome was assessed by the 24-hour National Institution of Health Stroke Scale score change.Long-term outcome was assessed by the 3-month modified Rankin Scale score.Of 52 ischemic stroke patients,29 were treated with thrombolysis and exhibited improved short-term outcomes compared with those without thrombolysis treatment（23 patients）.Patients with both vascular stenosis and blood flow mismatch（13 patients） exhibited the best short-term outcome,while there was no correlation of long-term outcome with CT angiography or CT perfusion findings.These data suggest that combined CT perfusion and CT angiography are useful for predicting short-term outcome,but not long-term outcome,after thrombolysis.

Efficacy of cattle encephalon glycoside and ignotin in patients with acute cerebral infarction: a randomized, double-blind, parallel-group, placebo-controlled study

Cattle encephalon glycoside and ignotin(CEGI)injection is a compound preparation formed by a combination of muscle extract from hea lthy rabbits and brain gangliosides from cattle,and it is generally used as a neuroprotectant in the treatment of central and peripheral nerve injuries.However,there is still a need for high-level clinical evidence from large samples to support the use of CEGI.We therefore carried out a prospective,multicenter,randomized,double-blind,parallel-group,placebo-controlled study in which we recruited 319 patients with acute cerebral infarction from 16 centers in China from October 2013 to May 2016.The patients were randomized at a 3:1 ratio into CEGI(n=239;155 male,84 female;61.2±9.2 years old)and placebo(n=80;46 male,34 female;63.2±8.28 years old)groups.All patients were given standard care once daily for 14 days,including a 200 mg aspirin enteric-coated tablet and 20 mg atorvastatin calcium,both taken orally,and intravenous infusion of 250–500 mL 0.9%sodium chloride containing 40 mg sodium tanshinone IIA sulfonate.Based on conventional treatment,patients in the CEGI and placebo groups were given 12 mL CEGI or 12 mL sterile water,respectively,in an intravenous drip of 250 mL 0.9%sodium chloride(2 mL/min)once daily for 14 days.According to baseline National Institutes of Health Stroke Scale scores,patients in the two groups were divided into mild and moderate subgroups.Based on the modified Rankin Scale results,the rate of patients with good outcomes in the CEGI group was higher than that in the placebo group,and the rate of disability in the CEGI group was lower than that in the placebo group on day 90 after treatment.In the CEGI group,neurological deficits were decreased on days 14 and 90 after treatment,as measured by the National Institutes of Health Stroke Scale and the Barthel Index.Subgroup analysis revealed that CEGI led to more significant improvements in moderate stroke patients.No drug-related adverse events occurred in the CEGI or placebo groups.In conclusion,CEGI may be a safe and effective treatment for acute cerebral infarction patients,especially for moderate stroke patients.This study was approved by the Ethical Committee of Peking University Third Hospital,China(approval No.2013-068-2)on May 20,2013,and registered in the Chinese Clinical Trial Registry(registration No.ChiCTR1800017937).

Predictors of unfavorable outcome at 90 days in basilar artery occlusion patients

BACKGROUND In a previous study,basilar artery occlusion(BAO)was shown to lead to death or disability in 80%of the patients.The treatment for BAO patients in the acute stage includes thrombolysis and intra-arterial thrombectomy,but not all patients benefit from these treatments.Thus,understanding the predictors of outcome before initiating these treatments is of special interest.AIM To determine the predictors related to the 90-d clinical outcome in patients with BAO in an Asian population.METHODS We performed a retrospective case review of patients admitted to a tertiary stroke center between 2015 and 2019.We used the international classification of diseases-10 criteria to identify cases of posterior circulation stroke.A neurologist reviewed every case,and patients fulfilling the criteria defined in the Basilar Artery International Cooperation Study were included.We then analyzed the patients’characteristics and factors related to the 90-d outcome.RESULTS We identified a total of 99 patients as real BAO cases.Of these patients,33(33.3%)had a favorable outcome at 90 d(modified Rankin Scale:0–3).Moreover,72 patients received intra-arterial thrombectomy,while 13 patients received intravenous tissue-type plasminogen activator treatment.We observed a favorable outcome in 33.3%of the cases and an unfavorable outcome in 66.7%of the cases.We found that the initial National Institutes of Health Stroke Scale(NIHSS)score and several BAO symptoms,including impaired consciousness,tetraparesis,and pupillary abnormalities,were significantly associated with an unfavorable outcome(P<0.05),while cerebellar symptoms were associated with a favorable outcome(P<0.05).In the receiver operating characteristic(ROC)analysis,the areas under the ROC curve of initial NIHSS score,impaired consciousness,tetraparesis,cerebellar symptoms,and pupillary abnormalities were 0.836,0.644,0.727,0.614,and 0.614,respectively.Initial NIHSS score showed a higher AUROC(0.836)compared to BAO symptoms.CONCLUSION The most important predictor of an unfavorable outcome was the initial NIHSS score.BAO symptoms,including tetraparesis,impaired consciousness,and pupillary abnormality were also related to an unfavorable outcome.

缺血性脑卒中患者院内合并肺部感染的影响因素分析

目的分析缺血性脑卒中患者院内合并肺部感染的影响因素。方法回顾性分析2020年3月至2022年2月期间在南通市第三人民医院治疗的214例缺血性脑卒中患者病历资料。根据《中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南》分组,未合并肺部感染患者作为对照组(n=104),合并肺部感染患者作为观察组(n=110)。对患者性别、年龄、发病至入院时间、合并基础疾病、鼻饲饮食、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、气管插管、呼吸机辅助通气等临床资料进行调查,分析缺血性脑卒中患者合并肺部感染的危险因素。结果观察组男56例,女54例,年龄(73.59±8.21)岁;对照组男45例,女59例,年龄(65.32±5.62)岁。单因素分析结果显示,观察组患者年龄、鼻饲饮食、NIHSS评分、GCS评分、是否气管插管、是否呼吸机辅助通气与对照组比较差异有统计学意义(t=8.511、χ^(2)=11.622、t=5.721、t=4.282、χ^(2)=6.868、χ^(2)=6.145,P均<0.05)。多因素Logistic回归分析结果显示,鼻饲饮食(OR=5.447,95%CI:2.477~11.976)、NIHSS评分(OR=8.339,95%CI:2.598~26.768)、GCS评分(OR=7.660,95%CI:3.369~17.413)、气管插管(OR=6.184,95%CI:2.447~15.628)、呼吸机辅助通气(OR=4.302,95%CI:1.830~10.110)是缺血性脑卒中患者合并肺部感染的独立危险因素。结论鼻饲饮食、病情严重程度、意识障碍、气管插管及呼吸机辅助通气是导致缺血性脑卒中患者发生肺部感染的独立危险因素,因此在患者入院时应及时评估,有针对性地实施预防措施。

急性脑梗死患者不同性质颈动脉粥样斑块及预后的sdLDL-C、Lp-PLA2水平观察

目的 观察急性脑梗死(ACI)患者的小而密低密度脂蛋白胆固醇(sdLDL-C)、脂蛋白相关磷脂酶A2(Lp-PLA2)水平,探讨其与颈动脉粥样斑块稳定性的关系,以期为早期识别和改善患者预后提供思路。方法 依据颈部血管超声检查粥样斑块性质结果,164例急性脑梗死患者(观察组)中无粥样斑块者49例、稳定粥样斑块者58例、不稳定粥样斑块者57例,以47例健康体检者为对照,比较2组的同型半胱氨酸(Hcy)、sdLDL-C、Lp-PLA2表达水平。统计患者入院时的美国国立卫生院卒中量表(NIHSS)得分,随访患者发病30 d的预后情况,并分析影响ACI预后的相关因素。结果 脑梗死患者的空腹血糖、甘油三酯、sdLDL-C/LDL-C、sdLDL-C/TC、Lp-PLA2水平均高于对照组,HDL-C水平低于对照组;有粥样斑块者的Hcy、sdLDL-C水平高于无粥样斑块者及对照组;不稳定粥样斑块者的TC、LDL-C水平高于无粥样斑块者及对照组,差异均有统计学意义(P<0.05)。预后不良组的不稳定粥样斑块发现率(45.78%)高于预后良好组(23.46%),入院时NIHSS评分及血糖、sdLDL-C、sdLDL-C/LDL-C、sdLDL-C/TC、Lp-PLA2水平均高于预后良好组,差异均有统计学意义(P<0.05)。结论 sdLDL-C、Lp-PLA2水平与急性脑梗死患者颈动脉粥样斑块的稳定性密切相关,对预后判断有积极意义。

分析标准剂量rt-PA静脉溶栓联合动脉取栓治疗急性脑梗死的临床效果

目的 探究标准剂量rt-PA静脉溶栓联合动脉取栓治疗急性脑梗死的效果。方法 随机选取海阳市人民医院于2021年7月—2023年7月收治的80例急性脑梗死患者为研究对象,通过随机数表法分成溶栓组与桥接组,各40例。溶栓组运用标准量静脉溶栓治疗,桥接组在经过30 min静脉溶栓治疗之后,对治疗效果不理想的患者,进行机械取栓。比较两组的国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分以及不良反应发生情况。结果 治疗后24 h、7 d、30 d,桥接组的NIHSS评分均低于溶栓组,差异有统计学意义(P均<0.05)。桥接组的不良反应总发生率为7.50%,溶栓组为2.50%,两组对比,差异无统计学意义(χ^(2)=0.263,P>0.05)。结论 标准剂量rt-PA静脉溶栓联合动脉取栓治疗有效地促进了患者神经功能的恢复,不良反应与溶栓治疗相当,对急性脑梗死的治疗提供了有力的支持。

NLR在急性缺血性脑卒中患者早期神经功能损伤、预后及复发风险评估中的价值

目的探讨中性粒细胞/淋巴细胞比值(NLR)在急性缺血性脑卒中(AIS)患者早期神经功能损伤、预后及复发风险评估中的价值。方法选取2022年4月至2023年10月宁波市医疗中心李惠利医院收治的经临床和影像学检查证实为AIS的患者236例为研究对象,根据TOAST分型标准分为大动脉粥样硬化型151例、心源性栓塞型30例、小动脉闭塞型55例。比较不同TOAST分型AIS患者性别、年龄、高血压史、糖尿病史、吸烟史、饮酒史、入院时美国国立卫生研究院卒中量表(NIHSS)、改良Rankin量表(mRS)、Essen卒中风险评分量表(ESRS)评分、中性粒细胞绝对值(N)、NLR、红细胞分布宽度(RDW)、超敏C反应蛋白(hs-CRP)、D-二聚体、同型半胱氨酸(Hcy)、IL-6、IL-10的差异。根据入院时NIHSS、mRS、ESRS评分结果,采用单因素及多因素二元logistic回归分析影响AIS患者神经功能损伤程度、预后状况及复发风险的因素。ROC曲线评估实验室指标判断AIS患者神经功能损伤程度、预后状况及复发风险的效能。采用Spearman秩相关分析AIS患者NLR与NIHSS评分、mRS评分、ESRS评分的相关性。结果不同TOAST分型AIS患者年龄、NIHSS评分、mRS评分、ESRS评分、N、NLR、RDW、hs-CRP、D-二聚体、Hcy、IL-6、IL-10水平比较,差异均有统计学意义(均P<0.05)。多因素分析显示,NLR是AIS患者神经功能损伤程度的独立影响因素(P<0.05)。NLR、hs-CRP、D-二聚体是AIS患者神经功能预后状况的独立影响因素(均P<0.05)。NLR、D-二聚体是AIS患者复发风险的独立影响因素(均P<0.05)。NLR判断AIS患者神经功能损伤程度的最佳截断值为2.52,灵敏度为0.734,特异度为0.528,AUC为0.670。NLR联合hs-CRP、D-二聚体判断AIS患者神经功能预后状况的最佳截断值为0.40,灵敏度为0.718,特异度为0.730,AUC为0.781。NLR联合D-二聚体判断AIS患者复发风险的最佳截断值为0.42,灵敏度为0.736,特异度为0.661,AUC为0.736。Spearman秩相关分析显示,NLR与NIHSS评分、mRS评分、ESRS评分均呈正相关(rs=0.291、0.358、0.277,均P<0.001)。结论NLR在AIS患者早期神经功能损伤、预后及复发风险评估中具有一定临床价值,NLR联合hs-CRP、D-二聚体等指标可有效提高AIS患者神经功能预后评估的效能。

血管性认知功能障碍病人血清微RNA-335-5p、血清应答因子水平及其临床意义

目的 探究血管性认知功能障碍(VCI)病人血清微RNA(miR)-335-5p、血清应答因子(SRF)水平及临床意义。方法以石家庄市人民医院2019年1月至2020年12月因脑卒中治疗后6个月出现VCI的110例病人为研究对象(VCI组),其中非痴呆型血管性认知功能障碍(VCIND)者48例(VCIND组)、血管性痴呆(VD)者62例(VD组)。同时间段该院脑卒中未合并认知障碍者110例为对照组。分析各组病人发病时(入院次日)、发病后6个月、发病后1年血清miR-335-5p、SRF水平。logistic回归模型分析脑卒中病人发生VCI的影响因素。Pearson法分析血清miR-335-5p与SRF水平的相关性。受试者操作特征曲线(ROC曲线)分析血清miR-335-5p、SRF水平对VCI的预测价值。结果 VCI组发病时miR-335-5p水平0.76±0.15低于对照组1.06±0.07,而SRF水平1.52±0.24高于对照组1.01±0.09,差异有统计学意义(P<0.05)。发病时,对照组、VCIND组、VD组的miR-335-5p水平逐次降低(1.06±0.07比0.86±0.17比0.68±0.14),SRF水平依次增加(1.01±0.09比1.32±0.25比1.67±0.24),差异有统计学意义(P<0.05)。VD组、VCIND组受试者在发病后6个月及1年时SRF水平低于发病时,而miR-335-5p水平高于发病时(P<0.05)。三组蒙特利尔认知评估量表(MoCA)评分、miR-335-5p、SRF组间、时间、交互作用差异有统计学意义(P<0.05)。发病时,VCI组血清miR-335-5p与SRF水平存在负相关性(r=-0.64,P<0.001)。年龄、美国国立卫生研究院卒中量表(NIHSS)评分、miR-335-5p、SRF是影响脑卒中病人VCI的危险因素(P<0.05)。ROC分析显示,血清miR-335-5p、SRF、miR-335-5p联合SRF预测脑卒中后VCI的曲线下面积为0.88[95%CI:(0.84,0.93)]、0.90[95%CI:(0.86,0.95)]、0.93[95%CI:(0.89,0.97)]。结论VCI病人血清miR-335-5p水平明显降低,而SRF水平升高,二者水平变化与VCI严重程度有关,是导致脑卒中后VCI的影响因素,且二者联合对脑卒中后VCI有较高预测效能。

补阳还五汤加减治疗脑血栓的临床效果

目的:探究补阳还五汤加减治疗脑血栓的临床效果。方法:选择2017年7月—2022年7月长春中医药大学附属白山医院收治的210例脑血栓患者,根据随机数表法分为两组,各105例。对照组进行常规脑血栓治疗,观察组在对照组的基础上加用补阳还五汤加减方治疗。观察并比较两组治疗总有效率、治疗前后肝肾功能指标、神经损伤程度及日常生活能力量表(ADL)评分。结果:观察组治疗总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗前后,两组肝肾功能指标比较,差异无统计学意义(P>0.05)。治疗前,两组神经损伤程度及ADL评分比较,差异无统计学意义(P>0.05);治疗15 d及30 d后,观察组神经损伤程度及ADL评分均显著低于对照组,差异有统计学意义(P<0.05)。结论:补阳还五汤加减治疗脑血栓的临床效果较好,安全性较高,且可显著改善患者的神经损伤及生活能力。

银杏二萜内酯葡胺治疗急性脑梗死患者外周血辅助型Th17细胞亚群水平改变与临床预后的关系

目的观察银杏二萜内酯葡胺(GDLM)治疗急性脑梗死患者外周血T细胞亚群的改变,并通过小鼠体内实验观察其对T细胞亚群的影响。方法选取2018—2019年兰州大学第一医院神经内科收治的急性脑梗死患者80例,根据接受治疗方案的不同分为观察组和对照组。两组患者均接受标准治疗,观察组加用GDLM治疗。比较两组患者临床疗效和卒中量表评分(NHISS)、血清C反应蛋白(CRP)水平、外周血Th17细胞水平变化。将C57B/L6雄性小鼠分为PBS组和GDLM两组,分别给予腹腔注射PBS或GDLM,第5、10天分析小鼠脾、引流淋巴结细胞中Th17细胞的改变。结果治疗前,两组患者NIHSS评分及血清CD4^(+)T细胞基线水平之间的差异无统计学意义(P>0.05);治疗后,两组患者CD4^(+)T细胞均较治疗前无明显变化,但血清CRP水平、CD4^(+)IL-17A^(+)T细胞(Th17细胞)均较治疗前降低(P<0.05);治疗后,观察组NIHSS评分低于对照组(P<0.05)。注射后第5天,GDLM组小鼠脾CD4^(+)CD44^(low)CD62L^(high)T细胞显著增加,差异有统计学意义(P<0.05),到第10天,GDLM组CD4^(+)CD44^(low)CD62L^(high)T细胞仍略高于对照组。注射后5天,GDLM组小鼠脾Th17细胞表现出降低趋势,第10天时则明显低于对照组(P<0.05)。结论GDLM治疗急性脑梗死效果显著,其机制可能是通过调节患者外周血T细胞亚群水平,抑制T细胞活化,抑制Th17细胞分化进而改善神经功能障碍。

不同疗程高压氧治疗颅脑损伤患者的临床效果

目的观察不同疗程高压氧治疗对颅脑损伤患者的效果。方法选取山东第二医科大学附属益都中心医院2019年5月至2021年11月收治的80例颅脑损伤患者作为研究对象,按照随机数字表法分为试验组(40例)与对照组(40例)。在常规治疗的基础上,试验组加用高压氧治疗4疗程共60次,而对照组加用高压氧治疗2疗程共30次。经综合治疗80 d后,比较两组患者的临床总有效率、美国国立卫生研究院卒中量表评分(NIHSS)、日常生活活动能力量表评分(ADL)。结果试验组患者的临床治疗总有效率高于对照组,差异有统计学意义(P<0.01)。试验组患者治疗后的NIHSS评分低于对照组,ADL评分高于对照组,差异有统计学意义(P<0.05)。结论长疗程(>30次)高压氧治疗能更有效提高颅脑损伤患者神经功能、日常生活能力,值得临床推广。

替罗非班治疗进展性脑梗死效果观察

目的探讨替罗非班治疗进展性脑梗死(PCI)的效果。方法选取医院2021年1月9日至2023年10月15日收治的PCI患者116例,按治疗方案的不同分为对照组和观察组,各58例。两组患者均予常规方案治疗,观察组患者加用盐酸替罗非班氯化钠注射液泵入治疗。结果观察组总有效率为96.55%,显著高于对照组的84.48%(P<0.05)。治疗90 d后,观察组预后良好率为96.55%,显著高于对照组的86.21%(P<0.05)。观察组治疗后2周、1个月、3个月的美国国立卫生研究院卒中量表评分均显著优于对照组(P<0.05)。与治疗前比较,两组患者治疗后的日常活动能力评分均显著改善,且观察组改善幅度较对照组更显著(P>0.05)。结论替罗非班治疗PCI,可改善患者的神经功能缺损程度及日常活动能力。

血浆circRNA_102046水平与急性缺血性脑卒中患者美国国立卫生研究院卒中量表评分以及炎症因子白细胞介素-2和肿瘤坏死因子-α表达的相关性分析

目的探讨血浆中circRNA_102046表达水平与急性缺血性脑卒中患者美国国立卫生研究院卒中量表(NIHSS)评分以及炎症因子白细胞介素-2(IL-2)和肿瘤坏死因子-α(TNF-α)表达的相关性。方法选取2020年12月至2022年3月在重庆医科大学附属第三医院神经内科住院治疗的43例急性缺血性脑卒中患者作为观察组,选取同期在本院健康体检受试者68例作为对照组。采用实时荧光定量PCR(RT-qPCR)检测两组血浆circRNA_102046表达水平;采用酶联免疫吸附测定(ELISA)法检测IL-2和TNF-α表达水平;采用ROC曲线分析circRNA_102046在急性缺血性脑卒中诊断和预后价值;分析circRNA_102046表达水平与NIHSS评分以及IL-2和TNF-α表达水平的相关性。结果血浆中circRNA_102046表达水平在急性缺血性脑卒中患者中高于健康对照组,差异有统计学意义(P<0.05),AUC为0.986,灵敏度为88.372%,特异度为98.529%;血浆中circRNA_102046表达水平在中重度神经功能缺损组高于轻度神经功能缺损组,AUC为0.889,灵敏度为93.750%,特异度为70.370%。急性缺血性脑卒中患者血浆中circRNA_102046表达水平与NIHSS评分、IL-2和TNF-α表达水平均呈正相关(r=0.665、0.446、0.653,P<0.05)。结论circRNA_102046在急性缺血性脑卒中患者血浆中明显高表达,并与患者神经功能缺损的严重程度和炎症因子表达正相关。circRNA_102046在急性缺血性脑卒中患者的诊断和疾病严重程度评估上具有重要临床价值。

NIHSS评分结合CT血管成像对超早期急性缺血性脑卒中临床预后的预测作用分析

目的 超早期急性缺血性脑卒中患者应用美国国立卫生研究院卒中量表(NIHSS)评分以及CT血管成像(CTA)相结合方式进行临床诊断,评估该诊断方式对患者临床预后的预测价值。方法 选取100例超早期急性缺血性脑卒中患者进行研究,以临床治疗后NIHSS评分为评判标准将患者分为预后良好组(NIHSS评分≤4分, 52例)和预后不良组(NIHSS评分>4分, 48例)。对比两组患者预后情况、NIHSS评分以及CT血管成像显示阻塞情况,分析超早期急性缺血性脑卒中患者临床预后的单因素及多因素,分析超早期急性缺血性脑卒中临床预后的受试者工作特征曲线(ROC)。结果 预后良好组患者基线NIHSS评分、出院时NIHSS评分、神经功能恢复率分别为(6.1±1.5)分、(2.4±0.5)分、(0.67±0.12),预后不良组分别为(11.8±2.3)分、(6.8±1.3)分、(0.46±0.19)。与预后不良组比较,预后良好组患者基线NIHSS评分、出院时NIHSS评分均明显更低,神经功能恢复率明显较高(P<0.05)。单因素分析结果显示,与预后不良组比较,预后良好组基线NIHSS评分及CT血管成像显示血管阻塞占比明显偏低(P<0.05)。多因素回归分析显示,基线NIHSS评分高、CT血管成像显示血管阻塞与超早期急性缺血性脑卒中早期临床预后密切相关,是超早期急性缺血性脑卒中临床预后的独立危险因素(P<0.05)。由ROC分析可知,NIHSS评分结合CT血管成像模型预测超早期急性缺血性脑卒中临床预后的敏感性和特异性均高于基线NIHSS评分模型和CT血管成像模型。结论 NIHSS评分结合CT血管成像对超早期急性缺血性脑卒中临床预后的预测能力突出。