Association between PPARG genetic polymorphisms and ischemic stroke risk in a northern Chinese Han population: a case-control study

Two common polymorphisms of the peroxisome proliferator-activated receptor gamma(PPARG) gene, rs1801282 and rs3856806, may be important candidate gene loci affecting the susceptibility to ischemic stroke. This case-control study sought to identify the relationship between these two single-nucleotide polymorphisms and ischemic stroke risk in a northern Chinese Han population. A total of 910 ischemic stroke participants were recruited from the First Hospital of China Medical University, Shenyang, China as a case group, of whom 895 completed the study. The 883 healthy controls were recruited from the Health Check Center of the First Hospital of China Medical University, Shenyang, China. All participants or family members provided informed consent. The study protocol was approved by the Ethics Committee of the First Hospital of China Medical University, China on February 20, 2012(approval No. 2012-38-1). The protocol was registered with the Chinese Clinical Trial Registry(registration number: ChiCTR-COC-17013559). Plasma genomic DNA was extracted from all participants and analyzed for rs1801282 and rs3856806 single nucleotide polymorphisms using a SNaPshot Multiplex sequencing assay. Odds ratios(ORs) and 95% confidence intervals(CIs) were calculated using unconditional logistic regression to estimate the association between ischemic stroke and a particular genotype. Results demonstrated that the G allele frequency of the PPARG gene rs1801282 locus was significantly higher in the case group than in the control group(P < 0.001). Individuals carrying the G allele had a 1.844 fold increased risk of ischemic stroke(OR = 1.844, 95% CI: 1.286–2.645, P < 0.001). Individuals carrying the rs3856806 T allele had a 1.366 fold increased risk of ischemic stroke(OR = 1.366, 95% CI: 1.077–1.733, P = 0.010). The distribution frequencies of the PPARG gene haplotypes rs1801282-rs3856806 in the control and case groups were determined. The frequency of distribution in the G-T haplotype case group was significantly higher than that in the control group. The risk of ischemic stroke increased to 2.953 times in individuals carrying the G-T haplotype(OR = 2.953, 95% CI: 2.082–4.190, P < 0.001). The rs1801282 G allele and rs3856806 T allele had a multiplicative interaction(OR = 3.404, 95% CI: 1.631–7.102, P < 0.001) and additive interaction(RERI = 41.705, 95% CI: 14.586–68.824, AP = 0.860;95% CI: 0.779–0.940;S = 8.170, 95% CI: 3.772–17.697) on ischemic stroke risk, showing a synergistic effect. Of all ischemic stroke cases, 86% were attributed to the interaction of the G allele of rs1801282 and the T allele of rs3856806. The effect of the PPARG rs1801282 G allele on ischemic stroke risk was enhanced in the presence of the rs3856806 T allele(OR = 8.001 vs. 1.844). The effect of the rs3856806 T allele on ischemic stroke risk was also enhanced in the presence of the rs1801282 G allele(OR = 2.546 vs. 1.366). Our results confirmed that the G allele of the PPARG gene rs1801282 locus and the T allele of the rs3856806 locus may be independent risk factors for ischemic stroke in the Han population of northern China, with a synergistic effect between the two alleles.

A Nested Case-Control Study to Explore the Association between Immunoglobulin G N-glycans and Ischemic Stroke

Objective This study prospectively investigates the association between immunoglobulin G(IgG)N-glycan traits and ischemic stroke(IS) risk.Methods A nested case-control study was conducted in the China suboptimal health cohort study,which recruited 4,313 individuals in 2013–2014. Cases were identified as patients diagnosed with IS, and controls were 1:1 matched by age and sex with cases. Ig G N-glycans in baseline plasma samples were analyzed.Results A total of 99 IS cases and 99 controls were included, and 24 directly measured glycan peaks(GPs) were separated from Ig G N-glycans. In directly measured GPs, GP4, GP9, GP21, GP22, GP23, and GP24 were associated with the risk of IS in men after adjusting for age, waist and hip circumference,obesity, diabetes, hypertension, and dyslipidemia. Derived glycan traits representing decreased galactosylation and sialylation were associated with IS in men(FBG2S2/(FBG2 + FBG2S1 + FBG2S2): odds ratio(OR) = 0.92, 95% confidence interval(CI): 0.87–0.97;G1n: OR = 0.74, 95% CI: 0.63–0.87;G0n: OR =1.12, 95% CI: 1.03–1.22). However, these associations were not found among women.Conclusion This study validated that altered Ig G N-glycan traits were associated with incident IS in men, suggesting that sex discrepancies might exist in these associations.

Genetic polymorphisms in pri-let-7a-2 are associated with ischemic stroke risk in a Chinese Han population from Liaoning, China: a case-control study

Ischemic stroke is a complicated disease, and its pathogenesis has been attributed to the occurrence of genetic polymorphisms.Evidence has suggested that the microRNA let-7a is involved in the pathogenesis of ischemic stroke.Pri-miRNA is the primary transcript, which undergoes several processing steps to generate pre-miRNA and, later, mature miRNAs.In this case-control study, we analyzed the distribution of prilet-7a-2 variants in patients at a high risk for ischemic stroke and the interactions of pri-let-7a-2 variants and environmental factors.Blood samples and clinical information were collected from 1086 patients with ischemic stroke and 836 healthy controls between December 2013 and December 2015 at the First Affiliated Hospital of China Medical University.We found that the rs1143770 CC genotype and the C allele were associated with a decreased risk of ischemic stroke, whereas the rs629367 CC genotype was associated with an increased risk for ischemic stroke.Moreover, these two single-nucleotide polymorphisms were in linkage disequilibrium in this study sample.We analyzed gene-environment interactions and found that rs1143770 exerted a combined effect on the pathogenesis of ischemic stroke, together with alcohol use, smoking, and a history of hypertension.Therefore, the detection of pri-let-7a-2 polymorphisms may increase the awareness of ischemic stroke risk.This study was approved by the Institutional Ethics Committee of the First Affiliated Hospital of China Medical University, China(approval No.2012-38-1) on February 20, 2012, and was registered with the Chinese Clinical Trial Registry(registration number: ChiCTR-COC-17013559) on December 27, 2017.

全身炎症反应指数与缺血性脑卒中患者复发风险的关联性研究

背景全身炎症反应指数(SIRI)是一种较新的炎症生物标志物,其与缺血性脑卒中患者复发的关系尚不明确。目的探讨SIRI水平与缺血性脑卒中患者1年内复发的关联性。方法选取2019年3月—2021年3月在南昌大学第一附属医院、南昌大学第二附属医院、南昌市第二医院和南昌市第三医院住院且确诊为缺血性脑卒中的患者作为研究对象进入队列,并对其随访1年。收集患者入院后48 h内的基线信息、随访过程中的缺血性脑卒中复发情况。采用Cox比例风险回归模型、限制性立方样条、亚组分析探讨SIRI与缺血性脑卒中患者1年内复发之间的关联性。结果本研究纳入了1023例患者,在1年随访期间共107例(10.46%)复发。多因素Cox比例风险回归模型分析结果显示,在调整变量后,SIRI升高是缺血性脑卒中复发的危险因素(HR=1.06,95%CI=1.01~1.10,P<0.05)。将SIRI按四分位数分类时,与Q1亚组(256例)相比,Q4亚组(256例)有较高的缺血性脑卒中复发风险(HR=1.80,95%CI=1.08~3.00,P<0.05)。限制性立方样条分析结果显示,SIRI与缺血性脑卒中复发风险呈J型的剂量-反应关系(PNonlinear=0.025)。进一步按性别、年龄、既往脑卒中、入院时美国国立卫生研究院卒中量表(NIHSS)评分分层进行亚组分析,结果显示,SIRI和入院时NIHSS评分分层存在交互作用(P<0.001),在NIHSS评分为0~1分时,SIRI(HR=1.25,95%CI=1.04~1.51,P=0.020)与缺血性脑卒中复发存在相关关系;在NIHSS评分为5~15分时,SIRI(HR=1.20,95%CI=1.12~1.28,P<0.001)与缺血性脑卒中复发存在相关关系;在上述评分区间SIRI升高与缺血性脑卒中复发风险增加有关。结论较高的SIRI与缺血性脑卒中复发风险增加明显相关。在SIRI与缺血性脑卒中复发之间观察到J型关联,且在NIHSS评分为0~1、5~15分的缺血性脑卒中患者中,SIRI升高与缺血性脑卒中复发风险增加有关。

脑血管病急性期血尿酸/血肌酐比值与脑血管事件复发及死亡的关系:一项前瞻性队列研究

背景脑卒中在世界各地有较高的死亡率和复发率。血尿酸(SUA)是嘌呤代谢的产物,已被认为是心脑血管病的危险因素。血尿酸/血肌酐比值(SUA/Scr)是代表肾功能标准化的SUA,目前有关SUA/Scr在急性脑血管病中的作用仍有争议。目的探讨脑血管病急性期SUA/Scr与脑血管事件复发和死亡的关系。方法本研究为前瞻性队列研究,选取2006年9月—2019年9月天津市环湖医院连续收治的首次发生脑血管事件的13313例患者为研究队列,并对患者进行随访,随访截至2020年9月。随访方式为门诊及电话相结合。随访主要终点事件为全因死亡,次要终点事件为脑血管事件复发、心血管事件复发、其他血管事件发生(如下肢动静脉栓塞)。采用Cox比例风险回归模型探究SUA/Scr与脑血管事件复发与死亡的关系。结果根据脑血管病急性期SUA/Scr四分位数,将患者分为Q1组(SUA/Scr≤3.16,n=3520)、Q2组(3.16<SUA/Scr≤3.94,n=3280)、Q3组(3.94<SUA/Scr≤4.92,n=3270)、Q4组(SUA/Scr>4.92,n=3243)。截至随访结束,774例(5.8%)患者死亡,2064例(15.5%)患者复发脑血管事件。脑血管病急性期SUA/Scr位于Q1~Q4的患者中,男性复发脑血管病的例数依次为302、375、408、337例,女性依次为99、125、169、249例;男性复发脑梗死的例数依次为261、314、345、283例,女性依次为90、101、142、205例;男性复发大动脉粥样硬化型脑梗死的例数依次为154、191、214、183例,女性依次为58、52、45、31例;男性全因死亡的例数依次为165、128、131、88例,女性依次为57、63、62、80例;男性因脑梗死死亡的例数依次为93、72、70、46例,女性依次为31、33、36、44例;男性因大动脉粥样硬化型脑梗死死亡的例数依次为58、52、45、31例,女性依次为17、18、27、24例。调整多项混杂因素后,SUA/Scr位于Q4相较于Q1是男性急性脑梗死复发的影响因素(HR=0.690,95%CI=0.500~0.953,P=0.026);SUA/Scr位于Q4相较于Q1是男性脑梗死亚组患者大动脉粥样硬化型脑梗死复发的影响因素(HR=0.740,95%CI=0.578~0.947,P=0.017)。SUA/Scr位于Q4相较于Q1是男性全因死亡、因脑梗死死亡的影响因素(HR=0.575,95%CI=0.368~0.901,P=0.003;HR=0.610,95%CI=0.353~0.814,P=0.011)。SUA/Scr位于Q3、Q4相较于Q1是男性出院后死亡的影响因素(HR=0.656,95%CI=0.476~0.904,P=0.010;HR=0.582,95%CI=0.409~0.829,P=0.001)。SUA/Scr位于Q4相较于Q1是男性脑梗死亚组患者因大动脉粥样硬化型脑梗死死亡的影响因素(HR=0.580,95%CI=0.386~0.873,P=0.007)。结论一定范围内,脑血管病急性期SUA/Scr升高对男性患者脑血管事件复发及死亡有一定的保护作用,低SUA/Scr与男性大动脉粥样硬化型脑梗死的死亡和复发风险升高有关,但与小动脉闭塞型脑梗死和心源性卒中复发和死亡无关。在女性患者中没有观察到SUA/Scr与脑血管事件复发及死亡的关系。

Synergistic effects of elevated homocysteine level and abnormal blood lipids on the onset of stroke

Hyperhomocysteinemia and abnormal blood lipids are independent risk factors for stroke. However, whether both factors exert a synergistic effect in the onset of stroke remains unclear. The present study is a retrospective analysJs of 2 089 cases of stroke and 2 089 control cases of simple in- tervertebral disk protrusion using a paired multivariate logistic regression method. Adjusting for known confounding variables including the patients＇ age, gender, smoking status, alcohol con- sumption status, patient and family medical history, and clinical biochemical indices, elevated ho- mocysteine level was related to the onset of stroke. Patients with elevated homocysteJne levels and abnormal blood lipids showed a 40.9 % increase in the risk for stroke compared to patients with normal homocysteine levels and blood lipids （odds ratio 1.409; 95% confidence interval 1.127-1.761）. These results indicate that elevated homocysteine and abnormal blood lipids exert synergistic effects in the onset of stroke. Patients with elevated homocysteine levels and abnormal blood lipids are predisposed to stroke.

Associations between thromboxane A synthase 1 gene polymorphisms and the risk of ischemic stroke in a Chinese Han population

Thromboxane A synthase 1 （TBXAS1） catalyses the synthesis of thromboxane A2 （TXA2）, which plays an important role in the pathogenesis of ischemic stroke. Thus, the TBXAS1 gene was investigated as a candidate gene involved in the formation of atherosclerosis. This case-control study collected peripheral blood specimens and clinical data of 370 ischemic stroke patients and 340 healthy controls in the Northern Chinese Han population from October 2010 to May 2011. Two TBXAS1 single-nucleotide polymorphisms, rs2267682 and rs10487667, were analyzed using a SNaPshot Multiplex sequencing assay to explore the relationships between the single-nucleotide polymorphisms in TBXAS1 and ischemic stroke. The TT genotype frequency and T allele frequency of rs2267682 in the patients with ischemic stroke were significantly higher than those in the controls （P 〈 0.01 and P = 0.02）. Furthermore, compared with the GG ＋ GT genotype, the TT rs2267682 genotype was associated with increased risk of ischemic stroke （odds ratio （OR） = 1.80, 95% confidence interval （CI）： 1.16–2.79, P 〈 0.01）. Multivariate logistic analysis with adjustments for confounding factors revealed that rs2267682 was still associated with ischemic stroke （OR = 1.94,95% CI ： 1.13–3.33, P = 0.02）. The frequency of the T-G haplotype in the patients was significantly higher than that in the controls according haplotype analysis （OR = 1.49, 95% CI： 1.10–2.00, P 〈 0.01）. These data reveal that the rs2267682 TBXAS1 polymorphism is associated with ischemic stroke. The TT genotype of TBXAS1 and T allele of rs2267682 increase susceptibility to ischemic stroke in this Northern Chinese Han population. The protocol has been registered with the Chinese Clinical Trial Registry （registration number： ChiCTR-COC-17013559）.

Association of G-protein coupled purinergic receptor P2Y2 with ischemic stroke in a Han Chinese population of North China

The G-protein-coupled purinergic receptor P2Y2(P2RY2) plays an important role in the mechanism of atherosclerosis, which is relevant to ischemic stroke. This retrospective case-control study aimed to assess the relationship between P2RY2 gene polymorphisms and ischemic stroke risk in the northern Han Chinese population. In this study, clinical data and peripheral blood specimens were collected from 378 ischemic stroke patients and 344 controls. The ischemic stroke participants were recruited from the First Affiliated Hospital of China Medical University and the First Affiliated Hospital of Liaoning Medical University. The controls were recruited from the Health Check Center at the First Affiliated Hospital of China Medical University. Ischemic stroke patients were divided into two subgroups according to the Trial of ORG 10172 in Acute Stroke Treatment(TOAST) classification: large-artery atherosclerosis(n = 178) and small-artery occlusion(n = 200) strokes. All subjects were genotyped for three single nucleotide polymorphisms(rs4944831, rs1783596, and rs4944832) in the P2RY2 gene using peripheral venous blood samples. The distribution of the dominant rs4944832 phenotype(GG vs. GA+AA) differed significantly between small-artery occlusion patients and control subjects(odds ratio(OR) = 1.720, 95% confidence interval(CI): 1.203–2.458, P < 0.01). Multivariable logistic regression analysis revealed that the GG genotype of rs4944832 was significantly more prevalent in small-artery occlusion patients than in control subjects(OR = 1.807, 95% CI: 1.215–2.687, P < 0.01). The overall distribution of the haplotype established by rs4944831-rs1783596-rs4944832 was significantly different between ischemic stroke patients and controls(P < 0.01). In ischemic stroke patients, the frequency of the G-C-G haplotype was significantly higher than in control subjects(P = 0.028), whereas the frequency of the T-C-A haplotype was lower than in control subjects(P = 0.047). These results indicate that the G-C-G haplotype of P2RY2 is a susceptibility haplotype for ischemic stroke. In addition, the GG genotype of rs4944832 may be associated with the development of small-artery occlusion in the northern Han Chinese population. The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of China Medical University on February 20, 2012(No. 2012-38-1) and the First Affiliated Hospital of Liaoning Medical University, China, on March 1, 2013(No. 2013-03-1). All participants gave their informed consent. This trial was registered with the ISRCTN Registry(ISRCTN11439124) on October 24, 2018. Protocol version(1.0).

Impact of Libido at 2 Weeks after Stroke on Risk of Stroke Recurrence at 1-Year in a Chinese Stroke Cohort Study

Background： There were few studies on the relation between changes in libido and incidence of stroke recurrence. The aim of this study was to investigate the relationship between libido decrease at 2 weeks after stroke and recurrent stroke at 1-year. Methods： It is a multi-centered, prospective cohort study. The 14th item of the Hamilton Depression Rating Scale-17 was used to evaluate changes of libido in poststroke patients at 2 weeks. Stroke recurrence was defined as an aggravation of former neurological functional deficit, new local or overall symptoms, or stroke diagnosed at re-admission. Results： Among 2341 enrolled patients, 1757 patients had completed follow-up data, 533 （30.34%） patients had decreased libido at 2 weeks, and 166 （9.45%） patients had recurrent stroke at l-year. Multivariate logistic regression analysis showed that, compared with patients with normal libido, the odds ratio （OR） of recurrent stroke in patients with decreased libido was reduced by 4 l% （OR = 0.59, 95% confidence interval [CI]： 0.40-0.87）. The correlation was more prominent among male patients （OR = 0.52, 95% CI： 0.31 0.85） and patients of≥60 years of age （OR = 0.57, 95% CI： 0.35-0.93）. Conclusions： One out of three stroke patients in China's Mainland has decreased libido at 2 weeks after stroke. Decreased libido is a protective factor for stroke recurrence at 1-year, which is more prominent among older male patients.

缺血性脑卒中患者早期复发的临床特征和危险因素

为探讨缺血性脑卒中患者早期复发的临床特点和危险因素，对复发的缺血性卒中患者进行了临床分析和病例－对照研究。结果６３７例完全性缺血性卒中，有２４例复发，其总复发率为３．８％（２４／６３７），其中脑血栓的复发率为３．４％（２０／５９１），脑栓塞为８．７％（４／４６）。大部分病例（７１％，１７／２４）复发发生在原患侧，且多为同卒中类型复发（８３％，２０／２４）。经ＭｃＮｅｍａｒ卡方检验发现高血压史、有ＴＩＡ或脑梗塞史、糖尿病等因素与对照相比有显著性差异，而缺血性心脏病、房颤、入院时高血糖、血脂增高和吸烟与复发无显著相关。认为缺血性脑卒中患者早期复发多为同卒中类型、同部位的复发，高血压、有ＴＩＡ或脑梗塞史、糖尿病可能为卒中早期复发的危险因素。

首发卒中患者6年后预后及其危险因素的前瞻性研究

目的分析脑卒中患者复发及生存的影响因素,为脑卒中的二级预防的改善提供科学依据。方法以2010年1-12月淮南市第一人民医院神经内科就诊的880例脑卒中首发病例为研究对象,前瞻性随访患者患病后6年的复发、死亡及其他结局。成运用COX模型分析影响该地区首发脑卒中患者复发的危险因素及生存率。结果随访期间共144例患者脑卒中复发,6年累积复发率为16.38%;在144例复发患者中65例死亡,占总复发患者的45%。其中1年生存率为89.19%,3年生存率为82.24%,6年生存率为79.17%。影响患者复发的危险因素包括:年龄≥65岁、房颤、吸烟、饮酒、高低密度脂蛋白-胆固醇(LDL-C)血症、糖尿病、高血压;同时合并3个及以上危险因素的卒中患者具更高的复发危险;服用他汀类药物及抗凝、抗血小板药物可减少随访期间内的脑卒中复发(P<0.01)。影响患者复发死亡的主要因素有年龄、文化程度、诊治医院级别、病情严重程度、出院时情况、再次复发和脑卒中类型及社会家庭支持等(P<0.01)。患者多于复发后死亡,且大多数为院外死亡(P<0.01)。结论出院后坚持二级预防规范化治疗者预后好;复发患者生存率比未复发者低。

脑卒中复发影响因素的Cox回归分析

目的探讨脑卒中复发状况及其主要影响因素。方法以1824例脑卒中新发病例为研究对象,排除短暂性脑缺血(TIA)和蛛网膜下腔出血,随访患者的复发情况,调查影响复发的各种因素。随访时间分别为3、6个月和1年。应用Cox比例风险回归模型对影响脑卒中复发的各种因素进行单因素和多因素分析。结果 1824例新发脑卒中,受访病例1651例(90.52%),失访病例173例(9.48%)。失访者和受访者差异无统计学意义(P>0.05)。脑卒中1年复发比例为15.26%。高血压史、TIA史、脑卒中家族史、总胆固醇、低密度脂蛋白是脑卒中复发的危险因素。结论防治脑卒中复发应加强脑卒中患者的高血压、TIA、血脂水平的监测和控制。

芪龙胶囊降低缺血性中风再发风险的临床研究

目的探讨芪龙胶囊对缺血性中风再发风险的影响。方法74例缺血性中风患者,随机分为观察组(36例)和对照组(38例)。对照组患者采取阿司匹林治疗,观察组患者采取阿司匹林联合芪龙胶囊治疗。两组均连续治疗12周。观察比较两组患者的临床疗效、入院时及治疗12周后美国国立卫生研究院卒中量表(NIHSS)评分、入院7d内90d复发风险评估量表(RRE-90)评分及艾森脑卒中风险分层量表(ESRS)评分、治疗12周后缺血性中风再发情况。结果入院时,两组患者的NIHSS评分比较差异无统计学意义(P>0.05)。治疗12周后,观察组患者的NIHSS评分(11.73±5.86)分明显低于对照组的(15.38±5.62)分,差异有统计学意义(P<0.05)。两组患者入院7d内RRE-90评分、ESRS评分比较差异无统计学意义(P>0.05)。观察组患者治疗12周后缺血性中风再发率为0,明显低于对照组的10.53%,差异有统计学意义(χ^2=4.006,P=0.045<0.05)。结论阿司匹林联合芪龙胶囊治疗缺血性中风患者的临床疗效显著,能够有效改善神经功能缺损,降低缺血性中风再发风险。

颅内动脉粥样硬化性狭窄程度与缺血性脑卒中复发相关性研究

目的 探讨颅内动脉粥样硬化性狭窄程度与缺血性脑卒中复发的相关性.方法 选取2017年2月~2018年9月本院收治的缺血性脑卒中患者80例作为研究对象,按照随访1年内是否缺血性脑卒中复发分为两组,各40例.随访1年,对缺血性脑卒中复发风险高危因素进行单因素及多因素分析Logistic回归分析,同时比较靶动脉狭窄情况与复发危险度评分相关性及靶动脉狭窄情况与复发时间之间的相关性.结果 合并高血压、糖尿病、高脂血症、高同型半胱氨酸血症,以及存在颅内动脉粥样硬化性狭窄为缺血性脑卒中复发的相关及独立危险因素.靶动脉狭窄情况与复发危险度评分之间呈正相关(P<0.05),靶动脉狭窄情况与复发时间之间呈负相关(P<0.05).结论 颅内动脉粥样硬化性狭窄是缺血性脑卒中复发的相关及独立危险因素,且颅内动脉粥样硬化性狭窄,复发几率越高,复发时间越早.

非肺静脉触发灶消融联合肺静脉隔离对低射血分数心房颤动患者的影响

目的探究肺静脉隔离联合非肺静脉触发灶消融对低射血分数的阵发性心房颤动(以下简称房颤)患者远期预后的影响。方法选取天津市第五中心医院接受导管消融术且左室射血分数(LVEF)<45%的阵发性房颤患者87例,根据治疗方式的不同分为Ⅰ组(肺静脉隔离联合非肺静脉触发消融)及Ⅱ组(肺静脉隔离)。随访2年,运用Log-rankχ~2比较两组未复发率的差异,Cox回归识别低射血分数的阵发性房颤患者术后复发的影响因子。结果两组患者随访后2年手术成功率、非肺静脉触灶及LVEF比较,差异有统计学意义(P<0.05)。Ⅰ组未复发率高于Ⅱ组(P<0.05)。冠状动脉疾病、非肺静脉触发灶、非肺静脉触发灶消融及LVEF是低射血分数合并阵发性房颤患者术后复发的独立影响因素(P<0.05)。结论肺静脉隔离联合非肺静脉触发灶消融对低射血分数的房颤患者远期疗效较好,值得临床推广。

Asymmetric Dimethylarginine Predicts One-year Recurrent Cardiovascular Events: Potential Biomarker of "Toxin Syndrome" in Coronary Heart Disease

Objective: To examine the prognostic value of serum levels of asymmetric dimethylarginine(ADMA)in patients with stable coronary heart disease(CHD) thus explore a potential biomarker of "toxin syndrome" in CHD.Methods: In this prospective nested case-control study, 36 of 1,503 Chinese patients with stable CHD experienced at least 1 recurrent cardiovascular event(RCE) during 1-year fol ow-up. Serum levels of ADMA at the start of fol ow-up were compared between these 36 cases and 36 controls which matched to cases in terms of gender, age, history of hypertension, and myocardial infarction. Results: Based on the crude model, subjects in the 2 highest ADMA quartiles showed signi?cantly higher risk of developing RCE than those in the lowest ADMA quartile [odds ratio(OR) 4.09, 95%confidence interval(CI) 1.01 to 16.58; OR 6.76, 95% CI 1.57 to 29.07]. This association was also observed in the case-mix model(OR 5.51, 95% CI 1.23 to 24.61; OR 7.83, 95% CI 1.68 to 36.41) and multivariable model(OR 6.64,95% CI 1.40 to 31.49; OR 13.14, 95% CI 2.28 to 75.71) after adjusting for confounders. The multivariable model which combined ADMA and high-sensitivity C-reactive protein(hs CRP) showed better predictive power with areas under the receiver operator characteristic curves(0.779) than the model of either ADMA(0.694) or hs CRP(0.636). Conclusion:Serum ADMA level may be a potential biomarker of "toxin syndrome" in CHD which shows favorable prognostic value in predicting 1-year RCE in patients with stable CHD. [The registration number is Chi CTR-PRNRC-07000012]

上海市城乡结合部社区卒中再发患者影响因素的研究

目的分析影响上海市城乡结合部社区卒中再发的危险因素。方法 2012年1月—2012年12月以上海浦东新区城乡结合部3个社区(周浦、康桥、航头)居民中的卒中患者为调查对象,共纳入符合标准的患者892例。其中480例有卒中再发史(再发组),412例无再发史(首发组)。采用横断面问卷调查方法,收集患者的一般情况、卒中常见危险因素,血压控制、药物二级预防、康复治疗等资料。结果单因素分析显示,再发组中有高血压、冠心病、心房颤动、糖尿病、高脂血症、体质量指数≥24 kg/m2患者的比率高于首发组,年龄高于首发组,差异均有统计学意义,P<0.05,或P<0.01;而收缩压控制≤140 mm Hg、规范服用活血化瘀类药、进行康复治疗患者的比率低于首发组,差异均有统计学意义,均P<0.01。多因素Logistic回归分析显示,年龄(OR=1.032,95%CI:1.015～1.050)、高血压(OR=2.782,95%CI:1.812～4.271)、冠心病(OR=1.654,95%CI:1.138～2.404)、糖尿病(OR=1.803,95%CI:1.200～2.709)、体质量指数≥24 kg/m2(OR=1.438,95%CI:1.074～1.926)是影响卒中再发的独立危险因素,而康复治疗为卒中再发的保护因素(OR=0.832,95%CI:0.696～0.996)。均P<0.05,或P<0.01。结论社区卒中二级预防应加强对高血压、冠心病、糖尿病、超重或肥胖等因素的治疗与控制,康复治疗可降低卒中再发的风险。

缺血性脑卒中复发的临床特点和危险因素研究

目的 探讨缺血性脑卒中患者早期复发的临床特点和危险因素。方法 对 6 8例复发的缺血性卒中患者进行临床分析和病例对照研究。结果 80 5例完全性缺血性卒中 ,有 6 8例复发 ,其总复发率为 8.5 % (6 8 80 5 ) ,其中脑血栓形成的复发率为 8.4 % (6 2 74 0 ) ,脑栓塞为 9.2 % (6 6 5 )。 6 9.0 %的病例复发在原患侧 ,复发前后类型相同者占89 .7%。结论 缺血性脑卒中患者早期复发多为同卒中类型、同部位的复发 ,高血压、有TIA或脑梗死史、糖尿病可能为卒中早期复发的危险因素。

Long-term prognosis and prognostic determinants of patients with first attack of mild and moderate ischemia at Beijing community hospitals

A total of 710 patients with first-ever ischemic stroke were consecutively recruited between January 2003 and December 2004 from five community hospitals/stations in five districts of Beijing, China. As of December 31, 2008, a total of 2 477 person-years were followed-up. During the five-year follow-ups, 117 adverse events occurred, including all-cause death and acute cardiovascular events （recurrent stroke, acute myocardial infarction, and sudden death）. The five-year cumulative mortality rate was 2.18/100 person-years （54 cases）, with 3.88/100 person-years （96 cases） of acute cardiovascular events and 3.02/100 person-years （75 cases） of recurrent stroke. Multiple factor analyses using the Cox proportional hazards ratio models showed that age, diabetes, and dependence of activities of daily living were independent predictors for death, acute cardiovascular disease events, or recurrent stroke. The results demonstrated that recurrent stroke was a major vascular disease that affected the prognosis of mild or moderate stroke patients. Secondary prevention of stroke patients should include active management of vascular risk factors and rehabilitation.

首发脑卒中患者复发恐惧轨迹特征及影响因素的纵向研究

目的探讨首发脑卒中患者复发恐惧的轨迹类别特征及影响因素。方法便利选取2018年5月至2021年5月收治的首发脑卒中患者,采用一般资料调查表、临床资料调查表、恐惧疾病进展简化量表(fear of progression questionnaire-short form,Fop-Q-SF)对患者进行调查。结果共随访调查了110例患者,失访12例,最终纳入98例。潜在类别增长模型识别出3种复发恐惧轨迹,按照其特征命名为复发恐惧稳定组、复发恐惧下降组和复发恐惧升高组,分别为21例(21.4%)、52例(53.1%)和25例(25.5%)。单因素分析显示,年龄、家庭人均月收入、病情程度、吞咽功能、自理能力与患者复发恐惧轨迹类别有关(P<0.05);多因素Logsitic回归分析显示,年龄、病情程度、吞咽功能、自理能力可预测首发脑卒中患者复发恐惧的轨迹类别(P<0.05)。结论首发脑卒中患者复发恐惧呈现3种不同变化轨迹,年龄、病情程度、吞咽功能、自理能力可预测复发恐惧轨迹类别。