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

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

Significance of 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.

Stable ischemic heart disease in the older adults

1 Introduction Ischemic heart disease is caused by atherosclerotic and/or thrombotic obstruction of coronary arteries. Clinical spec- trum of ischemic heart disease expands from asymptomatic atherosclerosis of coronary arteries to acute coronary syn- dromes （ACS） including unstable angina, acute myocardial infarction （non-ST elevation myocardial infarction and ST elevation myocardial infarction）. Stable ischemic heart dis- ease （SIHD） refers to patients with known or suspected SIHD who have no recent or acute changes in their symp- tomatic status, suggesting no active thrombotic process is underway.

Review of Medical Treatment of Stable Ischemic Heart Disease

Medical treatment is the initial treatment strategy and is the cornerstone of management in patients with stable ischemic heart disease (IHD). Many patients are not suitable for percutaneous or surgical revascularization because of unfavourable anatomy, or the presence of co-morbidities. In addition, many patients have recurrence of angina following revascularization due to restenosis or incomplete revascularization. Furthermore, randomized clinical trials comparing optimal medical treatment to revascularization have not clearly shown that myocardial revascularization is superior to optimal medical treatment. Traditional drugs for angina treatment include b-blockers, calcium channel blockers and nitrates. Newer drugs are available with different mechanisms of action and with equal efficacy that do not cause significant hemodynamic deterioration. The availability of these newer drugs expands the therapeutic potential of medical treatment to even a wider population with stable IHD. Revascularization in patients with stable ischemic heart disease has never been shown to reduce hard endpoints (death or myocardial infarction) in randomized clinical trials.

Stable Ischemic Heart Disease in the Older Adult

Demographic trends worldwide show a progressively aging population and an increase in the overall medical complexity of elderly patients with cardiovascular disease.Elderly patients,especially those aged 75 or older,are relatively underrepresented in many of the clinical trials that helped create major society guidelines for evaluation and management of ischemic heart disease.Consequently,risk benefi t ratios of a guideline-based approach in these patients are not well defi ned,especially with regards to pharmacotherapies and percutaneous coronary interventions.In this article we offer a practical approach to defi ning the elderly population,and provide an evidenced based review of the diagnostic and therapeutic implications of advanced age in the evaluation and management of ischemic heart disease.

Contemporary Management of Patients with Stable Ischemic Heart Disease

The overall goals of therapy for patients with stable ischemic heart disease are to minimize the likelihood of death while maximizing health and function.Initial risk assessment with noninvasive testing is indicated to determine whether invasive evaluation is needed in addition to medical therapy.All patients with stable ischemic heart disease need optimal medical therapy,which includes risk factor management with lifestyle modifi cations and pharmacologic therapy.First-line pharmacologic therapy is focused on preventing myocardial infarction and death with antiplatelet agents,lipid-lowering therapy,and antihypertensive therapies.In addition,antianginal therapy and anti-ischemic therapy are indicated to alleviate symptoms,reduce ischemia,and improve quality of life.The commonly used antianginal agents include nitrates,beta-blockers,calcium channel blockers,and ranolazine.When medical therapy is not adequate to relieve angina,revascularization with percutaneous coronary intervention or coronary artery bypass grafting is indicated.We review the indications and evidence for antianginal agents and other therapies for angina.

Novel Imaging Approaches for the Diagnosis of Stable Ischemic Heart Disease in Women

Conventional recommendations for diagnostic testing for the evaluation of stable ischemic heart disease in women have largely paralleled those in men.Although they are designed primarily for the identifi cation of obstructive coronary artery disease(CAD),traditional approaches can lead to overtesting in women without differentiating who is truly at risk.Several unique factors related to the presentation,diagnosis,and underlying pathophysiology of stable ischemic heart disease in women necessitate a more specific approach to the assessment of their risk,complete with separate guidelines when appropriate.This overview highlights how advanced noninvasive imaging tools,including cardiac computed tomography angiography,positron emission tomography,and cardiac magnetic resonance imaging,are enabling very sensitive assessments of anatomic atherosclerotic plaque burden,macrovessel-and microvessel-related ischemia,and myocardial fi brosis,respectively.Moving forward,effective diagnostic testing will need to identify women at high risk of adverse cardiovascular events(not anatomically obstructive CAD per se)without overtesting those at low risk.Judicious application of novel imaging approaches will be critical to broadening the defi nitions of CAD and ischemia to better refl ect the whole spectrum of pathological phenotypes in women,including nonobstructive CAD and coronary microvascular dysfunction,and aid in the development of needed evidence-based strategies for their management.

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。

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。

老年缺血性脑卒中患者颈动脉斑块特征及血液流变学与疾病分型及严重程度的关系

目的分析老年缺血性脑卒中患者颈动脉斑块特征及血液流变学与疾病分型及严重程度的关系。方法选择240例老年缺血性脑卒中患者为观察组,按疾病分型[完全前循环梗死(TACI)、部分前循环梗死(PACI)、后循环梗死(POCI)、腔隙性梗死(LACI)]和病情严重程度(轻度、中度、重度)对观察组患者进行二次分组;另选取60例老年健康体检者为对照组。检测受试者颈动脉斑块特征[颈动脉内膜中层厚度(IMT)、斑块数量、斑块最大长径、斑块性质]、血液流变学[红细胞沉降率(ESR)、红细胞比容(HCT)、血浆纤维蛋白原(Fib)、血浆黏度、全血黏度]指标,分析颈动脉斑块特征及血液流变学与疾病分型及严重程度的关系。结果观察组IMT、斑块数量、斑块最大长径、ESR、HCT、Fib、血浆黏度、全血黏度水平高于对照组,差异有统计学意义(P<0.05);LACI组IMT、斑块数量、斑块最大长径低于TACI、PACI、POCI组,稳定型斑块比率则更高,差异有统计学意义(P<0.05);LACI组ESR、HCT、Fib、血浆黏度、全血黏度水平低于TACI、PACI、POCI组,差异有统计学意义(P<0.05);轻度组IMT、斑块数量、斑块最大长径低于中度组和重度组,稳定型斑块比率高于中度组和重度组,中度组的IMT、斑块数量、斑块最大长径低于重度组,差异均有统计学意义(P<0.05);轻度组ESR、HCT、Fib、血浆黏度、全血黏度水平低于中度组和重度组,中度组上述指标低于重度组,差异有统计学意义(P<0.05)。结论老年缺血性脑卒中患者颈动脉斑块特征及血液流变学与疾病分型及严重程度有关,TACI、PACI、POCI型老年缺血性脑卒中患者的颈动脉斑块状态和血液流变学异常情况较LACI型患者更为严重。

彩色多普勒血流成像在缺血性脑血管病患者颈动脉狭窄评估中应用价值分析

目的:探讨彩色多普勒血流成像(CDFI)在缺血性脑血管病患者颈动脉狭窄评估中的应用价值。方法:回顾性分析2021年1月—2023年11月寿光市人民医院收治的125例缺血性脑血管病患者颈动脉数字减影血管造影(DSA)及CDFI检查结果,以DSA结果为金标准分析CDFI诊断颈动脉狭窄的灵敏度、特异度、准确度、阳性预测值、阴性预测值,并用Kappa检验验证CDFI与DSA诊断颈动脉狭窄的一致性;根据DSA结果显示的颈动脉狭窄情况将患者分为颈动脉狭窄组与正常组,比较两组患者颈动脉血搏动指数(PI)、阻力指数(RI)、舒张期血流速度(EDV)、收缩期峰值流速(PSV)。结果:DSA结果显示,125例患者中74例存在颈动脉狭窄,设为颈动脉狭窄组;51患者无颈动脉狭窄,设为正常组。CDFI检查结果显示,125例患者中73例存在颈动脉狭窄,以DSA结果为金标准,CDFI诊断颈动脉狭窄的灵敏度为97.30%、特异度为98.04%、准确率为97.60%、阳性预测值为98.63%、阴性预测值为96.15%,且Kappa检验结果显示,CDFI与DSA诊断颈动脉狭窄的一致性极好(Kappa值=0.950,P<0.05)。颈动脉狭窄组患者PI、RI高于对照组,EDV、PSV低于对照组,差异有统计学意义(P<0.05)。结论:CDFI在缺血性脑血管病患者颈动脉狭窄评估中的应用价值较高,便于临床更好地对患者进行治疗,促进患者病情好转。

颈部血管超声联合经颅多普勒超声对缺血性脑血管疾病患者颅内动脉狭窄程度的诊断价值

目的探讨颈部血管超声(CVUS)联合经颅多普勒超声(TCD)对缺血性脑血管疾病患者颅内动脉狭窄程度的诊断价值。方法回顾性分析2020年2月至2022年1月大连理工大学附属中心医院收治的130例缺血性脑血管疾病患者的临床资料,所有患者均行CVUS、TCD检查,以临床诊断结果为金标准,分析CVUS、TCD及联合诊断对缺血性脑血管疾病患者颅内动脉狭窄程度的诊断效能。结果临床诊断结果显示,130例患者中,轻度狭窄118例(90.77%),中重度狭窄12例(9.23%)。CVUS检出轻度狭窄114例,中重度狭16例;TCD检出轻度狭窄110例,中重度狭窄20例;联合诊断检出轻度狭窄100例,中重度狭窄例30。联合诊断灵敏度高于TCD单一诊断,差异有统计学意义(P<0.05),但CVUS与联合诊断的灵敏度,CVUS、TCD及联合诊断的特异度、准确度比较差异无统计学意义。结论CVUS及TCD分别对缺血性脑血管疾病的定性诊断具有一定价值,联合诊断对缺血性脑血管疾病的定性诊断价值较高。

中性粒细胞/淋巴细胞比值对穿支动脉病变型脑梗死预后的影响

目的研究影响穿支动脉病变型脑梗死(PAD)不良预后的危险因素。方法回顾性分析2021年9月至2023年5月在苏州大学附属独墅湖医院神经内科住院的174例急性PAD患者。根据90 d改良后Rankin评分(mRS)0~2分为预后良好组,3~6分为预后不良组;使用logistic回归模型分析影响PAD患者预后的危险因素。根据病变部位供血动脉所起源颅内大动脉分为前循环(n=101)、后循环组(n=73),分析前循环、后循环与预后不良的相关性。结果多因素logistics回归显示年龄增长(OR=1.071,95%CI:1.012~1.133)、入院NIHSS评分升高(OR=2.764,95%CI:1.868~4.089)、患糖尿病(OR=3.301,95%CI:1.009~10.793)、中性粒细胞/淋巴细胞比值(NLR)升高(OR=2.601,95%CI:1.150~4.482)是PAD患者预后不良的危险因素(P<0.05)。ROC曲线结果提示NIHSS评分以及NLR升高相较于年龄增高以及患糖尿病病史预测PAD患者不良预后的AUC更大,总体敏感性及特异性更高,提示其预测不良预后的价值可能更高。前循环组中LYM下降及NLR上升与预后不良显著相关(P<0.05),后循环组中NE上升、LYM下降以及NLR上升均与预后不良显著相关(P<0.05)。结论基线NLR及NIHSS评分升高,高龄及糖尿病病史可能是PAD患者不良预后的独立危险因素,NLR可作为预测PAD预后的潜在生物学指标值。

慢性颈内动脉闭塞评估及治疗中国专家共识

随着医疗诊断技术的进步及我国老年人口的不断增加,慢性颈内动脉闭塞(CICAO)在临床上越来越常见。伴有严重血流动力学障碍的症状性CICAO患者有较高的再发缺血性卒中的风险,与CICAO慢性缺血相关的认知功能障碍也越来越受到重视。但是,目前临床上对于CICAO尚缺乏统一的评估和治疗方案。该专家共识对CICAO相关的最新临床研究进行总结,并结合国内相关领域专家的临床实践经验,对CICAO患者的评估、治疗及围手术期管理提出了针对性意见,以期进一步规范临床诊疗流程,提高国内神经病学医师对CICAO患者的诊治水平。

针药结合治疗心肌梗死研究进展

心肌梗死是冠脉闭塞引起的心肌缺血缺氧性坏死,具有高死亡率及发病率,其发生发展过程中涉及炎症反应、氧化应激、免疫紊乱及能量代谢紊乱等多个环节。针药结合治疗心梗效果显著,是近年来研究的热点与难点。针药结合的方式主要有“针灸结合中药”“针灸结合西药”及“针灸结合中西医药”等。“针药结合”就是将“针”和“药”的作用相结合,达到“多靶点、多途径”的协同作用,体现“针药合一,内外兼治”的理念。通过对近十年来针药结合治疗心肌梗死的相关研究作一综述,旨在为临床治疗心肌梗死提供借鉴。

上海地区汉族人胰岛素抵抗与急性缺血性脑血管病关系的研究

目的 调查上海地区汉族人胰岛素抵抗(IR)是否会对急性缺血性脑血管病(AICD)患者血管病变带来影响。方法 选择自2017年1月1日至2022年1月1日,在上海市松江区中心医院住院的AICD,共250例患者,均为上海地区汉族人,根据IR与否,患者被分为2组。(1)IR组:共172例;(2)非IR组:共78例。记录患者的人口学资料和既往史资料。完成血糖、胰岛素、C肽的测量。计算稳态评估模型-胰岛素抵抗(homeostasis model assessment-insulin resistance,HOMA-IR)指数。通过颈动脉、椎动脉超声、头颅磁共振血管成像评估颅内外动脉狭窄或闭塞情况。结果 与非IR组比较,IR组患者葡萄糖(空腹)、胰岛素(空腹)、胰岛素(1h)、胰岛素(2h)、C肽(1h)和C肽(2h)水平较高,差异有统计学意义(P<0.05)。与非IR组比较,IR组患者表现为心源性栓塞型的比例低,差异有统计学意义(P<0.05)。IR组与非IR组患者在大动脉粥样硬化型、小动脉闭塞型、其他明确病因型、不明原因型的比例,差异无统计学意义(P> 0.05)。IR组与非IR组患者在颅内动脉包括前循环血管(包括大脑中动脉、大脑前动脉和颈内动脉脉C2段以远)、后循环血管(包括基底动脉、大脑后动脉)狭窄或闭塞的比例,差异均无统计学意义(P> 0.05)。IR组与非IR组患者在颅外动脉包括右侧颈动脉斑块、左侧颈动脉斑块、双侧颈动脉斑块、颈动脉狭窄或闭塞、颈动脉内膜增厚、椎动脉V1和V2段狭窄或闭塞的比较,差异均无统计学意义(P>0.05)。结论 在上海地区汉族人AICD患者中,IR对TOAST病因学分型中大动脉粥样硬化型、小动脉闭塞型、其他明确病因型、不明原因型的比例均无影响,IR对颅内动脉、颅外动脉狭窄或闭塞的比例均无影响。IR的患者发生心源性栓塞型的比例低。

彩色多普勒超声在缺血性脑血管疾病患者颈动脉狭窄程度诊断中的应用价值

目的:分析彩色多普勒超声在缺血性脑血管疾病患者颈动脉狭窄程度诊断中的应用价值。方法:选取2022年2月—2024年2月日照市中心医院收治的缺血性脑血管疾病患者96例作为观察组,将同期体检健康者67名作为健康组,两组均进行彩色多普勒超声检查,比较两组及不同颈动脉狭窄程度缺血性脑血管疾病患者的颈总动脉收缩期最大血流速度、颈总动脉舒张末期最小血流速度、颈总动脉平均血流速度。结果:观察组颈总动脉收缩期最大血流速度、颈总动脉舒张末期最小血流速度、颈总动脉平均血流速度大于健康组,差异有统计学意义(P<0.001)。96例缺血性脑血管疾病患者中,重度狭窄21例,中度狭窄27例,轻度狭窄48例;不同颈动脉狭窄程度缺血性脑血管疾病患者颈总动脉收缩期最大血流速度、颈总动脉舒张末期最小血流速度、颈总动脉平均血流速度比较,重度狭窄患者<中度狭窄患者<轻度狭窄患者,差异有统计学意义(P<0.05)。结论:彩色多普勒超声在缺血性脑血管疾病患者颈动脉狭窄程度诊断中的应用价值较高,能够有效检测患者的颈动脉狭窄程度及颈总动脉收缩期最大血流速度、颈总动脉舒张末期最小血流速度、颈总动脉平均血流速度,值得临床应用。

颈动脉斑块METmRNA表达与缺血性脑血管病的相关性

目的探讨颈动脉斑块中METmRNA表达与缺血性脑血管病症(ICVD)发生的相关性,为缺血性脑血管病的预防和治疗提供参考。方法纳入新密市中医院2021年1月~2023年3月收治的行颈动脉内膜剥脱术的ICVD患者97例,根据检出斑块性质分为易损组、非易损组、并存组,采用qRT-PCR法检测剥离斑块METmRNA,分析METmRNA表达量与斑块性质、ICVD类型、ICVD严重程度的相关性。结果易损组、非易损组、并存组mRNA表达量分别为0.763±0.047、0.591±0.039、0.708±0.043,差异有统计学意义,均P<0.05;短暂性脑缺血、脑梗死、脑动脉盗血综合征、慢性脑缺血四类患者间mRNA表达量分别为0.711±0.068、0.765±0.077、0.655±0.071、0.671±0.083,差异有统计学意义,均P<0.05;NIHSS分级轻度、中度、中重度、重度患者间mRNA表达量分别为0.642±0.072、0.671±0.074、0.754±0.039、0.789±0.051,差异有统计学意义,均P<0.05;颈动脉斑块中METmRNA表达量与斑块类别、ICVD分类、NIHSS分级、颈动脉狭窄分级、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白显著相关,均P<0.05。结论颈动脉斑块中METmRNA表达与ICVD的发生显著相关,主要通过参与斑块不稳定性发展导致短暂性脑缺血、脑梗死的发生,并与高血糖、高脂血症存在相互作用。

认知护理干预在颈动脉支架成形术治疗女性缺血性脑血管病中的应用效果

目的探讨认知护理干预在颈动脉支架成形术治疗女性缺血性脑血管病中的应用效果。方法选取2022年2月至2023年1月兰陵县人民医院收治的行颈动脉支架成形术治疗的83例女性缺血性脑血管病患者,以抛硬币法分为对照组(41例)与研究组(42例)。对照组采用常规护理干预,研究组在对照组的基础上结合认知护理干预。比较两组认知功能、负面情绪、术后并发症发生率。结果研究组干预后认知功能较对照组高(P<0.05);研究组干预后的焦虑、抑郁评分较对照组低(P<0.05);研究组术后并发症总发生率较对照组低(P<0.05)。结论对行颈动脉支架成形术治疗缺血性脑血管病的女性患者实施认知护理干预的效果较好,值得推荐。