BACKGROUND Post-stroke cognitive impairment(PSCI)is not only a common consequence of stroke but also an important factor for adverse prognosis of patients.Biochemical indicators such as blood lipids and blood pressure...BACKGROUND Post-stroke cognitive impairment(PSCI)is not only a common consequence of stroke but also an important factor for adverse prognosis of patients.Biochemical indicators such as blood lipids and blood pressure are affected by many factors,and the ability of evaluating the progress of patients with PSCI is insufficient.Therefore,it is necessary to find sensitive markers for predicting the progress of patients and avoiding PSCI.Recent studies have shown thatβ-amyloid protein 1-42(Aβ1-42)and thyroid hormone levels are closely related to PSCI,which may be the influencing factors of PSCI,but there are few related studies.AIM To investigate the relationship between serum levels of Aβand thyroid hormones in acute stage and PSCI and its predicted value.METHODS A total of 195 patients with acute cerebral infarction confirmed from June 2016 to January 2018 were enrolled in this study.Baseline data and serological indicators were recorded to assess cognitive function of patients.All patients were followed up for 1 year.Their cognitive functions were evaluated within 1 wk,3 mo,6 mo and 1 yr after stroke.At the end of follow-up,the patients were divided into PSCI and non-PSCI according to Montreal cognitive assessment score,and the relationship between biochemical indexes and the progression of PSCI was explored.RESULTS Compared with patients with non-PSCI,the levels of Aβ1-42,triiodothyronine(T3)and free thyroxin were lower in the patients with PSCI.Repeated measures analysis of variance showed that the overall content of Aβ1-42 and T3 in PSCI was also lower than that of the non-PSCI patients.Further analysis revealed that Aβ1-42(r=0.348),T3(r=0.273)and free thyroxin(r=0.214)were positively correlated with disease progression(P<0.05),suggesting that these indicators have the potential to predict disease progression and outcome.Cox regression analysis showed that Aβ1-42 and T3 were important factors of PSCI.Then stratified analysis showed that the lower the Aβ1-42 and T3,the higher risk of PSCI in patients who were aged over 70,female and illiterate.CONCLUSION Aβ1-42 and T3 have the ability to predict the progression of PSCI,which is expected to be applied clinically to reduce the incidence of PSCI and improve the quality of life of patients.展开更多
目的系统评价中医传统功法对卒中后认知障碍患者的干预效果。方法利用计算机检索The Cochrane Library、PubMed、Embase、Web of Science、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普中文科技期刊数据库中有关中医...目的系统评价中医传统功法对卒中后认知障碍患者的干预效果。方法利用计算机检索The Cochrane Library、PubMed、Embase、Web of Science、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普中文科技期刊数据库中有关中医传统功法干预卒中后认知障碍患者的随机对照试验,检索时限为建库至2023年12月31日,采用RevMan 5.4软件进行Meta分析。结果共纳入15项随机对照试验研究,包括918例研究对象。Meta分析结果显示,中医传统功法在提高卒中后认知障碍患者的认知功能[SMD=0.86,95%CI(0.68,1.04),P<0.001]、缩短P300检测的潜伏时间[MD=-11.52,95%CI(-16.06,-6.98),P<0.001]、增加P300检测的波幅高度[MD=1.06,95%CI(0.44,1.67),P<0.001]等方面均优于对照组。结论中医传统功法可有效提高卒中后认知障碍患者的认知功能。展开更多
目的:系统评价脑卒中后认知障碍的风险预测模型。方法:检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、EMbase、the Cochrane Library、Web of Science和EBSCO数据库中的脑卒中后认知障碍风险预测模型相关研究,...目的:系统评价脑卒中后认知障碍的风险预测模型。方法:检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、EMbase、the Cochrane Library、Web of Science和EBSCO数据库中的脑卒中后认知障碍风险预测模型相关研究,检索时限为建库至2023年1月30日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险和适用性。结果:共纳入16项研究,包括19个脑卒中后认知障碍风险预测模型,其中,16个模型采用了Logistic回归分析方法,2个模型采用了随机森林的方法,1个模型采用了LASSO回归的方法。建模时受试者工作特征曲线下面积(AUC)为0.773~0.940。4个模型进行了Hosmer-Lemeshow(H-L)检验,其中2个模型报告了P值且P≥0.05。11个模型进行了内部验证,5个模型进行了外部验证,4个模型同时进行了内部验证和外部验证。16项研究适用性较好,但存在较高的偏倚风险,主要问题集中在分析领域。结论:脑卒中后认知障碍风险预测模型整体性能良好,但模型质量有待提高,在未来的研究中需优化研究设计、扩大样本量、根据临床需要选择合适的预测因子、改进统计分析方法,并注重模型的外部验证,以验证模型的泛化能力。展开更多
基金Supported by Science and Technology Support Projects in Biomedicine Field of Shanghai Science and Technology Commission,No.19441907500Naval Medical University Military Medical Innovation,No.2017JS07Science and Technology Action Innovation Program by Science and Technology Commission of Shanghai,No.17411950104
文摘BACKGROUND Post-stroke cognitive impairment(PSCI)is not only a common consequence of stroke but also an important factor for adverse prognosis of patients.Biochemical indicators such as blood lipids and blood pressure are affected by many factors,and the ability of evaluating the progress of patients with PSCI is insufficient.Therefore,it is necessary to find sensitive markers for predicting the progress of patients and avoiding PSCI.Recent studies have shown thatβ-amyloid protein 1-42(Aβ1-42)and thyroid hormone levels are closely related to PSCI,which may be the influencing factors of PSCI,but there are few related studies.AIM To investigate the relationship between serum levels of Aβand thyroid hormones in acute stage and PSCI and its predicted value.METHODS A total of 195 patients with acute cerebral infarction confirmed from June 2016 to January 2018 were enrolled in this study.Baseline data and serological indicators were recorded to assess cognitive function of patients.All patients were followed up for 1 year.Their cognitive functions were evaluated within 1 wk,3 mo,6 mo and 1 yr after stroke.At the end of follow-up,the patients were divided into PSCI and non-PSCI according to Montreal cognitive assessment score,and the relationship between biochemical indexes and the progression of PSCI was explored.RESULTS Compared with patients with non-PSCI,the levels of Aβ1-42,triiodothyronine(T3)and free thyroxin were lower in the patients with PSCI.Repeated measures analysis of variance showed that the overall content of Aβ1-42 and T3 in PSCI was also lower than that of the non-PSCI patients.Further analysis revealed that Aβ1-42(r=0.348),T3(r=0.273)and free thyroxin(r=0.214)were positively correlated with disease progression(P<0.05),suggesting that these indicators have the potential to predict disease progression and outcome.Cox regression analysis showed that Aβ1-42 and T3 were important factors of PSCI.Then stratified analysis showed that the lower the Aβ1-42 and T3,the higher risk of PSCI in patients who were aged over 70,female and illiterate.CONCLUSION Aβ1-42 and T3 have the ability to predict the progression of PSCI,which is expected to be applied clinically to reduce the incidence of PSCI and improve the quality of life of patients.
文摘目的:系统评价脑卒中后认知障碍的风险预测模型。方法:检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、EMbase、the Cochrane Library、Web of Science和EBSCO数据库中的脑卒中后认知障碍风险预测模型相关研究,检索时限为建库至2023年1月30日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险和适用性。结果:共纳入16项研究,包括19个脑卒中后认知障碍风险预测模型,其中,16个模型采用了Logistic回归分析方法,2个模型采用了随机森林的方法,1个模型采用了LASSO回归的方法。建模时受试者工作特征曲线下面积(AUC)为0.773~0.940。4个模型进行了Hosmer-Lemeshow(H-L)检验,其中2个模型报告了P值且P≥0.05。11个模型进行了内部验证,5个模型进行了外部验证,4个模型同时进行了内部验证和外部验证。16项研究适用性较好,但存在较高的偏倚风险,主要问题集中在分析领域。结论:脑卒中后认知障碍风险预测模型整体性能良好,但模型质量有待提高,在未来的研究中需优化研究设计、扩大样本量、根据临床需要选择合适的预测因子、改进统计分析方法,并注重模型的外部验证,以验证模型的泛化能力。
文摘目的目前关于脑卒中后认知功能障碍(post stroke cognitive impairment,PSCI)预后的研究较少,尤其是关于接受结构化认知康复治疗但预后无显著改善患者的脑血管病危险因素尚未有报道。本研究旨在探讨影响认知康复治疗应用效果的脑血管病危险因素,为临床实践提供依据。方法对149例缺血性脑卒中患者[年龄(63.60±9.66)岁,男性64.4%]进行为期8周的非药物结构化认知康复治疗,并收集纵向的预后数据。采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)和痴呆生活质量量表(dementia-quality of life instrument,DemQOL)在基线、治疗结束时和治疗结束后6个月进行整体认知功能和生活质量评估。最后通过回归分析评估结构化认知康复治疗对卒中后认知功能障碍预后的影响。结果卒中发作次数更多的患者在接受结构化认知康复治疗结束时MoCA评分提高不明显(OR=2.17,95%CI:0.98~4.81,P=0.056)。与基线相比,脑白质高信号程度越严重的患者在接受结构化认知康复治疗结束时MoCA评分提高越不明显(OR=2.13,95%CI:1.04~4.38,P=0.039)。存在深部微出血的患者在接受认知康复治疗后6个月MoCA评分改善不明显(OR=19.93,95%CI:1.04~384,P=0.047)。结论卒中发作次数、脑白质高信号程度和深部微出血等脑血管病危险因素影响认知康复治疗的预后。然而,这些发现仍需进一步研究验证,且可指导未来临床试验的设计。
