阿司匹林预防缺血性卒中

全球性大规模抗血小板疗法随机对照临床试验研究结果表明,阿司匹林预防高危人群缺血性卒中,对降低其发病率、减少病死率及致残率有十分肯定的疗效,主张推广使用长疗程、中等剂量(75～325mg/d)阿司匹林,作为预防性常规治疗。     

肿瘤与缺血性卒中

文章对与肿瘤有关的缺血性卒中的易患因素、发病机制、临床特征及诊治措施进行了综述。     

可溶性粘附分子与缺血性卒中

细胞粘附分子在动脉粥样硬化形成和缺血／再灌注损伤中起重要作用，在有缺血性卒中危险因素的人群和缺血性卒中病人中均发现有可溶性粘附分子含量的变化，定量检测其血清含量对于探讨缺血性卒中发病机制和指导临床治疗有潜在的价值。     

急性缺血性卒中的并发症

急性缺血性卒中并发症对病人的近期及远期预后均有显著影响，包括神经系统并发症、内科系统并发症及全身并发症。文章对这些并发症的发生率、治疗及结局作了综述。     

缺血性卒中患者抗栓药依从性研究

目的：评估缺血性卒中患者起病1年后使用抗栓药的依从性及其影响因素。方法：由住院病历中获取连续出院的缺血性卒中患者的一般资料、是否应用抗栓药及其种类，对其中应用抗栓药的患者在出院后1年进行电话随访，调查卒中后1年时抗栓治疗的依从性，同时对影响抗栓药依从性的相关因素进行了分析。结果：连续出院的缺血性卒中患者225例，应用抗栓药患者201例（其中95．0％使用阿司匹林）。完成出院1年时随访176例，其中67．0％继续抗栓治疗。Logistic回归分析显示，应用阿司匹林（OR7．028，95％CI1．241～39．784）、卒中门诊随访（OR2．257，95％CI1．050～4．764）、功能预后好（MRS评分〈2分）（ORl．337，95％C10．997～1．793）为依从性良好的独立预测因素。结论：在缺血性卒中二级预防中，抗栓治疗的依从性尚不能令人满意，应用阿司匹林、卒中门诊随访、功能预后较好有助于提高长期抗栓治疗的依从性。     

牙周病与缺血性卒中

牙周病是一种常见的感染性疾病,其致病病原体可通过多种途径诱导和加速动脉粥样硬化性病变,从而促进缺血性卒中的发生。大量流行病学证据表明牙周病,如牙周炎、牙龈炎等与缺血性卒中有关。     

缺血性卒中的白蛋白治疗

白蛋白是血浆中含量最多、分子量最小、溶解度大、功能较多的一种蛋白质。白蛋白不易透过血脑屏障,具有重要的结合转运功能,能通过调节胶体渗透压消除或减轻脑水肿,亦可结合体液中的毒性成分使之失效,还能转运营养成分和有关治疗药物,发挥广泛的临床治疗作用。近年来,人们发现白蛋白在脑缺血中有着显著的保护作用。     

代谢综合征与缺血性卒中

代谢综合征正在全球范围内广泛流行.但其究竟在多大程度上增高了缺血性卒中风险,现行诊断标准是否合理,以及该综合征是否属于一个独立的疾病实体,一直存在争论.文章就此进行了讨论.     

间歇性跛行与缺血性卒中

间歇性跛行是发生于腿部肌群的疼痛、痛性痉挛、疲乏和麻木感,症状仅在活动时出现.间歇性跛行不仅是下肢动脉闭塞性疾病的临床表现,而且也是全身动脉粥样硬化的先兆,它是缺血性卒中的又一独立危险因素.间歇性跛行与缺血性卒中有着类似的发病机制,它们在微循环和氧化代谢方面均存在障碍.对于伴有间歇性跛行的缺血性卒中患者可通过防治危险因素,药物或手术治疗等途径来进行治疗,其中,西洛他唑(cilostazol)是目前治疗该类患者最有效的药物.     

缺血性卒中新的危险因素

近年来,缺血性卒中的新的危险因素在不断提出。文章就遗传因素、炎症因素、颈部疾病和操作、肾脏疾病、药物因素和饮食因素等方面新的危险因素做了综述。     

卵圆孔未闭致缺血性卒中临床分析

目的：探讨青年缺血性卒中的可能原因和防治方法。方法分析收集2012年5月至2012年9月4个月间缺血性卒中的临床资料和防治措施。结果卵圆孔未闭（PFO）9例,其中＆lt;45岁的患者7例。结论对45岁以下原因不明的缺血性卒中患者,PFO 是1个独立的危险因素,除常规的同型半胱氨酸、血管炎系列（如抗心磷脂抗体）、血糖、血脂、心电图、TCD、颈部血管超声、心脏彩超、头颈部 CTA、MRA、颅脑 DSA 等,在有条件的医院应行经食道超声检查,提高 PFO 的检出率,行卵圆孔封堵术及早干预,降低卒中的再发风险。     

Family history,waist circumference and risk of ischemic stroke: A prospective cohort study among Chinese adults

Background and aimsThe associations between genetic factors and waist circumference (WC) with stroke risk have been evaluated in Western studies. However, evidence of this association has rarely been reported in the Chinese population. This study aimed to evaluate the association between WC and family history of stroke (FHS) with ischemic stroke (IS) risk among Chinese adults and to further explore the potential interaction of these associations.Methods and resultsThe China Kadoorie Biobank (CKB) study recruited 35,508 participants aged 30–79 years from the Qingdao urban area during 2004–2008. A total of 33,355 participants were included in study. Cox regression analysis was used to estimate the multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the independent and interactional associations between FHS and WC and IS risk. Participants with FHS had a 29% (HR = 1.29, 95% CI: 1.12–1.50) higher IS risk than those without FHS. Participants with excessive WC (85 cm for males and 80 cm for females) had a 78% (HR = 1.78, 95% CI: 1.51–2.10) higher IS risk than those with normal WC. The combined effect of FHS and excessive WC on IS was statistically significant (HR = 2.29, 95% CI: 1.84–2.86). The present study further found statistically significant multiplicative interactions of FHS and WC with IS risk (P _interaction < 0.001).ConclusionThe present study indicated that FHS and WC were significantly associated with an increased risk of IS. The association between FHS and IS was associated with excessive WC.     

Chronic HCV infection is a risk factor of ischemic stroke

Objectives

Cerebrovascular diseases are leading cause of death worldwide. Plaque rupture and embolization account for one-third of ischemic stroke. The causes are not fully known, but inflammation plays a pathogenic role. Recently, HCV infection has been identify as risk of atherosclerosis. HCV replicates within carotid plaques and brain endothelia cells; moreover, HCV patients showed higher levels of inflammation. Thus, we hypothesized that subjects carrying HCV are at higher risk of stroke. Accordingly, we evaluated prevalence and role of HCV infection in patients with stroke.

Methods

A priori sample size was calculated. Overall, 820 consecutive patients were enrolled, 123 with stroke and, as control, 697 age- and gender-matched (295 with COPD; 402 with diseases other than HCV-associated). Patients were evaluated for HCV and conventional risk of stroke.

Results

Prevalence of HCV was higher in patients with stroke than that observed in control (26.8% vs. 6.6%, p = 0.0001). An analysis of stroke patients showed that those HCV positive were younger (p = 0.017) had lower serum levels of cholesterol (p = 0.001), triglycerides (p = 0.045), and higher serum levels of inflammation markers (ESR, p = 0.001; CRP, p = 0.0001; fibrinogen, p = 0.012). A multivariate analysis showed that HCV infection was an independent risk factor of stroke (O.R. 2.04, 95% C.I. 1.69–2.46; p = 0.0001). A secondary analysis showed that HCV patients had higher (p = 0.031) prevalence of past ischemic heart disease.

Conclusions

HCV infected patients are at higher and earlier risk of stroke. Inflammation is a key mediator. Clinicians in clinical practice and researchers in future trials should take into account these new findings.     

圆形分布法在缺血性中风事件昼夜分布中的应用

目的探讨缺血性中风发病时间的昼夜分布规律。方法采用圆形分布对２６３例缺血性中风患者的发病时间进行统计分析。结果缺血性中风发病的高峰时点平均为８∶２１,标准差（ｓ）为４小时零３分,９５％的缺血性中风发病时段为０∶２５～１６∶１７。结论圆形分布对于昼时性资料是否具有集中趋势提供良好的统计分析,缺血性中风的发病时间存在昼夜２４ｈ的分布差异。     

血清胱抑素C水平在缺血性卒中患者急性期及其亚型中的变化和意义

目的分析血清胱抑素C(Cys-C)在急性缺血性卒中患者及其中国缺血性卒中亚型(CISS)中的表达和意义。方法回顾性纳入2014年8月至2015年4月于兰州大学第二医院神经内科住院的200例首发急性缺血性卒中患者作为观察组,入选同期健康体检及住院的非脑血管疾病患者136例作为对照组。按照CISS分型标准对缺血性卒中患者进行病因分型,检测所有患者的空腹血清Cys-C水平。采用多因素非条件Logistic回归分析缺血性卒中及其亚型与Cys-C水平的关系。结果 (1)观察组患者及其大动脉粥样硬化性(LAA)、心源性卒中(CS)、穿支动脉疾病(PAD)亚组患者血清Cys-C水平均高于对照组(1.06±0.25)、(1.12±0.23)、(1.17±0.42)、(1.01±0.21)mg/L比(0.94±0.16)mg/L,均P﹤0.05);(2)LAA亚组患者血清Cys-C水平高于PAD亚组患者(P﹤0.05);(3)Logistic回归分析结果显示,高水平血清Cys-C是缺血性卒中的危险因素(OR=19.148,95%CI:3.814~96.133,P﹤0.001);将观察组与对照组合并后,按照血清Cys-C水平进行五分位数划分,调整其他因素影响后,最高五分位数血清Cys-C水平对缺血性卒中影响显著(OR=4.461,95%CI:1.599~12.443,P0.05),并且血清Cys-C水平处于最高五分位数时,对LAA型影响更为明显(OR=7.075,95%CI:1.883~26.589,P=0.004)。结论血清Cys-C水平升高可能是缺血性卒中的独立危险因素,并且对LAA型影响更为明显。     

中华医学会系列杂志2004～2013年布鲁杆菌病文献分析

目的了解中华医学会系列杂志近年来布鲁杆菌病（布病）文献分布情况和研究状况,为布病研究提供文献计量学资料。方法对中华医学会系列杂志2004～2013年的85种期刊进行检索,对布病文献分布情况进行统计,并对文献的内容分类、分析。结果中华医学会系列杂志10年间以布病研究为主的文献共计45篇,分布于16种杂志;其中论著29篇（64．4％）,病例报告13篇（28．9％）,综述3篇（6．7％）;10年间布病研究文献的论著中以流行病学调查和实验室检查研究最多（分别为12篇,36．4％）,其他为临床分析（10篇,30.3％）,其中1篇论著同时进行了临床分析与实验室检查研究;基金资助项目报道8篇（17．8％）;刊文量不少于5篇的为《中华传染病杂志》、《中华流行病学杂志》和《中华实验和临床感染病杂志》。中华医学会系列杂志2009～2013年布病文献刊文数（33篇,73．3％）多于2004—2008年布病文献篇数（12篇,26．7％）,差异有统计学意义（P〈0．05）。结论中华医学会系列杂志是广大医务工作者获取布病知识的重要来源,近5年布病相关研究文献数量显著提高,但布病的刊载量仍显不足,学科建设仍有待加强。     

缺血性卒中患者血清生物标志物的应用现状

缺血性卒中具有高发病率、高致残率及高病死率的特点,血清中神经元特异性烯醇化酶、S-100β蛋白、细胞间黏附分子1、C反应蛋白、纤维蛋白原、D-二聚体及血清铁蛋白等生物标志物对缺血性卒中的辅助诊断、出血转化风险预测及预后判断等方面有重要的应用价值.该文对以上血清生物标志物在缺血性卒中中的应用作一综述.     

Lipoprotein (a) and the risk of ischemic stroke in young women

Background and purpose: lipoprotein (a) (lp (a)) is a lipid-containing particle similar to LDL which has been found in atherosclerotic plaque. The role of lp (a) in ischemic stroke remains controversial, but some studies suggest lp (a) is particularly important as a risk factor for stroke in young adults. We investigated the role of lp (a) as a risk factor for stroke in young women enrolled in the Stroke Prevention in Young Women Study. Methods: subjects were participants in a population-based, case-control study of risk factors for ischemic stroke in young women. Cases were derived from surveillance of 59 regional hospitals in the central Maryland, Washington DC, Pennsylvania and Delaware area. Lp (a) was measured in 110 cases and 216 age-matched controls. Demographics, risk factors, and stroke subtype were determined by interview and review of medical records. Results: lp (a) values were higher in blacks than whites, but within racial groups, the distribution of lp (a) values was similar between cases and controls. After adjustment for age, race, hypertension, diabetes, cigarette smoking, coronary artery disease, total cholesterol and HDL cholesterol, the odds ratio for an association of lp (a) and stroke was 1.36 (95% CI 0.80–2.29). There was no dose-response relationship between lp (a) quintile and stroke risk. Among stroke subtypes, only lacunar stroke patients had significantly elevated lp (a) values compared to controls. Conclusions: we found no association of lp (a) with stroke in a population of young women with ischemic stroke. Small numbers of patients limit conclusions regarding risk in ischemic stroke subtypes, but we could not confirm previous suggestions of an association of lp (a) with atherosclerotic stroke in young adults.     

非瓣膜病性心房颤动伴缺血性卒中的复发分析

目的探讨非瓣膜病性心房颤动（房颤）伴缺血性卒中患者的复发及其影响因素。方法回顾性分析1992—2002年住院非瓣膜病性房颤伴缺血性卒中患者386例,随访收集有关临床资料,进行复发分析并研究其复发的相关因素。结果非瓣膜病性房颤伴缺血性卒中患者的10年累计复发率为34％,Cox回归单因素分析发现,高血压、糖尿病、短暂性脑缺血发作（TIA）、高脂血症、附壁血栓是非瓣膜病性房颤伴缺血性卒中患者复发的危险因素,Cox回归多因素分析发现高血压病,TIA发作史与附壁血栓为非瓣膜病性房颤合并缺血性卒中复发的独立危险因素;而阿司匹林与华法林治疗对非瓣膜病性房颤合并缺血性卒中复发有保护作用。结论高血压病、TIA发作史与附壁血栓为非瓣膜病性房颤合并缺血性卒中复发的独立危险因素,阿司匹林与华法林治疗对非瓣膜病性房颤合并缺血性卒中复发有保护作用。     

缺血性脑中风发病时间周期性差异及相关因素分析

连续观察了１０年共１６３２例首次发病的急性缺血性脑中风住院患者的发病时间，发现在济南地区夏季（６、７、８月）发病率较高（Ｐ＜０．０１），并存在着昼夜２４小时周期节律性差异，以每日的上午６∶００～１０∶００为发病高峰时间段（Ｐ＜０．００５），夜间发病率最低，本文还就其机制进行了讨论。