急性脑卒中与血清N末端B型利钠肽相关性的研究

目的 探讨急性脑卒中患者的血清N末端B型利钠肽 (NT-pro BNP)的变化,评价血清NT-pro BNP测定的临床意义.方法 74例患者分别为急性脑梗死 (CI) (42例)和急性脑出血 (ICH)组 (32例),根据入院时NIHSS评分分为轻度、中度和重度3个亚组,采用ECLIA法检测发病48 h内 (急性期)及发病第21天 (亚急性期)的血清NT-pro BNP水平,与健康对照组进行比较,比较急性期与亚急性期间、各亚组间的血清NT-pro BNP水平差异.结果 CI组和ICH组急性期血清NT-pro BNP显著高于对照组 (P<0.01),并在亚急性期显著下降(P<0.01);各亚组间急性期血清NT-pro BNP水平均有显著统计学差异 (P<0.01).结论 急性期脑卒中患者急性期血清NT-pro BNP水平与病情程度相关.     

Prevention of Cardioembolic Stroke

Cardiac causes of ischemic stroke lead to severe neurological deficits from large intracranial artery occlusion compared to small vessel ischemic stroke. The most common cause of cardioembolic stroke is atrial fibrillation (AF), which has an increasing incidence with age. AF stroke trials demonstrate that anti-coagulation is superior to anti-platelet therapy in terms of ischemic stroke prevention. Recently, warfarin was compared with dabigatran, an oral, direct thrombin inhibitor, and was found to be at least equally effective in reducing ischemic stroke with less intracranial bleeding risk. Future research is investigating other direct thrombin inhibitors as potential alternatives to warfarin, which has a narrow therapeutic index, requires frequent blood monitoring, has multiple drug interactions, and a higher rate of intracranial bleeding. Other causes of cardioembolic stroke include myocardial infarction, left ventricular thrombus, reduced ejection fraction, valvular abnormalities, and endocarditis. Patent foramen ovale is a common finding on echocardiograms in patients with and without stroke (up to 20% of the population), and it is a controversial source of cryptogenic stroke. The best way to prevent cardioembolic stroke remains early detection and treatment of AF, and treating the underlying stroke mechanism. Cardiac magnetic resonance imaging is an emerging technology and reveals some sources of cardiac embolism missed by echocardiography, and might provide an additional diagnostic tool in investigating cardioembolic stroke.     

心源性脑梗死的影像学特征

正不同原因所致不同类型的脑梗死防治策略不尽相同[1]。脑梗死病因的确定,主要依靠各种相关的辅助检查,其中,头颅计算机断层扫描(computerized tomography,CT)或磁共振成像(magnetic resonance imaging,MRI)是临床常用的辅助检查,它们可以显示脑梗死病灶的部位、大小和数目等信息,可初步提供查找病因的方向。遗憾的是,有的医师在读阅这些影像学结果时,仅仅确认是否存在梗死灶,     

Early Triage of Cardioembolic Sources Using Chest Spectral Computed Tomography in Acute Ischemic Stroke

ObjectivesThe present study investigated the potential usefulness of delayed-phase, low-dose, non-gated, chest spectral CT scans (DSCT) for the early triage of cardioembolic (CE) sources in patients admitted with acute ischemic stroke (AIS), and for the simultaneous detection of myocardial disease and thrombotic complications.Material and methodsSince July 2020 and promoted by the COVID-19 pandemic, we implemented the use of DSCT after cerebrovascular CT angiography (CTA) among patients with AIS using a dual-layer spectral CT. We explored the presence of CE sources, as well as late myocardium iodine enhancement (LIE) and pulmonary thromboembolism. Among patients further undergoing transesophageal echocardiogram (TEE) or cardiac CTA, we explored the diagnostic performance.ResultsFifty consecutive patients with AIS who underwent DSCT after cerebrovascular CTA comprised the patient population. The confidence degree for excluding cardiac thrombi was significantly higher than for LIE (4.4±0.8 vs. 3.4±1.3, p<0.0001). DSCT identified a CE source in 4 (8%) and LIE in 24 (48%) patients. The iodine ratio of CE sources was significantly lower compared to the left atrial appendage of patients with no CE sources (0.25±0.1 mg/mL vs. 0.91±0.2 mg/mL, p<0.0001). TEE/cardiac CT, performed in 20 (40%) patients, identified a CE source in 5 (25%) cases, whereas DSCT identified 4 (20%), leading to a sensitivity and specificity of 80% (95% CI 28–99%) and 100% (95% CI 78–100%) respectively (kappa 0.86).ConclusionsIn this pilot study, we identified DSCT as a potential unsophisticated approach for the early triage of CE sources among patients with AIS undergoing CTA upon admission.     

MRA、TCD及椎动脉超声对椎基底动脉系统缺血性卒中的诊断价值

目的 探讨椎动脉磁共振血管成像(MRA)、经颅多普勒(TCD)及椎动脉超声对椎基底动脉系统缺血性卒中的临床诊断价值.方法 对41例椎基底动脉系统缺血性卒中的患者进行椎动脉MRA、TCD及椎动脉超声检测,观察其异常情况.结果 41例患者中椎动脉MRA异常27例(65.85%),TCD异常32例(78.05%),椎动脉超声异常25例(60.98%).椎动脉MRA能清楚地显示血管病理形态,主要表现为椎动脉局部狭窄、单侧椎动脉变细及血流信号降低.结论 椎动脉MRA、TCD与椎动脉超声的联合检查有助于椎基底动脉系统缺血性卒中的病因诊断.     

Preventing Cardioembolic Stroke in Atrial Fibrillation with Dabigatran

Dabigatran is a direct inhibitor of thrombin that has recently been approved for primary and secondary stroke prevention and prevention of systemic embolism in patients with atrial fibrillation. The RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy [with Dabigatran Etexilate]) study showed that dabigatran given at a dose of 110 mg twice a day (bid) was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin (International Normalized Ratio target 2.0–3.0), and lower rates of major hemorrhage. Dabigatran administered at a dose of 150 mg bid was significantly more effective compared with warfarin and showed a similar rate of major hemorrhages. Both dosages resulted in an approximately 60% to 70% relative reduction of intracranial hemorrhage. The dosage of 110 mg bid should be preferably used in patients older than 75 years at a higher bleeding risk. The Hemoclot (Hyphen BioMed, Mason, OH) test to measure dabigatran serum concentration is commercially available, but presence of the drug may also be detected using the activated partial thromboplastin time or thrombin time.     

自动ASPECTS评分法在急性缺血性卒中早期影像评估中的应用价值

目的 评价自动ASPECTS评分法在急性缺血性卒中早期影像评估中的实际临床应用价值.方法 回顾性分析2020年6-10月在北京天坛医院连续就诊的急性缺血性卒中病例,收集影像归档和通信系统上由RAPID软件评估的基于CT的自动ASPECTS评分,以DWI高信号作为梗死核心标准获得DWI ASPECTS评分,将自动ASPE...     

The C-Type Natriuretic Peptide Receptor is the Predominant Natriuretic Peptide Receptor mRNA Expressed in Rat Hypothalamus

The natriuretic peptide receptors (NPR) are membrane-bound guanylate cyclases with extracellular binding domains specific for particular members of the natriuretic peptide family. NPR-A binds atrial natriuretic peptide (ANP) with high affinity, whereas the NPR-B appears to be specific for C-type natriuretic peptide (CNP). Previous data indicating extensive overlap between localization of ANP and CNP in hypothalamic neuroendocrine circuits suggest the importance of determining whether specificity of natriuretic peptide action may be conferred via receptor type present on target cells. To address this issue, we used in situ hybridization histochemistry to localize NPR-A and NPR-B mRNA in the hypothalamus. NPR-A mRNA was not found in substantial abundance in any hypothalamic nucleus; however, detectable NPR-A signal was observed in other brain regions, including the subfornical organ and medial habenula. In contrast, NPR-B mRNA was expressed throughout the hypothalamus, including neurons of the magnocellular and parvocellular paraventricular, the arcuate, and the supraoptic nuclei. Expression was also seen in other nuclei essential to neuroendocrine control, including the median preoptic, anteroventral periventricular, tuberomammillary, ventromedial and suprachiasmatic nuclei. NPR-B mRNA was also observed in the neural lobe of the pituitary gland, suggesting expression by pituicytes. The results suggest that NPR-B is the primary natriuretic peptide receptor in hypothalamus, and by inference indicate that CNP is the primary active natriuretic peptide in neuroendocrine regulation.     

表观弥散系数对确定急性缺血性卒中缺血半暗带的潜在价值

目的 探讨表观弥散系数（apparent diffusion coefficient,ADC）对确定急性缺血性卒中缺血半暗带的潜在价值。 方法 选择发病9 h内完成多模式磁共振成像（magnetic resonance imaging,MRI）检查的前循环急性缺血性卒中患者49例。应用自制软件进行灌注加权像（perfusion-weighted imaging,PWI）和弥散加权像（diffusion-weighted imaging,DWI）异常区域的体积测量。缺血半暗带以PWI/DWI错配表示。同时采用全自动图像分析系统,以DWI图像计算得到的ADC图作为输入数据,来判断缺血半暗带的存在（以下简称为ADC方法）,然后比较这两种方法在判断缺血半暗带方面的差异。 结果 入选的49例患者中,存在PWI/DWI错配者为43例,符合ADC方法判断缺血半暗带标准者有41例。这两种方法在判断是否存在缺血半暗带的结果中有41例相符,对判断缺血半暗带的差异无统计学意义（P>0.05）。ADC方法判断缺血半暗带的敏感度为88.4%、特异度为50.0%。 结论 由于不需做PWI检查,ADC方法对确定缺血半暗带具有潜在的临床实用价值,有可能成为一种简便易行的确定缺血半暗带的方法。     

蒙特利尔认知评估量表在缺血性脑卒中人群中的应用价值探讨

目的：探讨蒙特利尔认知功能评估（MoCA）量表筛查缺血性脑卒中后非痴呆型血管性认知功能障碍（VCIND）的应用价值,并与简易精神状态检查（MMSE）量表比较。方法：选取非认知功能障碍（NCI）组76例,VCIND组66例。由2名神经科医生进行MoCA及MMSE量表评估。结果：MoCA总平均分为（22.61±4.722）分,MMSE为（27.35±2.615）分,总分相关分析r=0.765,P=0.000。排除受教育程度影响因素后,受教育年限≤9年者：MoCA除命名分项外,其余各分项在两组间均差异有统计学意义（P〈0.05）。受教育年限〉9年者：MoCA除命名、计算力和定向力分项外,其余各分项在两组间均差异有统计学意义（P〈0.05）。应用ROC曲线及约登指数最大值初步确定MoCA用于识别VCIND与NCI组最佳分界值为24/25分,其筛查VCIND的灵敏度和特异度分别为64.29%和79.31%,优于MMSE（灵敏度61.67%,特异度64.63%）,差异有统计学意义（P〈0.05）。结论：MoCA筛查VCIND灵敏度和特异度较高,是一种有效的筛查VCIND量表,但应用于中国人群尚存在不足。