脑梗死合并糖尿病对患者神经功能的影响

Background:Diabetes is a factor resulting cerebral infarction.Neurological injury in patients suffered from cerebral infarction complicated with diabetes is more common and severe than that in patients with cerebral infarction alone.From December 1990 to Octomber 2001,144 patients with CT proved cerebral infarction were surveyed including 28 patients suffered from cerebral infarction complicated with diabetes and 116 patients with cerebral infarction alone.Here is the report.     

老年糖尿病住院患者感染危险因素分析

INTRODUCTION Incidence of diabetes combined with infection was very high,disease condition was serious,course of disease was long which made treatment very difficult[1- 3].Senile diabetes were more easy to be infected because of bad control effect of blood glucose and decreased immune function and the infection was difficult to control.Corresponding risk factors about senile diabetes combined with infection were analyzed in this article to make timely diagnosis and treatment.     

中青年急性脑梗死发病危险因素分析

Background: People paid more attention to the search of onset risk factors of cerebral apoplexy of middle and young people because of its severe harmfulness. We analyzed clinical data of 57 patients with acute cerebral infarction of middle age and young people from 1997～ 2000.     

高压氧对脑梗死患者血浆SOD和CRP的影响及临床意义

Objective To study the effect of hyperbaric oxygenation(HBO) therapy on the activities of serum SOD and CRP of patients with cerebral infarction and its clinical significance. Methods 78 patients with cerebral infarction were randomly divided into hyperbaric oxygen group (HBO Group, 40 cases)and clinical group (38 cases). The clinical group was treated with clinical conventional treatment only. HBO group was treated with HBO combined with clinical conventional treatment. 21 healthy volunteers were assigned to control group. Before and after treatment, the activities of serum SOD and CRP level were measured, and the curative effect were evaluated. Results The pretreatment serum SOD and CRP of the HBO group and clinical group were significantly different from the control group (P＜ 0. 01). Compared with the pretreatment and posttreatment serum level of the HBO group, SOD raised, CRP lowered, the difference was significant(P＜ 0. 01).Compared with clinical group, SOD raised, CRP lowered and the total cure rate of the HBO group were more significant different(P ＜0.01). Conclusion HBO therapy raised the activities of SOD and lower the level of CRP in serum of the patients with cerebral infarction, and improved the free radicals scavenging ability in the body. Therefore, HBO therapy has a good effect for cerebral infarction. The experiment suggests that the activities of SOD and CRP level in serum can be used to judge the curative effect and prognosis of HBO therapy for cerebral infarction.     

血液流变学异常与高血压和脑梗死发生、转归的相关性

Background:Increased blood pressure in hypertension is related to vessels resistance,cardiac output,as well as blood viscosity.Stroke is common following hypertension.A number of studies reported that abnormal blood rheology was frequent in stroke suggesting correlation of blood rheology with onset,development,recovery of hypertension.Hypertension is the most one of independent risk factors of stroke.In the current paper,we investigated pathogenesis and development of hypertension and cerebral infarction to provide principle foundation for early prevention and treatment of cerebral infarciton.     

大面积脑梗死的早期诊断对神经功能恢复的影响

Background: Because there are acute occurrence and severe clinical findings in large area cerebral infarction, early diagnosis is very significant to early treatment and nerve function recovery. Objective: To discuss the effects of early diagnosis of large area cerebral infarction on nerve function recovery. Unit: Department of Urology, Second Hospital of Changtu County in Liaoning Province. Subjective: The cases in the research came from 132 patients with cerebral infarction identified by CT examination during 1995～ 2000, including 59 males and 73 females. The ages ranged from 37 to 72 years old, and mean age was 59. There were 78 patients who were troubles with hypertension past, 41 diabetes and 62 coronary heart diseases with atrial fibrillation. 132 patients entered the hospital in the episode day, and other 4 patients did 24 hours after the episode day. In the patients, there were 132 appeared with complete hemiplegia, 87 with different level conscious disturbance ( 60 somnolence and lethargy, 27 coma ), 76 accompanied with anepia, 93 with headache and vomiting, 36 with tic, 33 with ocular disturbance, 64 identified as papilledema, and 26 appeared with cerebral symptoms, 37 occurred metula hemorrhage. Intervention: All the 132 patients accepted cerebral CT examination within 24 hours since the onset of illness, and decreasing intracranial pressure,thrombolysis,protecting brain cells,anti-inflammation treatments. Result: There were large area low-density focuses in the blood-supplied region of middle cerebral artery and internal jugular vein in 19 patients' CT films 10 hours after onset of illness, and in addition 8 cases were transferred to surgery department for cerebral hernia. 37 patients with cerebral hemorrhage after infarction accepted neutrality therapy, and the symptoms relieved obviously for 29 days in the hospital. 69 patients restored conscious disturbance and muscular force of the troubled limbs notably, 29 cases left the hospital automatically, and 34 case were died ( 13 died of brain hernia, 21 died of infection and other diseases ). There were not examined focuses in post-cerebral CT, and large area infarction appeared in CT films 24 later. Conclusion: It is capital for decrease of fatality rate and mutilation rate and nerve function restoration to perform early diagnosis and apply early treatment of large area cerebral infarction.     

The relativity of the activity change of tissue—type plasminogen activator and type 1 plasminogen activator inhibitor in patients with cerebral infarction and defect of nerve function

AIM：To explore the dynamic changes of the activity of tissue-type plasminogen activator(t-PA) and type 1 plasminogen activator inhibitor (PAI-1) and its clinical significance by observing the activity of t-PA and PAI-1 in patients in acute and recovery phases of arteriosclerotic cerebral infarction.METHODS:Testing the activity of plasme t-PA and PAI-1 of 91 patients with arteriosclerotic cerebral infarction and 80 healthy old ages by Chromgenic substrate methods and controlling them.RESULTS:The activity of t-PA in acute and recovery stage of arteriosclerotic cerebral infarction patients were apparently lower than that of control and the activity of PAI-1 were higher than that of control.volume of cerebral infarction was negatively related to the activity of t-PA and positively related to the activity of PAI-1.CONCLUSION:The plasma fibrinolytic activities of the acute and recovery stage patients with arteriosclerotic cerebral infarction declined.     

The acupuncture therapy and auricular—plaster therapy on 22 patients with stubborn hiccup after stroke

The patients with acute cerebral infarction often suffer from stubborn hiccup and are difficult to cure.OBJECTIVE:To observe the effect of acupuncture therapy and auricular-plaster therapy on the patients with stubborn hiccup after acute cerebral infarction.     

Relation of plasma homocysteine with folic acid and Vitamine B12 in patients with cerebral infarction

Objective:To discuss the relationship of cerebral infarction with hyperhomocysteinemia and the relationship between hyperhomocysteinemia and folic acid and Vitamine B12.Method:We measured the concentrations of homocysteine with FIPA(fluorescence polarization immunoassay ) and Vitamin B12 and folic acid with chemiluminescent competitive immunoassay in 40 cerebral infarction patients and 30 healthy controls.Results:The concentration of homocysteine in study group was higher than the controls‘ (P<0.01).Serum folic acid level in study group was lower than that in control group (P<0.05).There is negative correlation between plasma homocysteine and serum folic acid (P<0.05).Conclusions:Hyperhomocysteinemia is an independent risk factor of atherosclerotic cerebral infarction.One reason of increased level of homocysteine in blood is that the deficiency of cofactors of enzymes involved in metabolism process.     

Analysis of differentially expressed genes related to cerebral ischaemia in young rats based on the Gene Expression Omnibus database

BACKGROUND The incidence rate of cerebral infarction in young people is increasing day by day, the age of onset tends to be younger, and its internal pathogenesis and mechanism are very complicated, which leads to greater difficulties in treatment. Therefore, it is essential to analyze the key pathway that affects the onset of cerebral infarction in young people from the perspective of genetics.AIM To compare the differentially expressed genes in the brain tissue of young and aged rats with midd...     

2型糖尿病合并脑梗死的影响因素分析

目的探讨2型糖尿病合并脑梗死的相关危险因素。方法检测105例2型糖尿病患者（A组：2型糖尿病合并脑梗死患者45例;B组：单纯2型糖尿病患者60例）和40例健康人（C组：健康对照组）的三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、糖化血红蛋白（HbAlc）、C反应蛋白（CRP）、D二聚体（L〉dimer）水平。通过多元回归分析将各组患者既往史、实验室检测指标等各项临床资料进行统计学分析,以筛选2型糖尿病合并脑梗死的危险因素。结果A、B组高血压痛史比例明显高于c组,差异均有统计学意义（P〈0．05）;A组患者重度颈动脉狭窄率明显高于B、C组,B组患者重度颈动脉狭窄率明显高于C组,差异均有统计学意义（P〈0．05）;A组患者TG、TC、HDL-C、LDL-C、HbAlc、CRP、D-dimer水平与B、C组比较差异有统计学意义（P〈0．05）。结论高血压病史、重度颈动脉狭窄率、TG、TC、LDL-C、HbAlc、CRP、D-dimer为2型糖尿病合并脑梗死的独立危险因素,而HDLC为保护性因素。     

再发脑梗死的危险因素研究

目的：探讨脑梗死再发的原因和危险因素。方法：对41例脑再梗死患者及112例随访未再发的初次脑梗死患者的临床伴发疾病及血脂代谢、凝血、纤溶系统、血浆同型半胱氨酸水平进行了综合分析。结果：脑再梗死伴高血压者明显多于初次脑梗死者，而伴糖尿病、缺血性心脏病者无此现象；脑再梗死者血PAI-1活性和纤维蛋白原水平显著高于初次脑梗死者；无论是初次脑梗死还是再发脑梗死血浆同型半胱氨酸均明显升高。结论：高血压、血纤溶系统活性升高、高水平纤维蛋白原、高同型半胱氨酸血症是脑梗死再发的重要危险因素。     

脑梗死患者微量白蛋白尿与脑卒中危险因素及复发的相关性

背景国外研究发现脑卒中危险因素与微量白蛋白尿有一定的关系,但结果并不一致.目的研究急性脑梗死患者微量白蛋白尿的发生率、与脑卒中危险因素及脑梗死复发的关系.设计以急性脑梗死患者和有脑梗死危险因素者为研究对象,以健康老年人为对照组的病例-对照研究.单位一所大学医院的神经内科病房.对象选择2000-01/2001-12重庆医科大学附属第一医院神经内科脑梗死及有脑梗死危险因素的住院病例共214例,年龄50～80岁.急性脑梗死组(发病在1周之内)78例,脑梗死危险因素组,如高血压、糖尿病、冠心病、短暂性脑缺血发作或脑卒中史(6个月以上)患者56例,28例健康老年人作为对照组.其中联合组包括急性脑梗死患者78例和脑梗死危险因素组中有短暂性脑缺血发作或脑卒中史者31例,共109例.方法测定过夜空腹12 h以上血白蛋白、血肌酐、血糖、总胆固醇、总三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇;用放射免疫法测定早晨第1次尿中白蛋白.主要观察指标①终点结局指标随访2年新血管事件(包括脑卒中复发、心肌梗死和血管性死亡)的发生率;②危险性指标脑梗死危险因素与微量白蛋白尿的关系;③替代指标各组微量白蛋白尿的发生率.结果急性脑梗死患者中微量白蛋白尿者占35%,显著高于脑梗死危险因素组(15%)和对照组(3.5%)(P均＜0.01).急性脑梗死组和联合组中存在6个独立预测微量白蛋白尿的危险因素,分别是糖尿病、血白蛋白水平、年龄、冠心病、高血压及高密度脂蛋白胆固醇(P＜0.05或P＜0.01).随访(1.5±0.9)年,急性脑梗死组23%再发血管意外,显著高于脑梗死危险因素组(12%)和对照组(0%)(P均＜0.01).急性脑梗死组微量白蛋白尿者36%再发血管意外,与大量白蛋白尿者(41%)和正常白蛋白尿者(10%)相比,差异均有显著性意义(P＜0.05).在急性脑梗死组、脑梗死危险因素组控制糖尿病、高血压后,微量白蛋白尿是脑卒中复发独立的预测指标,危险率分别是3.8(95%CI,1.2～13.5;P＜0.05)、4.7(95%CI,1.4～16.7;P＜0.01).结论急性脑梗死患者微量白蛋白尿较常见.在调整脑卒中基本危险因素后,微量白蛋白尿是脑梗死复发的独立危险因素.     

糖尿病并脑梗死患者血清同型半胱氨酸水平及前列地尔治疗对其影响

目的了解糖尿病并脑梗死患者血清同型半胱氨酸（homocysteine,Hcy）水平及前列地尔治疗对其影响。方法收集2010年7月-2011年7月来我院门诊就诊的糖尿病并恢复期脑梗死47例,均予前列地尔注射液治疗2周,治疗前后测定空腹血糖和血清Hcy水平并进行比较。结果糖尿病并脑梗死患者血清Hcy水平明显升高,高Hcy血症的发生率为72．3％。予前列地尔注射液治疗2周后,血清Hcy水平明显下降,与治疗前比较差异有统计学意义（P〈0．01）;脑梗死治疗总有效率为91．5％。结论糖尿病并恢复期脑梗死患者血清Hcy水平明显升高,前列地尔可通过降低血清Hcy水平有效改善脑梗死症状。     

短暂性脑缺血发作预测脑梗死风险模型ABCD2评分的改进

目的 探讨改进的ABCD2评分法对短暂性脑缺血发作(transient ischemic attack,TIA)后7d内发生脑梗死风险的预测价值.方法 本研究纳入了2014年7月至2015年12月在南通大学第二附属医院就诊的133例TIA患者,记录其TIA后7d内脑梗死的发生情况.使用单因素和多因素Logistic回归分析可能导致脑梗死的危险因素.采用ABCD2联合颈动脉超声(carotid ultrasound)的改良评分法(ABCD2-CU评分法)给TIA患者进行评分.绘制受试者工作特征曲线(ROC)曲线,观察曲线下面积(AUC),评估ABCD2评分及ABCD2-CU评分对TIA后脑梗死风险的预测价值及其差异.结果 133例TIA患者7d内有35例(26.3％)进展为脑梗死.单因素分析提示入院时血压≥140/90 mmHg(1 mmHg =0.133 Kpa)、单侧肢体无力、言语障碍、持续时间≥10 min、糖尿病史、高血压病史、颈动脉斑块形及颈动脉狭窄等8项危险因素与TIA后早期脑梗死密切相关(均P＜ 0.05).多因素Logistic回归分析提示单侧肢体无力[OR(95％ CI),3.52 (1.76～12.34)]、持续时间≥10min [2.45 (1.06～9.27)]、糖尿病史[3.37 (1.27～ 10.94)]、高血压病史[4.15 (1.71～13.34)]、颈动脉斑块[6.32 (2.46 ～ 19.40)]及颈动脉狭窄[12.73(2.67 ～44.35)]是TIA后早期进展脑梗死的独立危险因素(均P＜0.05).ABCD2-CU评分(AUC =0.802,95％ CI:0.717 ～0.888,P=0.000)对脑梗死的预测价值高于ABCD2评分(AUC=0.614,95％CI:0.511～0.717,P=0.036).结论 ABCD2-CU评分较ABCD2评分在判断TIA后早期脑梗死风险方面有更高的临床价值,可帮助医生鉴别高危患者,以早期采取及时预防措施.     

大动脉粥样硬化狭窄性脑梗死的危险因素分析

目的 了解大动脉粥样硬化狭窄性脑梗死与小动脉闭塞性脑梗死危险因素有无不同。方法 从河北任丘康济医院神经内科自2014年建立的缺血性卒中急性期干预、二级预防登记研究数据库中根据入组标准抽取了符合标准的736例脑梗死患者。根据有无大动脉狭窄将患者分为2组: 狭窄组303例,平均年龄(64.41±10.9)岁;非狭窄组433例,平均年龄(61.88±11.08)岁。分析大动脉粥样硬化狭窄性脑梗死与小动脉闭塞性脑梗死危险因素有无不同。结果 单因素分析年龄、空腹血糖、糖尿病、高密度脂蛋白与大动脉粥样硬化狭窄性脑梗死有关,有统计学意义。以大动脉粥样硬化狭窄性脑梗死为应变量,将单因素分析有意义的自变量进行多因素Logistic回归分析,在校正了空腹血糖等因素后,显示年龄(校正OR=1.024;95% CI=1.010~1.039; P<0.05)、糖尿病(校正OR=1.572;95% CI=1.113~2.219; P<0.05)是大动脉粥样硬化狭窄性脑梗死相关的独立危险因素。而高密度脂蛋白胆固醇(校正OR=0.650;95% CI=0.432~0.977; P<0.05)是大动脉粥样硬化狭窄性脑梗死的保护因素。结论 大动脉粥样硬化狭窄性脑梗死与小动脉闭塞性脑梗死危险因素有所不同,糖尿病、年龄是大动脉粥样硬化狭窄性脑梗死的独立危险因素,而高密度脂蛋白胆固醇是大动脉粥样硬化狭窄性脑梗死的保护因素。     

2型糖尿病合并脑梗死患者血清同型半胱氨酸和血小板聚集率检测的临床价值

目的探讨血清同型半胱氨酸(Hcy)和血小板聚集率(PagT)对诊断2型糖尿病合并脑梗死患者的临床价值。方法选取该院2型糖尿病合并脑梗死患者65例(合并脑梗死组),2型糖尿病患者55例(单纯糖尿病组),50例健康体检者作为健康对照组。分别检测3组研究对象的Hcy、PagT、血压、体质量、身高等各项指标并进行比较;再通过多因素Logistic回归分析确定2型糖尿病合并脑梗死的危险影响因子。结果合并脑梗死组Hcy、PagT水平明显高于单纯糖尿病组及健康对照组,差异有统计学意义(P0.05)。Hcy和PagT均为2型糖尿病合并脑梗死的危险影响因素;Person相关性分析显示,Hcy、PagT对糖尿病合并脑梗死疾病的严重程度呈正相关关系。结论 Hcy、PagT水平在2型糖尿病合并脑梗死患者中显著升高,可通过检测糖尿病患者Hcy、PagT水平预测脑血管疾病的发展进程。     

血管紧张素Ⅰ转换酶基因多态性与脑梗死的相关性研究

目的 探讨中国人群血管紧张素Ⅰ转换酶(ACE)基因插入／缺失(I／D)多态性和脑梗死的相关性。方法 用聚合酶链反应-限制性片段长度多态性的方法检测242例脑梗死和283例正常对照的ACE基因多态性，多元Loglstic回归模型分析其与脑梗死的相关性。结果 经年龄、性别、饮酒、吸烟、文化程度、糖尿病、高血压调整后，ACE基因与脑梗死、高血压、糖尿病无显著相关；高血压导致脑梗死发病危险性显著增加(OR=7．28，P=0．000)；ACE基因ID／DD基因型和高血压对脑梗死的发生有明显交互作用，显著增加脑梗死的危险性(交互作用系数=1.62，OR=7．29)，为2型交互作用中的超相乘模型。结论 ACE基因I／D多态性与脑梗死发病无相关性，但ACE基因ID／DD基因型和高血压对脑梗死有交互作用，增加脑梗死的危险性。     

2型糖尿病合并急性脑梗死外周血CD34~+水平变化及其意义

背景:CD34+细胞是一种新的血管内皮标志物,通过检测CD34+细胞水平可以反映血管内皮功能的变化。目的:分析外周血CD34+细胞数量变化与脑梗死发病的关系。方法:纳入观察对象110例,分为4组,2型糖尿病组、急性脑梗死组、2型糖尿病合并急性脑梗死组各30例,健康对照组20例。应用流式细胞仪ProCOUNT方法测定外周血CD34+/外周血单核细胞值,分析外周血CD34+/单核细胞值与脑血管病危险因素的相关性。结果与结论:4组外周血CD34+/单核细胞值经过方差分析,差异具有显著性意义(P<0.05),健康对照组高于2型糖尿病组、急性脑梗死组、2型糖尿病合并脑梗死组(P<0.01),2型糖尿病组高于急性脑梗死组、2型糖尿病合并脑梗死组(P<0.01)。2型糖尿病合并急性脑梗死患者外周血CD34+/单核细胞值与空腹血糖和收缩压呈负相关,与高密度脂蛋白胆固醇/低密度脂蛋白胆固醇的比值呈正相关,与舒张压、吸烟、胆固醇、三酰甘油无相关性。提示CD34+细胞可能使脑血管病危险因素受到影响从而参与了脑梗死的发生,监测CD34+细胞水平变化也许能用来预测2型糖尿病患者急性脑梗死的发生。     

急性脑梗死合并2型糖尿病患者微栓子与血清基质金属蛋白酶-9的关系

目的探讨急性脑梗死合并2型糖尿病患者脑动脉微栓子与血清基质金属蛋白酶-9含量的关系。方法前瞻性地纳入颈动脉系统急性脑梗死患者118例,分为糖尿病急性脑梗死组60例、非糖尿病急性脑梗死组58例。收集一般临床资料,采用EMS-9型经颅多普勒超声检测仪及酶联免疫吸附测定法(ELISA)分别检测所有入组患者大脑中动脉微栓子信号及血清基质金属蛋白酶-9浓度,并进行相关分析。结果糖尿病并急性脑梗死患者微栓子信号阳性率高于非糖尿病急性脑梗死患者(P<0.05);糖尿病并急性脑梗死患者的血清基质金属蛋白酶-9含量明显高于非糖尿病急性脑梗死患者(P<0.01);Logistic回归提示,血清基质金属蛋白酶-9是微栓子信号阳性的危险因素(OR=1.013,P<0.01)。结论糖尿病并急性脑梗死患者微栓子信号阳性率与血清基质金属蛋白酶-9含量更高,基质金属蛋白酶-9的高表达可能促进微栓子的产生。