Objective To explore the impact of gender difference in 90-day outcomes after mechanical thrombectomy for acute cerebral infarction. Methods A prospective registration, observational, and retrospective analysis study was carried out. Patients with acute cerebral infarction who were admitted to the Department of Neurology of the First Affiliated Hospital of Chengdu Medical College and the Department of Neurology of Nanjing First Hospital between June 2015 and June 2019 were collected. Patients were divided into two groups based on gender. The detailed demographic, laboratory examination, imaging examination and clinical data were collected. Then, the data were analyzed using univariate and multivariate logistic regression analyses. Results A total of 298 patients were included. Among them, there were 185 males and 113 females. The differences in age, smoking, atrial fibrillation, using antiplatelet drugs before stroke, TOAST classification, and involved cerebrovascular sites between the two groups were statistically significant (P<0.05), and there was no statistically significant difference in other baseline data between the two groups (P>0.05). The results of univariate logistic regression analysis showed that the rate of 90-day favourable outcome of female patients was lower than that of male patients [odds ratio (OR)=0.462, 95% confidence interval (CI) (0.275, 0.775), P=0.030]. The results of multivariate logistic regression analysis showed that, after adjusting for confounding factors, there was no independent correlation between gender and the 90-day favourable outcome of patients with acute cerebral infarction who underwent mechanical thrombectomy [OR=1.511, 95% CI (0.745, 3.066), P=0.253]. Conclusion The gender has no significant effect on the 90-day favourable outcome of acute cerebral infarction patients treated with mechanical thrombectomy.
Objective To explore the association between procalcitonin (PCT) level and the development of malignant brain edema (MBE) after acute cerebral infarction. Methods The data on patients with stroke admitted to the Department of Neurology of West China Hospital, Sichuan University between January 1, 2017 and December 31, 2018 were retrospective collected. Patients were divided into MBE group and non-MBE group based on whether MBE had occurred. The basic information and neuroimaging data of two groups of patients were compared and analyzed. Results A total of 798 patients were included. Among them, there were 93 cases of MBE (11.65%) and 705 cases of non-MBE (88.35%). The median time of MBE occurrence (lower quartile, upper quartile) was 29 (24, 54) hours after onset. The difference in the National Institutes of Health Stroke Scale, large-scale middle cerebral artery infarction, dysarthria, low fever, consciousness status, chronic heart failure, TOAST typing, mechanical ventilation, gastric tube placement, PCT on the first and third day of admission between the two groups were statistically significant (P<0.05). There was no statistically significant difference in the other indicators between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that both day 1 PCT and large-scale middle cerebral artery infarction were associated with MBE. Conclusions Elevated PCT within 24 hours from onset is independently associated with the development of MBE after acute cerebral infarction. Patients with elevated PCT after cerebral infarction may require careful clinical management.
ObjectiveTo observe the relationship between the serum level changes of high-sensitivity C-reactive protein (hsCRP), interleukin (IL)-18, intercellular adhesion molecule-1(ICAM1), matrix metalloproteinase (MMP)-9 and lipoprotein-associated phospholipase A2(Lp-PLA2), and the multiple factors of acute cerebral infarction (ACI). MethodsWe chose 76 patients with ACI treated between July 2012 and June 2014 as our study subjects.On the second day (acute phase) and the 15th day (recovery phase) after onset, we checked the patients for their serum levels of hsCRP, IL-18, ICAM1, MMP-9 and Lp-PLA2.Then, multiple linear regression analysis was performed to observe the correlation of the serum level change degree of inflammatory factors with hypertension, diabetes, coronary heart disease, smoking history, carotid atherosclerotic plaque, lipid levels, infarct size and National Institute of Health Stroke Scale (NIHSS) score. ResultsThe changes of all the inflammatory factors in the acute phase and the recovery phase of cerebral infarction were not significantly related to smoking history, hypertension, coronary heart disease, low-density lipoprotein and NIHSS scores (P > 0.05).The changes of hsCRP and ICAM1 had significant correlation with cerebral infarct size, diabetes mellitus and carotid atherosclerotic plaque (P < 0.05), and the change level of Lp-PLA2 was related to diabetes mellitus, and carotid atherosclerotic plaque (P < 0.05).MMP-9 serum level change had correlation with only cerebral infarct size (P < 0.05). ConclusionsSerum level changes of inflammatory factors are related to various factors of cerebral infarction.The main factors that affecting the serum level changes are cerebral infarction area, diabetes mellitus and carotid atherosclerosis.
Objective To assess the efficacy and safety of fructose-1,6 diphosphate (FDP) in the treatment of cerebral infarction. Methods We searched MEDLINE, EMbase, Cochrane CENTRAL Register of Controlled Trials, CBM and CNKI in 2006. Randomized controlled trials(RCTs) or quasi-randomized controlled trials involving FDP for cerebral infarction were collected. We assessed the quality of the studies and conducted meta-analyse with The Cochrane Collaboration’s RevMan 4.2. Results Ten RCTs were included, 9 of which were of low quality and only one was graded as high quality. None of the trials reported the number of patients who had died or were dependent at the end of long term follow-up. After 7 to 30 days of treatment, improvement of neurological deficiency was associated with FDP compared with placebo or control [OR 2.45, 95%CI (1.91,3.15)]. There was no statistical difference in the death rate between the FDP and control groups at the end of the treatment [RD –0.01, 95%CI (–0.03,0.01)]. One study found that FDP had a similar safety profile [OR 1.24, 95%CI (0.32,4.75)] to the control group. None of the trials compared the costs in the treatment groups. Conclusions The quality of the published clinical trials on FDP in the treatment of cerebral infarction is poor. FDP may improve short-term neurological deficits, but seems unlikely to decrease mortality. Moreover, we found no evidence to support the long-term efficacy of FDP on mortality, dependency and neurological deficit. Large-scale and high quality clinical trials with sufficient follow-ups are needed to evaluate the role of FDP in the treatment of cerebral infarction.
目的:初步探讨体外血浆脂蛋白过滤器（DELP）对急性脑梗死患者的临床疗效及安全性。方法:采用随机、基础治疗平行对照试验设计，将符合入选标准的患者随机分为两组:试验组3例，发病48 h内和间隔一天上午接受DELP治疗，对照组2例，仅给予基础治疗。用NIHSS量表，Barthel指数和改良Rankin评分评价神经功能恢复状况。结果:治疗后14 d治疗组NIHSS降低趋势明显优于对照组，治疗后90 d治疗组mRS良好预后的患者比例显著高于对照组。两组均未发现明显不良反应，治疗前后两组的实验室指标无显著变化。结论:DELP治疗急性脑梗死所致的神经功能缺损效果及安全性良好，为临床急性脑梗死的治疗提供了一条新的途径。
目的:探讨急性脑梗死的常规治疗和加用依达拉奉治疗的疗效变化。方法: 100例急性脑梗死患者随机分为治疗组和对照组,每组各50例,对照组用常规治疗方法(灯盏花和胞二磷胆碱静滴,口服阿司匹林等治疗),治疗组在常规治疗基础上加用生理盐水250mL+依达拉奉注射液30mg静脉滴注,每日2次,7～14天为1个疗程,进行疗效评定。治疗前、治疗后１４天和２１天对患者进行欧洲卒中评分(ESS)、日常生活活动能力(ＡＤＬ)评定。通过增分率判断疗效,同时记录不良反应。结果:治疗组１４天和21天评定ESS的有效率分别为78．0％和84．0％,对照组为52．0％和58．0％;１４天和２１天评定ＡＤＬ的有效率治疗组为８０.0％和８８．0％,对照组为56．0％和66．0％;治疗组无明显不良反应．结论:依达拉奉治疗急性脑梗死安全有效。
ObjectiveTo explore the association between prediabetes and poor outcome in patients with acute ischemic stroke (AIS).MethodsThe patients with first-ever AIS who were hospitalized in the Department of Neurology, the First Affiliated Hospital of Henan University of Science and Technology from September to December 2018 were retrospectively enrolled. According to the different levels of hemoglobin A1c, the patients were divided into prediabetes group, diabetes mellitus (DM) group and non-DM group. The outcome of the patients 3 months after the discharge was assessed by the modified Rankin Scale and dichotomized as good and poor outcomes. ResultsA total of 188 patients were included, and 160 were eventually included. Among them, 66 cases were in the non-DM group, 39 were in the prediabetes group, and 55 were in the DM group; 68 patients were in the poor prognosis group and 92 were in the good prognosis group. There was no statistically significant difference among the non-DM group, prediabetes group, and DM group (P>0.05) except for hyperlipidemia (χ2=7.781, P=0.020), triglyceride (TG) (F=8.220, P<0.001) and admission blood glucose (F=44.356, P<0.001). There was no statistically significant difference between the good prognosis group and the poor prognosis group (P>0.05) except for hyperlipidemia (χ2=4.847, P=0.028), admission blood glucose (t=−2.940, P=0.004), TG (t=−2.766, P=0.006), and NIHSS (Z=−6.038, P<0.001). Prediabetic [odds ratio (OR)=4.053, 95% confidence interval (CI) (1.491, 11.019)] and diabetic [OR=5.986, 95%CI (2.330, 15.379)] patients had a worse prognosis 3 months after the discharge.ConclusionIn adults with first-ever AIS, prediabetes and diabetes were associated with poor prognosis in patients with AIS after 3 months.
Acute cerebral infarction is characterized by high incidence rate, high recurrence rate, high disability rate and multiple complications. Early evaluation and treatment of acute cerebral infarction is particularly important to improve the survival rate and prognosis of patients. As an easily available clinical laboratory indicator, blood routine test can reflect the pathological changes in the body to a certain extent. In recent years, many studies have shown that the indicators such as red cell volume distribution width, mean platelet volume, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in blood routine examination have important values in the onset, severity and prognosis of acute cerebral infarction. This article reviews the correlations of the above parameters and ratio parameters with acute cerebral infarction, in order to provide some reference and basis for clinical diagnosis, treatment and prognosis evaluation of acute cerebral infarction.
目的:研究银杏达莫联合血塞通注射液对急性脑梗死的治疗效果。方法:分成3组,分别为银杏达莫组、血塞通组、银杏达莫联合血塞通治疗组,每组40例。3组给予不同治疗后分别对治疗前及治疗后14、21 d对神经功能缺损及疗效进行评定。结果:银杏达莫组及血塞通组相比,在治疗后第14及21天,银杏达莫联合血塞通组神经功能缺损明显减轻(Plt;005),且疗效更明显(Plt;005)。结论:与银杏达莫组及血塞通组相比,银杏达莫与血塞通联合治疗可更加改善神经功能缺损(Plt;005),并能提高疗效,出血副作用无增加。