ABSTRACT
Objective To compare the effect of arterial thombolysis with urokinase and intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA) in treatment of ischemic stroke.Methods One hundred patients with ischemic stroke were divided into intravenous thrombolysis (with rt-PA) group and arterial thrombolysis (with urokinase) group with 50 cases each by random digits table method.The thrombolytic recanalization rate,mortality rate and complications after treatment were observed and compared between two groups.Results The thrombolytic recanalization rate in intravenous thrombolysis (with rt-PA) group was higher than that in arterial thrombolysis (with urokinase) group [88.0％ (44/50) vs.66.0％ (33/50)],the complication rate in intravenous thrombolysis (with rt-PA) group was lower than that in arterial thrombolysis (with urokinase) group [6.0％ (3/50) vs.28.0％ (14/50)],and there was significant difference (P ＜ 0.05).There was no significant difference in mortality between two groups (P ＞ 0.05).There was no significant difference in the National Institutes of Health Stroke Scale (NIHSS) scores before treatment between two groups (P ＞ 0.05).The NIHSS scores 1,3,10,30 d after treatment were lower than those before treatment in two groups,and there were significant differences (P ＜ 0.05).There was no significant difference in NIHSS scores at different times and modified Rankin Scale 30 d after treatment between two groups (P＞ 0.05).Conclusions The efficacy of rt-PA in ischemic stroke patients is significantly better than that of the arterial thrombolysis with urokinase,with higher recanalization rate and fewer complications.It is safe and effective,and can be as the first choice for the treatment of ischemic stroke thrombolysis.
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Objective To investigate the risk factors for cerebral microbleeds (CMBs) and its correlation with the 24 h microalbuminuria (mALB) in patients with small artery occlusion (SAO).Methods The patients with SAO were enrolled.CMBs were detected with susceptibility-weighted imaging.The demographic and clinical characteristics and 24 h mALB of the patients were compared.Multivariate logistic regression analysis was used to identify the independent risk factors for CMB in patients with SAO.Spearman correlation analysis was used to investigate the correlation between the 24 h mALB and the degree of CMBs.Results A total of 90 patients with SAO were enrolled and 35 patients (38.89％) had CMBs.CMBs mainly distributed in basal ganglia/thalamus and infratentorial (62％) regions.The Age (70.8 ± 5.4 vs.67.3 ± 8.1; t =2.461,P =0.016),proportion of hypertension (80.0％ vs.52.7％ ;x2 =6.851,P =0.009),and 24 h mALB levels (16.257 ± 6.031 mg/24 h vs.11.910 ±5.458 mg/24 h; t =3.536,P =0.001) in the CBM group were significantly higher than those in the non-CMB group.Spearman rank correlation analysis showed that the 24 h mALB and the severity of CMB in patients with SAO showed a significant positive correlation (rs =0.795,P =0.000).The higher the 24 h mALB level was,the more severe the CMB degree would be.Multivariate logistic regression analysis showed that only 24 h mALB was the only independent risk factor for CMBs in patients with SAO (odds ratio,1.100,95％ confidence interval 1.031-1.176; P =0.002).Conclusions The 24 h mALB is an independent risk factor for CMB in patients with SAO.The 24 h mALB level is positively correlated with the severity of CMB,and it may be used as a marker for small vascular injury.
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Objective To observe the therapeutic effect of folic acid on transient ischemic attack(TIA)patients with homocysteinaemia (Hcy ). Methods 129 patients of primary TIA with Hcy were divided into two groups randomly. The observation group ( n = 65 )was administered with conventional therapy and folic acid, and the control group ( n=64 ) was only given conventional therapy. The variances of the plasma HCA level three months later were compared, and remission rate of TIA and complete stroke incidence one year later were analyzed between two groups. Results The Hcy incidence rate of TIA patients was up to 41.4%. Three months later, the plasma HCA level of observation group was lower than control group( ( 14.27 ± 6. 13 ) μmol/L vs (24.99 ± 6.87 )μmol/L, t=2.799, P＜0. 01 ) ,and much lower than that of the control group post-treatment ( ( 14. 27 ±6. 13)μmol/L vs (24.68 ± 6.89) μmol/L, t = 2.735, P ＜ 0.01 ). One year later, the complete stroke incidence of TIA in observation group was lower than that of the control group(9.8% vs 25.0%, P＜0.05 ) ,and complete remission rate was higher than the latter(73.8% vs 50.0%, P ＜ 0. 01 ). Conclusion Folic acid can decrease the plasma HCA level of TIA patients with Hcy efficiently,and improve the prognosis of such patients.