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Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) on admission for early neurological deterioration (END) in patients with lacunar stroke.Methods Patients with acute lacunar stroke admitted to the Department of Neurology,the Second People's Hospital of Lianyungang from June 2015 to October 2017 were enrolled retrospectively.END was defined as an increase of ≥2 in the National Institutes of Health Stroke Scale (NIHSS) score within 72 h of admission.Multivariate logistic regression analysis was used to determine the independent risk factors for END.The receiver operating characteristic (ROC) curve was used to analyze the predictive value of NLR for END in patients with lacunar stroke.Results A total of 309 patients with acute lacunar infarction were enrolled,including 180 males (58.2％),aged 59.7 ±7.3 years;65 patients (21.0％) in END group and 244 (79.0％) in non-END group.Multivariate logistic regression analysis showed that after adjusting for other confounders,NLR was an independent risk factor for END in lacunar stroke (odds ratio 4.508,95％ confidence interval 3.128-7.547;P＜0.001).ROC curve analysis showed that the area under the curve of NLR predicting END in patients with lacunar stroke was 0.725 (95％ confidence interval 0.671-0.776;P ＜ 0.001);the optimal cut-off value was 2.32,the sensitivity of predicting END was 61.21％,and the specificity was 72.54％.Conclusion The elevated NLR after admission is an independent risk factor for END in patients with lacunar stroke,which has certain value for early identification and prediction of END.
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Objective To investigate the relationship between the right-to-left shunt(RLS)detected with contrast-enhanced transcranial Doppler (c-TCD) and recurrent stroke in patients with cryptogenic stroke.Methods The consecutive patients w ith ischemic stroke w ere enrol ed. The patients w ith cryptogenic stroke w ere screened according to the TOAST criteria. They w ere divided into either a RLS positive group or a RLS negative group according to the c-TCD findings, and then they w ere fol ow ed up for a period of one year. They w ere also divided into a recurrent group and a non-recurrent group according to w hether they had recurrence or not. Results A total of 118 patients w ith cryptogenic ischemic stroke w ere enrol ed, including 46 in the RLS positive group, 72 in the RLS negative group, 10 in the recurrent group, and 108 in the non-recurrent group. There w ere no significant differences in demographic and baseline data betw een the RLS negative group and the RLS positive group. There w ere significant differences in RLS positive rate (7/10 vs.39/108; P=0.046) and proportion of patients with server RLS (2/10 vs.1/108; P=0.019) betw een the recurrent group and the non-recurrent group. Multivariate logistic regression analysis show ed that the positive RLS w as an independent predictor of recurrent stroke (odds ratio 4.896, 95% confidence interval 1.135-21.120;P=0.033). Conclusions The positive RLS may be an independent risk factor for the recurrence in patients w ith cryptogenic ischemic stroke.
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Objective To investigate the correlation between the plasma homocysteine (Hcy) level and intra/extracranial artery stenosis in patients with ischemic stroke.Methods The medical history,baseline clinical data,imaging and Hcy and other laboratory test results in patients with ischemic stroke were collected.The patients were divided into either a stenosis group or a non-stenosis group according to magnetic resonance angiography.The artery stenosis group was further redivided into an isolated intracranial stenosis group,an isolated extracranial stenosis group,and combined extracranial and intracranial stenosis group.The relationship between plasma Hcy level and intra/extracranial stenosis was analyzed.Results A total 147 patients with ischemic stroke were enrolled,including 115 patients in the stenosis group and 32 in the non-stenosis group.There were significant differences in age (t =4.577,P ＜ 0.001),the plasma levels of Hcy (t =3.65,P ＜ 0.001),C-reactive protein (t =2.06,P =0.041),low-density lipoprotein cholesterol (LDL-C) (t =1.896,P =0.046),high-density lipoprotein cholesterol (HDL-C) (t =-4.261,P ＜ 0.001),as well as the proportions of diabetes mellitus (x2 =5.772,P =0.016),hypertension (x2 =10.507,P =0.001) and smoking (x2 =12.282,P ＜ 0.001) between the stenosis group and the non-stenosis group.Multivariate logistic regression analysis showed that age ≥60 years (odds ratio [OR] 3.374,95％ confidence interval [CI] 1.351-8.426; P=0.009),Hcy ＞15 mmol/L (OR 2.274,95％ CI 1.147-8.173; P=0.025),hypertension (OR 5.782,95％ CI 2.045-16.345; P =0.001),and smoking (OR 3.514,95％ CI 1.200-10.293; P=0.002) were the independent risk factors,while HDL-C ＞ 1.0 mmol/L was an independent protective factor for intra/extracranial stenosis (OR 0.166,95％ CI 0.054-0.511; P =0.002).The stenosis group was redivided into an isolated extracranial stenosis group (n =24),an isolated intracranial stenosis group (n =61) and a combined extracranial and intracranial stenosis (n =30) according to the sites of stenosis.The comparison of the clinical data and risk factors among the three groups showed that there were significant differences in the proportions of patients with hypertension (x2 =7.024,P=0.003),as well as the plasma levels of LDL-C (F =3.276,P =0.042) and C-reactive protein (F =3.645,P =0.029).Multivariate logistic regression analysis showed that hypertension was the common independent risk factor for isolated intracranial stenosis (OR 3.795,95％ CI 1.261-11.424; P =0.018),isolated extracranial artery stenosis (OR 18.490,95％ CI 3.117-10.966; P=0.001) and combined extracranial and intracranial stenosis (OR 9.178,95％ CI2.211-38.094; P=0.002),and the increased HDL-C level was the common protective factor for isolated intracranial artery stenosis (OR 0.150,95％ CI 0.043-0.523; P =0.003),isolated extracranial artery stenosis (OR 0.078,95％ CI 0.012-0.488; P=0.006) and combined extracranial and intracranial stenosis (OR 0.089,95％ CI 0.021-0.385; P=0.001).Age was an independent risk factor for isolated intracranial stenosis (OR 6.351,95％ CI 2.277-17.717; P ＜ 0.001).The increased LDL-C level was an independent risk factor for isolated extracranial stenosis (OR 6.021,95％ CI 1.212-29.917; P =0.028).The increased Hcy level was an independent risk factor for isolated extracranial stenosis (OR 4.376,95％ CI 1.026-18.671; P-0.046) and combined extracranial and intracranial stenosis (OR 4.951,95％ CI 1.378-17.783; P =0.014).Conclusions The increased plasma Hcy level correlated with extracranial stenosis.
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Objective To investigate the predictors of systemic inflammatory response syndrome (SIRS) in patients with acute ischemic stroke. Methods The patients with acute ischemic stroke admitted to hospital from January 2010 to April 2014 were enroled. The demographics, vascular risk factors, baseline clinical data, and laboratory tests in both groups were colected. Flow cytometry was used to analyze the peripheral blood T helper cel (Th) subgroup. Double antibody sandwich enzyme-linked immunosorbent assay was used to detect the levels of peripheral blood interferon-γ (IFN-γ) and interleukin-4 (IL-4). Results A total of 143 patients with acute ischemic stroke were enroled, including 56 in a SIRS group and 87 in a non-SIRS group. Univariate analysis showed that there were significant differences in the history of hypertension, history of stroke, baseline systolic blood pressure, low-density lipoprotein cholesterol level, National Institutes of Health Stroke Scale (NIHSS) score, percentage of Th1 cels, and IFN-γ concentration in patients of both groups (al P < 0. 05). Multivariate logistic regression analysis showed that the NIHSS score ≥6 (odds ratio [ OR] 2. 40, 95% confidence interval [ CI] 1. 24 - 5. 15, P = 0. 008), decreased percentage of Th1 cels (OR 2. 81, 95% CI 1. 51 - 6. 83, P = 0. 013), and decreased IFN-γ concentration (OR 4. 63, 95% CI 1. 01 - 9. 72, P = 0. 004) were the independent predictive factors for occurring SIRS in patients with acute ischemic stroke. Conclusions Severe neurological deficit, decreased percentage of Th1 cels or decreased IFN-γ level may increase the risk of acute ischemic stroke patients with SIRS.
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Objective To investigate the distribution characteristics of cerebral artery stenosis and its risk factors in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke examined with MRI and magnetic resonance angiography (MRA) were divided into either a stenosis group or a non-stenosis group according to whether they had cerebral artery stenosis or not.The patients in the stenosis group were redivided into a simple intracranial stenosis,simple extracranial stenosis,and intracranial + extracranial stenosis subgroups according to their stenotic sites; they were redivided into either a young and middle-aged subgroup (＜60) or an elderly subgroup (≥60) according to their age; they were redivided into either a single-branch lesion subgroup or multibranch lesion subgroup according to the number of vascular stenosis.The distribution characteristics and influencing factors of cerebral artery stenosis were analyzed.Results A total of 232 patients with acute ischemic stroke were enrolled,and 114 of them (62.0％) were simple intracranial stenosis,30 (16.3％) were simple extracranial stenosis,and 40 (21.7％) were intracranial+ extracranial stenosis.The patients with anterior circulation stenosis (76.6％) were more common than those with posterior circulation stenosis (33.7％).They were mainly in the middle cerebral artery (64.4％) and posterior cerebral artery (53.8％) respectively.Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.049,95％ confidence interval [CI] 1.015-1.084; P =0.005),hypertension (OR 10.063,95％ CI 4.402-23.004; P ＜ 0.001),diabetes (OR 3.873,95％ CI 1.141-13.147; P =0.030),smoking (OR 3.311,95 ％ CI 1.112-9.855; P =0.031),and fibrinogen (OR 6.085,95％ CI 1.396-26.533; P=0.016) were the independent risk factors for cerebral artery stenosis in patients with acute ischemic stroke; hypertension (OR 10.779,95％ CI 4.468-26.007; P＜ 0.001),diabetes (OR 3.593,95％ CII.018-12.685; P =0.047),and smoking (OR 4.408,95％ CI 1.403-13.826; P =0.011) were the independent risk factors for simple intracranial artery stenosis; hypertension (OR 6.143,95％ CI 1.838-20.537; P=0.003),diabetes (OR 8.179,95％ CI 1.844-36.287; P=0.006),and fibrinogen (OR 2.410,95％ CI 1.046-5.551; P =0.039) were the independent risk factors for simple extracranlal artery stenosis.C reactive protein (CRP) level of the intracranial + extracranial stenosis group was significantly higher than that of the simple intracranial stenosis (P=0.001) and simple extracranial stenosis (P =0.018) groups.There was no significant difference between the two groups,but the mean level of the 3 groups was higher than that of the normal value.The simple intracranial stenosis and the simple extracranial stenosis were most common in the young and middle-aged group,and the simple intracranial stenosis and the intracranial + extracranial stenosis were more common in the elderly group.The age (P=0.036) and uric acid level (P=0.006) in the subgroup of multiple branches stenosis were significantly higher than those in the subgroup of single branch stenosis,but only age (OR 1.030,95％ CI 1.003-1.057; P =0.028) was significantly independent correlated with the multiple branches stenosis.Conclusions Intracranial artery stenosis is common in cerebral artery stenosis of patients with acute ischemic stroke.The proportion of intracranial + extracranlal stenosis increases sfightly with age.Age,hypertension,diabetes,smoking,and fibrinogen are the independent risk factors for cerebral artery stenosis in patients with acute ischemic stroke.Hypertension and diabetes are the common independent risk factors for simple intracranial and extracranial artery stenosis in patients with acute ischemic stroke.Smoking is an independent risk factor for simple intracranial artery stenosis in patients with acute ischemic stroke.Fibrinogen is a simple independent risk factor for extracranial artery stenosis in patients with acute ischemic stroke.CRP and uric acid may be the inflammatory predictive factors associated with the patients with acute ischemic stroke and cerebral artery stenosis.
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Objective To investigate the correlation of microembolic signals (MES) and outcome in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were enrolled in the study.The MES of middle cerebral artery was monitored dynamically using transcranial color Doppler ultrasound.The early lesions of ischemic stroke were evaluated by MRI.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate neurological deficits.The modified Rankin scale was used to evaluate the outcome,and the stroke recurrence was recorded.Results A total of 135 patients with acute ischemic stroke were enrolled,in which,33 were cardiogenic cerebral embolism,49 were large artery atherosclerotic stroke,24 were small arterial occlusive stroke,and 29 were other clear causes or cryptogenic stroke.Multivariate logistic regression analysis showed that coronary heart disease (odds ratio [OR],5.862,95％ confidence interval [CI] 2.008-17.114; P =0.000) was the independent risk factor for positive MES within 48 hours after stroke onset,while the history of antithrombotic treatment (OR 0.376,95％ CI 0.141-0.998; P =0.045) was its independent protective factor.In addition,coronary heart disease (OR 4.879,95％ CI 1.257-18.939; P =0.033),hypertension (OR 4.958,95％ CI 1.029-23.882; P =0.030),and diabetes (OR 3.659,95％ CI 1.027-13.034; P =0.050) were the independent risk factors for positive MES within 1 week after stroke onset.The NIHSS scores of the patients of the positive MES at baseline and 1 week and the clinical outcome at 3 months had no significant differences with the patients of negative MES,however,stroke recurrence and deaths increased significantly (P =0.019).Conclusions MES within 48 hours of onset was not associated with the outcome in patients with acute ischemic stroke at 3 months,however,the incidence of endpoint events such as recurrence and death was significantly higher in patients of positive MES within 3 months.
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Objective To study the relationship between hyperhomocysteinemia and intracranial and extracranial vascular stenosis in patients with ischemic cerebrovascular disease.Methods 405 patients with ischemic cerebrovascular disease were chosen to detect their serum homocysteine(Hcy) concentrations using automatic biochemical analyzer by enzymatic cycle detection,and the levels of serum folate and Vitamin B12 were detected .The intracranial vascular were detected by Transcranial Doppler, and the extracranial vascular were detected by Color Doppler. The internal carotid arteries(ICA) were classified as normal, mild stenosis(95%). Results Mean serum Hcy concentrations were significantly higher in patients with stenosis of intracranial or (and) extracranial vascular than that in the patients with no arterial stenosis (P0.05). The serum Hcy concentrations were different significantly in patients with different severities of the ICA stenosis and the MCA stenosis (all P0.05). The serum Hcy concentrations were positive correlation with severities of the ICA stenosis and the MCA stenosis(r=0.356, P