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The impact of climate change on the health of elderly individuals is a growing concern.Research has shown that fluctuations in blood glucose levels, resulting from temperature changes, can trigger ischemic stroke in elderly patients.This effect is observed in both high and low temperatures, highlighting the need for effective prevention strategies to mitigate the risk of stroke among vulnerable populations.It is necessary to analyze the seasonal variation of blood glucose fluctuation and its correlation with elderly ischemic stroke, and explore the blood glucose management strategies to cope with temperature change among the elderly population.
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Objective:To investigate the seasonal changes of glycated hemoglobin (HbA1c) in patients with acute ischemic stroke in Tianjin.Methods:Acute ischemic stroke patients with available HbA1c data admitted to the Department of Neurology, the Second Hospital of Tianjin Medical University from January 1, 2011 to December 31, 2020 were enrolled retrospectively. The demographic data, vascular risk factors, baseline clinical data and routine blood test findings were collected. The seasonal changes of various indexes were investigated. Multiple linear stepwise regression analysis was used to determine the influencing factors of HbA1c.Results:A total of 2 721 acute ischemic stroke patients with available HbA1c data were included, of whom 1 779 (65.4%) also had diabetes mellitus, 942 patients (34.6%) did not have diabetes mellitus. The baseline National Institutes of Health Stroke Scale score, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol and uric acid in the winter group were significantly higher than those in the summer group (all P<0.05). HbA1c had seasonal difference in acute ischemic stroke patients without diabetes mellitus ( P<0.05). For acute ischemic stroke patients with diabetes mellitus, HbA1c showed seasonal fluctuations only at HbA1c >7% ( P<0.05). Multiple linear stepwise regression analysis showed that combined with diabetes mellitus, using insulin and/or oral hypoglycemic drugs, fasting blood glucose, uric acid, creatinine and season were the independent infuencing factors of HbA1c. Conclusions:HbA1c in patients with acute ischemic stroke in Tianjin is characterized by seasonal fluctuations, which is high in winter and spring and low in summer and autumn. This difference is related to the level of HbA1c.
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Objective:To investigate the seasonal changes of fasting plasma glucose (FPG) levels in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke who were hospitalized in the Department of Neurology, the Second Hospital of Tianjin Medical University and had fasting blood glucose data from January 1, 2016 to December 31, 2020 were enrolled retrospectively. The general data and FPG results of all patients were collected, and the seasonal changes of various indexes were analyzed. Multiple linear regression analysis was used to determine the influencing factors of FPG.Results:A total of 1 323 patients with acute ischemic stroke who had FPG data were enrolled, of whom 519 patients (39.2%) had diabetes mellitus and 804 (60.8%) had no diabetes mellitus. The baseline National Institutes of Health Stroke Scale score, body mass index, systolic blood pressure, diastolic blood pressure and FPG in the winter group were significantly higher than those in the summer group (all P<0.05). Further subgroup analysis of gender and age showed that the FPG level of elderly patients aged 65-80 years had significant seasonal changes ( P<0.05). Multiple linear regression analysis showed that age, season, body mass index, whether complicated with diabetes mellitus, whether using insulin and/or oral hypoglycemic drugs were the independent influencing factors of FPG levels. Conclusion:The FPG levels in patients with acute ischemic stroke have the characteristics of seasonal fluctuation, which is more obvious in elderly patients aged 65-80 years.
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Objective:To investigate the effects of endoplasmic reticulum(ER)stress on the stability of atherosclerotic plaques in mice by examining the action of lipopolysaccharide(LPS)-induced Toll-like receptor 4(TLR4)on the protein expression levels in the ER stress pathway in atherosclerotic plaques of polipoprotein E gene knockout (ApoE -/-) mice. Methods:From October 2015 to February 2016, 24 ApoE -/-mice were randomly divided into the control group, the LPS group and the TAK group after 10 weeks of high-fat feeding(n=8, each group). After 10 weeks of intervention, peripheral blood was extracted by removing the eyeballs for the measurement of total cholesterol(TC), triglycerides(TG)and oxidized low density lipoprotein(ox-LDL). Then mice were sacrificed to obtain carotid and aortic specimens.Immunohistochemistry was used to detect the expression of carotid plaque macrophages(MOMA-2), smooth muscle actin(α-actin), TLR4, interleukin-1β(IL-1β), interleukin-6(IL-6), tumor necrosis factor-α(TNFα)and nuclear factor-κ-gene binding(NFκB). Western blotting was used to determine the expression of PKR-like eukaryotic initiation factor 2αkinase(PERK), C/EBP-homologous protein(CHOP)and glucose-regulated protein 78(GRP78). Results:The levels of TC, TG and ox-LDL were elevated in the LPS group, compared with the control and TAK groups[(25.0±2.3) mmol/L vs. (20.2±1.6) mmol/L and (20.8±2.6) mmol/L, (1.3±0.1) mmol/L vs.(1.3±0.1) mmol/L and (1.0±0.1) mmol/L, (17.4±1.3) mmol/L vs.(15.8±1.6) mmol/L and (12.1±1.1) mmol/L, P<0.05]. The comparison of plaque morphology and pathology showed that the LPS group had a wider range of atherosclerotic plaques, more macrophages and fewer vascular smooth muscle cells than the control and TAK groups( P<0.05). The expression of TLR4, IL-1β, IL-6, TNFα, NFκB, PERK, CHOP and GRP78 was higher in the LPS group than in the control and TAK groups( P<0.05). Compared with the control group, the expression of PERK, CHOP and GRP78 was lower in the TAK group( P<0.05). The expression of TLR4, PERK, CHOP and GRP78 was higher in the LPS group. Conclusions:LPS-induced TLR4 can up-regulate the expression of proteins in the ER stress pathway, increase the secretion of inflammatory cytokines downstream of the ER stress pathway, aggravate lipid metabolism disorders and increase the instability of atherosclerotic plaques.
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Objective:To investigate the effects of endoplasmic reticulum(ER)stress on the stability of atherosclerotic plaques in mice by examining the action of lipopolysaccharide(LPS)-induced Toll-like receptor 4(TLR4)on the protein expression levels in the ER stress pathway in atherosclerotic plaques of polipoprotein E gene knockout (ApoE -/-) mice. Methods:From October 2015 to February 2016, 24 ApoE -/-mice were randomly divided into the control group, the LPS group and the TAK group after 10 weeks of high-fat feeding(n=8, each group). After 10 weeks of intervention, peripheral blood was extracted by removing the eyeballs for the measurement of total cholesterol(TC), triglycerides(TG)and oxidized low density lipoprotein(ox-LDL). Then mice were sacrificed to obtain carotid and aortic specimens.Immunohistochemistry was used to detect the expression of carotid plaque macrophages(MOMA-2), smooth muscle actin(α-actin), TLR4, interleukin-1β(IL-1β), interleukin-6(IL-6), tumor necrosis factor-α(TNFα)and nuclear factor-κ-gene binding(NFκB). Western blotting was used to determine the expression of PKR-like eukaryotic initiation factor 2αkinase(PERK), C/EBP-homologous protein(CHOP)and glucose-regulated protein 78(GRP78). Results:The levels of TC, TG and ox-LDL were elevated in the LPS group, compared with the control and TAK groups[(25.0±2.3) mmol/L vs. (20.2±1.6) mmol/L and (20.8±2.6) mmol/L, (1.3±0.1) mmol/L vs.(1.3±0.1) mmol/L and (1.0±0.1) mmol/L, (17.4±1.3) mmol/L vs.(15.8±1.6) mmol/L and (12.1±1.1) mmol/L, P<0.05]. The comparison of plaque morphology and pathology showed that the LPS group had a wider range of atherosclerotic plaques, more macrophages and fewer vascular smooth muscle cells than the control and TAK groups( P<0.05). The expression of TLR4, IL-1β, IL-6, TNFα, NFκB, PERK, CHOP and GRP78 was higher in the LPS group than in the control and TAK groups( P<0.05). Compared with the control group, the expression of PERK, CHOP and GRP78 was lower in the TAK group( P<0.05). The expression of TLR4, PERK, CHOP and GRP78 was higher in the LPS group. Conclusions:LPS-induced TLR4 can up-regulate the expression of proteins in the ER stress pathway, increase the secretion of inflammatory cytokines downstream of the ER stress pathway, aggravate lipid metabolism disorders and increase the instability of atherosclerotic plaques.
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Objective@#To investigate the predictive value of mean platelet volume/platelet count ratio (MPV/PC) for short-term outcome in patients with acute noncardioembolic stroke.@*Methods@#Patients with acute noncardioembotic stroke admitted to the Department of Neurology, the Second Hospital of Tianjin Medical University from April 2018 to April 2019 were retrospectively enrolled. According to the modified Rankin Scale (mRS) score at discharge or 14 days after onset, patients were divided into the good outcome group (mRS 0-2) and the poor outcome group (mRS >2). The demographic, baseline clinical data, laboratory findings were collected and compared between the good outcome group and the poor outcome group. MPV/PC values were calculated according to the average platelet volume and platelet count in blood routine. Multivariate logistic regression analysis was used to determine the independent predictive factors of poor outcome. Receiver operating characteristic (ROC) curves analysis was used to evaluate the predictive value of MPV/PC for poor outcome.@*Results@#A total of 596 patients with acute noncardioembolic stroke were enrolled, including 391 (65.60%) with good outcome and 205 (34.40%) with poor outcome. MPV/PC in the poor outcome group was significantly higher than that in the good outcome group (0.06±0.08 vs. 0.04±0.03; t=-4.392, P<0.001). Multivariate logistic regression analysis showed that MPV/PC was an independent predictive factor for the poor outcome (odds ratio 1.088, 95% confidence interval 1.042~1.137; P<0.001). ROC curve analysis showed that the best cut-off value for MPV/PC to predict poor oucotme was 0.050, the area under the curve was 0.772 (95% confidence interval 0.732~0.812), the sensitivity was 62.1%, the specificity was 81.6%, the positive predictive value was 86.3%, and the negative predictive value was 92.2%.@*Conclusion@#MPV/PC is an independent predictive factor for poor short-term outcome in patients with acute noncardioembolic stroke, and has certain predictive value.
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Objective@#To investigate the correlation between meteorological factors and short-term outcomes in patients with acute noncardioembolic stroke.@*Methods@#Patients with acute noncardioembotic stroke admitted to the Department of Neurology, the Second Hospital of Tianjin Medical University from March 2009 to February 2012, were enrolled retrospectively. The modified Rankin Scale (mRS) scores were collected at discharge or 14 d after onset, and good outcome was defined as mRS 0-2 , poor outcome as mRS >2. The demographic, baseline clinical data, laboratory findings, and meteorological parameters on the day of onset were compared between the good outcome group and the poor outcome group. Multivariate logistic regression analysis was used to determine the independent risk factors of short-term outcomes.@*Results@#A total of 868 patients with acute noncardioembolic stroke were enrolled, including 535 (61.6%) with good outcome and 333 (38.4%) with poor outcome. Univariate analysis showed that age, baseline National Institutes of Health Stroke Scale score, systolic pressure, fasting blood glucose, daily average wind speed as well as the proportion of ischemic heart disease, history of stroke or transient ischemic attack, and moderate to severe stroke in the poor outcome group were significantly higher than those in the good outcome group; daily average temperature and daily average relative humidity in the poor outcome group were significantly lower than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that lower daily average temperature (odds ratio 0.978, 95% confidence interval 0.959-0.998; P=0.032) and higher daily average wind speed (odds ratio 1.442, 95% confidence interval 1.065-1.953; P=0.018) were independently correlated with the short-term outcomes.@*Conclusion@#Daily average temperature and daily average wind speed were significantly correlated with the short-term outcomes in patients with acute noncardioembolic stroke.
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Objective To investigate the predictive value of mean platelet volume/platelet count ratio (MPV/PC) for short-term outcome in patients with acute noncardioembolic stroke.Methods Patients with acute noncardioembotic stroke adhnitted to the Department of Neurology,the Second Hospital of Tianjin Medical University from April 2018 to April 2019 were retrospectively enrolled.According to the modified Rankin Scale (mRS) score at discharge or 14 days after onset,patients were divided into the good outcome group (mRS 0-2) and the poor outcome group (mRS ＞2).The demographic,baseline clinical data,laboratory findings were collected and compared between the good outcome group and the poor outcome group.MPWPC values w ere calculated according to the average platelet volume and platelet count in blood routine.Multivariate logistic regression analysis was used to determine the independent predictive factors of poor outcome.Receiver operating characteristic (ROC) curves analysis was used to evaluate the predictive value of MPV/PC for poor outcome.Results A total of 596 patients with acute noncardioembolic stroke were enrolled,including 391 (65.60％) with good outcome and 205 (34.40％) with poor outcome.MPV/PC in the poor outcome group was significantly higher than that in the good outcome group (0.06 ± 0.08 vs.0.04 ± 0.03;t =-4.392,P ＜ 0.001).Multivariate logistic regression analysis show ed that M PV/ PC was an independent predictive factor for the poor outcome (odds ratio 1.088,95％ confidence interval 1.042 ～ 1.137;P＜0.001).ROC curve analysis showed that the best cut-off value for MPV/PC to predict poor oucotme was 0.050,the area under the curve was 0.772 (95％ confidence interval 0.732 ～ 0.812),the sensitivity was 62.1％,the specificity was 81.6％,the positive predictive value was 86.3％,and the negative predictive value was 92.2％.Conclusion MPV/PC is an independent predictive factor for poor short-term outcome in patients with acute noncardioembolic stroke,and has certain predictive value.
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Objective To investigate the correlation between meteorological factors and short-term outcomes in patients with acute noncardioembolic stroke.Methods Patients with acute noncardioembotic stroke admitted to the Department of Neurology,the Second Hospital of Tianjin Medical University from March 2009 to February 2012,were enrolled retrospectively.The modified Rankin Scale (mRS) scores were collected at discharge or 14 d after onset,and good outcome was defined as mRS 0-2,poor outcome as mRS ＞ 2.The demographic,baseline clinical data,laboratory findings,and meteorological parameters on the day of onset were compared between the good outcome group and the poor outcome group.Multivariate logistic regression analysis was used to determine the independent risk factors of short-term outcomes.Results A total of 868 patients w ith acute noncardioembolic stroke w ere enrolled,including 535 (61.6％) with good outcome and 333 (38.4％) with poor outcome.Univariate analysis showed that age,baseline National Institutes of Health Stroke Scale score,systolic pressure,fasting blood glucose,daily average wind speed as w ell as the proportion of ischemic heart disease,history of stroke or transient ischemic attack,and moderate to severe stroke in the poor outcome group were significantly higher than those in the good outcome group;daily average temperature and daily average relative humidity in the poor outcome group w ere significantly low er than those in the good outcome group (all P ＜ 0.05).Multivariate logistic regression analysis showed that lower daily average temperature (odds ratio 0.978,95％ confidence interval 0.959-0.998;P =0.032) and higher daily average wind speed (odds ratio 1.442,95％ confidence interval 1.065-1.953;P =0.018) w ere independently correlated with the short-term outcomes.Conclusion Daily average temperature and daily average wind speed were significantly correlated with the short-term outcomes in patients with acute noncardioembolic stroke.
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Objective To investigate the correlation between anemia and stroke severity and short-term outcome in elderly patients with acute ischemic stroke. Methods Elderly patients with acute ischemic stroke (age≥60 years) admitted to the Department of Neurology, the Second Hospital of Tianjin Medical University between January 2015 and December 2017 were enrolled retrospectively. The demographic and clinical data were collected. The National Institutes of Health Stroke Scale (NIHSS) score at admission was used to evaluate the neurologic deficits, ≤8 was defined as a mild stroke and >8 was defined as moderate to severe stroke. Clinical outcomes were assessed using the modified Rankin Scale (mRS) at discharge or 14 d after onset (whichever occurs first), with 0 to 2 defined as a good outcome and >2 as a poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of the severity and early outcome of stroke. Results A total of 516 patients were enrolled in the study, their age was 74.10 ± 8.64 years, and 291 (56.4% ) were males; 111 (21.5% ) in anemia group and 405 (78.5% ) in non-anemia group, 336 (65.1% ) in mild stroke group, 180 (34.9% ) in moderate to severe stroke group, 303 (58.7% ) in good outcome group, and 213 (41.3% ) in poor outcome group. Univariate analysis showed that the proportion of patients with anemia in the moderate to severe stroke group was significantly higher than that in the mild stroke group (29.4% vs. 17.3% ; χ2 =10.303, P=0.001). The proportion of patients with anemia in the poor outcome group was significantly higher than that in the good outcome group (32.9% vs. 13.5% ; χ2 = 27.687, P< 0.001 ). Multivariate logistic regression analysis showed that anemia was an independent risk factor for stroke severity (odds ratio 3.263, 95% confidence interval 1.446-7.361; P=0.004) and short-term poor outcome (odds ratio 1.928, 95% confidence interval 1.609-2.311; P= 0.029 ). Conclusions Anemia is significantly associated with stroke severity and short-term outcome in elderly patients with acute ischemic stroke.
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Platelets contain a large number of microRNAs (miRNAs),for example,miR-223,miR-126,and miR-191 are highly expressed in platelets,affecting platelet reactivity through different targets.Platelet-associated miRNAs are involved in platelet activation and are associated with the onset risk and outcome of ischemic stroke,and may be a novel marker for early diagnosis and prognostic evaluation of ischemic stroke and provide new therapeutic targets for ischemic stroke.Moreover,platelet-associated miRNAs may play a regulatory role in platelet function and gene expression,and have potential role in evaluating the efficacy of antiplatelet drugs,especially in screening high on-treatment platelet reactivity and high-risk patients as early as possible to guide individualized treatment of antiplatelet drugs.
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Objective To investigate the predictive value of red blood cell distribution width (RDW) for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke received intravenous thrombolysis in the Department of Neurology,the Second Hospital of Tianjin Medical University between January 2017 and December 2018 were enrolled retrospectively.The National Institutes of Health Stroke Scale (NIHSS) score declined ≥4 or the NIHSS score 0-1 in 24 h after thrombolytic therapy was defined as early improvement,and the NIHSS score declined＜4 was defined as no early improvement.Multivariate logistic regression analysis was used to determine the independent risk factors for no early improvement.Receiver operator characteristic (ROC)curve was used to analyze the predictive value of RDW for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke.Results A total of 119 patients were enrolled in the study,46 (38.7％) had early improvement and 73 (61.3％) had no early improvement.Hypersensitive C-reactive protein,RDW,the time from onset to thrombolysis,and the proportion of complicated hypertension and fasting blood glucose in the no early improvement group were higher or longer than those in the early improvement group,and the differences were statistically significant (all P ＜0.05).Multivariate logistic regression analysis showed that the elevated RDW was an independent risk factor for no early improvement (odds ratio 3.119,95％ confidence interval 1.584-6.141;P =0.001).ROC curve analysis showed that the best cut-off value of RDW for predicting no early improvement after intravenous thrombolysis in acute ischemic stroke was 13.35％.The area under the curve was 0.737 (95％ confidence interval 0.645-0.828).The sensitivity and specificity were 64.4％ and 87.0％,respectively.Conclusion Elevated RDW has certain predictive value for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke.
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Objective To investigate the predictive value of peripheral blood neutrophil to lymphocyte ratio (NLR) for early stroke risk after transient ischemic attack (TIA).Methods Patients with TIA admitted to the Department of Neurology,the Second Hospital of Tianjin Medical University from August 2015 to July 2017 were enrolled retrospectively.According to whether or not ischemic stroke occurred within 90 d after the onset of TIA,they were divided into stroke group and non-stroke group.Multivariate logistic regression analysis was used to determine the independent risk factors for early stroke after TIA,and the receiver operating characteristic curve was used to evaluate the predictive value of baseline NLR for early stroke risk after TIA.Results A total of 131 patients with TIA were enrolled.Among them,23 (17.5％) had a stroke within 90 d,mainly within 7 d after the onset of TIA (n =13,56.5％).Univariate analysis showed that the differences between the two groups were statistically significant in terms of age,ABCD2 score,hypertension,duration of symptoms ≥60 min,diabetes,triglyceride,baseline NLR level,intracranial artery stenosis,use of antiplatelet drugs and dual antiplatelet drugs (all P ＜ 0.05).Multivariate logistic regression analysis showed that after adjusting for the confounding factors,the baseline NLR level (odds ratio [OR]2.631,95％ confidence interval [CI] 1.372-5.046;P =0.004) and ABCD2 score (OR 3.049,95％ CI 1.130-8.226;P =0.028) were the independent risk factors for early stroke after TIA,and use of dual antiplatelet agents (OR 0.195,95％ CI 0.046-0.826;P =0.026) were the independent protective factor.The receiver operating characteristic curve analysis showed that when the NLR cut-off value was 2.84,the area under the curve was 0.803 (95％ CI 0.716-0.889),and the sensitivity and specificity of predicting early stroke risk after TIA were 80.8％ and 69.5％,respectively.Conclusion Higher baseline NLR has certain predictive value for early stroke risk after TIA.
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Objective To investigate the influencing factors of short-term and long-term outcomes in patients with acute ischemic stroke. Methods From March 2015 to March 2016, patients with acute ischemic stroke treated at the Department of Neurology, the Second Hospital of Tianjin Medical University were enrolled prospectively. The demographic and baseline clinical data of the patients were recorded. The modified Rankin scale(mRS)was used to assess the short-term outcomes at 14 d and one year after onset. Good outcome was defined as mRS 0-2, and poor outcome was defined as > 2. Death or new cardiocerebrovascular events were recorded.Multivariable logistic regression analysis was used to determine the influencing factors of short-term and long-term outcomes in patients with acute ischemic stroke.Results A total of 514 patients with acute ischemic stroke were enrolled, including 338 (65.8％) with short-term good outcome and 176 (34.2％) with poor outcome. There were significant differences in age, atrial fibrillation, history of past stroke or transient ischemic attack (TIA), etiological typing of stroke, baseline NIHSS score, severity of stroke, pulmonary infection, dysphagia, and urinary incontinence between the short-term good outcome group and the poor outcome group (P<0.05). Multivariable logistic regression analysis showed that history of past stroke or TIA(odds ratio[OR]2.188, 95％ confidence interval[CI] 1.192-4.014;P=0.011),baseline NIHSS score(OR 1.504,95％ CI 1.362-1.661;P=0.001),and urinary incontinence (OR 4.114, 95％ CI 1.934-8.751; P=0.001) were the independent influencing factors of short-term outcome. A total of 467 patients completed 1-year follow-up, including 315 (67.5％)with long-term good outcome and 152(32.5％)with poor outcome.There were significant differences in age,history of ischemic heart disease, stroke or TIA, etiological typing of stroke, baseline NIHSS score, severity of stroke, pulmonary infection, dysphagia, urinary incontinence, secondary prevention of antiplatelet drugs and statins between the long-term good outcome group and the poor outcome group(all P<0.05).Multivariable logistic regression analysis showed that age(OR 1.029,95％ CI 1.004-1.055; P=0.022), past history of stroke or TIA(OR 1.983, 95％ CI 1.082-3.633; P=0.027), baseline NIHSS score (OR 1.271, 95％ CI 1.153-1.400; P=0.001), urinary incontinence (OR 4.996, 95％ CI 2.308-10.813; P= 0.001), and secondary prevention using antiplatelet drugs (OR 0.227, 95％ CI 0.125-0.414; P=0.001) were the independent influencing factors of long-term outcome. The baseline NIHSS score (OR 1.184, 95％ CI 1.070-1.310;P<0.001) and secondary prevention using antiplatelet agents (OR 0.064, 95％ CI 0.014-0.284; P< 0.001) were the independent influencing factors of death or occurring vascular events. Conclusion Age, past history of stroke or TIA, baseline NIHSS score, urinary incontinence, antiplatelet drugs for secondary prevention were independently associated with the outcomes in patients with acute ischemic stroke. Early and targeted intervention of modifiable factors and the emphasis on the use of antiplatelet agents in secondary prevention might reduce stroke recurrence and improve outcomes.
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Objective To investigate the predictive value of early neutrophil to lymphocyte ratio(NLR) in peripheral blood for long-term recurrence of ischemic stroke. Methods Patients w ith first-ever acute ischemic stroke w ere enrolled prospectively. The demographics and baseline clinical data of the patients at admission w ere documented and NLR w as calculated. According to the results of 2-year follow-up, they w ere divided into the recurrence group and the non-recurrence group. Multivariate Cox regression analysis w as used to identify the independent risk factors for stroke recurrence and receiver operator characteristic (ROC) curve w as used to evaluate the predictive value of baseline NLR level for recurrent risk of ischemic stroke. Results A total of 395 patients w ith acute ischemic stroke w ere enrolled, 76 patients had recurrence (19.2%) during the follow-up period. Univariate analysis show ed that there w ere significant differences in age,smoking,hyperlipidemia, atrial fibrillation, baseline National Institutes of Health Stroke Scale (NIHSS) score, total cholesterol, low-density lipoprotein cholesterol, fasting blood glucose, homocysteine, NLR, and discontinuation of statins betw een the recurrence group and the non-recurrence group (all P<0.05). Multivariate Cox regression analysis show ed that the baseline NLR level w as an independent risk factor for the recurrence of ischemic stroke (hazard ratio 1.087,95% confidence interval 1.025-1.363; P=0.021). ROC curve analysis show ed that w hen the baseline NLR cutoff value w as 3.61,the area under ROC curve w as 0.756 (95%confidence interval 0.692-0.821).The sensitivity and specificity of predicting recurrence in patients w ith ischemic stroke w ere 73.7% and 73.0%, respectively. Conclusion The higher baseline NLR has a certain predictive value for recurrence of ischemic stroke.
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Objective To explore the relationship between ambient temperature variation and blood pressure fluctuations in acute ischemic stroke patients.Methods Clinical data of 5 730 ischemic stroke patients hospitalized at the Departments of Neurology and Geriatrics of The Second Hospital of Tianjin Medical University and air temperature data during the corresponding period were retrospectively analyzed.The relationship between air temperature and blood pressure in patients with acute ischemic stroke was analyzed.Results Of 5 730 patients,4 428 (77.28％)had hypertension and most of them were male(56.26％ 3 362 cases).The systolic and diastolic blood pressure levels were higher in hypertensive males than in hypertensive females[(153.9 ± 21.7) mmHg vs.(150.7 ± 23.6)mmHg,(85.9±13.3)mmHg vs.(83.0±12.5)mmHg,1 mm Hg=0.133 kPa,both P＜0.05].The systolic pressure tended to increase and diastolic pressure tended to decrease with increasing age (both P ＜ 0.05).The systolic and diastolic blood pressure levels of patients were slightly higher in autumn and winter than in spring and summer (P ＜ 0.05).The mean monthly maximum and minimum temperature had negative correlations with the systolic blood pressure of patients.There was a linear positive correlation between the average monthly diurnal temperature range and the systolic and diastolic blood pressure.The systolic or diastolic blood pressure increased by 0.088 mmHg or 0.076 mmHg respectively with each 1 ℃ drop in the mean monthly maximum and minimum temperature.The systolic or diastolic blood pressure increased by 1.043 mmHg or 0.654 mmHg respectively with each 1 ℃ increase in the average monthly diurnal temperature range.Conclusions Hypertension is a risk factor for ischemic stroke,and ambient temperature variation is related to baseline blood pressure fluctuations in hypertensive patients with acute ischemic stroke.The temperature reduction and the increase of average diurnal temperature rang can lead to the elevation of blood pressure,which is more obvious in autumn and winter,especially in elderly patients.
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Objective To investigate the correlation between white blood cell count to mean platelet volume ratio (WMR) in peripheral blood and short-term prognosis of large artery atherosclerotic stroke (LAA).Methods From March 2015 to March 2018,patients with acute ischemic stroke admitted to the Department of Neurology,the Second Hospital of Tianjin Medical University were enrolled retrospectively.According to the TOAST etiological classification criteria,they were divided into LAA group and non-LAA group.According to the modified Rankin scale (mRS) score at 14 d after onset,they were divided into short-term good outcome group (0-2) and short-term poor outcome group (＞2).The clinical data,routine laboratory results and WlMR were collected and compared.Multivariatelogistic regression analysis was used to determine the independent risk factors for LAA and its short-term poor outcome.Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of WMR for LAA short-term poor outcome.Results A total of 873 patients with acute ischemic stroke were enrolled,including 447 in the LAA group and 400 in the non-LAA group.WMR in the LAA group was significantly higher than that in the nonLAA group (0.96 ±0.16 vs.0.94 ±0.05;t =-2.397,P =0.017).Multivariate logistic regression analysis showed that WMR was not an independent risk factor for LAA (odds ratio 1.150,95％ confidence interval 0.999-1.325;P =0.052).WMR in the LAA short-term poor outcome group was significantly higher than that in the LAA short-term good outcome group (1.04 ± 0.129 vs.0.87 ± 0.146;t =-13.338,P ＜ 0.001).Multivariate logistic regression showed that WMR was an independent risk factor for LAA shortterm poor outcome (odds ratio 1.242,95％ confidence interval 1.025-1.504;P=0.027).ROC curve analysis showed that the optimal cutoff value of WMR in predicting LAA short-term poor outcome was 0.89,the area under the curve (AUC) was 0.799 (95％ confidence interval 0.755-0.843),the sensitivity was 85％,the specificity was 77.7％,the positive predictive value was 74.04％,and the negative predictive value was 86.93％.Conclusion The increased level of WMR are not independent risk factor for LAA,but are independent associated with poor short-term outcomes in LAA.
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Objective To investigate the correlations of peripheral blood platelet-to-lymphocyte ratio (PLR) with large atherosclerotic (LAA) stroke and its severity.Methods Inpatients with acute ischemic stroke admitted to hospital were enrolkel retrospectively.They were divided into LAA and non-LAA (including cardioembolism,small vessel occlusion,other undetermined etiology,and undetermined etiology) according to the TOAST classification.LAA was further divided into a mild stroke group (score ＜8) and a moderate to severe stroke group (score ≥8) according to the National Institutes of Health Stroke Scale.The general clinical data,laboratory measurements,and PLR were compared.Multivariate logistic regression analysis was used to identify the independent risk factors for LAA and its severity.Results A total of 676 patients with acute ischemic stroke were enrolled,including 391 patients with LAA,224 of them with mild stroke and 167 with moderate to severe stroke;285 with non-LAA,including 94 cardiogenic embolism,137 small vessel occlusion,18 other undetermined etiology and 36 undetermined etiology.PLR in the LAA group was significantly higher than that in the non-LAA group (172.24 ± 70.45 vs.148.37 ± 45.84;t =5.001,P ＜ 0.001).Multivariate logistic regression analysis showed that PLR (odds ratio 1.012,95％ confidence interval 1.004-1.021;P =0.006) was an independent risk factor for LAA.PLR in the mild LAA group was significantly lower than that in the moderate to severe LAA group (149.74 ±47.68 vs.202.42 ± 83.70;t =7.864,P ＜0.001).Multivariate logistic regression analysis showed that PLR (odds ratio 1.025,95％ confidence interval 1.008-1.042;P =0.003) was an independent risk factor for the severity of LAA.Conclusions PLR is associated with LAA and its severity.
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Objective To inves1tigate the needs and influencing factors of patients with cerebrovascular disease and their caregivers in rural areas.Methods An online questionnaire designed by World Stroke Organization for stroke patients and their caregivers was used,and modified appropriately according to China's national conditions.A questionnaire survey about general situation,and needs for psychological support,stroke-related knowledge,diagnosis and nursing,social support,and functional recovery in inpatients with cerebrovascular disease and their caregivers in rural areas was performed.Results A total of 514 patients with stroke and their caregivers (n =514) completed the questionnaires.93.0％ of the patients had the needs for mental support,followed by clinical diagnosis and nursing (84.8％),stroke knowledge (74.7％),social support and functional recovery (53.5％);95.1％ of the caregivers had the needs for mental support,followed by stroke knowledge (89.9％),clinical diagnosis and nursing (84.0％),social support,and functional recovery (66.3％).The degree of need for stroke knowledge,social support,and functional recovery in caregivers was higher than that in the patients (all P ＜ 0.05).Multiple linear regression analysis showed that age,gender,degree of education,the National Institutes of Health Stroke Scale score,and the time from the first stroke onset were the influencing factors of needs for patients with cerebrovascular disease and their caregiver.Conclusions Many needs have not been met in patients with cerebrovascular disease and their caregivers,especially the psychological demand.The regional and individual services should be provided according to the different demands in patients with cerebrovascular disease and their caregivers,enhance the awareness of the prevention and treatment of stroke,and continuously improve the construction of rural health service system.
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Objective To investigate the sleep quality and the risk factors for sleep disorders in population at high-risk for stroke:.Methods A cross-sectional survey was conducted in population at highrisk for stroke:in Water Park and Wangdingdi Communities,Nankai District,Tianjin in March 2016.The residents were divided into either a good sleep group or a sleep disorder group according to the Pittsburgh Sleep Quality Index (PSQI).Multivariate logistic regression analysis was used to determine the risk factors affecting sleep quality.They also divided into a stroke history group and a non-stroke history group according to the high-risk population with or without previous history of stroke.The sleep quality was compared between the 2 groups,and the correlation between sleep disorders and stroke outcomes was analyzed.Results A total of 565 residents at high-risk for stroke were enrolled in the study,and 178 01.5％) had sleep disorders.The age in the sleep disorder group was significantly older than that in the good sleep group (66.70 ±8.97 years vs.62.87 ±9.46 years;t =4.540,P＜0.001).The proportions of female (68.0％ vs.49.1％;x2 =16.190,P ＜ 0.001),hypertension (69.7％ vs.57.9％;x2 =7.154,P =0.005),ischemic heart diseases (48.9％ vs.35.4％;x2 =9.253,P =0.002),history of previous stroke or transient ischemic attack (TIA) (30.9％ vs.18.9％;x2 =10.080,P =0.001),and carotid plaques (71.9 vs.53.7％;x2 =16.688,P ＜0.001) in the sleep disorder group were higher than those in the good sleep group.Multivariate logistic regression analysis showed that after adjusting for age and sex,the history of previous stroke or TIA (odds ratio [OR] 1.712,95％ confidence interval [CI] 1.105-2.653;P =0.016),and carotid plaques (OR 1.583,95％ CI 1.003-2.498;P =0.048) were the dependent risk factors for sleep disorders.The total score of PSQI in patients with previous stroke was significantly higher than that in patients without previous stroke (7.25 ±4.71 vs.6.13 ±4.20,t =-2.578,P =0.010).The sleep latency score (1.24 ± 1.06 vs.0.95 ± 1.02;t =-2.868,P =0.004) and sleep disorder score (1.23 ± 0.63 vs.1.07 ± 0.61;t =-2.622,P =0.009) in patients with previous stroke history were significantly higher than those without.According to the modified Rankin Scale scores,the patients with a history of stroke were divided into a good outcome group (0-2) and a poor outcome group (＞2),including 105 (82.0％) and 23 patients (18.0％),resectively.The proportion of patients with sleep disorders (78.3％ vs.35.2％;x2 =14.251,P＜0.001) and the PSQI score (median and four percentile interval:6 [3-8] vs.12 [8-18];Z =-4.392,P ＜0.001) in the poor outcome group were significantly higher than those in the good outcome group.Conclusions The incidence of sleep disorder is high in the high-risk population,the previous stroke or TIA history and carotid plaques are the independent risk factors for sleep disorder in the high-risk population,and sleep disorder is associated with the poor outcomes of strokes.Therefore,attention should be paid to the sleep quality of this stroke high-risk population and control the risk factors of causing sleep disorders,especially for those with a history of stroke.This will help reduce the risk of stroke.