Predictive value of serum lipoprotein-associated phospholipase A 2for the outcome in patients with large atherosclerotic stroke / 国际脑血管病杂志

Objective To investigate the predictive value of serum lipoprotein-associated phospholipase A2(Lp-PLA2) for the outcomes in patients with large atherosclerotic stroke (LAA). Methods Patients with LAA admitted to the Second People's Hospital of Lianyungang from March 2015 to January 2018 were enrolled retrospectively. The outcomes were evaluated by the modified Rankin Scale at 90 d after onset, 0-2 was defined as good outcome. Multivariate logistic regression analysis was used to identify the independent risk factors for poor outcome. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of Lp-PLA2for outcomes. Results A total of 121 patients with LAA were enrolled, including 64 males (52.9%) and 57 females (47.1%), aged 63.5 ±9.5 years; 72 (59.5%) had good outcome and 49 (40.5%) had poor outcome. The differences were statistically significant in the proportion of diabetic patients (26.4% vs.65.3%; χ2=18.110, P<0.001) and glycated hemoglobin ( 6.39% ±2.33% vs. 7.58% ±3.12%; t=1.663, P=0.041), baseline National Institutes of Health Stroke Scale (NIHSS) score (5 [3-6] vs.10[7 -14]; Z= -7.498, P< 0.001), and Lp-PLA2(194.7 ±84.3 μg/L vs.291.4 ± 82.6 μg/L; t= -5.447, P<0.001) between the good outcome group and the poor outcome group. Multivariate logistic regression analysis showed that diabetes ( odds ratio [ OR] 1.215, 95% confidence interval [CI] 1.102-1.601; P=0.046), glycosylated hemoglobin ( OR 2.275, 95% CI 1.065-4.865; P=0.037), baseline NIHSS score ( OR 2.113, 95% CI 1.585-2.734; P=0.015), and Lp-PLA2(OR 5.183, 95% CI 3.203-8.134; P<0.001) were the independent risk factors for poor outcomes in patients with LAA. ROC analysis showed that the area under the curve of Lp-PLA2predicting poor outcome was 0 .792 (95% CI 0.713-0.872); the optimal cut-off value was 260.5 μg/L, the sensitivity for predicting poor outcome was 79.6%, and the specificity was 84.7%. Conclusion The higher serum Lp-PLA2level is an independent predictive factor for poor outcome in patients with LAA. It has a higher predictive value for poor outcome.

Effects of preventive antidepressant application on prognosis and serum BDNF level of acute cerebral infarction / 重庆医学

Objective To investigate the effect of preventive antidepressants application on the prognosis of and serum brain derived neurotrophic factor(BDNF) level in acute cerebral infarction(ACI).Methods One hundred and forty-one patients with ACI were prospectively and randomly selected.Seventy-two cases in the intervention group was added with sertraline for 12 weeks on the basis of the routine therapy,while 69 cases in the control group only used the routine therapy.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the nervous function impairment degree and daily living ability.The Hamilton Depression Rating Scale-17 was used to evaluate the emotion after stroke.The cognition function was evaluated by the Mini-Mental State Examination (MMSE).The BDNF level was detected by using the double antibody sandwich enzyme-linked immunosorbent assay.Results The NIHSS and HAMD scores after 3-month treatment were (1.77±0.58)points and (5.43±1.77)points in the intervention group,and (4.06±0.79)points and(10.27±3.78)points in the control group,which were significantly decreased compared with before treatment(P＜0.05);the BI value in the intervention group and control group were (96.24±4.58) and (77.64±6.96),which weresignificantly increased compared with before treatment (P＜0.05),and serum BDNF levels were (8.38±0.74)ng/mL and (5.72 ±0.67)ng/mL respectively,which were significantly increased compared with before treatment,moreover the change in the intervention group was more obvious than that in the control group (P＜0.05).The MMSE score had no statistical difference between the two groups (P＞0.05).The PSD occurrence rate was 10.0％ in the intervention group,which was significantly decreased compared with 53.6％ in the control group (P＜0.05).Conclusion Preventive antidepressants application in the patients with ACI can increase the serum BDNF level,improves the prognosis and is worth promotion and application.

Recurrent stroke in patients w ith right-to-left shunt and cryptogenic stroke / 国际脑血管病杂志

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.

Correlation between plasma homocysteine level and intra/extracranial stenosis in patients with ischemic Stroke / 国际脑血管病杂志

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.

Distribution and risk factors of cerebral artery stenosis in patients with acute ischemic stroke / 国际脑血管病杂志

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.

The correlation between copeptin and clinical severity and prognosis in acute cerebral infarction / 重庆医学

Objective To explore the ability of copeptin to predict infarction severity and prognosis after 3 months in patients with acute cerebral infarction .Methods One hundred and thirty‐eight consecutive patients were included with an acute cerebral in‐farction and admitted to the hospital within 72 h .Plasma copeptin levels were measured by double antibody enzyme linked immu‐nosorbent assay and neurological impairment were evaluated by the national institutes of health stroke scale score (NIHSS) after hospitalization .The patients were divided into mild ,moderate and severe groups according to NIHSS score .At the same time ,60 healthy adults were selected as control group .Unfavorable outcome was defined as a modified rankin scale score>2 .The correlation of plasma copeptin levels with 3 month unfavorable outcome was analyzed .Results Upon admission ,plasma copeptin level in pa‐tients was statistically significantly higher than that in healthy controls (P<0 .01) ,the highest was found in severe subgroup (P<0 .05) .Multivariate logistic regression analysis revealed that copeptin was independently associated with unfavorable outcome within 3 months (OR=4 .403 ,95% CI:1 .120-8 .328 ,P<0 .05) .Conclusion Copeptin levels contribute to mirror the initial infarction se‐verity and even bear an association with poor outcome of patients with cerebral infarction within 3 months .

Microembolic signals and outcome in patients with acute ischemic stroke: a prospective case series study / 国际脑血管病杂志

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.

Etiology of intestinal nutrition related diarrhea and its nursing / 中国实用护理杂志

Objective Aims To analyze the etiology of intestinal nutrition related diarrhea and to study its nursing. Method The rate and etiology of intestinal nutrition related diarrhea of 180 patients receiving intestinal nutrition through traditional nasal way from 2002 to 2003 year 180 patients(A group) was analysed retrospectively and new nursing was studied.From 2004 to 2005 year,202 patients(B group) received intestinal nutrition through nutrition pump and intensive nursing.The intestinal nutrition related diarrhea rate of two groups was compared. Results The diarrhea rate of B group was insignificantly lower than that of A group(P