摘要:目的:觀察阿托伐他丁對腦梗死大鼠腦保護的作用以及對腦源性神經營養因子(braindeprived neurotrophic factor,BDNF)的影響。方法: 線栓法制備SD大鼠大腦中動脈梗死(middle cerebral artery occlusion,MCAO)再灌注模型。將大鼠隨機分為:假手術組;MCAO組的2 h、24 h、3 d、5 d組;阿托伐他丁組的2 h、24 h、3 d、5 d組。MCAO組和阿托伐他丁組的各時程組再分別分為腦梗死體積亞組、免疫組化亞組,每亞組及假手術組各6只大鼠。在不同時間點觀察阿托伐他丁組和MCAO組大鼠神經行為評分、腦梗死體積,用免疫組化法檢測BDNF陽性細胞數。結果: 神經行為評分和腦梗死體積在阿托伐他丁組和MCAO組的2 h組之間無顯著性差異(Pgt;0.05),在阿托伐他丁24 h、3 d、5 d組均顯著低于對應時程的MCAO組(Plt;0.05);各組缺血半暗帶BDNF陽性細胞數均增高,但阿托伐他丁組的陽性細胞數顯著高于對應時程的MCAO組(Plt;0.05)。結論:阿托伐他丁能提高大鼠局灶腦缺血半暗帶BDNF的表達水平,促進神經元的修復。Abstract: Objective: To observe the effect of atorvastatin in cerebral protection and braindeprived neurotrophic factor(BDNF) in rats. Methods: Ischemic reperfusion model of rats as established by an intraluminal filament and recirculation at different time point respectively. One hundred and two healthy SD rats were randomly assigned into three groups for different preconditioning, including the sham surgery group (SS, n=6), the sham and middle cerebralartery occlusion (MCAO) group (MCAO, n=48), and the atorvastatin and MCAO group (atorvastatin +MCAO, n=48). The latter two groups were further divided into two subgroups on different time points of tests. Each subgroup hase six rats. In the atorvastatin +MCAO group, intragastric administration of atorvastatin was given for five days, then the MCAO followed. In the MCAO group, the MCAO was given directly. The neurophysical marks and the volume of the cerebral infarction in atorvastatin group and MCAO group were determined at different time point. The expression of BDNF was valued by immunohistochemitry respectively. Results: At 2 h, there were no differences in the neurophysical marks and volume of the cerebral infarction between atorvastatin group and MCAO group (Pgt;0.05). At 24 h,3 d,5 d, the neurophysical marks and volume of the cerebral infarction of atorvastatin group were lower than that of MCAO group in the corresponding time (Plt;0.05). Around the necrotic areas,BDNF positive neurons were increased in both groups, but they were higher in atorvastatin group than in MCAO group in the corresponding time (Plt;0.05). Conclusion: Atorvastatin could increase the expression level of BDNF and promote the ischemic neuron to revive.
摘要:目的:觀察銀杏達莫聯合依達拉奉治療急性腦梗死的臨床療效。方法:將50例急性腦梗死患者隨機分為治療組與對照組各25例,均予常規治療,治療組加用依達拉奉注射液30 mg及銀杏達莫注射液20 mL靜滴。兩組均以14 d為一個療程,于治療前、治療結束比較兩組神經功能缺損評分情況。結果:治療組治療顯效率顯著高于對照組。結論:銀杏達莫聯合依達拉奉可有效治療急性腦梗死。Abstract: Objective: To observe the therapeutic effect of Edaravone combined with Gingko Bilobate on acute cerebral infarction. Methods: Fifty cases with acute cerebral infarction were devided into two groups randomly, 25 cases in each. Two groups received routine therapy for 14 days, while in therapeutic group 30 mg Edaravone and 20 mL Ginkgo Bilobate were intravenously drip infused additionally per day. The therapeutic effect was evaluated through scoring of nervous function defect before and after treatment. Results: The obvious effective rate of therapeutic group was superior to the one of the control group (Plt;0.05). Conclusion: Edaravone combined with Gingko Bilobate can treat the patients with acute cerebral infarction effectively.
Objective
To investigate the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and proximal femoral locking compression plate (PFLCP) for intertrochanteric fracture in elderly patients combined with hemiplegia due to cerebral infarction.
Methods
The clinical data of 67 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction between October 2013 and January 2017 were retrospectively analyzed. Among them, 32 cases were treated with PFNA internal fixation (PFNA group), and 35 cases were treated with PFLCP internal fixation (PFLCP group). There was no significant difference in gender, age, injury side, modified Evans classification of fracture, preoperative medical disease, and interval from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative bed time, incidence of perioperative complications, time of fracture healing, and hip Harris score at 6 months and 1 year after operation were recorded and compared.
Results
Both groups were followed up 12-24 months with an average of 14 months. Compared with the PFLCP group, the PFNA group had shorter operation time, less intraoperative blood loss, and shorter bed time, and the differences were significant (P<0.05). X-ray films showed that the fractures healed in both groups. The fracture healing time of the PFNA group was shorter than that of the PFLCP group, but the difference was not significant (t=0.743, P=0.460). During hospitalization, there were 3 cases of pulmonary infection, 2 cases of deep venous thrombosis of lower limbs, and 1 case of urinary tract infection in the PFNA group; and the incidence of perioperative complications was 18.8% (6/32). There were 4 cases of pulmonary infection, 6 cases of deep venous thrombosis of lower limbs, 1 case of recurrent cerebral infarction, and 1 case of stress ulcer in the PFLCP group; and the incidence of perioperative complications was 34.3% (12/35). There was no significant difference in the incidence of perioperative complications between 2 groups (χ2=2.053, P=0.152). At 6 months after operation, the Harris total score and individual scores in the PFNA group were higher than those in the PFLCP group (P<0.05). At 1 year after operation, there was no significant difference in the Harris total score and pain score, life ability score, and walking ability score between the PFNA group and the PFLCP group (P>0.05); However, the joint deformity and activity score of the PFNA group was significantly better than that of the PFLCP group (t=4.112, P=0.000).
Conclusion
For intertrochanteric fracture in elderly patients with cerebral infarction hemiplegia, the PFNA has shorter operative time, less intraoperative blood loss, shorter bed time after operation, and better short-term hip function when compared with the PFLCP.
Objective
To evaluate the clinical efficacy and safety of imported and domestic oxiracetam injection in the treatment of acute cerebral infarction.
Methods
Between March 2013 and July 2014, a multicenter randomized blind controlled clinical study was conducted to learn the clinical efficacy and safety of imported oxiracetam injection (produced by Korea Pharmaceutical Corporation) and domestic oxiracetam injection (named as Oulantong, produced by Harbin Medisan Pharmaceutical Co., Ltd) in the treatment of acute cerebral infarction. West China Hospital of Sichuan University was in charge of the study, and the participants included the People’s Hospital of Guangxi Zhuang Autonomous Region, Affiliated Hospital of Guilin Medical University, Department of Neurology of Jilin Provincial People’s Hospital, the Second Affiliated Hospital of Kunming Medical University, the First Hospital of Lanzhou University, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, the First Affiliated Hospital of Soochow University, the First Affiliated Hospital of Tianjin University of TCM, Chongqing Three Gorges Central Hospital, and the Second Affiliated Hospital of Soochow University. A total of 240 patients with acute cerebral infarction were randomly divided into trial group (basic treatment plus imported oxiracetam injection) and control group (basic treatment plus domestic oxiracetam) with 120 patients in each. Follow-up was conducted 1 week, 2 weeks and 12 weeks after treatment. Finally, 200 patients consistent with the study criteria were included, including 101 in the trial group and 99 in the control group. National Institute of Health Stroke Scale (NHISS), Modified Rankin Scale (mRS) and Barthel Index (BI) were used to evaluate patients’ neurologic impairment, disability degree, life quality and treatment effective rate. Safety indexes included adverse events and life vital signs.
Results
NHISS scores of the trial group and the control group were respectively (7.46±1.99) and (7.20±2.47) points before the treatment, (5.81±2.30) and (5.54±2.58) points one week after the treatment, (3.93±2.40) and (3.79±2.39) points two weeks after the treatment, (1.85±1.63) and (2.08±2.01) points 12 weeks after the treatment. There was no significant difference between the two groups at all time points (P>0.05). BI and mRS grading were not significantly different between the two groups at all time points after the treatment (P>0.05). NHISS score, mRS grading and BI at each time point after the treatment were significantly different from those before the treatment (P<0.05). No significant differences were found between the two groups in the treatment effective rate at each time point (P>0.05). Fifty patients (41.66%) in the trial group had 111 adverse events (92.50%), and 61 (50.83%) in the control group had 145 adverse events (120.83%). There was no significant difference between the two groups (P>0.05). Moreover, most of the adverse reactions were at a mild degree. Life vital signs two weeks after the treatment were not significantly different between the two groups, either (P>0.05).
Conclusion
Imported oxiracetam injection is of similar efficacy and safety with domestic Oulantong injection in the treatment of acute cerebral infarction.
Objective To explore the correlation between DL-3-n-butylphthalide (NBP) and early neurological deterioration (END) after cerebral infarction in real-world study. Methods A multicenter registry observational study was conducted, enrolling patients with acute cerebral infarction within 72 h of onset from five hospitals in Deyang from March 31st, 2019, to July 31st, 2021. The patients were divided into two groups based on the treatment regimen, whether they received NBP in addition to standard therapy or not. The primary endpoint was END after cerebral infarction, and the secondary endpoint was unfavorable outcome (defined as modified Rankin Scale score of 3 to 6) 90 d after onset. Results A total of 314 patients with cerebral infarction were included in the study, among whom, 126 received standard therapy without NBP treatment (standard treatment group) and 188 received NBP in addition to standard therapy (NBP treatment group). A total of 69 cases occurred END within 10 d after admission. In the NBP treatment group, 32 cases (17.0%) had END within 10 d after admission, while in the standard treatment group, 37 cases (29.4%) occurred END, and the difference between the two groups was statistically significant (P=0.010). Logistic regression analyses showed that the influencing factors related to END included the serum neurofilament light chain level on admission [odds ratio (OR)=1.020, 95% confidence interval (CI) (1.004, 1.035), P=0.013], NBP treatment [OR=0.449, 95%CI (0.253, 0.797), P=0.006], and dual antiplatelet therapy [OR=0.373, 95%CI (0.196, 0.710), P=0.003], and the influencing factors for poor neurological functional prognosis in patients with cerebral infarction included age [OR=1.063, 95%CI (1.024, 1.103), P=0.002], National Institute of Health Stroke Scale score on admission [OR=1.532, 95%CI (1.313, 1.787), P<0.001], NBP treatment [OR=0.375, 95%CI (0.177, 0.794), P=0.010], and END [OR=7.450, 95%CI (3.294, 16.852), P<0.001]. Conclusion The results of our study provide the initial evidence that NBP treatment reduces the occurrence of END, and improves the neurological functional prognosis 90 d after onset in the real world.
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 compare the risk factors between multiple cerebral infarction (MCI) and single cerebral infarction (SCI). This would be beneficial for carrying out corresponding prevention and treatment. Methods We prospectively registered consecutive cases of ischemic stroke in the neurological wards and divided them into two groups: MCI group and SCI group according to their clinical and imaging data. Firstly, the single variable analyses of 24 factors that could be related to the onset of MCI were conducted, and then the multivariate non-condition stepwise logistic regression was performed. Results Significant differences were noted between MCI group and SCI group in terms of age, gender, hpertension, diabetes, heart valvular disease, smoking, cerebral infarction history and first systolic blood pressure after admission. The logistic regression analyses showed that factors of age (OR=1.014, 95%CI 1.003 to 1.026), hypertension (OR=1.566, 95%CI 1.185 to 2.068), smoking (OR=1.473, 95%CI 1.052 to 2.061), cerebral infarction history (OR=1.948, 95%CI 1.326 to 2.864) were independent risk factors for MCI. Conclusion Compared to SCI, age, hypertension, smoking and cerebral infarction history were independent risk factors for MCI patients.
Objective To explore the relationship between neurofilament light chain (NfL) level and early neurological deterioration (END) after acute cerebral infarction (ACI). Methods The means of multi-center observational study were adopted to include patients with ACI within 72 hours of onset in 4 hospitals in Deyang between March 31, 2019 and July 31, 2021, to explore the risk factors of END. Results A total of 339 patients with ACI were included in this study, including 131 women and 208 men, aged (68.1±11.6) years. END occurred in 80 patients within 7 days after admission, and the incidence of END was 23.6%. The National Institute of Health Stroke Scale score and NfL level of patients without END were lower than those with END (P<0.05). Cox proportional risk model showed that NfL level [hazard ratio (HR)=1.037, 95% confidence interval (CI) (1.025, 1.050), P<0.001], admission National Institute of Health Stroke Scale score [HR=1.202, 95% CI (1.127, 1.282), P<0.001], initial blood glucose [HR=1.068, 95% CI (1.006, 1.133), P=0.030] were related to the occurrence of END. Conclusion The level of NfL, the severity of stroke, and the bloodglucose at admission are related to the occurrence of END in patients with ACI. Measures can be taken to control the above problems as soon as possible to prevent the occurrence of END.
Objectives
To investigate the risk factors, clinical features, and clinical outcomes of severe cerebral infarction (SCI), and explore the association between different risk factors and outcomes in SCI.
Methods
We prospectively registered consecutive cases of acute ischemic stroke at the neurological wards of West China Hospital, Sichuan University from January 1st, 2008 to May 27th, 2013. Patients with ischemic stroke within 30 days of symptom onset were included. SCI was defined as the score of National Institutes of Health Stroke Scale greater than 15. Data were collected on clinical and biological variables, risk factors for stroke and the presence of comorbidities. The data management and analysis were performed with the SPSS 16.0 package. Univariate and multivariate analysis were used to analyze the predictors of SCI and its outcomes.
Results
Of the 3 364 enrolled cases, 348 (10.3%) were SCI. Compared with non-SCI (NSCI), SCI patients were older, with a lower proportion of males, higher NIHSS scores, lower Glasgow Coma Scale (GCS) scores, and higher proportions of previous heart disease history and previous stroke history, and lower hemoglobin levels on admission. SCI group had a greater proportion of large-artery atherosclerosis (LAA) and cardioembolism (CE) and less proportion of small artery occlusive infarction. After adjustment for the confounders, age [odds ratio (OR)=1.020, 95% confidence interval (CI) (1.010, 1.031), P<0.001], LAA [OR=1.442, 95%CI (1.062, 1.958), P=0.019], and CE [OR=1.919, 95%CI (1.319, 2.793), P=0.001] were independently associated with SCI. The case fatality and case fatality or disability with SCI were 32.1% and 83.3% at the end of 3 months, and 41.8% and 79.3% at the end of 1 year. Among different types, patients with undetermined type had the highest mortality rate, with patients with LAA being the lowest (P≤0.001). There was no significant association between TOAST type and the rate of fatality or disability. Multiple factor analysis showed that the most important independent predictive factor of prognosis was age. Meanwhile, sex and previous stroke history were also the independent predictive factors for death at the 3rd month. Hyperlipidemia, valvular heart disease, and GCS score on admission were independent predictive factors for death/disability at the 3rd month.
Conclusions
Our study indicates that patients with SCI accounted for 10.3% of acute ischemic stroke. The case fatality or disability in SCI patients are higher than those in NSCI patients. The old age, LAA and CE are independent predictive factors of SCI. Age is the most important prognostic factor of patients with SCI.
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.
