Objective To analyze the risk factors and etiological classification in young patients with cerebral infarction.Methods From January 2010 to December 2018,5 120 patients with acute cerebral infarction were admitted to neurology ward of Beijing Anzhen Hospital,Capital Medical University.Among them,337 young patients and 337 matched (1:1) middle-aged and old patients were selected.Age,sex,smoking,alcohol consumption,comorbidities of diabetes,dyslipidemia,hypertension,heart disease,stroke,hyper-homocysteine (Hcy) and sleep apnea syndrome were recorded.Risk factors and etiological types of cerebral infarction were analyzed.Results Prevalence rates of cerebral infarction risk factors in young patients from high to low were male,hypertension,smoking history,hyperlipidemia,history of alcohol consumption,hyper-Hcy,diabetes,heart disease history,stroke/family history,hyperuricemia,sleep apnea syndrome and migraine.Prevalence rates of cerebral infarction risk factors in middle-aged and old patients from high to low were hyperlipidemia,hypertension,male,smoking history,diabetes,heart disease history,stroke/family history,history of alcohol consumption,hyper-Hcy,hyperuricemia,sleep apnea syndrome and migraine.Proportions of male,smoking history,history of alcohol consumption and hyper-Hcy in young patients were higher while the proportions of hypertension,diabetes,hyperlipidemia,heart disease history,stroke/family history were lower than those in middle-aged and old patients [81.9％ (276/337) vs 70.3％ (237/337),64.4％ (217/337) vs 49.3％ (166/337),38.3％ (129/337) vs 23.7％ (80/337),37.4％ (126/337) vs 18.4％ (62/337);66.2％ (223/337) vs 78.9％ (266/337),25.2％(85/337) vs 40.4％ (136/337),49.3％ (166/337) vs 81.0％ (273/337),16.3％ (55/337) vs 37.7％ (127/337),12.5％ (42/337) vs 32.6％ (110/337)] (all P ＜ 0.05).Atherosclerosis type of cerebral infarction took the highest ratio among young patients;small artery occlusion type accounted for 32.0％ (108/337);unexplained type accounted for 12.8％ (43/337);cardiogenic type accounted for 10.1％ (34/337).Males took a large ratio in young patients with unexplained type of cerebral infarction.Among middle-aged and old patients,atherosclerosis type and small artery occlusion type of cerebral infarction accounted for high ratios.Conclusions Young men are more likely to suffer from cerebral infarction than women.Cerebral infarction in young adults are associated with various risk factors.Atherosclerosis type of cerebral infarction is the most common etiological type.It is of great significance for the prevention and treatment of young stroke to strengthen health education on smoking and alcohol cessation,promote healthy diet and raise the awareness of stroke risk factors among young people.

Aim Spontaneous subarachnoid haemorrhage (SAH) caused by ruptured cerebral aneurysm is a severe subtype of haemorrhagic stroke. Although the incidence of SAH is relatively low among all cerebrovascular diseases, the mortality is the highest. The critical management of SAH is challenging. We provide this evidence-based guideline to present current and comprehensive recommendations for the diagnosis and treatment of non-trauma SAH. Methods A formal literature search of MEDLINE (1 January 1990-30 June 2019) was performed. Data were synthesised with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The Chinese Stroke Association's levels of evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by Chinese Stroke Association's Stroke Fellow Committees. It is intended that this guideline be fully updated every 3 years. Results Evidence-based guidelines are presented for the care of patients presenting with non-trauma SAH. The focus of the guideline was subdivided into transfer and systems of care, diagnosis flowchart, aetiology and differentiation, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, management of vasospasm and delayed cerebral ischaemia, management of hydrocephalus, management of seizures and management of medical complications. Conclusions The guideline offers a framework for SAH management. Early professional and aggressive care of SAH might help dramatically.

我们为什么会中暑—— 高温、高湿、无风是主因 中暑是夏季常见病,是人体在高温、高湿、无风的环境下,由于水和电解质丢失过多、机体散热功能衰竭而引起的以中枢神经和心血管功能障碍为主要表现的热损伤性疾病. 引起中暑的主要原因是高温、高湿、无风的环境,在日最高气温达到35℃以上的高温天气或环境中,中暑的病人会明显增多.中暑还与空气湿度有关,如果湿度过大,即使气温不到35℃,也会发生中暑.所以,夏天人们不要在太阳底下暴晒,并采取科学的防暑措施.需要注意的是,有些人即使呆在空调房间里也会中暑,这可能与房间不通风并频繁出入空调房间有关.

目的 了解缺血性脑卒中患者血压控制及降血压药物使用情况,分析影响降压药物使用的因素.方法 选择2014年1～12月连续收住我院神经内科病房的住院且确诊为缺血性脑卒中和短暂性脑缺血发作患者总计740例,将360例复发性脑卒中纳入分析,高血压314例(87.2％),糖尿病142例,对入选患者血压控制及降血压药物使用情况进行调查.结果 314例高血压患者中,血压达标率为28.3％;142例糖尿病患者中,血压达标率为9.2％.314例高血压患者,服用任1种抗高血压药物248例,药物治疗率79.0％,有21.0％未服用任何降压药物.2型糖尿病、冠心病、吸烟、饮酒、服用抗血小板药物与降压药物治疗有关(P＜0.05).冠心病(OR=0.275,95％CI:0.094～0.804,P=0.018)及服用抗血小板药物(OR=0.547,95％CI:0.310～0.966,P=0.038)是影响患者降压治疗的独立危险因素.结论 缺血性脑卒中患者血压控制达标率与指南要求存在差距,伴糖尿病患者血压控制达标率更不理想,应加强脑卒中患者血压控制.

Objective To study the characteristics of ambulatory blood pressure(ABP) in hypertensive patients with carotid atherosclerosis and their clinical significance.Methods ABP was monitored in 111 hypertensive patients with carotid atherosclerosis.The patients were divided into plague group(n = 66) and non-plague group(n = 45) according to their carotid artery ultrasongraphic findings.The plague group was further divided into single plaque group(n= 24)and multiple plaque group(n= 42)and their ABP was compared.Results The average 24 h,day and night SBP,DBP,and arterial pressure,non-spoon type blood pressure were significantly higher in plague group and multiple plaque group than in non-plague group and single plague group(P0.05). Conclusion Continuous blood pressure elevation is an important factor for the occurrence of carotid atherosclerosis.Carotid artery plaque is easier to cause circadian rhythm disorders of blood pressure.

动脉粥样硬化是一种基因和环境共同作用导致的复杂疾病,DNA甲基化是一种重要的表观遗传修饰调控机制,由环境因素导致,并可通过有丝分裂遗传下去.目前已有研究表明,DNA甲基化在动脉粥样硬化疾病的发生发展过程中起到至关重要的作用.本文综述了DNA甲基化在动脉粥样硬化方面的研究进展.

阿尔茨海默病(Alzheimer's disease,AD)是最常见的神经系统退行性疾病.流行病学调查结果显示,2010年全世界痴呆患者约为3560万,并以每20年翻1倍的速度增长,预计2030年将达到6570万,2050年达到1.154亿.痴呆患者中AD的比例为50％～75％[1].近年来研究发现,胰岛素抵抗和2型糖尿病可能与AD的高发病率具有相关性.有学者认为,AD是一种神经内分泌紊乱疾病,甚至称之为3型糖尿病.目前,AD公认的病理机制包括β淀粉样肽沉积、tau蛋白过度磷酸化和氧化应激等,但最新的研究表明,胰岛素信号转导通路障碍可能是AD的发病机制之一,这个结论也支持AD是神经内分泌疾病[2].目前认为,β淀粉样多肽寡聚体是导致胰岛素信号转导通路障碍的神经毒性物质[3].充分理解AD的神经内分泌紊乱机制和3型糖尿病的新观点,可以为诊断和治疗AD提供新思路,为干预具有胰岛素抵抗的肥胖患者提供新的依据.

<正>卒中是发病率、致残率和死亡率都很高的常见病之一。目前,卒中已成为全球60岁以上人群的第二大死因。在我国,卒中已取代冠状动脉粥样硬化性心脏病成为死亡和成年人残疾的主要原因。我国每年新发卒中约250万例,每年约有160万人死于卒中,存活患者750万例,卒中复发率达11.2%。我国每年用于卒中的医疗支出达400亿元人民币,是心血管疾病医疗费用的10倍,严重影响我国的经济发展。世界卫生组

<正>1高血压与卒中卒中是神经科最常见的疾病,而高血压是已被许多研究证实的卒中独立危险因素,是脑血管病患者的第一杀手。卒中二级预防中控制血压可减少卒中的复发,并且血压管理对于卒中患者的康复至关重要。1.1流行病学过去40年间全球卒中发病率差别加大,高收入国家卒中发病率减少42%,低或中等收入国家增加100%。从2000年到2008年,中低等收入国家卒中的发生首次超过高收

<正>他汀类药物在脑卒中患者中的应用,既往多是在冠心病人群中进行的一级预防研究。虽然,这些研究一致证实,他汀类药物用于脑卒中一级预防能降低脑卒中风险,但对于已经罹患缺血性脑卒中的患者,他汀类药物作用如何,一直不得而知。心脏保护研究(HPS)的脑卒中和(或)短暂性脑缺血发作(TIA)亚组分析,同样未能支持脑卒中患者应使用他

张茁:眩晕有旋转感,而头晕没有.有人认为,若颈椎X线片发现骨质增生,就是颈椎病导致的脑供脑不足,每年定期输液可以预防并治疗头晕,这个观点是绝对错误的,没有任何科学证据.45岁以上的正常人拍颈椎X线片都会有骨质增生,但不是所有人都会有后循环缺血,只有椎动脉粥样硬化的病理基础才可能导致后循环缺血,那些觉得输液后症状好转多数是患者的心理作用.目前国际上广泛用后循环缺血替代脑供血不足这一提法.

Objective To summarize the short-term efficacy and applied experience of carotid endarterectomy(CEA) in symptomatic carotid artery stenosis.Methods A total of 40 patients with symptomatic carotid artery stenosis to receive CEA were recruited in this study.All the patients had clinical symptoms of cerebral ischemia.The carotid atheromatous plaque and carotid stenosis were first screened by carotid Doppler ultrasonography and transcranial Doppler (TCD), then conformed respectively through enhanced magnetic resonance angiography (CE-MRA),CT angiography (CTA),digital subtraction angiography (DSA).The degrees of carotid artery stenosis of extracranial segment were all equal to or more than 70%.In them,5 cases combined ulcer lesion,and 1 case combined one-lateral internal carotid stenosis and another lateral internal carotid complete occlusion.CEA operation was carried out under general anesthesia using endotracheal intubation combined cervical plexus block.Carotid temporal shunting tube was used in all cases.Patch angioplasty was performed in 32 cases.Results No perioperative deaths happened.Thirty-one cases had significant improvement of ischemic cerebral symptom,and 9 cases had certain improved.Postoperative hyper-perfusion syndrome and hemodynamic instability happened separately in 1 case.The complications of perioperative period of symptomatic carotid artery stenosis were 5.0% consistent with the standard of American Heart Association (AHA) equal to or less than 6%.All cases were followed up.No vascular restenosis happened during re-examination of double lateral cervical vascular ultrasonography at 6 weeks and 3 months after operation.Conclusions CEA is a safe and effective treatment method for symptomatic carotid artery stenosis.

Objective To observe the dynamic changes of adiponectin after the onset of acute stroke and the relationship between adiponectin and atherosclerotic plaque,and to discuss the clinical significance. Methods A total of 40 acute stroke patients(stroke group) were chosen to determine 24-hour and 72-hour adiponectin and hs-CRP levels.Other 40 healthy normal subjects served as controls.According to the properties of the carotid plaques,the stroke patients were divided into three groups including soft plaque,hard plaque and mixed plaque groups.The levels of adiponectin in the patients of different groups were compared.Results The levels of adiponectin of patients in acute stroke group at 21 hours and 72 hours after onset of disease obviously decreased compared with the control group,but hs-CRP levels obviously increased.The level of adiponectin of patients in acute stroke group at 72 hours obviously decreased compared with at 24 hours after onset of disease,but hs-CRP levels obviously increased.The adiponectin levels in different plaque groups had no statistically significant difference.Conclusion The decrease in adiponectin level has close correlation with the occurrence of the stroke.Once atherosclerosis is formed,the course of progress of plaque does not depend on the level of adiponectin.

Objective To investigate the value of acute physiology and chronic health evaluationⅡ(APACHEⅡ) in assessing the death risk of emergency and critical stroke patients in intensive care unit of neurology department(NICU).Methods One hundred and forty-three consecutive patients with acute stroke at NICU were enrolled in this study between November 2008 and November 2009.The data of physiological factors were collected in the first twenty-four hours after admission to hospital.The average scores of APACHEⅡwere compared between the dead patients and the surviving patients.The prediction of mortality by APACHEⅡwas evaluated.Results The average scores of APACHEⅡwere(22.3±5.9) in dead patients and(9.5±4.5) in surviving patients,with significant t test result(P0.05).The expectative mortality calculated with APACHEⅡwas in accordance with real mortality.Conclusion The use of APACHEⅡin evaluation of prognosis of patients in NICU is feasible.

目的 观察阿托伐他汀对急性脑梗死患者血清基质金属蛋白酶-9 (matrix metalloproteinase-9,MMP-9)的影响.方法 入选急性脑梗死患者128例,根据入院后颈动脉彩超结果,分为颈动脉粥样硬化(atherosclerosis,AS)稳定斑块组51例、颈动脉AS易损斑块组46例,无斑块组31例.各组给予阿托伐他汀20mg/d口服干预治疗,疗程2周.比较治疗前及治疗2周后患者血清MMP-9水平变化.结果 ①治疗前易损斑块组和稳定斑块组血清MMP-9浓度分别为(419.93±113.12)μg/L和(271.45±80.34) μg/L,均高于无斑块组(147.36±23.62) μg/L,易损斑块组也高于稳定斑块组(均P＜0.01).②阿托伐他汀治疗2周后易损斑块组、稳定斑块组及无斑块组血清MMP-9水平分别下降至(242.58±101.63)μg/L、091.36±79.-8) μg/L和(126.72±22.86) μg/L,与本组治疗前相比,差异具有统计学意义(均P＜0.01).结论 急性脑梗死患者中血清MMP-9的水平与AS斑块的发生和稳定性相关,阿托伐他汀治疗能显著降低急性颈内动脉系统脑梗死患者MMP-9水平.

Objective To analyze the incidence,risk factors of stroke-associated pneumonia(SAP) in elderly inpatients of the neurological intensive care unit.Methods We retrospectively investigated 148 elderly acute stroke in patients(age≥60) of the neurological intensive care unit in Beijing Anzhen Hospital between January 2008 to December 2010.The patients were divided into SAP group(90 cases) and non-SAP group(58 cases).The incidence,risk factors and etiology of the stroke associated pneumonia were discussed.Results The SAP incidence of elderly inpatients of neurological intensive care unit was 60.8%.Logistic regression analysis showed that senility, smoking,prolonged bed rest,critical neurological impairment,impaired consciousness,dysphagia, mechanical ventilation and stem infarction of middle cerebral artery were the risk factors for SAP. The mortality in the SAP group(33 of 90,36.7%) was much higher than the non-SAP group(4 of 58,6.9%,P0.01).Conclusions SAP was one of the most critical complications after stroke. Elderly critical patients were more susceptible to SAP that resulted in high mortality.The clinicians should pay high attention to SAP.

降低高血压患者的血压能够有效减少卒中事件,包括一级预防与二级预防,都已经被证实了.在降压的幅度之外,如何能更有效的减少卒中的发生,成为近期学术探讨的热点. 2010年3月,牛津大学的Peter M Rothwell教授在Lancet杂志上发表了一篇重量级综述-<通常血压假说的局限性与血压变异性、不稳定性及阵发性高血压的重要性>,提出平均血压具有一定的局限性,血压的不稳定性和变异性与心脑血管事件也密切相关.

Aim As atherosclerosis developed,it will rupture or plug the vascular lumen when reached a certain extent,thus can affect the blood flow.Atherosclerotic plaque can always be found in carotid artery in which blood flow will supply our brain.Flow reduction will result in a stroke.Carotid endarterectomy(CEA) is one surgical method which will remove the plaque in the carotid artery through surgical method.So that can restore blood flow and prevent stroke.This article describes the development of CEA,evidence-based way,risks and complications,so that will help more clinicians to have a better understand the CEA as well as the relationship between ischemic stroke,thus encourage them to continue to promote this new technology in China.

Objective To investigate the secondary prevention of ischemic stroke drug treatment compliance and impact of anti-platelet drug compliance factors.Methods From August 2007 to September 2007,ischemic stroke or TIA patients who were admitted into internal medicine of neurology wards of 21 Hospitals in Beijing,a total of 541 recurrent stroke patients who were analyzed,retrospectively.Results There were 541 recurrent stroke patients.Uses of antiplatelet,antihypertension,antidiabetic and lipid-lowering therapy 58.4%,82.3%、85.3% and 14.2%,respectively.Age≥60(P=0.011),retirement (P=0.021),history of stroke (P<0.001),history of angina (P=0.001),history of myocardial infarction (P=0.037) and history of hypertension(P=0.016)was associated with anti-platelet drug compliance.Conclusions The present investigation has revealed a low drug compliance for secondary prevention of ischemic stroke,suggesting that the current status of secondary prevention of recurrent stroke is far from ideal.

Objective We aimed to test the differences of the plasma total homocysteine(tHcy)levels,cerebrovascular risk factors between patients with and without obvious leukoaraiosis. Methods 200 elderly hospitalized patients were investigated. 97 and 103 were demonstrated with and without marked leukoaraiosis by MRI. The severity and distribution pattern of leukoaraiosis were classified. The tHcy levels and the risk factors were compared between leukoaraiosis cases and controls. Results Leukoaraiosis of moderate degree(ARWMC score 2)was more prevalent. The distribution of leukoaraiosis was the most marked in the deep white matter,secondary to periventricular,and basal ganglia area was the least. The incidence of hypertension,previous stroke and tHcy levels were higher in leukoaraiosis cases than those of controls(P0.05). Conclusion Leukoaraiosis frequently co-existed with several cerebrovascular risk factors.