Background and purpose Multiple factors play important roles in the occurrence and prognosis of stroke. However, the roles of monogenic variants in all-cause ischaemic stroke have not been systematically investigated. We aim to identify underdiagnosed monogenic stroke in an adult ischaemic stroke/transient ischaemic attack (TIA) cohort (the Third China National Stroke Registry, CNSR-III).Methods Targeted next-generation sequencing for 181 genes associated with stroke was conducted on DNA samples from 10 428 patients recruited through CNSR-III. The genetic and clinical data from electronic health records (EHRs) were reviewed for completion of the diagnostic process. We assessed the percentages of individuals with pathogenic or likely pathogenic (P/LP) variants, and the diagnostic yield of pathogenic variants in known monogenic disease genes with associated phenotypes.Results In total, 1953 individuals harboured at least one P/LP variant out of 10 428 patients. Then, 792 (7.6%) individuals (comprising 759 individuals harbouring one P/LP variant in one gene, 29 individuals harbouring two or more P/LP variants in different genes and 4 individuals with two P/LP variants in ABCC6) were predicted to be at risk for one or more monogenic diseases based on the inheritance pattern. Finally, 230 of 792 individuals manifested a clinical phenotype in the EHR data to support the diagnosis of stroke with a monogenic cause. The most diagnosed Mendelian cause of stroke in the cohort was cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. There were no relationships between age or family history and the incidence of first symptomatic monogenic stroke in patients.Conclusion The rate of monogenic cause of stroke was 2.2% after reviewing the clinical phenotype. Possible reasons that Mendelian causes of stroke may be missed in adult patients who had an ischaemic stroke/TIA include a late onset of stroke symptoms, combination with common vascular risks and the absence of a prominent family history.

Objective This study aimed to explore whether cerebrovascular disease clinical decision support system(CDSS)could improve the key performance indicators of medical care quality. Methods In our study,ischemic stroke patients hospitalized in Ward 2 of Vascular Neurology,Beijing Tiantan Hospital,Capital Medical University before applying cerebrovascular disease CDSS(January to November 2020)were retrospectively included as the control group.Ischemic stroke patients admitted after the application of CDSS assisted diagnosis and treatment(January to November 2021)were included as the intervention group.The baseline characteristics and key performance indicators of medical care quality for ischemic stroke in these two groups were compared to assess the impact of cerebrovascular disease CDSS on medical care quality of stroke. Results A total of 1331 patients were included in this study,including 651 in the control group and 680 in the intervention group.The mean age of the control group was(71.7±11.8)years,with 490 males(75.3％),and the mean age of the intervention group was(72.3±10.2)years,with 498 males(73.2％).Among the key performance indicators of medical care quality of ischemic stroke,the proportion of patients who were unable to walk within 48 h of admission received deep vein thrombosis prevention(86.3％vs.65.0％,P<0.01),the rate of patients who were discharged with antithrombotic therapy(98.1％vs.96.2％,P=0.03),and the rate of patients with atrial fibrillation with anticoagulation therapy(70.1％vs.44.2％,P<0.01)in the intervention group were higher than those in control group. Conclusions Cerebrovascular disease CDSS can improve the key performance indicators of medical care quality in patients with ischemic stroke.

目的 探究低分子右旋糖酐扩容治疗急性脑梗死的有效性及安全性.方法 选取江苏省常州市武进中医医院 2018 年 2 月至 2022 年 2 月收治的 160 例急性脑梗死患者,按照随机数字表法将其分为研究组和对照组,各80例.对照组予以常规治疗+阿托伐他汀钙治疗,研究组予以低分子右旋糖酐扩容治疗.两组均治疗 1周后评估疗效,比较两组血清白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平,比较两组日常生活能力量表(ADL)、Barthel指数(BI)、认知功能蒙特利尔认知评估法(MOCA)评分及两组不良反应发生情况.结果 研究组临床疗效优于对照组,差异有统计学意义(P＜0.05).治疗 1周后,两组TNF-α、IL-6、水平均低于治疗前,且研究组低于对照组,差异有统计学意义(P＜0.05).治疗 1周后,两组MOCA、ADL、BI评分均高于治疗前,且研究组高于对照组,差异有统计学意义(P＜0.05).两组不良反应总发生率比较,差异无统计学意义(P＞0.05).结论 低分子右旋糖酐扩容治疗急性脑梗死,有助于促进患者快速康复,降低炎症水平,改善认知功能,提高生活质量,安全可靠.

临床预测模型在大数据与精准医学时代对精准风险分层、个性化诊疗和管理愈发重要.现有的缺血性卒中复发风险预测模型在开发队列人群、预测因子、预测结局、开发方法以及预测性能上存在较大差异.此外,开发方法上的缺陷、报告内容上的不完整以及外部验证和模型影响研究的缺失,使其临床应用效果受限.因此,后续的临床预测模型研究,一方面,应重视现有模型的验证和评价;另一方面,在开发新预测模型时,在预测因子的选取、模型的选用和拟合、展示方式及结果报告上,应遵循相应的方法学规范,以提高预测性能.

目的 本研究自发性颈动脉夹层涉及自发性颈总动脉分叉夹层(spontaneous common carotid artery bifurcation dissection,sCCABD)及自发性颈内动脉夹层(spontaneous internal carotid artery dissection,sICAD),对与此相关的缺血性卒中颅内缺血病灶分布特征与受累血管节段间的关系进行分析.方法 本研究为单中心回顾性研究,连续入组2014年12月1日—2021年11月15日住院的sCCABD及sICAD相关缺血性卒中患者,收集患者一般临床资料、既往病史、影像学特征等信息.将患者分为颅内无梗死病灶组、单发梗死病灶组和多发梗死病灶组3组,比较不同组患者的影像学特征、受累血管部位及节段数等的差异.结果 研究纳入sCCABD及sICAD相关缺血性卒中患者17例,其中无梗死病灶组2例,单发梗死病灶组4例,多发梗死病灶组11例.无梗死病灶组夹层发生于C1升段(2例)、C2段(1例)、C3段(1例)、C4段(1例),单发梗死病灶组夹层在C1升段(5例)最多见,多发梗死病灶组夹层多发生于C1升段(5例)和C3段(5例),C2段(4例)、C1球部(3例)和C4段(3例)次之,颈总动脉分叉(1例)和C5段(1例)最少.脑梗死灶分布模式:单发梗死病灶组表现为区域性梗死(2例)、局部梗死(1例)、深部较大梗死(1例);多发梗死病灶组以内分水岭梗死(4例)、区域性梗死(3例)最多见,局部梗死(2例)、深部较大梗死(2例)次之,浅表小面积梗死(1例)、深部较小梗死(1例)最少.结论 本研究sCCABD及sICAD相关缺血性卒中患者以多发脑梗死居多,血管夹层多发生于C1升段和C3段,C1球部、C2段和C4段次之,颈总动脉分叉和C5段最少,球部可以受累或闭塞,颅内缺血病灶的多少与受累血管节段数量间的关系还不明确,还需进一步积累病例深入探讨.

1 病例介绍和诊疗思路 患者男性,59岁,主因"突发左侧肢体无力伴言语不清5天,加重1天"入院.患者5天前(2022-09-14)安静状态下无明显诱因突发左侧肢体无力,上肢不可抬举,无法独自站立,伴吐字含糊,可完全理解他人语言,左侧口角下垂.否认饮水呛咳、头晕、头痛、恶心、呕吐,否认视物旋转、视物成双等,否认心慌等不适.

目的 探讨7 T MRI三维序列对三叉神经及邻近血管的显示效果.材料与方法 前瞻性纳入2022年5月至2023年1月同时行7 T颅脑三维时间飞跃法磁共振血管成像(three dimensional time of flight magnetic resonance angiography,3D TOF MRA)、三维T1 加权磁化准备 2 快速梯度回波(three dimensional T1-weighted magnetization prepared 2 rapid gradient echo,3D T1-MP2RAGE)序列和三维T1加权磁化准备快速梯度回波(three dimensional T1-weighted magnetization prepared rapid gradient echo,3D T1-MPRAGE)序列扫描的24例患者.由两位医生对三叉神经显示情况评分,并对3D T1-MPRAGE和3D T1-MP2RAGE第二个反转时间生成的图像(3D T1-MP2RAGE GRETI2)三叉神经与邻近血管关系进行判读,比较两组图像的信噪比(signal to noise ratio,SNR).采用Kappa检验评价两医生评分的一致性,采用χ2检验评价两组图像判读结果的一致性,采用配对t检验比较两组图像的SNR.结果 两位医生对三组图像的评分一致性较好(Kappa值分别为0.846、1.000和0.846);两组图像三叉神经与邻近血管关系判读结果无差异(χ2=0.174,P＞0.05),3D T1-MP2RAGE GRETI2组SNR高于3D T1-MPRAGE组,分别为(62.12±33.94)和(35.52±15.32),差异有统计学意义(P＜0.001).结论 7 T颅脑三维MRI中,3D T1-MP2RAGE GRETI2图像SNR高于3D T1-MPRAGE,且图像上邻近血管显示为高信号易于观察,对三叉神经与邻近血管的显示优于3D T1-MPRAGE和3D TOF MRA序列.

目的:探讨不同图像滤波函数对提高7T超高场强磁共振颅脑成像幕下结构图像均匀度的价值.方法:选取2021年11月-2022年1月在北京天坛医院国家神经系统疾病临床医学研究中心进行7T颅脑磁共振检查的脑白质病变患者的磁共振影像资料进行研究,共46例患者入组.其中12例患者在常规序列组套扫描结束后,分别加扫勾选均衡化滤波函数和勾选B1 滤波函数的矢状位 3D 各向同性 T1-MPRAGE(Magnetization prepared rapid gradient echo,MPRAGE)序列;34 例患者在常规序列组套扫描结束后仅加扫勾选B1滤波函数的矢状面3D各向同性T1-MPRAGE序列,检查组套中包含未勾选图像滤波函数的矢状面3D各向同性T1-MPRAGE序列.观察并分析未勾选图像滤波函数组、勾选均衡化滤波函数组和勾选B1滤波函数组三组图像幕下结构的图像均匀度,包括图像均匀度的主观评分和客观评价.结果:主观评分结果:勾选均衡化滤波函数组的图像在3D后处理软件内有明显的线样伪影,主观评分为0分,未勾选图像滤波函数组和勾选B1滤波函数组图像的主观评分分别为2.85±0.42和3.93±0.25,差异有统计学意义(P=0.00);客观评价结果:未勾选图像滤波函数组和勾选B1滤波函数组图像的均匀度分别为脑干(0.78±0.03)和(0.97±0.07)、脑脊液(0.79±0.06)和(0.93±0.06)、小脑(0.76±0.08)和(0.91±0.08),勾选 B1 滤波函数组图像均匀度明显优于未勾选图像滤波函数组,差异有统计学意义(P=0.00).结论:B1滤波函数能够在不增加扫描时间的情况下明显改善7T超高场颅脑磁共振成像幕下结构的图像均匀度,提高图像质量.

（接上期）2.6跨省就诊2.6.1本省跨省到外省就诊对于缺血性卒中患者，西藏自治区患者流出到其他省份就诊的比例最大（31.4%），其次是青海省（10.4%）、北京市（9.8%）、内蒙古自治区（9.3%）和安徽省（6.4%）。多数居住在西藏自治区和青海省的跨省就诊的缺血性卒中患者会选择去四川省就诊，

我国正面临着全球最大的卒中挑战。全球疾病负担（global burden of disease,GBD）研究结果显示，2019年我国新发卒中394万例，卒中患者达到2876万例，卒中死亡人数为219万例。此外，卒中也是我国伤残调整生命年（disability-adjusted life years,DALYs）的首位原因，2019年卒中所致DALYs达到4590万。近期的几项大型流行病学调查对与卒中有关的既往疾病数据进行了更新。2018年我国18～69岁成人的超重和肥胖率分别为34.4%和16.8%;18岁及以上无高血压病史的成人中50.9%处于高血压前期，成人高血压的加权患病率为27.5%。根据美国糖尿病学会诊断标准，2017年我国18岁及以上成人中，总糖尿病和糖尿病前期的加权患病率分别为12.8%和35.2%;45岁以上成人的心房颤动加权患病率为1.8%，患者人数相当于790万人。医院质量监测系统（hospital quality monitoring system,HQMS）中1672家三级公立医院的数据显示，2019年收治卒中病例3 411 168例，其中缺血性卒中（ischemic stroke,IS）2 818 875例（82.6%），脑出血（intracebral hemorrhage,ICH）485 474例（14.2%），蛛网膜下腔出血（subarachnoid hemorrhage,SAH）106 819例（3.1%）。中位年龄为66岁，59.6%为男性。在IS、ICH和SAH中儿童卒中（年龄＜18岁）分别有1379例（＜0.1%）、2604例（0.5%）和1250例（1.2%）。超过三分之一[1 231 519例（36.1%）]的卒中病例参加了城镇居民基本医疗保险，其次是城镇职工基本医疗保险[(891 103例（26.1%）]和新型农村合作医疗保险[543 108例（15.9%）]。主要危险因素是高血压（IS 57.3%、ICH 69.9%、SAH 44.1%），主要并发症是肺炎或肺部感染（IS 10.4%、ICH 34.6%、SAH29.7%）。总体的院内死亡/非医嘱离院率为8.5%，从IS的6.0%到SAH的20.6%不等。住院时间为9.0（6.0～13.0）d，范围从IS的10.0（7.0～13.0）d到ICH的14.0（8.0～22.0）d。HQMS中2847家二级公立或民营医院的数据也有类似的结果。HQMS的数据显示，内蒙古自治区、安徽省、西藏自治区和北京市去外省就医比例较高。北京市、天津市、上海市和宁夏回族自治区等省外来诊患者比例较高。2019年中国卒中中心联盟（Chinese Stroke Center Alliance,CSCA）联合1337家医院进行了调查，汇总323 601例卒中数据显示，指南推荐的IS、ICH和SAH患者关键绩效指标综合评分分别为0.78±0.20分、0.69±0.27分和0.60±0.31分。

BACKGROUND The Essen risk score improves stratification of patients with acute ischemic stroke by early stroke recurrence. Recent study showed it could also predict myocardial infarction (MI). This study aimed to compare the Essen score’s ability to predict cerebrovascular events with compared cardiovascular events. METHODS We included patients with acute ischaemic stroke or transient ischaemic attack within seven days from the Third China National Stroke Registry. One-year cumulative event rates of combined vascular events (a composite of MI, stroke recurrence or vascular death) and cardiac events (a composite of MI, heart failure or cardiac death) was estimated using the Kaplan-Meier method. The predictive value of the Essen score was assessed with C-statistics. In multivariate Cox regression analyses, we assessed whether Essen score, etiological subtype and imaging parameters were associated with outcomes. RESULTS Of 13,012 patients were included, the cumulative one-year event rates were 10.03% for combined vascular events and 0.77% for cardiac events, respectively. Compared with those with an Essen score < 3, patients with an Essen score ≥ 3 were more likely to have a subsequent combined vascular event [hazard ratio (HR) = 1.39, 95% CI: 1.24−1.55] and cardiac events (HR = 2.30, 95% CI: 1.53−3.44). The score tended to be more predictive of the risk of MI (C-statistic = 0.63, 95% CI: 0.55−0.71) and cardiac events (C-statistic = 0.62, 95% CI: 0.56−0.67) than stroke recurrence (C-statistic = 0.55, 95% CI: 0.54−0.57) and combined vascular events (C-statistic = 0.56, 95% CI: 0.54−0.57). In multivariable analysis after adjusted Essen score, patients with multiple acute infarctions or single acute infarctions and large artery atherosclerosis subtype were independently associated with an increased risk of combined vascular events. While the cardioembolism subtype was associated with an increased risk of cardiac events. CONCLUSIONS The Essen score is potentially more suitable for risk stratification of cardiovascular events than cerebrovascular events. Moreover, future predictive tools should take brain imaging findings and cause of stroke into consideration.

Degeneration and adaptation are two competing sides of the same coin called resilience in the progressive processes of brain aging or diseases. Degeneration accumulates during brain aging and other cerebral activities, causing structural atrophy and dysfunction. At the same time, adaptation allows brain network reorganize to compensate for structural loss to maintain cognition function. Although hidden resilience mechanism is critical and fundamental to uncover the brain aging law, due to the lack of datasets and appropriate methodology, it remains essentially unknown how these two processes interact dynamically across brain networks. To quantitatively investigate this complex process, we analyze aging brains based on 6-year follow-up multimodal neuroimaging database from 63 persons. We reveal the critical mechanism of network resilience that various perturbation may cause fast brain structural atrophy, and then brain can reorganize its functional layout to lower its operational efficiency, which helps to slow down the structural atrophy and finally recover its functional efficiency equilibrium. This empirical finding could be explained by our theoretical model, suggesting one universal resilience dynamical function. This resilience is achieved in the brain functional network with evolving percolation and rich-club features. Our findings can help to understand the brain aging process and design possible mitigation methods to adjust interaction between degeneration and adaptation from resilience viewpoint.

脑血管病是常见疾病,常被称为人类健康的"头号杀手",是一种具有高患病率、高发病率、高死亡率和高致残率的"四高"疾病,给个人、家庭、社会带来沉重的负担.流行病学显示,脑血管病已成为全球人口第二位的死亡原因,我国成年人死亡的首位病因[1-2].MRI在脑血管病的发病机制、诊断、风险评估与治疗决策中起着关键作用,已经普遍应用于临床.常见的MRI为1.5T MRI和3.0T MRI,虽然7.0T MRI具有更高的性能优势,但由于全球装机量少,目前主要用于科学研究.2022年6月,我国国家药品监督管理局批准首台7.0T MRI应用于临床,标志着我国超高场磁共振临床应用时代的序幕正式开启.本文通过检索回顾既往研究的文献结合首都医科大学附属北京天坛医院神经影像研究中心对7.0T MRI的应用体会,简要展示7.0T MRI在脑血管病研究中的应用价值.

Stroke and Vascular Neurology (SVN)2019年9月上线文章"The Third China National Stroke Registry(CNSR-Ⅲ)for patients with acute ischaemic stroke or transient ischaemic attack: design,rationale and baseline patient characteristics",由首都医科大学附属北京天坛医院王拥军教授团队完成.作者在文中介绍了第三次中国国家卒中登记(The Third China National Stroke Registry,CNSR-Ⅲ)的研究方案和登记患者的基线特征.

Objective To investigate the status of secondary prevention medications adherence in patients with ischemic cerebrovascular diseases in China, and the relationship between 3-month medication adherence and 1-year recurrent stroke after discharge in patients with acute ischemic stroke or TIA. Methods Patients diagnosed with first-ever acute ischemic stroke or TIA from Stroke and Transient Ischemic Stroke Treatment Adherence Registry in China were enrolled in this study. Medication adherence was defined as taking all secondary prevention medications prescribed at discharge continuously and regularly during the 3-month follow up. Multivariate logistic regression analysis was used to analyze the relationship between 3-month medications persistence and 1-year recurrent stroke after discharge. Results A total of 2768 patients were selected, with the mean age 62.3±11.4 years and 988 (35.7%) female patients. 2016 patients (72.8%) persisted in taking all secondary prevention medications during the 3-month follow up; the drug adherence rate were 95.3%, 90.9%, 90.2%, 85.4% and 73% for antiplatelet agents, blood glucose-lowering drugs, antihypertensive drugs, lipid-lowering drugs, and anticoagulation agents, respectively. The diabetes history (OR 1.40, 95% CI 1.14-1.73, P=0.0016) and the cessation history of blood glucose-lowering drugs might be the influence factors for drugs adherence, while there were no statistical significance after adjusting for the confounding factors. After adjusting for the confounders including age, sex, medical history and so on, logistic regression analysis showed 3-month persistence of secondary prevention medications was an independent influence factor for recurrent stroke at 1 year after discharge ( OR 0.36, 95% CI 0.14-0.91, P=0.0301). Conclusions The 3-month persistence of secondary prevention drugs was much more satisfactory compared to the previous results reported in Chinese patients. The 3-month persistence of secondary prevention medications was an independent influence factor for recurrent stroke at 1 year after discharge.

目的 调查急性缺血性卒中伴吞咽困难的住院患者,并探索吞咽康复治疗的影响因素及其与预后的相关性.方法 选取2012-2013年的1 581例多中心的缺血性卒中住院患者,吞咽困难的临床诊断由康复治疗师进行专业的床边吞咽评估得出.吞咽困难的康复治疗包括吞咽康复训练、电刺激或磁刺激,以及辅助治疗等.随访时间为12个月,终点事件包括全因死亡、卒中复发和功能预后不良.采用多因素Logistics回归模型对吞咽困难患者进行康复治疗的影响因素进行分析,采用Cox回归模型对吞咽困难患者进行康复治疗与预后的相关性进行分析.结果 本研究共纳入1581例伴吞咽困难的急性缺血性卒中患者,其中962例(60.8％)进行了吞咽康复治疗.进行吞咽康复治疗的影响因素包括:入院时较低的国立卫生研究院卒中量表评分、接受肢体康复治疗、深静脉血栓预防、颈动脉血管成像检查以及在年出院数较高的医院住院(均P＜0.05).与未进行吞咽康复治疗的患者相比,行吞咽康复治疗的患者12个月全因死亡风险较低[危险比(hazard ratio,HR):0.76;95％置信区间(confidence interval,CI):0.60～ 0.95],卒中复发比例较低[HR:0.73;95％CI:0.55～0.96],功能预后不良的比例较低(比值比:0.68;95％ CI:0.50～0.93)(均P＜0.05).结论 伴吞咽困难的急性缺血性卒中患者进行吞咽康复治疗的影响因素包括:入院时NIHSS评分,医院的年卒中出院人数,是否行肢体康复、深静脉血栓预防和颈动脉血管成像检查等.吞咽康复治疗可改善伴吞咽困难的急性缺血性卒中患者12个月的预后.

Objective To investigate the effect of multiple intracranial atherosclerotic stenosis (ICAS) on early stroke recurrence in patients with TIA and minor ischemic stroke. Methods 1089 patients with noncardioembolic high-risk TIA and minor ischemic stroke in the imaging subgroup of the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) randomized clinical trial were included in this study. Based on MRA results after admission, ICAS status were grouped into no ICAS, single ICAS and multiple ICAS. The outcomes were recurrent stroke (including ischemic or hemorrhagic stroke) during 90-day follow-up. Cox proportional hazards models were used to assess the association of ICAS status and stroke recurrence. Results 608 patients had no ICAS, 298 patients had single ICAS and 183 patients had multiple ICAS, and their corresponding risk of recurrent stroke was 5.43%, 9.06% and 18.03%, respectively. Patients with ICAS (including single and multiple ICAS) had a significantly higher risk of s recurrent stroke than patients without ICAS (12.50% vs 5.40%, P<0.0001). The risk of recurrent stroke in patients with mutiple ICAS was the highest (18.03%) and was 3.578 times higher than that of patients without ICAS ( HR 3.578, 95% CI 2.189-5.850). Conclusions Multiple intracranial arterial stenosis was an independent risk factor of 90-day recurrent stroke in patients with noncardioembolic high-risk TIA and minor ischemic stroke.

Objectives: Although statin therapy is associated with lower recurrence in patients with acute ischaemic stroke, data-evaluating associations between inpatient statin use and stroke recurrence in diabetic patients after acute stroke onset are limited. Methods: This study was based on population data from the Chinese National Stroke Registry. Patients with acute ischaemic stroke and no history of statin therapy were selected. Individuals treated regularly with any type or dosage of statins during acute hospitalization were defined as having inpatient statin therapy. The subjects were divided into two groups according to statin use status during acute hospitalization. Multivariate logistic regression analysis was used to analyse the associations between statin use and stroke recurrence in patients with or without diabetes. Results: A total of 11,429 patients, 2341 (20.48%) with diabetes, were selected for analysis. Statin therapy during hospitalization was documented in 4982 (43.59%). Logistic analysis showed no significant associations between inpatient statin use and stroke recurrence in diabetic subjects at 3 months (OR = 0.90, 95% CI = 0.69-1.16, P = 0.40) or 1 year (OR = 0.92, 95% CI = 0.74-1.16, P = 0.48), but statin use was significantly associated with lower recurrence in non-diabetic patients at both 3 months (OR = 0.80, 95% CI = 0.69-0.92, P = 0.002) and 1 year (OR = 0.82, 95% CI = 0.72-0.93, P = 0.002) after discharge. Conclusion: Inpatient statin use was associated with lower stroke recurrence in non-diabetic patients after acute ischaemic stroke, but no definite association between inpatient statin use and stroke recurrence in patients with diabetes mellitus was found.

The infarct patterns of ischemic cerebrovascular diseases are diverse. Based on the number of infarct, the infarct pattern can be classified as no infarct, single infarct or multiple infarcts. Single infarct can be classified according to the size and location of the infarcts, and multiple infarcts can be classified according to the involved territory of culprit artery. Different patterns of single and multiple infarcts are related to the etiology and mechanism.

目的 探讨不同胰岛素抵抗状态对无糖尿病史的非致残性缺血性脑血管病(non-disabling ischemic cerebrovascular events,NICE)患者卒中复发风险的影响.方法 使用稳态模型胰岛素抵抗(homeostasis model assessment of insulin resistance,HOMA-IR)指数对胰岛素抵抗进行评估.根据不同胰岛素抵抗状态,使用四分位法将无糖尿病史的NICE患者分为4组.该研究的主要研究终点为90 d新发卒中(包括缺血性和出血性卒中).利用多元Cox回归模型校正潜在协变量,评估不同胰岛素抵抗状态与卒中复发风险之间的关系,同时对不同抗血小板聚集治疗、不同胰岛素抵抗状态与卒中复发之间的交互作用进行统计分析.结果 本研究共纳入2325例NICE患者.根据患者不同胰岛素抵抗状态分组,4组界值分别为Q1(HOMA-IR指数＜1.35)、Q2 (1.35≤HOMA-IR指数＜2.17)、Q3 (2.17≤HOMA-IR指数＜3.39)及Q4 (HOMA-IR指数≥3.39),4组患者人数分别为585例、575例、585例及580例.90 d随访时,共出现167例卒中复发,其中氯吡格雷联合阿司匹林组为68例,阿司匹林组为99例.与Q1组(6.3％)比较,Q2组(9.2％,校正HR1.56,95％CI1.01～2.41,P=0.04)、Q3组(5.6％,校正HR1.04,95％CI 0.64～1.69,P=0.89)和Q4组(7.6％,校正HR 1.35,95％CI 0.85～ 2.15,P=0.21)患者卒中复发风险均未明显上升.结论 本研究未在NICE患者中发现胰岛素抵抗与卒中复发风险升高相关.