Histon deacetylase 4 (HDAC4) modulates memory and cognitive impairment, but its association with post-stroke cognitive impairment (PSCI) is unclear. This study aimed to investigate the potential of HDAC4 for predicting PSCI risk. Sixty-nine PSCI patients and 70 control post-stroke (CPS) patients were enrolled in this case-control study. In all stroke patients, HDAC4 in peripheral blood mononuclear cells was detected by quantitative polymerase chain reaction; T-helper 17 (Th17) cells were detected by flow cytometry, and interleukin-17A was detected by enzyme-linked immunosorbent assay. HDAC4 was reduced in PSCI patients compared with CPS patients (P = 0.001). In total stroke patients, HDAC4 showed negative linkages with age (P = 0.003), history of diabetes (P = 0.012), stroke recurrence (P = 0.001), Th17 cells (P = 0.027), and interleukin-17A (P = 0.002). Additionally, multivariate logistic regression analysis revealed that HDAC4 (per unit) [odds ratio (OR) = 0.438, P = 0.024] was independently associated with a lower PSCI risk, but age (per unit) (OR = 1.061, P = 0.016) and multifocal disease (yes vs. no) (OR = 2.490, P = 0.014) were independently associated with a higher PSCI risk. By receiver operator characteristic curves, HDAC4 had an acceptable value for predicting PSCI risk [area under the curve (AUC) = 0.656, 95% confidence interval = 0.566-0.746]. The combination of HDAC4, age, and multifocal disease showed a good value for predicting PSCI risk (AUC = 0.728, 95% confidence interval = 0.644-0.811). HDAC4 may serve as a potential biomarker for predicting PSCI risk, which could facilitate the early screening and prevention of PSCI, thus promoting the management of stroke.

The formation of infarct core volume(ICV)in acute ischemic stroke is due to the irreversible injury of brain tissue caused by cerebral vascular occlusion,which has the most direct influence on the prognosis and treatment choice of stroke.Based on the development of imaging technology,ICV can be shown by different imaging methods,but the limitations of current imaging should be paid attention to.In this study,the application of different imaging assessment of ICV was reviewed to provide a basis for clinical treatment strategies to improve patient prognosis.

目的 分析急性前循环大血管闭塞性脑卒中(acute anterior circulation large vessel occlusive stroke,ALVOS)患者梗死核心体积(ischemia core volume,ICV)大小的影响因素及其与临床预后的关系.方法 回顾性收集2022年1月至2022年9月邯郸市中心医院神经内科收治的ALVOS患者62例,其中男性40例,女性22例,平均年龄65.6岁.根据ICV大小将患者分为小ICV(small-ICV,S-ICV)组(ICV＜50 mL,n=38)和大ICV(large-ICV,L-ICV)组(ICV≥50 mL,n=24),比较两组患者间临床特征的差异;采用多因素Logistic回归分析ALVOS患者形成L-ICV的独立影响因素;采用受试者工作特征(receiver operating characteristic,ROC)曲线评估ICV对ALVOS患者临床预后的预测效能;采用Kaplan-Meier生存分析法探讨ICV对患者生存期影响;采用Cox风险回归分析法分析ALVOS并发L-ICV患者发生死亡的危险因素.结果 与S-ICV患者比较,L-ICV患者美国国立卫生研究院卒中量表(NIHSS)评分及血红蛋白浓度较高,区域软脑膜侧支循环(regional lepto-meningeal collateral,rLMC)评分以及合并高血压史比例较低(P＜0.05);多因素Logistic回归分析显示血红蛋白浓度高(OR=1.082,95％CI:1.020～1.148;P＜0.01)是ALVOS患者发生L-ICV的独立危险因素,而rLMC评分高(OR=0.788,95％CI:0.678～0.916;P＜0.01)是发生L-ICV的保护性因素.ROC曲线分析显示预后良好和不良的ICV截断值是52.55 mL.Kaplan-Meier生存分析显示L-ICV组患者的累计生存率明显低于S-ICV组(P＜0.05).进一步对L-ICV组进行多因素Cox风险回归分析结果显示,症状性颅内出血(HR=28.855,95％CI:2.975～279.849,P＜0.05)和糖尿病(HR=13.832,95％CI:1.040～183.820,P＜0.05)是 L-ICV组患者生存的独立影响因素.结论 血红蛋白水平高是ALVOS患者形成L-ICV的独立危险因素,而rLMC评分高是其保护性因素.ICV大小对ALVOS患者的预后具有良好的预测价值.L-ICV ALVOS患者预后良好率、累计生存率低于S-ICV,其中症状性颅内出血和糖尿病是L-ICV患者生存的独立影响因素.

随着"互联网+"时代的到来,互联网技术在全球卫生系统的应用增加,其在急性缺血性卒中救治中的应用也得到相应发展.基于互联网信息技术,应用手机等终端设备应用程序,使急性缺血性卒中救治更加的高效、便捷、实用,但应重视应用过程中的伦理学问题.本研究对"互联网+"在急性缺血性卒中院前急救、院前院内衔接、院内绿色通道中的应用进行综述,为构建"互联网+"卒中救治新模式提供帮助.

Background Long noncoding RNA growth arrest-specific 5 (lnc-GAS5) is involved in the pathophysiology of acute ischemic stroke (AIS) by regulating vascular stenosis, inflammation, and neurocyte apoptosis. This study aimed to explore the clinical value of lnc-GAS5 in patients with AIS. Methods Plasma samples were collected from 120 patients with AIS at admission and 60 controls after enrollment, and lnc-GAS5 expression in the plasma of all participants was assessed by reverse transcription quantitative polymerase chain reaction. In patients with AIS, disease severity was evaluated using National Institute of Health Stroke Scale (NIHSS) score, and plasma inflammatory cytokine levels were measured by enzyme-linked immunosorbent assay. Recurrence-free survival (RFS) was calculated during a 36-month follow-up period. Results Lnc-GAS5 expression levels were higher in patients with AIS than in the controls (p < 0.001), and it had the potential to discriminate the controls from patients with AIS (area under the curve: 0.893, 95% confidence interval: 0.849-0.938). In patients with AIS, elevated lnc-GAS5 levels were positively correlated with NIHSS score (r = 0.397, p < 0.001), diabetes mellitus (p = 0.046), and higher levels of tumor necrosis factor alpha (TNF-alpha; r = 0.374, p < 0.001), interleukin-6 (IL-6; r = 0.223, p < 0.001), and interleukin-17A (IL-17A; r = 0.222, p = 0.015). The expression levels of lnc-GAS5 were also negatively correlated with the levels of interleukin-10 (IL-10; r = -0.350, p < 0.001) and RFS (p = 0.036). Conclusion Lnc-GAS5 is correlated with higher susceptibility to AIS, inflammation, and severity, and can predict an increased risk of AIS recurrence, indicating that monitoring of lnc-GAS5 might improve the management of AIS.

目的 观察银杏内酯注射液联合多奈哌齐治疗血管性痴呆(VaD)的临床疗效及对氧化应激的影响.方法 收集2018年1月-2020年1月在邯郸市中心医院治疗的80例VaD患者,按随机数字表法分为对照组和观察组各40例.在常规治疗基础上,对照组予多奈哌齐治疗2个月,观察组予银杏内酯注射液联合多奈哌齐治疗2个月,治疗前后进行简易精神状态量表(MMSE)和日常生活能力量表(ADL)评分,检测超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)水平,并记录2组临床疗效及治疗过程中的不良反应.结果 治疗后观察组MMSE评分、ADL评分及SOD、GSH-Px水平均明显高于对照组(P均＜0.05),MDA明显低于对照组(P＜0.05);观察组总有效率80.0％ (32/40)明显高于对照组的57.5％(23/40),差异有统计学意义(P＜0.05);2组不良反应发生率均较低,差异无统计学意义(P＞0.05).结论 银杏内酯注射液联合多奈哌齐治疗VaD患者临床疗效显著,可有效抑制氧化应激,不良反应轻微.

目的 旨在探讨血尿酸水平与非痴呆性血管性认知功能障碍(vascular cognitive impairment with no dementia,VCIND)的相关性.方法 采用病例对照研究,选取邯郸市第一医院老年科VCIND患者100例,并选取认知功能正常者100例作为对照组,收集其基线信息、既往病史、简易精神状态量表评分等,并检测血尿酸水平.采用t检验计算两组尿酸水平的差异,并采用多因素Logistic回归分析探讨血尿酸水平与VCIND的相关性.结果 V C I N D组患者血尿酸水平较认知功能正常组高[(269.25±57.90)μm o l/L v s(237.19±55.25)μmol/L],在校正混杂因素后尿酸水平仍与VCIND存在相关性(比值比1.100,95％可信区间1.042～1.161).结论 血尿酸水平与VCIND存在相关性,这将为血管性认知功能障碍的预防提供重要依据.

目的 观察完善院内绿色通道对缩短急性缺血性卒中(AIS)患者从入院到溶栓治疗的时间(DNT)及溶栓率的影响.方法 统计2013年1月以来于该院就诊的AIS患者,对总体溶栓率,时间窗内患者溶栓率及DNT进行分析,比较绿色通道完善前后溶栓率及DNT变化情况.结果 绿色通道完善改进后,于该院就诊的AIS患者的溶栓率(7.56％)较绿色通道完善改进前(0.62％)明显增加,DNT持续缩短(108 min vs.53 min).结论 通过整改绿色通道流程,可使溶栓率显著提高.证明在院前延误严重,溶栓率较低的地区,完善院内绿色通道,是提高AIS患者溶栓率的重要措施.

目的:观察中药减轻脑膜炎治疗中副作用的临床疗效。方法:采用随机数字表法将87例脑膜炎患者随机分为2组,对照组45例予两性霉素B保守治疗,观察组42例在两性霉素B保守治疗基础上按抗生素使用阶段予中药治疗,观察对比治疗前、治疗第1月后、治疗第2月后患者的血液生化检验指标、血常规指标和副作用发生情况。结果:治疗后观察组血液生化指标中的谷丙转氨酶、肌酐、血尿素氮和血常规指标中的红细胞计数与对照组比较,差异均有显著性意义(P<0.05)。观察组副作用发生率35.71%,低于对照组发生率88.89%(P<0.01)。结论:中药可以有效减轻脑膜炎治疗中的副作用,值得临床继续探讨。

Objective To estimate the function of somatosensory evoked potentials(SEP)、brainstem auditory evoked potentials(BAEP)and blink reflex(BR)in the evaluation of brain stem infarction. Method 64 cases of brain stem infarction were admitted to the hospital and divided into severe or moderate groups based on the GCS(≤or>8). The BAEP and SEP Results were divided into gradeⅠ,gradeⅡand gradeⅢaccording to CANT classification,the BR Results were divided into normality and abnormity. The performance of evoked potentials was compare between severe group and moderation group, and the different levels of evoked potentials and prognosis were also compared. Results (1)The mortality of the patients in the severe group was 42.68%,significantly higher than that in the group of moderate group(19.44%). A good proportion of moderate group was 36.11%,much better than those in the sever group(7.14%).(2)The mortality of the patients withⅢgrade SEP and BAEP was 57.69%and 58.82%,the mortality of the patients with abnormity BR was 48.34%,significantly higher than the proportion of good. The proportion of good with the I grade SEP and BAEP was 59.09% and 52.38%,the proportion of good with normality BR was 60.60%,much higher then the proportion of death. Conclusion SEP、BAEP and BR can objective ly evaluate brain function in patients with brain stem infarction,and can predict prognosis.

近年来,高尿酸血症的患病率迅速上升,且随着年龄的增长而升高.目前已有研究显示,高尿酸血症是脑梗死等疾病的危险因素[1,2].本文通过对短暂性脑缺血发作(transient ischemic attack,TIA)患者血尿酸(serum uric acid,SUA)水平的观察,探讨SUA与TIA发生之间的相关性.

<正>同型半胱氨酸(Homocysteine,Hcy)是体内甲硫氨酸代谢的一个重要中间产物。在遗传、年龄、营养、疾病等多种因素影响下,Hcy的生成与代谢失去平衡,导致高同型半胱氨酸血症(Hyperhomocysteinemia,Hhcy)。Hhcy是众多疾病的危险因素,已经有许多证据显示Hhcy与神经系统疾病存在着广泛联系,本文就Hhcy在神经病学几个领域内的研究作一综述。1Hcy及Hhcy同型半胱氨酸是一种含硫氨基酸,是甲硫氨

<正>近来研究表明,同型半胱氨酸(homocysteine,Hcy)增高引发的高Hcy血症与脑血管病、痴呆、帕金森病等疾病的发生和发展有十分密切的关系。本文对中老年人群的血浆同型Hcy与脑梗死、血管性帕金森综合征(vascular parkinsonism,VP)的相关性进行探讨。

Objective To investigate the risk factors correlated with the brachial-ankle pulse wave velocity(baPWV) in the healthy population.Methods Selecting the normal population who accepted the routine physical,various indexs were measured,the normal population were divided into the control group(the baPWV<1400cm/s)and the symptomless-arteriosclerosis group(the baPWV≥1400cm/s)by the baPWV,the results of the two groups were analized by the statistical analysis.Results The age(AGE),blood glucose(GLU),systolic pressure(SBP),diastolic pressure(DBP),pulse pressure(PP),low-density lipoprotein(LDL),carotid artery intima-media thickness(IMT) and the body mass index(BMI)in the baPWV increased group were significantly higher than that in the control group,the single argument Logistic logistic regressions were carried out(take the AGE,GLU,TG,LDL,SBP,DBP,PP,IMT and BMI as the independent variate,take the baPWV as the dependent variate),the results showed that the AGE,GLU,LDL,SBP,DBP,PP,IMT and BMI were factors of influence in the development of the symptomless-arteriosclerosis.Though,the AGE,GLU,SBP and the PP were the independent risk factors of the baPWV.Conclusions The baPWV increases gradually as the rise of the AGE,GLU,SBP,DBP,PP,LDL,IMT and BMI,the AG,GLU,SBP and the PP are the independent risk factors of the baPWV in the increasing of the baPWV.

<正>血管性帕金森综合征(vascular parkinsonism,VP)是脑血管病变导致脑内纹状体多巴胺受体功能异常所出现的一组临床症状群。其发生与纹状体多巴胺受体遭到破坏有关。我们通

目的:BAEP与核磁共振在不同年龄组前庭系统性眩晕中的应用.方法:①所有经临床症状+前庭功能试验诊断眩晕的病人,分为青、中、老年三组,观察在不同组中,周围性眩晕、中枢性眩晕所占的比例.②所有病人进行BAEP及脑核磁检查,比较在周围性眩晕中BAEP与脑核磁阳性率的差别.③比较在中枢性眩晕中BAEP与脑核磁阳性率的差别.结果:①三个年龄组周围性眩晕与中枢性眩晕所占比例不同:青年组周围性眩晕占47.1%,中年组周围性眩晕占29.5%,老年组周围性眩晕占23%,差异有统计学意义(P＜0.05).青年组中枢性眩晕所占比例9.7%,中年组中枢性眩晕所占比例增加26.3%,老年组中枢性眩晕所占比例增加42%,差异有统计学意义(P＜ 0.05).②在周围性眩晕中BAEP与脑核磁阳性率的比较:BAEP在诊断周围性眩晕患者中的阳性率为69.4%,脑核磁诊断周围性眩晕的阳性率为11.3%,差异有统计学意义(P＜0.05).③在中枢性眩晕患者中BAEP与脑核磁阳性率的比较:BAEP在诊断中枢性眩晕患者中的阳性率为64.6%,脑核磁诊断中枢性眩晕的阳性率为94.8%,差异有统计学意义(P＜0.05).结论:BAEP与核磁共振在不同年龄组前庭系统性眩晕中的诊断价值不同.

目的 探讨血浆同型半胱氨酸(Hcy)对血管性帕金森综合征(VP)影响及临床意义.方法 测定56例血管性帕金森综合征患者及52例健康对照者的血浆Hcy、叶酸(FA)、维生素B12水平.对Hcy增高的VP患者予以叶酸、维生素B12等药物治疗,并记录治疗前后的Webster评分.结果 VP组的Hcy水平显著高于对照组(P＜0.05);血浆FA、维生素B12的水平低于对照组(P＜0.05);Hcy水平增高的VP患者Webster评分明显高于Hcy水平正常的患者(P＜0.05);而经药物治疗后,Webster评分较治疗前明显降低(P＜0.05).结论 Hcy与VP发病及VP的严重程度可能存在相关性;对Hcy增高的VP患者常规给予降低Hcy治疗,对VP患者的治疗和预后有益.

Objective:To explore the impact of different levels of carotid artery-medial thickness on the prognosis of patients with cerebral infarction.Methods:272 patients with cerebral infarction, according to carotid artery-into the normal thickness, thickening, plaque groups were hospitalized the same day and 14 days of hospitalization neurological deficit score, using the U.S.national institutes of health stroke scale(NIHSS), were taken as the difference between the prognostic indicator in patients with cerebral infarction, using t test of carotid artery in different groups-media thickness in patients with cerebral infarction prognosis.Results:Difference score of 165 cases of male patients with carotid artery was lower, when the film thickness increased.With statistical significance(P0.05).The same to female patients.Conclusion:Between the carotid artery-medial thickness and the prognosis of patients have the correlation.As the carotid artery-in the film thickness increases as the prognosis worse.

<正>慢性脑供血不足(CCCI),是临床常见病,多由高血压、动脉硬化、高血脂、糖尿病等引起。中医药在缺血性中风的治疗上具有独特的优势CCCI。我院在缺血性中风防治方面积累了一定经验,通过观察星蒌承气方对CCCI患者血栓前状态各因子的影响,探讨其抗脑缺血的作用机制。

目的 探讨脑梗死患者预后和颈动脉内-中膜厚度的相关性.方法 入选146例脑梗死住院患者,根据颈动脉内-中膜厚度分为正常、增厚、斑块组,每组均在住院当天和住院第14d神经功能缺损评分,采用美国国立卫生院神经功能缺损评分(NIHSS),分别取差值作为脑梗死患者的预后指标.结果 82例男性脑梗死患者随颈动脉内-中膜厚度的增加,评分的差值降低,具有统计学意义(P<0.05),64例女性脑梗死患者随颈动脉内-中膜厚度的增加,评分的差值降低,具有统计学意义(P<0.05).结论 脑梗死患者预后和颈动脉内-中膜厚度之间具有相关性,随颈动脉内-中膜厚度的增加,预后越差.