ImportanceDual antiplatelet therapy has been demonstrated to be superior to single antiplatelet in reducing recurrent stroke among patients with transient ischemic attack or minor stroke, but robust evidence for its effect in patients with mild to moderate ischemic stroke is lacking.ObjectiveTo evaluate whether dual antiplatelet therapy is superior to single antiplatelet among patients with mild to moderate ischemic stroke.Design, Setting, and ParticipantsThis was a multicenter, open-label, blinded end point, randomized clinical trial conducted at 66 hospitals in China from December 20, 2016, through August 9, 2022. The date of final follow-up was October 30, 2022. The analysis was reported on March 12, 2023. Of 3065 patients with ischemic stroke, 3000 patients with acute mild to moderate stroke within 48 hours of symptom onset were enrolled, after excluding 65 patients who did not meet eligibility criteria or had no randomization outcome.InterventionsWithin 48 hours after symptom onset, patients were randomly assigned to receive clopidogrel plus aspirin (n = 1541) or aspirin alone (n = 1459) in a 1:1 ratio.Main Outcomes and MeasuresThe primary end point was early neurologic deterioration at 7 days, defined as an increase of 2 or more points in National Institutes of Health Stroke Scale (NIHSS) score, but not as a result of cerebral hemorrhage, compared with baseline. The superiority of clopidogrel plus aspirin to aspirin alone was assessed based on a modified intention-to-treat population, which included all randomized participants with at least 1 efficacy evaluation regardless of treatment allocation. Bleeding events were safety end points.ResultsOf the 3000 randomized patients, 1942 (64.6%) were men, the mean (SD) age was 65.9 (10.6) years, median (IQR) NIHSS score at admission was 5 (4-6), and 1830 (61.0%) had a stroke of undetermined cause. A total of 2915 patients were included in the modified intention-to-treat analysis. Early neurologic deterioration occurred in 72 of 1502 (4.8%) in the dual antiplatelet therapy group vs 95 of 1413 (6.7%) in the aspirin alone group (risk difference −1.9%; 95% CI, −3.6 to −0.2; P = .03). Similar bleeding events were found between 2 groups.Conclusions and RelevanceAmong Chinese patients with acute mild to moderate ischemic stroke, clopidogrel plus aspirin was superior to aspirin alone with regard to reducing early neurologic deterioration at 7 days with similar safety profile. These findings indicate that dual antiplatelet therapy may be a superior choice to aspirin alone in treating patients with acute mild to moderate stroke.Trial RegistrationClinicalTrials.gov Identifier: NCT02869009

Introduction: Cerebrotendinous xanthomatosis (CTX) is an autosomal recessive lipid metabolism disorder. It is caused by a defect in the sterol-27-hydroxylase gene, leading to the deposition of cholesteryl and bile alcohol in large amounts, causing a variety of clinical manifestations; however, tremor as the main manifestation of CTX has not been reported. Patient’s concerns and clinical findings: Herein, we report a 27-year-old woman, who developed head and body tremors at the age of 12 years. Many hospitals misdiagnosed her condition as idiopathic tremor and Parkinson disease, with a poor curative effect. Primary diagnosis and intervention: We diagnosed her with CTX and treated with chenodeoxycholic acid and clonazepam. Conclusion: The patient’s condition considerably improved. This case could help avoid misdiagnosis and mistreatment in clinical practice.

1 临床资料 患者,男, 59岁.因"左眼眶肿胀伴视力下降5年,加重10余天"于2020年12月7日就诊于四平吉奥脑病医院.患者5年前突发左眼眶组织肿胀,左眼突出,伴左眼视力下降,无视物重影及眼球活动障碍,无肢体活动不灵,先后到多家医院就诊,均未明确诊断,予以对症治疗无明显好转.最终于某外院眼科诊断为"炎性眼病",予以糖皮质激素等对症治疗后,眼眶肿胀明显好转,视力下降略有好转但仍存在.之后左侧眼眶肿胀及视力下降每年急性加重1～2次,均在使用激素后好转.10余天前症状再发,到我院就诊后收入我科.既往荨麻疹病史50余年,春季多发,近5年多在眼眶肿胀时伴发.个人史及家族史无特殊.查体:体温36.6℃,血压110/80 mmHg,甲状腺触诊无肿大,听诊无血管杂音.神经系统查体:神清,语利.

BACKGROUND:Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a cerebrovascular disease that is closely related to the NOTCH3 gene. Recurrent ischemic stroke, progressive cognitive dysfunction, and mental symptoms are the main clinical manifestations, whereas symptomatic intracranial hemorrhage is rare.METHODS:We detected a heterozygous mutation of c.1759C>T in exon 11 of the NOTCH3 gene that caused recurrent intracranial hemorrhage in CADASIL.RESULTS:Second-generation sequencing of a sample of the patient's genome revealed a heterozygous mutation of c.1759C>T in exon 11 of NOTCH3, which resulted in amino acid changes (p.R587C). This variation may be rated as a CADASIL clinical variation.CONCLUSION:The discovery of this mutation site provides an important theoretical basis for a gene-based diagnosis and treatment of recurrent intracranial hemorrhage.

抗中性粒细胞胞质抗体(ANCA)相关性血管炎是累及全身多系统自身免疫性疾病,其中肾和肺为其最常累及的器官,累及中枢神经系统者较为少见[1].现将我科收治的1例胞质型ANCA相关性血管炎并发脑梗死报道如下. 1临床资料 患者男性,79岁,主因"突发言语不清8 h"于2021年2月4日急诊以"脑血管病"收入大连医科大学附属第一医院神经内科.患者于入院8 h前无明显诱因突然出现言语不清,表现为言语表达能力欠佳,词汇不连贯,但逻辑及理解能力尚可,无头晕和头痛,无肢体活动不灵,无视物模糊及重影,无饮水呛咳及吞咽困难,无尿便失禁及意识丧失.

Background:Intracranial atherosclerotic stenosis (ICAS) is one of the leading causes of stroke worldwide. Current diagnostic evaluations and treatments remain insufficient to assess the vulnerability of intracranial plaques and reduce the recurrence of stroke in symptomatic ICAS. On the other hand, asymptomatic ICAS is associated with an increased risk of cognitive impairment. The pathogenesis of ICAS related cognitive decline is largely unknown. The aim of SICO-ICAS study (stroke incidence and cognitive outcomes of ICAS) is to elucidate the pathophysiology of stroke and cognitive impairment in ICAS population, comprehensively evaluating the complex interactions among life-course exposure, genomic variation, vascular risk factors, cerebrovascular burden and coexisting neurodegeneration.Methods:SICO-ICAS is a multicenter, prospective, observational cohort study. We aim to recruit 3,000 patients with symptomatic or asymptomatic ICAS (>50% or occlusion) who will be followed up for ≥12 months. All participants will undergo pre-designed magnetic resonance imaging packages, blood biomarkers testing, as well as detailed cognitive domains assessment. All participants will undergo clinical visits every 6 months and telephone interviews every 3 months. The primary outcome measurement is ischemic stroke or cognitive impairment within 12 months after enrollment.Discussion:This study will establish a large prospective ICAS cohort, hopefully discover new biomarkers associated with vulnerable intracranial plaques, identify subjects at high risk for incident ischemic stroke or cognitive impairment, and eventually propose a precise diagnostic and treatment strategy for ICAS population.Trial Registration:Chinese Clinical Trials Register ChiCTR2200061938.

Objective: Distant ischemic postconditioning (DIPC) has been confirmed to have a neuroprotective effect in animal models of ischemia. However, there are only a few studies on its efficacy and safety in clinical applications. Method: We divided 86 patients with acute non-cardiogenic mild to moderate cerebral infarction into DIPC and control groups.Result: After 7 days of using different pressure DIPC therapies, the National Institutes of Health Stroke Scale (NIHSS) scores on the eighth day significantly decreased, and modified Rankin scale significantly increased in the DIPC group, compared to that before treatment. On the eight day of admission, the decrease in the NIHSS scores significantly differed between the two groups. However, there was no change in the early neurological deterioration and platelet aggregation rates between the two groups on the eighth day.Conclusion: These results demonstrate that DIPC can safely and effectively improve neurological deficits in acute stages of mild to moderate cerebral infarction without affecting the efficacy of antiplatelet drugs.

BACKGROUND:Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of stroke worldwide, and it is associated with a high risk of recurrent stroke with currently recommended treatments. We aimed to evaluate the effect of chronic remote ischaemic conditioning on prevention of ischaemic events in patients with symptomatic ICAS. METHODS:The RICA trial is a multicentre, randomised, double-blind, sham-controlled trial at 84 stroke centres in China. Patients aged 40-80 years with ischaemic stroke or transient ischaemic attack attributable to angiographically verified 50-99% stenosis of a major intracranial artery were randomly assigned (1:1), via an interactive web-based system by computer-generated randomisation code, to either remote ischaemic conditioning or sham remote ischaemic conditioning once daily for 12 months and voluntarily thereafter. All investigators and patients were masked to treatment allocation. The primary efficacy endpoint was the time to first occurrence of non-fatal or fatal ischaemic stroke, with survival analysed by the Kaplan-Meier method. Primary and safety analyses were done in the intention-to-treat population. The RICA trial is registered with ClinicalTrials.gov, number NCT02534545. FINDINGS:Between Oct 28, 2015, and Feb 28, 2019, 3033 patients were enrolled and randomly assigned to either remote ischaemic conditioning (n=1517; intervention group) or sham remote ischaemic conditioning (n=1516; sham group). Median follow-up was 3·5 years (IQR 2·7-4·4). A non-fatal or fatal ischaemic stroke occurred in 257 (16·9%) patients in the intervention group compared with 288 (19·0%) patients in sham group. There was no difference in the survival distribution for time to first occurrence of non-fatal or fatal ischaemic stroke (hazard ratio 0·87, 95% CI 0·74-1·03; p=0·12). In the intervention group, 79 (5·2%) patients died from any cause, and in the sham group, 84 (5·5%) patients died from any cause (hazard ratio 0·93, 95% CI 0·68-1·27; p=0·65). No intervention-related serious adverse events were observed. INTERPRETATION:No evidence was found for a difference between remote ischaemic conditioning and sham remote ischaemic conditioning in lowering the risk of ischaemic stroke in patients with symptomatic ICAS. The benefit of remote ischaemic conditioning might have been diluted by poor compliance. Future studies of remote ischaemic conditioning in this population should address challenges in patients' compliance and assess longer term treatment. FUNDING:Ministry of Science and Technology China, Beijing Municipal Education Commission, Beijing Municipal Finance Bureau. TRANSLATION:For the Chinese translation of the abstract see Supplementary Materials section.

Objective:To assess the value of amide proton transfer weighted (APTw) imaging in the evaluation of pH changes in infarct core (IC) and ischemic penumbra (IP) in subacute cerebral infarction.Methods:The data of twenty-three subacute cerebral infarction patients with unilateral steno-occlusive disease of the middle cerebral artery (subacute infarction group) from April to November 2019 in the First Affiliated Hospital of Dalian Medical University were prospectively analyzed. Fifteen healthy volunteers were enrolled in this study as the control group. All subjects underwent conventional MRI, DWI, 3D-pseudo continuous arterial spin labeling (3D-pCASL) and APTw sequences. Based on DWI images, relative cerebral blood flow (rCBF) and APTw images to determine the region of IC, blood flow penumbra [cerebral blood flow(CBF)-DWI mismatch area, IP CBF] and metabolic penumbra (APTw-DWI mismatched area, IP APT). 3D ROIs were used to semi-automatically measure the APTw signals and the volume of IC and IP CBF of the patients in subacute infarction group. The comparison of APTw signals between the infarct side and the contralateral side in the subacute infarction group, the comparison of bilateral APTw signals in the control group, and the comparison of APTw signals in the IC and IP CBF regions were performed by paired-sample t test or Wilcoxon signed-rank test. The paired-sample t test or Mann-Whitney U test was used to compare the APTw signals between the two groups. The Friedman test was applied to compare the difference of volumes among IP CBF1.5, IP CBF2.5 and IP APT . Results:There was no significant difference of the APTw signals among the IC, the contralateral side in the subacute infarction group and the control group ( P>0.05). The APTw signals of IP CBF and IC of the infarction group were statistically different ( P<0.05). Compared with the contralateral side of IP CBF1.5 (3.7±1.7, -1.84±1.48, 5.57±2.75), the APTwmax (3.07±1.41, t=-3.012, P=0.006), APTw min [-1.30 (-1.74, -0.57), Z=-2.099, P=0.036], and APTwmax-min(4.51±2.58, t=-3.273, P=0.003) signals in the IP CBF1.5 were decreased ( P<0.05). Compared with the contralateral side of IP CBF2.5 [-1.53 (-2.80, -0.91), 5.31±2.61], the APTw min [-1.08 (-1.60, -0.49), Z=-2.616, P=0.009] and APTwmax-min (4.41±2.72, t=-3.228, P=0.004) signals in the IP CBF2.5 were decreased. The volumes of IP CBF1.5 [107.51(50.08, 138.61)mm 3], IP APT [99.00 (53.27, 121.335) mm 3] and IP CBF2.5 [89.91 (51.53, 139.87) mm 3] were successively reduced (χ2=7.913, P=0.019), and the volume of IP CBF2.5 was significantly smaller than that of IP CBF1.5 ( P=0.037). Conclusion:The acid-base metabolism in the IC of subacute cerebral infarction is not obvious, but the blood flow penumbra has local acid-base metabolism imbalance, and the range of metabolic penumbra coincides with the blood flow penumbra.

Background Autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a cerebrovascular disease closely related to the NOTCH3 gene. More than 200 mutations in this gene have been reported to be associated with this disease. Methods The NOTCH3 gene from CADASIL patient was screened for mutations by whole-exome sequencing (WES). PCR amplification and direct Sanger sequencing were used to verify the suspicious gene mutation sites detected by WES. Results We performed second-generation sequencing on a sample of the patient's genome and found a heterozygous deletion-insertion mutation c.512_605delinsA in exon 4 of NOTCH3, which resulted in amino acid changes p.G171_A202delinsE. This variation was confirmed by the direct Sanger sequencing. It may be rated as a CADASIL clinical variation. Conclusion Discovery of this mutation site provides an important theoretical basis for specific gene-based diagnosis and treatment of CADASIL.

短暂性全面遗忘症(transient global amnesia syndrome,TGA)是一种好发于中老年人的顺行性遗忘综合征,其病因及发病机制目前尚不清楚,主要表现为短暂性近记忆障碍、远事记忆保留、持续时间短暂,约数分钟至数小时,常24 h内自行缓解,可有短暂性的对时间、空间或人物的定向力障碍,书写、计算和对话等较复杂的皮质高级活动保留完整,自知力存在,不伴有其他神经功能的损害[1].尾状核是位于皮质下基底节区的灰质核团,其血液供应来于颈内动脉系统,引起尾状核梗死的原因主要为供应尾状核头部、内囊前支及壳核的Heubner动脉梗死所致[2].随着有效影像学确定的尾状核梗死病例的出现,对其功能有了更加深入的认识,尾状核梗死后除引起运动功能异常外,还能引起认知功能障碍,临床工作中尾状核病变引起所致的认知功能障碍容易被忽视,尤其以貌似短暂性全面遗忘症起病的病例更容易漏诊误诊,现将我科收治的1例此病患者报道如下,以提高临床医生对该疾病的认识.

目的 探讨短暂性全面遗忘(transient global amnesia,TGA)患者脑血管危险因素、临床特点、影像学特征、预后及与短暂性脑缺血发作(TIA)的相关性.方法 回顾性分析大连医科大学附属第一医院神经内科收治的TGA患者61例为TGA组和TIA患者61例为TIA组,对比2组脑血管危险因素、临床特点及影像学特征,TGA组随访6个月.结果 与TIA组比较,TGA组高血压、糖尿病、冠心病、吸烟、血脂异常、高同型半胱氨酸血症及TG水平明显降低(P＜0.05,P＜0.01),症状持续时间明显延长[300.0(150.0,480.0)min vs 20.0(5.0,60.0)min,P=0.000].TGA组6个月内无缺血性脑卒中发生,TGA组复发患者9例(14.75％),复发患者与未复发患者年龄、性别、高血压、糖尿病、冠心痛、血脂异常、高同型半胱氨酸血症及同型半胱氨酸水平等脑血管危险因素比较,无统计学差异(P＞0.05).TGA组发作前有潜在诱发因素或事件15例(24.59％).TGA组颈动脉、颅内动脉粥样硬化发生率明显低于TIA组(9.84％ vs 80.33％,P＜0.01;32.79％ vs 59.02％,P＜0.05).结论 TGA与脑血管危险因素不相关,其发病与病前应激因素及潜在诱发因素或事件相关.TGA是一个良性病程,预后较好,可能不是TIA的一种特殊亚型.

Emodin (EMO) possesses extensive pharmacological activities, which has been proven to exert the protective impact in diverse nervous system diseases. Nonetheless, whether EMO emerges a neuro-protective activity in hypoxic-evoked ischemic brain injury is still further probed. The intention of the research is to disclose whether EMO emerges neuro-protective activity in hypoxic-evoked ischemic brain injury. PC-12 received hypoxia administration, and then cell viability, apoptosis and autophagy were estimated. After EMO disposition, the above-involved cellular processes were evaluated again. MiR-25 functions in EMO-affected cells were also estimated. The interrelation between miR-25 and neurofilament light-chain polypeptide gene (NEFL) and the conceivable roles of NEFL in hypoxia-disposed cells were investigated. The latent mechanism was uncovered by mTOR and Notch pathways determination. Hypoxia triumphantly triggered apoptosis and autophagy, but EMO repressed these functions in PC-12 cells. Increased miR-25 was induced by EMO, and inhibited miR-25 abated the impacts of EMO on hypoxia-disposed PC-12 cells. NEFL as a neoteric target gene of miR-25 was predicated, and overexpressed NEFL annulled the functions of EMO in hypoxia-injured cells. EMO activated mTOR and Notch pathways through repressing NEFL. The investigations corroborated that EMO weakened hypoxia-triggered injury via elevating miR-25 by targeting NEFL in PC-12 cells.

Objective To analyze the clinical effect of Ixeris sonchifolia Hance combined with western medicine in the treatment of vertigo caused by vertebrobasilar ischemia (VBI).Methods 80 cases of vertigo caused by vertebrobasilar ischemia were randomly divided into research group (n=40) and control group (n=40).The control group was treated with butyphthalide sodium chloride,the research group was treated with Ixeris sonchifolia Hance on the basis of the treatment in the control group.Both groups were treated for 10 d.Compared the total effective rate,the changes of Vd and VP in vertebral artery (VA) and basilar artery (BA) before and after treatment,the change of hemorheology,and adverse reactions in both groups.Results The total effective rate of the research group was higher than that of the control group (92.50％ vs.67.50％),with statistically significant difference (P＜0.05).Vd and VP in VA and BA in the two groups significantly increased after treatment (P＜0.05),Vd and VP in VA and BA in the research group were higher than those in the control group after treatment (P＜0.05).Low shear viscosity,high shear viscosity,plasmic viscosity,and fibrinogen in the two groups significantly decreased after treatment (P＜0.05),low shear viscosity,high shear viscosity,plasmic viscosity,and fibrinogen in the research group were lower than those in the control group after treatment (P＜0.05).There were no obvious adverse reactions during the treatment course.Conclusion Ixeris sonchifolia Hance combined with western medicine in the treatment of vertigo caused by vertebrobasilar ischemia has significant clinical effect,of great significance.

Objective It is to explore the curative effect of adjuvant therapy with different dose of ligustrazine in patients with transient ischemic attack and on the levels of serum C-reactive protein (CRP),homocysteine(Hcy),lipoprotein lipase A2 (Lp-PLA2),nerve ene alcoholize enzyme (NSE),tumor necrosis factor-a (TNF-α),interleukin 6 (IL-6).Methods 146 patients with transient ischemic attack were randomly divided into 2 groups,A group was given conventional treatment plus ligustrazine injection 120 mg by intravenous drip,B group was given routine therapy plus ligustrazine injection 240 mg by intravenous drip,once per day,and both groups were treated for 4 weeks.The levels of serum CRP,Hcy,Lp-PLA2,NSE,TNF-α,IL-6 were detected before and after treatment in both groups,the times of transient ischemic attack at 4 weeks before treatment,in 2 and 4 weeks after treatment,and incidence of stroke and adverse reactions within 1 year was calculated.Results The levels of CRP,Hcy,Lp-pla2,NSE,TNF-α,IL-6 and the number of arterial microemboli in the brain were significantly decreased in group B than those in group A (P ＜ 0.05).The number of transient ischemic episodes in 2 and 4 weeks after treatment was significantly less while incidence of stoke within 1 year was lower in group B than that in group A (P ＜0.05).No obvious side effect related to the medicine was found in both groups.Conclusion Large doses of ligustrazine has better clinical curative effect on transient ischemia,which is worth clinical promotion.

目的 观察阿托伐他汀对大鼠脑缺血再灌注后基质金属蛋白酶9(MMP-9)表达的影响.方法 选择SD大鼠96只,随机分为:假手术组16只,脑缺血再灌注组40只,阿托伐他汀组40只.建立大脑中动脉缺血2h再灌注模型.阿托伐他汀组在建立模型前21 d予以阿托伐他汀灌胃.假手术组分为24 h和48 h,每个时间点8只.缺血再灌注组和阿托伐他汀组根据缺血再灌注时间分为3、12、24、48、96 h,每个时间点8只.于各个时间点进行神经行为学测试;TTC染色测定缺血体积;免疫组织化学SABC法测定MMP-9蛋白的表达变化;RT-PCR法对各组脑组织中MMP-9 mRNA表达进行分析.结果 与缺血再灌注组比较,阿托伐他汀组3、12、24、48、96 h神经功能评分明显降低,梗死体积明显减小[(102.37±10.31)mm3 vs (135.26±12.16) mm3,(105.78±9.23)mm3 vs (155.07±14.12)mm3,(110.56±13.45)mm3 vs (162.47±11.41)mm3,(119.71±10.01)mm3 vs (180.27±14.27)mm3,(121.63±11.23)mm3 vs(193.41±11.56)mm3,P＜0.05];12、24、48、96 h MMP-9蛋白、mRNA表达显著降低,差异有统计学意义(P＜0.05).结论 脑卒中前预服用阿托伐他汀可能通过降低MMP-9水平来达到脑保护的效果.

目的：探讨基质金属蛋白酶（MMP）－9血清水平及其基因多态性与颈动脉斑块易损性之间的相关性。方法选取2011年3月至2013年4月在大连医科大学附属第一医院神经内科住院治疗且发病时间在48 h 之内的脑梗死患者271例，根据 B 超检查结果，分为斑块稳定组和斑块易损组，利用酶联免疫吸附法对两组患者血清 MMP－9水平进行检测，采用 PCR－酶切反应过程对 MMP－9基因多态性进行测定。结果斑块易损组患者血清 MMP－9水平高于斑块稳定组（P＜0.05）；斑块易损组 MMP－9不同基因型频率分布与斑块稳定组相比差异显著（ P＜0.05），斑块易损组 T ／T 和 C ／T 基因型频率高于斑块稳定组，斑块易损组与斑块稳定组（TT＋CT）／CC 的 OR ＝1.73（95％CI 1.14～3.18，P＜0.05）；斑块易损组等位基因频率分布与斑块稳定组相比，差异具有统计学意义（P＜0.05），斑块易损组与斑块稳定组 T ／C 的 OR ＝1.56（95％CI 1.07～2.83，P＜0.05）。结论MMP－9血清水平及其基因多态性与颈动脉斑块易损性密切相关，可以将血清 MMP－9水平检测和－1562C ／T 位点多态性测定作为临床患者颈动脉斑块易损性判断的早期标志物。

目的:本研究试图通过测量梗死区引流静脉的相位差,并结合局部血流动力学的改变,探讨SWI上引流静脉信号变化的可能机制以及其对急性脑梗死患者的临床应用价值.方法:回顾性分析急性缺血性脑梗死患者20例,年龄47～82岁,平均61岁;发病时间7～48小时,平均28小时.行磁敏感加权成像(SWI)、动态磁敏感对比增强灌注加权成像(DSC-PWI)扫描,测量梗死区与对侧相应区域静脉血管的相位差(分别用Δφ病灶和Δφ对侧表示),测量梗死区与对侧相应区域的rCBF值、rrCBF值及rCBV值,测量脑梗死患者NIHSS评分.结果:①梗死区静脉相位差Δφ病灶=547.0±155.7spin,对侧静脉相位差Δφ对侧=282.65±96.67spin,梗死区静脉相位差显著大于健侧(t=5.861,P＜0.001);②梗死区rCBF值小于健侧(t=-8.978,P＜0.001),梗死区rCBV值亦小于健侧(P=0.008);③Δφ病灶与NIHSS评分呈显著正相关(r=0.933,P＜0.001),Δφ病灶与rrCBF呈显著正相关(r=0.681,P=0.001),rrCBF与NIHSS评分呈正相关(r=0.645,P=0.002).结论:SWI脑梗死引流静脉相位差所反映的氧代谢异常与CBF的相关性符合脑血流-代谢耦联机制,可作为临床评价急性梗死患者病情程度的可靠指标.

目的：了解缺血性脑卒中危险人群的一级预防现状，分析影响治疗依从性的因素。方法从2013‐03—09于大连医科大学附属第一医院参加缺血性脑卒中危险因素筛查的患者中筛选出危险人群，收集其临床特征，调查慢病的知晓、治疗、控制情况，并于登记后第3个月、第6个月进行随访；观察治疗的依从情况，使用多因素Logistic回归进行分析。结果本调查共入组615例缺血性脑卒中危险人群，其高血压病的知晓率为66.5％，治疗率为53.2％，控制率为19.9％；糖尿病的知晓率为44.8％，治疗率为38.4％，控制率为17.4％；血脂异常的知晓率为58.2％，治疗率为25.5％，控制率为11.0％。3个月随访时高血压、糖尿病、血脂异常的治疗依从率分别为75.8％、72.0％、19.8％；6个月时分别为68.6％、56.0％、12.0％。Logis‐tic回归分析发现高龄（OR＝1.974，P＝0.045）、医保（OR＝1.973，P＝0.047）与高血压治疗依从性好相关；高龄（OR＝4.573， P＝0.012）与糖尿病治疗依从性好相关；高龄（OR＝3.094，P＝0.025）、居住于城市（OR＝2.982，P＝0.042）与血脂异常治疗依从性好相关。结论缺血性脑卒中危险人群一级预防的现状仍不理想，尤以血脂异常的治疗和依从性最差。

目的 探讨CT灌注(computerized tomography perfusion,CTP)联合CT血管造影(computerizedtomography angiography,CTA)检查在后循环短暂性脑缺血发作患者中的应用价值,并对后循环短暂性脑缺血发作的病因、发病机制进行研究.方法 对50例后循环短暂性脑缺血发作患者进行CTP、CTA检查,测定脑干、小脑局部平均通过时间(mean transmit time,MTT)、脑血流量(cerebral blood flow,CBF)及脑血容量(cerebral blood volume,CBV)灌注参数,获得相应参数图,进行兴趣区与对侧镜像区域参数的比较.结果(1)39例患者CT灌注成像发现与临床症状相对应的灌注异常区,阳性率为78％;(2)比较灌注异常区与对侧正常对照区平均MTT、平均CBF及平均CBV,患侧MTT较健侧明显延长,患侧CBF明显低于健侧,两者差异具有统计学意义(P＜0.05);(3)50例患者中有40例(80％)CTA显示椎基底动脉异常,其相应供血区CTP异常者34例(85％);10例CTA未发现血管异常患者中,CTP异常者5例(50％),两者差异具有统计学意义.结论 CTP能够反映后循环TIA患者的脑灌注状态,CTA可以直观准确地评价相应供血血管的病变情况,后循环的低灌注是后循环TIA的主要发病机制,椎基底动脉狭窄是后循环TIA的主要病因.二者联合应用为后循环TIA的病因、发病机制及诊断提供了直接客观的影像学依据.