目的 探索红细胞微粒(red blood cell microparticles,RMPs)对急性脑梗死(acute cerebral infarction,ACI)患者近期临床预后的影响.方法 招募2015年12月—2018年3月就诊于邯郸市第一医院的ACI患者共168例,根据患者电子病历系统收集患者临床基线资料,入组后抽取静脉血进行实验室指标检测,同时出院后随访患者近期预后,根据预后情况将患者分为预后良好组(n=127)及预后不良组(n=41),比较两组患者临床特征差异性,应用多因素Logis?tic回归分析RMPs与ACI预后不良的相关性,通过受试者工作特征(ROC)曲线评估RMPs预测ACI预后不良的价值.结果 本研究发现,预后不良组低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、超敏C反应蛋白(high-sensitivity C-reactive protein,Hs-CRP)、RMPs、D-二聚体及NIHSS评分高于预后良好组,同时多因素Logistic发现,RMPs、D-二聚体、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分与ACI患者近期预后不良有相关性,其优势比(OR)(95％CI)分别为29.93(3.14～285.40)、3.55(1.36～9.27)及6.44(1.09～38.14);RMPs预测ACI患者近期预后不良的价值曲线下面积(AUC)(95％CI)为0.83(0.75～0.92),其最佳预测界值为51.36％,该界值下敏感性(95％CI)为0.85(0.78～0.91),特异性(95％CI)为0.53(0.49～0.62).结论 RMPs是预测ACI近期预后不良的指标,同时RMPs也是ACI患者预后不良的独立危险因素.

目的 分析基质金属蛋白酶9(matrix metalloproteinase,MMP-9)对缺血性脑卒中(ischemic stroke,IS)患者认知功能障碍的影响.方法 选择2017年1月至2019年1月河北省邯郸市第一医院收治的210例IS患者,入院后72h内进行认知功能障碍评估,将存在认知障碍患者84例归为观察组,认知功能正常患者126例为对照组.根据抽取外周静脉血检测MMP-9水平,分析两组患者临床资料及MMP-9表达差异性,探讨MMP-9与IS患者认知功能障碍的相关性及其诊断价值.结果 观察组患者脑梗死病灶数目、美国国立卫生院脑卒中量表评分及枕叶和丘脑部位梗死显著高于对照组.观察组患者外周血中MMP-9表达水平显著高于对照组(t=8.424,P<0.01).MMP-9诊断IS患者认知功能障碍的价值曲线下面积为0.84(0.80～0.90),最佳诊断界值为392.57,该界值下敏感性和特异性分别为0.63和0.71.MMP-9与蒙特利尔认知评估量表评分之间为负相关关系(r=-0.318,P<0.01),MMP-9>392.57是影响IS患者认知功能障碍的因素,其优势比为4.36(2.09～8.17).结论 MMP-9在IS认知功能障碍的患者中表达显著上调,是潜在的诊断认知功能障碍的指标,同时,MMP-9>392.57是IS患者发生认知功能障碍的危险因素.

目的 研究盐酸替罗非班联合阿司匹林治疗前循环脑梗死早期进展患者的应用效果.方法 采用回顾性分析方法,选取2018年1月至2019年7月河北省邯郸市第一医院收治的70例前循环脑梗死早期进展患者作为研究对象,根据不同用药方式分为对照组和研究组,每组各35例.对照组患者单用阿司匹林治疗,研究组患者联用盐酸替罗非班与阿司匹林治疗.比较两组患者治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数评定量表(BI)评分与治疗后总有效率.结果 研究组患者治疗前后NIHSS评分分别为(16.78±2.51)分、(9.27±2.14)分,BI评分分别为(43.28±1.55)分、(57.04±1.86)分,总有效率为91.43％;对照组患者治疗前后NIHSS评分分别为(16.65±2.43)分、(11.38±2.33)分,BI评分分别为(43.59±1.64)分、(50.12±1.73)分,总有效率为68.57％.两组患者治疗前NIH-SS评分、BI评分比较,差异无统计学意义(P>0.05);两组患者治疗后较治疗前NIHSS评分明显升高,BI评分明显降低;研究组较对照组治疗后NIHSS评分更低,BI评分及总有效率更高,差异均具有统计学意义(P<0.05).结论 前循环脑梗死早期进展患者治疗中盐酸替罗非班联合阿司匹林的应用效果显著,可有效改善患者神经功能.

目的;评价机械取栓辅助动脉内溶栓对急性缺血性脑卒中的疗效及对患者颅内血流动力学和神经损伤标志物的影响.方法;回顾性分析本院2015-06—2017-12收治的86例急性缺血性脑卒中患者资料,根据不同治疗方式分为对照组(41例)和观察组(45例),对照组采用动脉内溶栓治疗,观察组采用机械取栓辅助动脉内溶栓治疗,比较两组血管再通情况、治疗前后颅内血流动力学指标水平、神经损伤标志物、美国国立卫生研究院卒中量表(NIHSS)评分、并发症和预后情况.结果;观察组血管再通率、恢复良好率均高于对照组(P<0.05).治疗后,两组最大峰值流速(Vs)、平均流速(Vm)均较治疗前上升,血管阻力指数(RI)、血管搏动指数(PI)、血清谷氨酸(Glu)、神经元特异性烯醇化酶(NSE)、S100β蛋白水平及NIHSS均较治疗前下降,且观察组改善情况均优于对照组(P<0.01).两组不良反应总发生率比较无统计学差异(P>0.05).结论;机械取栓辅助动脉内溶栓对急性缺血性脑卒中患者疗效优于单纯动脉内溶栓治疗.

目的 探讨盐酸多奈哌齐联合美金刚治疗血管性认知障碍的临床疗效,及其对患者血清基质金属蛋白酶-9(MMP-9)和组织金属蛋白酶抑制剂-1(TIMP-1)水平的影响.方法 将120例血管性认知障碍患者随机分为研究组和对照组,各60例.研究组患者给予盐酸多奈哌齐联合美金刚治疗,对照组患者单用盐酸多奈哌齐治疗.结果 治疗后,研究组患者简易智能精神状态评估量表(MMSE)、长谷川痴呆量表(HDS)、痴呆严重程度临床评定量表(CDR)评分及大脑中动脉收缩期血流速率(Vs)明显高于对照组患者(P<0.05),日常生活功能量表(ADL)评分、平均血流速率(Vm)、脉动指数(PI)、MMP-9及TIMP-1水平明显低于对照组患者(P<0.05);两组患者血、尿常规,肝、肾功能检查均无明显变化,均未出现明显不良反应.结论 盐酸多奈哌齐联合美金刚治疗血管性认知障碍,可明显改善临床症状,降低血清MMP-9及TIMP-1水平,疗效优于单用盐酸多奈哌齐,且不良反应少,值得临床推广.

Objective To evaluate the efficacy of super selective artery thrombolysis for patients with acute internal middle cerebral artery occlusions.Methods A total of 88 patients with acute internal middle cerebral artery infarction were collected in this study,all patients were divided into observation group and control group by random number table.Patients in the control group were treated with conventional methods,and observation group were treated with super selective arterial thrombolysis method.The clinical effect and adverse reaction were observed.Results The neurologic impairment score(7.2±2.2) of observation group after treatment was significant better than that in control group (14.4±2.4).There were no serious adverse reactions in the two groups.The satisfaction rate of patients in observation group and the control group was 95.5% and 72.7%,respectively.Conclusion Super selective arterial thrombolysis treatment can obviously improve the defect of nerve function and clinical symptoms without obvious adverse reaction in patients with acute middle cerebral artery infarction.

目的:探讨血清一氧化氮(NO)水平与脑梗死后患者血管性认知障碍的相关性.方法: 选择脑梗死后血管性认知障碍96例为患者组,另选择同期来我院体检的认知功能正常者60例为对照组,采用硝酸还原酶比色法测定两组受试对象血清NO水平,分析蒙特利尔认知评估量表(MOCA)各项评分和NO水平的相关性.结果:患者组血清NO水平为(114.6±13.2)mg/L, 明显高于血清NO水平(61.3±4.5)mg/L,差异有统计学意义(t=6.352,P<0.05).Spearman相关分析显示,患者组血清NO水平与MOCA总分呈负相关(r=-0.514,P<0.05),其中患者血清NO水平与视空间与执行能力呈负相关(r=-0.276,P<0.05),与命名呈负相关(r=-0.235,P<0.05),与语言呈负相关(-0.241,P<0.05),与延迟回忆呈负相关(-0.217,P<0.05),但与抽象思维及定向力均无关(P>0.05).结论:血清NO水平是诱发脑梗死后血管性认知障碍的一种独立性危险因素,其和认知障碍严重程度具有相关性,NO的高表达会促进本病的发生及发展.

Objective To investigate the relationship between serum matrix metalloproteinase-9 (MMP-9),cystatin C and nitric oxide (NO)levels and cognitive dysfunction after cerebral infarction. Methods From March 2015 to July 2016,100 patients with cognitive dysfunction after cerebral infarction were selected as the patients group,and 70 patients without cognitive impairment in the same period were se-lected as control group The level of serum cystatin c was determined by immuno-turbidimetric assay,and the serum NO level was determined by nitric acid reductase colorimetry. Meanwhile,the levels of serum NO were measured by enzyme-linked immunosorbent assay (ELISA) (MOCA)and serum MMP-9,cystatin C and NO levels in patients with chronic obstructive pulmonary disease (AMI). Results The level of serum MMP-9 in the patients was (462. 7 ± 64. 2)ng / ml,which was significantly higher than that in the control group (142. 3 ± 45. 8 mg /L)(t = 7. 093,P < 0. 05). The serum cystatin C level was (678. 1 ± 78. 2 μg / L),which was significantly higher than that of the control group (302. 6 ± 45. 5)μg / L (t = 8. 126,P < 0. 05). The serum NO level in the patients was (121. 4 ± 15. 6 mg / L),which was signifi-cantly higher than that in the control group (62. 5 ± 3. 2 mg / L)(t = 8. 405,P < 0. 05). Serum cystatin c level was negatively correlated with MOCA score (r =-0. 627,P < 0. 05),and there was a negative correlation between serum MMP-9 level and MOCA total score in the pa-tient group (r =-0. 526,P < 0. 05). The serum level of NO was negatively correlated with the total score of MOCA (r =-0. 526,P <0. 05). Conclusion The serum levels of MMP-9,cystatin C and NO are independent risk factors for cognitive dysfunction after cerebral in-farction,which are closely related to the severity of cognitive impairment. The high expression of MMP-9,cystatin C and NO can promote the occurrence and development of cognitive dysfunction after cerebral infarction.

Objective To investigate the relationship between CD147 and β - amyloid of Alzheimer’s Disease. Methods CD147 cDNA was transfected into SH - SY5Y cell line,and cells with overexpression of CD147 were screened by G418. The over expression cells and normal cells were set as the experimental group and control group,respectively. Total protein of each group were extracted after cultured at the same condi-tion. Western Blot was employed to detect the expression of CD147 protein. Immunohistochemistry and Elisa were used to detect the activity of β- amyloid. Results The content of CD147 in experimental group was significantly higher than that of the control group,the difference was statis-tically significant( P ﹤ 0. 05). The contents of β - amyloid were significantly lower than the control group( P ﹤ 0. 05). Conclusion CD147 is a negative regulator of β - amyloid of Alzheimer’s Disease.

目的：观察机械溶栓结合尿激酶治疗急性脑梗死的临床效果。方法将我院收治的64例急性脑梗死病人随机分组治疗和研究组。研究组32例采用机械溶栓结合尿激酶动脉溶栓治疗；对照组32例采用尿激酶动脉溶栓治疗,比较两组病人的临床疗效。结果研究组治疗总有效率为93.75%,病人血管再通情况良好,明显优于对照组71.89%；研究组治疗前 Barthel指数评分为37.12分±7.09分,与对照组37.68分±7.64分比较,差异无统计学意义(t=0.13,P>0.05)；经治疗后,研究组 Barthel指数评分为66.10分±6.03分,与对照组40.12分±5.30分比较,差异有统计学意义(t=7.19,P<0.05)。结论将机械溶栓结合尿激酶动脉溶栓治疗急性脑梗死病人,可提高治疗效果,安全性较高。

Objective :To explore the curative effect of clopidogrel combined with aspirin on acute cerebral infarction .Methods :200 cases of the acute cerebral infarction patients were randomly divided into two groups .100 cases in the control group were given aspirin tablet ,maintenance of water ,electrolyte level ,reduce the intracranial pressure and other conventional treatment .And 100 patients in the observation group ,given clopidogrel tablet com‐bined with aspirin treatment .The differences in clinical efficacy were observed in the two groups and the European Stroke Scale ( ESS) and adverse drug reaction (ADR) were evaluated .Results :After the treatment ,the European Stroke Scale ( ESS) score of the observation group was decreased ,and was lower than that of the control group and the difference was statistically significant (P < 0 .05) ;the activities of daily life ( ADL ) score of the observation group was increased ,and was higher than that of the control group and the difference was statistically significant ( P< 0 .05) ;The total effective rate in the observation group was 97 % ,higher than 86 % of the control group ,and the difference was statistically significant (P < 0 .05) .The incidence of adverse drug reactions in the observation group was 3 % ,lower than 4 % of the control group ,and the difference was no statistically significant (P > 0 .05) .Con‐clusion :Clopidogrel combined with aspirin had its remarkable effect on the treatment of acute cerebral infarction , and a combination of the two had high clinical efficiency ,which could significantly promote the activities of daily liv‐ing ,but few side effects and deserves popularization in the clinical practice .

目的：观察不同动脉溶栓时间，血管再通后脑水肿发生率及其对急性缺血性脑卒中（Acute ischemic stroke，AIS）患者预后影响。方法：回顾我院2011年6月—2014年6月收治的75例轻中度AIS应用动脉溶栓治疗患者资料，按照其发病至溶栓时间分为0～1 h组（n=18）、1～3 h组（n=31）及3～6 h组（n=26），随访1年，比较各组患者血管再通后脑水肿发生率及预后。结果：至随访结束时，0～1 h组患者血管再通后均未出现脑水肿，1～3h组及3～6h组患者血管再通后均出现脑水肿。末次随访时，1～3h组及3～6h组患者脑水肿部位均出现了明显的软化灶。各组患者溶栓后NIHSS评分均较溶栓前显著下降，1～3 h组、3～6 h组各时期NIHSS评分均显著高于0～1 h组，差异有统计学意义（P＜0.05），1～3 h组、3～6 h组各时期组间NIHSS评分比较，差异无统计学意义（P＞0.05）。1～3 h组、3～6 h组神经功能改善总有效率、生活能力恢复预后良好率显著低于0～1 h组，差异有统计学意义（P＜0.05），1～3 h组、3～6 h组2组间神经功能改善总有效率、生活能力恢复预后良好率比较，差异无统计学意义（P＞0.05）。结论：AIS发病至溶栓时间1～6 h时，患者血管再通后脑水肿发生率为100.0%，影响患者神经功能和生活能力恢复，在今后的治疗中，应及时对AIS患者实施动脉溶栓治疗，以降低脑水肿发生风险，改善患者预后。

目的 探讨细胞外基质金属蛋白酶诱导因子(CD147)与阿尔茨海默病γ-分泌酶的相关性.方法 CD147 cDNA转染人神经母细胞瘤,并通过遗传霉素G418筛选CD147超表达细胞.超表达细胞设为实验组,正常细胞设为对照组,Western Blot检测两组CD147含量,Elisa分析两组Aβ40和Aβ42含量.结果 实验组和对照组CD147含量分别为(40.23±0.20) μg/μL和(27.98 ±0.12)μg/L,实验组显著高于对照组(t=90.97,P＜0.05).实验组和对照组Aβ40与Aβ42总含量分别为(141.05±2.13) pg/mL和(323.41±2.78)pg/mL,实验组显著低于对照组(t=90.19,P＜0.05).结论 随着CD147含量的增加,Aβ的生成减少,而γ-分泌酶是生成Aβ的限速酶,可知γ-分泌酶随着CD147含量的增加而呈负增长,提示CD147对γ-分泌酶的活性起着负调节作用.

Objective To investigate the indications and efficacy of clopidogrel hydrogen and aspirin in the treatment of a‐cute cerebral infarction.Methods From March 2012 to May 2014 ,168 cases of patients with acute cerebral infarction in our hospital were divided into control group and observation group according to the random principle ,each group of 84 cases ,the control group received conventional treatment on the basis of aspirin treatment ,observation group was treated by clopidogrel therapy on the basis of control group. The neurological deficits of patients in the two groups after treatment were assessed ,and the efficacy and adverse reactions were compared.Results The total effective rate of control group after treatment was 71.43% ,which was 90.48% in observation group ,the difference was significant (P<0.05). The neurological deficit scores of two groups showed no difference before treatment (P>0.05) ,and were improved after treatment ,the improvement of the ob‐servation group was better than that of the control group ,the difference was statistically significant (P<0.05).All the patients had no severe complications and adverse reactions during treatment.Conclusion Clopidogrel and aspirin can significantly im‐prove the efficacy of clinical course of acute cerebral infarction ,and reduce the adverse reactions ;the patients’ prognosis is good ,it’s worthy of promotion and application in clinical practice.

目的：探讨氢氯吡格雷联合阿司匹林治疗急性进展性脑梗死的临床疗效。方法将接受治疗的100例急性进展性脑梗死患者按随机数字表法分成对照组和观察组，各50例。对照组采用氢氯吡格雷治疗，观察组在对照组基础上联合应用阿司匹林治疗。结果观察组患者治疗有效率为92.00％，优于对照组的80.00％（ P＜0.05）；观察组神经功能缺损评分为（10.77±6.38）分，优于对照组的（16.54±6.68）分（ P＜0.05）；观察组血液流变学改善情况优于对照组（ P＜0.05）。结论采用氢氯吡格雷联合阿司匹林治疗急性进展期脑梗死患者，可有效改善缺氧、缺血症状，有助于促进神经功能的恢复和血流变学的改变，值得临床推广。

Objective: To investigate the expression of extracellular matrix metalloproteinase inducer in SH-SY5 Y cells and the spacial relationship with the expression of ubiquitin. Methods: Human neuroblastoma cell line SH-SY5 Y was treated with MG-132 proteasome inhibitors at different concentrations(0, 0.5, 1, 2.5 and 5 μmol/L)in vitro. After 24 h, In-cell Western and Western Blot methods were employed to detect the expression of CD147 protein. Immunofluorescence double labeling method was used to detect the co-localization of ubiquitin and CD147. Results:When MG-132 proteasome inhibitors were used to deal with SH-SY5 Y cultured in vitro, The expression of CD147 protein in SH-SY5 Y cells was increased with MG-132 proteasome inhibitors in a concentration dependent manner. When the inhibitor concentration was 5 μmol/L, the expression of CD147 was significantly higher than that in the control(0 μmol/L)(P0.05). The expressions of Ubiquitin and CD147 were co-localized in SH-SY5 Y cells. Conclusion: CD147 may be degraded by the ubiquitin-proteasome pathway.

<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 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.

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.

资料与方法 研究对象选择我院2007年7月～2009年10月原发性高血压住院患者,高血压的诊断采用<中国高血压防冶指南>2005年修订版的诊断标准.除外心力衰竭,心律失常,肝功能异常,睡眠障碍,服药期间出现头痛、眩晕等不良反应未能继续服药者,共入选129例,其中男73例,女56例,年龄50～75岁.