BackgroundVascular disease is the second most common cause of dementia. The prevalence of vascular dementia (VaD) has increased over the past decade. However, there are no licensed treatments for this disease. Carotid atherosclerosis (CAS) is highly prevalent and is the main cause of ischemic stroke and VaD. We studied co-expressed genes to understand the relationships between CAS and VaD and further reveal the potential biomarkers and therapeutic targets of CAS and VaD.MethodsCAS and VaD differentially expressed genes (DEGs) were identified through bioinformatic analysis Gene Expression Omnibus (GEO) datasets GSE43292 and GSE122063, respectively. Furthermore, a variety of target prediction methods and network analysis approaches were used to assess the protein–protein interaction (PPI) networks, the Gene Ontology (GO) terms, and the pathway enrichment for DEGs, and the top 7 hub genes, coupled with corresponding predicted miRNAs involved in CAS and VaD, were assessed as well.ResultA total of 60 upregulated DEGs and 159 downregulated DEGs were identified, of which the top 7 hub genes with a high degree of connectivity were selected. Overexpression of these hub genes was associated with CAS and VaD. Finally, the top 7 hub genes were coupled with corresponding predicted miRNAs. hsa-miR-567 and hsa-miR-4652-5p may be significantly associated with CAS and VaD.

目的 探讨大动脉粥样硬化型脑梗死不同CISS机制、危险因素与替罗非班治疗后病情进展的关系,探讨不同发病机制及危险因素对替罗非班疗效的影响.方法 收集192例接受替罗非班治疗的急性缺血性脑梗死患者作为研究对象,根据患者治疗后7d内病情是否进展分为对照组(133例)和进展组(59例).对比两组患者的美国国立卫生研究院卒中量表(NIHSS)、ESSEN卒中风险量表(ESRS)和出院时改良Rankin量表(mRS)评分,对两组患者发病机制分型及危险因素进行多因素Logistic回归分析.结果 进展组治疗24h、7d的NIHSS评分、入院时ESRS评分、出院时mRS评分均高于对照组,两组差异有统计学意义(P<0.05);多因素Logistic回归分析显示糖尿病、高血压、后循环梗死及CISS分型中的混合机制是替罗非班治疗后脑梗死病情进展的独立危险因素(OR=2.319,95％CI:1.180～4.561,P=0.015;OR=2.714,95％CI:1.260～5.964,P=0.011;OR=0.498,95％CI:0.254～0.975,P=0.042;OR=2.847,95％CI:1.049～7.723,P=0.040).结论 脑梗死病情进展患者入院时ESRS评分、治疗24h、7d的NIHSS评分、出院时mRS评分明显升高,CISS分型中的混合机制及糖尿病、高血压、后循环梗死是替罗非班治疗后脑梗死病情进展的独立危险因素.

Background: Stroke is the leading cause of morbidity and mortality in China. Recurrent stroke (RS) could occur in a significant portion of patients with ischemic stroke with devastating consequence. Methods: To investigate the association between lifestyle and the risk of RS in Chinese patients with acute large-vessel ischemic stroke (ALVIS). A total of 258 patients with ALVIS were recruited in the study (median age 63 years, 30.6% female), and followed for a median of 366 days. The primary outcomes were first RS. Cox Regression and Akaike information criterion were used to establish the best-fit nomograms. Results: During follow-up, 38 of 258 (14.7%) participants had the primary endpoint event. After adjusting for confounding factors in multivariate Cox regression analysis, healthy lifestyles, including bland diet (hazard ratio [HR], 0.365; 95% CI, 0.138-0.965), daily fruit consumption (HR, 0.474; 95% CI, 0.238-0.945), good sleep (HR, 0.364; 95% CI, 0.180-0.739), housework: HR (0.461; 95% CI, 0.200-1.065), and HDL (HR, 0.329; 95% CI, 0.130-0.831) were associated with significantly decreased risk for RS after ALVIS, while smoking was associated with a substantial increase in RS risk (HR, 2.590; 95% CI, 1.340-5.005) and included into the nomogram. A weighted point (from 0 to 100) was given to each risk factor, and the total points could be used to predict the probability of RS for the patient. Conclusion: The nomogram shows that healthy lifestyles (bland diet, daily fruit consumption, good sleep, cigarette cessation, and housework) were important for reducing RS in patients with ALVIS.

目的 探讨阿托伐他汀治疗进展性缺血性脑卒中(PIS)后心力衰竭的临床效果.方法 60例PIS后心力衰竭患者,按随机数字表法分为观察组与对照组,各30例.所有患者均采取常规稳压及控制血糖治疗,在此基础上对照组患者使用阿司匹林+氯吡格雷治疗,观察组在对照组基础上加用阿托伐他汀治疗.比较两组治疗效果;治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、日常生活能力评定量表(ADL)评分;不良反应发生率及复发率.结果 观察组治疗总有效率96.67％明显高于对照组的80.00％,差异有统计学意义(P<0.05).治疗前,两组NIHSS、ADL评分比较差异无统计学意义(P>0.05);治疗后,观察组的NIHSS评分、ADL评分分别为(13.36±2.18)、(75.54±7.19)分;对照组的NIHSS评分、ADL评分分别为(18.65±2.56)、(70.21±7.04)分.治疗后,两组NIHSS评分、ADL评分均优于治疗前,且观察组NIHSS评分、ADL评分均优于对照组,差异有统计学意义(P<0.05).观察组不良反应发生率为10.00％,对照组不良反应发生率为13.33％,比较差异无统计学意义(P>0.05).观察组复发率0低于对照组的13.33％,差异有统计学意义(P<0.05).结论 针对PIS后心力衰竭患者采取阿托伐他汀、阿司匹林与氯吡格雷的联合治疗方式,可取得满意的疗效,改善患者神经功能及提高患者日常生活能力,因此值得在临床中大力推广使用.

目的 观察动脉内灌注替罗非班治疗进展性缺血性脑卒中的有效性及安全性.方法 53例进展性缺血性脑卒中患者,根据治疗方法不同分为实验组(24例)与对照组(29例).对照组予以双抗治疗,实验组予以责任血管动脉内灌注替罗非班治疗,停泵前6 h予以双抗,后续综合治疗与对照组相同.比较两组治疗前与治疗后24 h、7 d的美国国立卫生研究院卒中量表(NIHSS)评分,出院时改良Rankin量表(mRS)评分,出血情况、死亡情况,治疗后24 h病情.结果 治疗后24 h、7 d,实验组的NIHSS评分分别为(7.08±3.11)、(4.87±3.45)分,均低于对照组的(9.75±4.23)、(7.83±4.37)分,差异均有统计学意义(P<0.05).实验组出院时mRS评分(1.50±1.18)分低于对照组的(2.29±0.99)分,差异有统计学意义(P<0.05).实验组出血率16.67％与对照组的17.24％比较,差异无统计学意义(P>0.05).两组均无死亡病例.治疗后24 h,对照组病情持续进展率为86.21％(25/29),高于实验组的8.33％(2/24),差异有统计学意义(P<0.05).结论 替罗非班动脉内灌注治疗进展性缺血性脑卒中的疗效显著,具有良好安全性,可提高患者预后.

目的 评估院内信息化系统在卒中绿色通道救治中的效果.方法 选取2019年1月—2020年3月医院急诊收治的经阿替普酶(rt-PA)静脉溶栓治疗的急性缺血性脑卒中患者,共68例.未使用绿色通道前的20例患者设为对照组,常规绿色通道模式的11例为过渡组;信息化卒中绿色通道模式的37例为研究组;比较3组患者的静脉溶栓达标率、就诊到溶栓治疗时间(DNT)、急诊到动脉穿刺时间(DPT)、治疗前后美国国立卫生研究院卒中量表(NIHSS)评分及出院时改良Rankin量表(mRS)评分.结果 与对照组、过渡组相比,研究组DNT时间、DPT时间显著缩短,DNT达标率显著提高,差异具有统计学意义(P<0.05);研究组治疗24 h后、7天NIHSS评分及出院时mRS评分均显著降低,差异具有统计学意义(P<0.05).与对照组相比,过渡组DNT时间、DPT时间及DNT达标率均有改善,但差异无统计学意义(P>0.05);治疗24 h后、7天NIHSS评分及出院时mRS评分无统计学差异(P>0.05).结论 信息化卒中绿色通道模式可有效减少院内延误,缩短救治时间,具有良好效果.

目的 探讨广州社区居民颈动脉病变流行率及相关因素.方法 对广州市35个社区35岁以上的居民进行脑血管病相关因素现况调查,调查手段包括面对面问卷,现场体检,睡眠心理测试,心电图,腹部、妇科、颈部血管B型超声检查,以及采取血液标本行有关生化指标检测,所有结果均输入专有数据库.结果 共有2276例居民参加了调查,颈动脉病变流行率是53.8％,以单纯硬化和混合性病变为主,并且男性高于女性(64.03％vs 48.96％,P=0.0003),嗜酒、吸烟、少做家务及焦虑抑郁在有颈动脉病变的人群中流行率高于无颈动脉病变的人群,对颈动脉病变与物质代谢紊乱每个指标如高血压、糖尿病、高血脂、高尿酸血症、高同型半胱氨酸血症、C反应蛋白之间关系均非常密切.结论 广州社区居民颈动脉病变的流行率高,加强对居民的正确生活习惯的宣传教育,以及动态监测病变对降低脑卒中发生风险非常必要.

目的:观察中医外治法治疗后循环缺血性眩晕的临床疗效.方法:将96例后循环缺血性眩晕患者随机分为两组,各48例.对照组采用倍他司汀氯化钠注射液和西医基础治疗,治疗组在对照组基础上加艾灸百会穴及中药氧化吸入治疗,7d为一个疗程,连续治疗2个疗程,治疗前后观察患者的经颅多普勒脑血管检查及临床疗效.结果:治疗组总有效率为95.8％,对照组总有效率为87.5％,两组比较差异有统计学意义(P＜0.05);经颅多普勒脑血管检查结果中治疗组椎动脉及椎基底动脉血液循环明显优于对照组,两组比较差异有统计学意义(P＜0.05).结论:中医外治法治疗后循环缺血性眩晕的临床疗效明显.