目的 分析CT灌注成像参数与前循环急性缺血性脑卒中静脉溶栓患者临床转归的相关性.方法 选取2019年10月—2021年10月于海南医学院第二附属医院接受静脉溶栓治疗并完成CT灌注成像检查及MIStar软件后处理的105例前循环急性缺血性脑卒中患者作为研究对象,根据发病后3个月时改良Rankin量表(mRS)评分分为转归良好组和转归不良组.收集所有患者临床资料,收集CT灌注成像参数包括灌注缺损(延迟时间>3 s)体积、缺血核心(相对脑血流量<30％)体积和缺血半暗带体积(灌注缺损体积-缺血核心体积).采用多因素Logistic回归模型分析CT灌注成像参数与临床转归的相关性,采用受试者工作特征(ROC)曲线评价CT灌注成像参数对临床转归的预测价值.结果 105例前循环急性缺血性脑卒中患者mRS评分≤2分者63例,>2分者42例.两组患者的性别构成、体重、高脂血症、房颤、溶栓前舒张压、糖化血红蛋白、白细胞计数、红细胞、中性粒细胞计数及缺血半暗带体积比较,差异无统计学意义(P>0.05),两组患者的年龄、吸烟、高血压、糖尿病、溶栓前收缩压、基线随机血糖、血红蛋白、入院至静脉溶栓时间(DNT)、发病至静脉溶栓时间(ONT)、灌注缺损体积、缺血核心体积、mRS评分及美国国立卫生研究院卒中量表(NIHSS)评分比较,差异有统计学意义(P<0.05).溶栓前收缩压[O^R=3.992(95％CI:1.496,10.652)]是影响前循环急性缺血性脑卒中患者临床转归的危险因素(P<0.05);NIHSS评分[O^R=0.840(95％CI:0.711,0.991)]和灌注缺损体积[O^R=1.081(95％CI:1.059,1.104)]是影响前循环急性缺血性脑卒中患者临床转归的保护因素(P<0.05).溶栓前收缩压、NHISS评分和灌注缺损体积及三者联合预测患者临床转归的敏感性分别为76.25％(95％CI:0.633,1.395)、83.75％(95％CI:0.721,1.554)、85.00％(95％CI:0.778,1.656)、86.30％(95％CI:0.812,1.714),特异性分别为81.95％(95％CI:0.713,1.522)、89.66％(95％CI:0.811,1.700)、90.80％(95％CI:0.835,0.953)和92.00％(95％CI:0.854,1.775),以三者联合检测的特异性最高,其中三指标单独检测以灌注缺损体积的特异性最高.同时,ROC曲线分析显示,灌注缺损体积预测转归不良的曲线下面积为0.866(95％CI:0.803,0.928);最佳截断值为109.37 mL.结论 溶栓前收缩压是影响前循环急性缺血性脑卒中患者临床转归不良的独立危险因素,NIHSS评分、灌注缺损体积是前循环急性急性脑卒中患者临床转归良好的保护因素,但缺血核心体积和缺血半暗带体积与患者临床转归无关.CT灌注成像参数灌注缺损体积评估前循环急性缺血性脑卒中患者静脉溶栓治疗后转归不良的价值较高.

Abstract Background CYP4 subfamily V member 2 (CYP4V2) polymorphisms are related to venous thromboembolism. However, the influence of CYP4V2 polymorphisms on the susceptibility to ischemic stroke (IS) remains undetermined. Methods We selected and genotyped five polymorphisms of CYP4V2 in 575 cases and 575 controls to test whether CYP4V2 variants were associated with the risk for IS in a Chinese Han population. Genotyping of CYP4V2 polymorphisms was performed using the Agena MassARRAY platform. Logistic regression analysis was used to assess the association between CYP4V2 polymorphisms and IS risk by calculating odds ratios (ORs) and 95% confidence interval (CI). False-positive report probability analysis was applied to assess the noteworthy relationship of the significant findings. Results CYP4V2 rs1398007 might be a risk factor for IS (OR = 1.34, 95% CI 1.05–1.71, p = 0.009). Specially, confounding factors (age, gender, smoking and drinking status) might affect the relationship between rs1398007 and IS susceptibility. Moreover, rs1053094 and rs56413992 were associated with IS risk in males. Multifactor dimensionality reduction analysis showed the combination of rs13146272 and rs3736455 had the strongest interaction effect (information gain value of 0.40%). Furthermore, genotypes of rs1398007 (p = 0.006) and rs1053094 (p = 0.044) were associated with the levels of high-density lipoprotein cholesterol (HDL-C) among healthy controls. Conclusion Our results first provided evidence that CYP4V2 rs1398007 might be a risk factor for IS, which provides instructive clues for studying the mechanisms of CYP4V2 to the pathogenesis of IS.

目的 分析药物治疗联合支架置人对症状性颅内动脉粥样硬化性狭窄(SICAS)患者脑血流灌注、认知功能及短期预后的影响.方法 选择住院治疗的124例SICAS患者为研究对象,依据治疗方案不同分为单纯组(60例,予以单纯药物治疗)和联合组(64例,在药物治疗基础上联合支架置入术).治疗前、治疗第10天时,采用CT脑灌注成像分析局部脑血流速度(rCBF)、局部脑血容积(rCBV)、平均通过时间(MTr).治疗前和治疗后3、14 d,记录2组蒙特利尔认知评估量表(MoCA)评分、美国国立卫生研究院卒中量表(NIHSS)评分.随访12个月,比较2组患者并发症发生率.结果 与治疗前比较,联合组治疗后rCBF、rCBV均不同程度升高,MTr下降,差异有统计学意义(P＜0.05);治疗后,2组CBF、rCBV、MTr比较,差异有统计学意义(P＜0.05).治疗后,2组MoCA评分均升高,且2组治疗后3、14 d MoCA评分比较,差异有统计学意义(P＜0.05).治疗后3、14 d,2组NIHSS评分下降,且联合组NIHSS评分低于单纯组,差异均有统计学意义(P＜0.05).联合组并发症总发生率低于单纯组,差异有统计学意义(P＜0.05).结论 药物治疗联合支架置入治疗SICAS能较好地改善脑血流和认知功能,提高神经功能,降低并发症发生率.

认知功能减退是与年龄相关的疾病,目前仍无有效的治疗手段.白藜芦醇是一种多酚类化合物,可通过多种途径改善大脑的功能状态,SIRT1的激活是白藜芦醇发挥作用的关键.该文对白藜芦醇的作用机制研究进展,包括抗氧化、抗炎、抗凋亡、改善突触可塑性、增加脑血流量及自噬作用进行综述.