BACKGROUND:Branch atheromatous disease (BAD)-related stroke has emerged as a meaningful subtype of ischemic stroke yet remained understudied. We aimed to investigate the demographic, clinical, therapeutic, and prognostic characteristics of BAD-related stroke. METHODS:The BAD-study was a nationwide, multicenter, prospective, observational cohort study in 20 Chinese hospitals from June 2021 to June 2023, enrolling patients aged 18 to 80 years with BAD-related stroke within 72 hours of onset. Eligible single subcortical infarct in the territory of lenticulostriate artery and paramedian pontine artery was included. Clinical, laboratory, and treatment data were collected at baseline. The primary outcome was a proportion of good outcomes (modified Rankin Scale score, 0-2) at 90 days. Main secondary outcomes included early neurological deterioration (END), cerebrovascular event, major bleeding, and excellent outcome (modified Rankin Scale score, 0-1) during 90-day follow-up. RESULTS:We finally enrolled 476 patients, with a median age of 60 (interquartile range, 53-68) years, and 70.2% were male. The median National Institutes of Health Stroke Scale score was 3 (interquartile range, 2-6) at enrollment. Involvement of the lenticulostriate artery was more common than the paramedian pontine artery (60.7% versus 39.3%). END occurred in 14.7% of patients, with a median time from onset of 38 (interquartile range, 22-62) hours. The rates of good and excellent outcomes were 86.5% and 72%, respectively. Its 90-day stroke recurrence rate was 1.9%. Acute-phase therapy (from onset to 7 days of enrollment) showed heterogeneity and was not associated with prognosis. Multivariable logistic regression analysis identified the National Institutes of Health Stroke Scale score ≥4 at admission and END as negative predictors and extracranial artery stenosis as a positive predictor of good outcomes. Age ≥60 years, National Institutes of Health Stroke Scale score ≥4 at admission, and END were negative predictors of excellent outcomes. CONCLUSIONS:With distinct demographic, clinical, and prognostic characteristics, along with a high incidence of END and a low risk of stroke recurrence, BAD-related stroke could be categorized as a separate disease entity. Moreover, its acute-phase treatment strategies were undetermined, awaiting further high-quality studies.

Background The Mean platelet volume-to-lymphocyte ratio (MPVLR) is an emerging and cost-effective biomarker that integrates MPV and lymphocytes, reflecting both thrombotic activity and inflammatory responses. Despite its potential, relatively few studies have explored the relationship between MPVLR and the prognosis of acute ischemic stroke (AIS). This study aims to investigate the correlation between MPVLR and short-term clinical outcomes in patients with AIS, providing insights into its prognostic significance. Method Data were collected from patients with AIS admitted to the Neurology Department of Beijing Shunyi District Hospital from January 2022 to August 2022. Patients were consecutively included and followed up three months post-symptom onset. The analysis of multivariable logistic regression was used to explore the association of MPVLR with poor functional outcomes. Additionally, a receiver operating characteristic (ROC) curve was analyzed to examine the predictive value of MPVLR. Results In this study enrolling 362 AIS patients, the MPVLR was found to be substantially higher in the group with poor outcomes compared to the group with good outcomes (P < 0.05). Patients in the lower tertile group had lower mRS scores (P < 0.05). In addition, previous stroke or TIA, MPVLR, and NIHSS scores at admission were identified as significant predictors of poor outcomes three months after AIS. The ROC curve revealed that the optimal cutoff value for MPVLR to predict poor outcomes at three months was 5.547. And the area under the curve for MPVLR was 0.727 (95% CI: 0.672–0.783), with a sensitivity of 82.2% and a specificity of 52.9%. Conclusions Elevated MPVLR values at admission were significantly correlated with short-term poor functional outcomes in AIS patients.

Objective To analyze the clinical characteristics of non-exercise symptoms in patients with vascular pakinsonism（VP）.Methods Clinical data of 66 elderly VP patients admitted to Department of Neurology of Shunyi District Hospital from January 2013 to December 2021 were retrospectively collected.They were divided into acute/subacute onset VP group（27 cases） and occult onset VP group（39 cases） according to our inclusion and exclusion criteria.Their clinical characteristics of non-motor symptoms were analyzed.Results There were no significant differences in proportions of hypertension, diabetes, hyperlipidemia and coronary heart disease between the 2 groups, but ratios of history of cerebrovascular disease（66.67% vs 23.08%,P=0.000） and ischemic cerebrovascular disease（48.15% vs 12.82%,P=0.032） were obviously larger in the acute/subacute onset group than the occult onset VP group.In terms of motor symptoms, the former group had larger proportions of unilateral bias and dysarthria, but lower proportions of abnormal gait, freezing, orthostatic hypotension and olfactory dysfunction when compared with the latter group（P＜0.05）.Conclusion Occult onset is more common in VP patients.According to the different clinical symptoms and onset forms, more attention should be paid to non-motor symptoms while to motor symptoms at the same time in these patients.

目的 研究心房颤动所致心源性脑卒中与动脉粥样硬化性脑卒中患者溶栓治疗疗效的异同。方法 选择2018年1月至2021年5月在北京市顺义区医院神经内科住院的脑卒中伴心房颤动溶栓治疗患者60例为病例组，同期住院的动脉粥样硬化性脑卒中溶栓治疗患者494例为对照组，所有患者均在发病4.5 h内给予阿替普酶静脉溶栓治疗，用美国国立卫生研究院卒中量表评估早期疗效，采用改良的Rankin量表评估远期预后。观察2组出血发生率。结果 2组溶栓早期预后有效率和溶栓远期预后比较，差异无统计学意义（P＞0.05）。病例组出血发生率明显高于对照组，差异有统计学意义（31.7%vs 5.5%,P＜0.01）。结论 心房颤动所致心源性脑卒中患者溶栓后出血发生率明显高于动脉粥样硬化性脑卒中患者，但没有影响到患者的预后，患者溶栓后早期预后及远期预后均较好。

目的:探讨伴持续性向地或背地变向性位置性眼震(DCPN)患者的临床特点及区别.方法:回顾性收集我院收治的眩晕患者56例纳入DCPN组,均经眼震视图检查及翻滚试验证实为持续性DCPN患者,并进一步分为背地DCPN亚组40例和向地DCPN亚组16例;收集同时期诊断为常见耳石症的患者66例纳入常见耳石组.记录患者的基本资料(年龄、性别、糖尿病、高血压、高脂血症、吸烟、饮酒、失眠等)以及发病诱因、耳部相关症状(听力下降、耳鸣等)特点;所有患者均完善头颅核磁、血管、眼震电图相关检查,比较常见耳石组与DCPN组及其亚组的临床特点、检查结果及预后等差异.结果:与常见耳石组相比,DCPN组的病程较长(P<0.05);与常见耳石组和背地DCPN亚组相比,向地DCPN亚组的平均年龄更小、女性比例更高、病程更长、听力下降和耳鸣患者的比例更高(均P<0.05).常见耳石组患者首次复位后有84.8％的患者痊愈,1周内均痊愈;背地DCPN亚组首次复位后62.5％的患者痊愈,10 d内均痊愈;向地DCPN亚组首次复位后均无效,结合药物治疗和多次手法复位治疗,1个月后随访均痊愈,病程最长24 d.所有患者在3月后随访均未复发.结论:伴持续性向地/背地DCPN患者临床病程长,背地性DCPN危险因素与常见耳石症相似,提示两疾病的同源性;而向地性DCPN发病年龄偏轻、女性多见、病程更长,其发病机制可能与耳石粘附及内耳病变相关.DCPN患者手法复位的效果比常见耳石患者差,向地性DCPN患者的复位效果更差.

脓毒症是由于机体对感染的反应失控导致的危及生命的器官功能障碍 [1]，脓毒性休克则是经充分的液体复苏后仍需血管活性药物维持循环稳定，并伴有高乳酸血症。由于有效循环血量不足，机体的组织、器官缺血缺氧，出现各种代谢功能紊乱，甚至可引起多器官功能衰竭，造成不可逆的损伤甚至死亡 [2,3]。脓毒症及脓毒性休克是重症监护室（intensive care unit, ICU）患者中导致危重症和死亡的首要原因 [4,5]，其造成的循环衰竭和代谢紊乱足以显著增加患者的病死率，同时患者通常会遗留长期的躯体和心理障碍，从而造成严重的医疗健康和社会经济负担 [6]，所以早期识别和及时诊治脓毒症和脓毒性休克非常重要。

Objective:To study the function and mechanism of miR-30a in rat cerebral ischemia-reperfusion (I/R) injury.Methods:The middle cerebral artery occlusion (MCAO) model was established by intravascular suture method, and the expression of miR-30a in brain tissue was detected by real-time quantitative polymerase chain reaction (qRT-PCR). After intracerebroventricular injection of miR-30a lentivirus, the infarct area was detected by 2, 3, 5-triphenyltetrazole chloride (TTC) staining, the neurological deficit was detected by Bederson method, and the concentration of neurotrophin-3 (3-NT) and nitric oxide (NO) in brain tissue was detected by enzyme-linked immunosorbent assay (ELISA). The protein levels of kelch like ECH associated protein 1 (Keap1), NF-E2-related factor 2 (Nrf-2) and hemeoxygenase-1 (HO-1) in brain tissue were detected by Western blot. Double luciferase reporter assay was used to detect the targeting relationship between miR-30a and Keap1.Results:Compared with sham operation group, the expression of miR-30a was down-regulated in a time-dependent manner after I/R. The overexpression of miR-30a can reduce the area of cerebral infarction tissue at the pathological level, the degree of neurological impairment at the functional level, the 3-NT, NO and Keap1 at the molecular level, and enhance the expression of Nrf2 and HO-1. The dual luciferase reporter assay also showed that miR-30a could bind to Keap1 mRNA.Conclusions:The expression of miR-30a was down-regulated in MCAO rat brain tissue, and miR-30a could attenuate cerebral I/R injury in rats by targeting Keap1.

目的 探讨细胞型Fas相关死亡域样白细胞介素-1β转换酶抑制蛋白(c-FLIP)不同单体沉默对重症急性胰腺炎(SAP)大鼠中性粒细胞凋亡的影响.方法 选取50只SD雄性大鼠建立SAP模型,将造模成功的40只大鼠随机分为对照组、c-FLIP siRNA-NC组、c-FLIPS siRNA组、c-FLIPL siRNA组,每组10只;另取10只大鼠为假手术组.c-FLIP siRNA-NC组、c-FLIPS siRNA组、c-FLIPL siRNA组大鼠尾静脉注射1 nmol/ml的对应siRNA溶液,假手术组、对照组大鼠尾静脉注射等量生理盐水;转染后72 h,测定各组大鼠腹水量、血清淀粉酶及血清中性粒细胞凋亡水平,并观察胰腺组织病理变化.测定各组大鼠中性粒细胞中c-FLIPS、c-FLIPL、受体相互作用蛋白1(RIP1)、半胱氨酸天冬氨酸蛋白酶-8(Caspase-8)mRNA和蛋白表达水平.结果 对照组、c-FLIP siRNA-NC组胰腺组织坏死严重、崩解,胰腺细胞排列紊乱,可见大量炎性细胞浸润;c-FLIPS siRNA组、c-FLIPL siRNA组胰腺细胞坏死减少,炎性细胞浸润减少,但胰腺组织疏松紊乱.与假手术组比较,对照组和c-FLIP siRNA-NC组腹水量、血清淀粉酶、中性粒细胞c-FLIPS mRNA和蛋白表达水平、c-FLIPL mRNA和蛋白表达水平升高,中性粒细胞凋亡率、RIP1 mRNA和蛋白表达水平、Caspase-8 mRNA和蛋白表达水平降低,差异有统计学意义(P＜0.05);但对照组与c-FLIP siRNA-NC组上述指标比较差异无统计学意义(P＞0.05).与c-FLIP siRNA-NC组比较,c-FLIPS siRNA组和c-FLIPL siRNA组腹水量、血清淀粉酶、中性粒细胞c-FLIPS、c-FLIPL mRNA和蛋白表达水平降低,中性粒细胞凋亡率、RIP1、Caspase-8 mRNA和蛋白表达水平升高,差异有统计学意义(P＜0.05);但c-FLIPS siRNA组比较与c-FLIPL siRNA组上述指标比较差异无统计学意义(P＞0.05).结论 沉默c-FLIP的两种单体c-FLIPS、c-FLIPL可明显促进SAP大鼠血液中性粒细胞凋亡,且对SAP具有明显缓解作用;其机制与c-FLIPS、c-FLIPL能明显抑制SAP大鼠血液中性粒细胞c-FLIPS、c-FLIPL的mRNA和蛋白表达,促进RIP1,Caspase-8 mRNA和蛋白的表达,进而激活坏死性凋亡途径有关.

原发性中枢神经系统淋巴瘤(primary central nervous sys-tem lymphoma,PCNSL)是一种少见的高度恶性肿瘤,PCNSL定义为淋巴瘤,累及大脑、软脑膜、眼睛或脊髓,而无中枢神经系统以外的淋巴瘤存在迹象,大多数肿瘤组织学与弥漫大B细胞淋巴瘤相同,且临床表现复杂,疾病进展快,预后差[1],既往研究显示[2]该病在免疫异常(艾滋病、器官移植或免疫抑制剂应用)发病率显著高于正常人群,提示本病与免疫功能低下或缺陷相关.近年来不少临床确诊病例出现在不伴此类疾病的免疫功能正常人群[3],提示其发病机制的复杂,可能存在更多诱因及途径.本文收集了2010年-2016年诊治的4例免疫功能正常患者,对其临床、影像、病理及预后进行随访,以进一步探讨其临床特点,为该疾病的诊治提供参考和依据.

目的 探讨甘露醇对心脏骤停模型大鼠心肺复苏后脑水肿的治疗作用.方法 选取雄性Wistar大鼠60只,随机分为假手术组(A组),模型组(B组),甘露醇(0.5 g/kg)6 h组(C1组)、12 h组(C2组)、18 h组(C3组)、24 h组(C4组),各10只.除A组外,所有大鼠均构建窒息性心脏骤停模型,C1组、C2组、C3组、C4组大鼠均于窒息性心脏骤停模型成功后缓慢静脉注射0.5 g/kg甘露醇5～10 min,且每隔6 h给药1次,即C1组给药2次,C2组给药3次,C3组给药4次,C4组给药5次;A组、B组大鼠不予任何药物.采用称重法测定大鼠脑含水量,采用氧分压检测仪检测大鼠大脑中动脉血流速率(VMCA),对大鼠神经功能进行评分,制作苏木精-伊红染色切片于显微镜下观察大鼠脑结构病理变化情况.结果 A组大鼠脑组织细胞结构完整、排列整齐,未见出血及炎性浸润;B组大鼠细胞排列松散,且部分细胞呈点状坏死,细胞边界不清,大量炎性细胞浸润,出血和水肿明显;C1组、C2组、C3组、C4组大鼠脑组织出血、水肿面积和点状坏死数量随给药次数逐渐减少.与A组比较,B组大鼠大脑含水量和神经功能评分均显著升高,VMCA显著降低(P<0.05);与B组比较,C1组、C2组、C3组、C4组大鼠大脑含水量和神经功能评分均显著降低,VMCA均显著加快,且随给药次数的增加大脑含水量和神经功能评分逐渐降低,VMCA逐渐升高(P<0.05).结论 甘露醇可通过增加VMCA、改善大脑水肿,起到保护心肺复苏后大鼠大脑的作用.

Objective To explore the relationship between time in range (TIR) derived from flash glucose monitoring system (FGM) and HbA1c in Chinese adults with type 1 diabetes mellitus (T1DM). Methods Adult T1DM patients attended outpatient department of Peking Union Medical College Hospital (PUMCH) between October 2018 to March 2019 were included. HbA1c and data of FGM were obtained at the same time. TIR was calculated, and the relationship between TIR and HbA1c was investigated by correlation and regression analysis. Results A total number of 77 patients who met the inclusion and exclusion criteria were included in the analysis. The average HbA1c was (7.5±1.3)%; TIR 62.0 (48.7, 67.8)% and CV (coefficient of variation) (39.7±8.1)%. TIR derived from FGM had a negative liner correlation with HbA1c (r=-0.645, P<0.001). The regression equation is:HbA1c=10.58-0.05×TIR. The HbA1c level decreased by 0.5% for every 10% increase in TIR. TIR was correlated with HbA1c negatively in both patients with stable glucose (CV<36%) and unstable glucose (CV ≥ 36%), but the correlation coefficient between TIR and HbA1c in stable glucose patients was higher. For a specific TIR, HbA1c was higher in stable glucose patients. Conclusions The FGM-derived TIR could be helpful in the glucose management of Chinese adult T1DM, while glucose variability should be taken into consideration in interpreting the relationship between TIR and HbA1c.

目的 了解青年脑梗死的危险因素及病因构成.方法 文章分析了2019年于北京市顺义区医院神经内科住院的65例青年脑梗死患者的病因及危险因素,根据发病年龄设置对照组比较分析危险因素,使用TOAST法对青年脑梗死组进行病因分型.结果 青年脑梗死组最常见的危险因素依次为吸烟史、高脂血症、高血压,对照组糖尿病患病率高于青年脑梗死组,具有统计学意义,其余危险因素差异无统计学意义.按照TOAST法进行病因分型,青年脑梗死组65例患者中,心源性栓塞8例,大动脉粥样硬化性卒中19例,小动脉卒中有18例,其他原因引发的缺血性卒中5例,原因不明的缺血性卒中有15例.结论 研究发现青年脑梗死患者的主要危险因素为吸烟、高脂血症、高血压,最主要的病因是大动脉粥样硬化型,心源性脑栓塞及其他原因引起发的缺血性卒中所占比例较高.

目的:分析进行性核上性麻痹的临床特征、影像学表现及预后.方法:通过观察及随访7例临床诊断进行性核上性麻痹患者,收集其相关临床资料,并随访患者生存情况.结果:7例进行性核上性麻痹患者,发病年龄56～74岁,中位数66岁,4例患者早期出现头晕,2例存在不明原因的焦虑抑郁,其余患者早期以走路不稳伴摔倒,4年内出现典型的垂直性眼肌麻痹,5年左右出现头颅核磁提示中脑被盖部萎缩,中脑前后径变小,呈现该病典型改变,多数患者约6～8年需他人帮助生活,依据最新的临床诊断标准,5例诊断为很可能PSP经典型(PSP-RS),2例为PSP帕金森综合征型(PSP-P).结论:进行性核上性麻痹典型症状多有走路不稳姿势异常伴摔倒,多存在轴性为主姿势异常,多表现为翻身及转身困难,美多巴治疗效果欠佳,多数患者早期有头晕、焦虑、抑郁状态改变,偶有视力改变,可能以视力、精神因素第一时间就诊于眼科或精神科,随着疾病进展,均可出现典型的垂直性眼肌麻痹及典型影像学改变,总体预后不佳.

目的 评估蛋白尿阴性的成人1型糖尿病(type 1 diabetes mellitus,T1DM)患者肾小球滤过率(estimated glomerular filtration rate,eGFR),并探究影响eGFR的相关因素.方法 纳入2018年6月～2019年6月在北京协和医院门诊就诊的T1DM患者,收集人体测量学指标,检测血糖、血脂、肌酐、C肽等指标,计算eGFR,通过Pearson相关性分析、多元线性回归方法,探讨蛋白尿阴性的成人T1 DM患者eGFR的相关因素.结果 共纳入89例T1DM患者,10例蛋白尿阳性,79例蛋白尿阴性,蛋白尿阴性患者平均年龄为39.03±13.20岁,平均病程为9.89±9.21年,平均HbA1c为7.44％±1.32％,平均eGFR为111.61±13.43ml/(min·1.73m2),其中eGFR 60～ 90ml/(min·1.73m2)者5例(6.3％).Pearson相关性分析显示,年龄、病程、SBP、TC、2hCP均与eGFR相关,而HbA1c与蛋白尿阴性患者eGFR水平无关.多元线性回归分析发现年龄、病程是eGFR的独立危险因素.结论 蛋白尿阴性的中国成人T1DM中eGFR下降不罕见,对于年龄较大、病程较长者,即使尿蛋白阴性仍需密切监测肾功能.

The reperfusion after an acute ischemic stroke can lead to a secondary injury, which is ischemia–reperfusion (I/R) injury. During ischemia, the reactive oxygen species (ROS) is over-produced, mostly from nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX). Besides, miRNAs are also associated with neuronal death in ischemic stroke. MiR-124-5p is selectively expressed within central nervous system (CNS) and is predicted to bind to NOX2 directly. Herein, we successfully set up cerebral I/R injury model in rats through middle cerebral artery occlusion (MCAO) surgery. After 12 h or 24 h of refusion, the superoxide dismutase (SOD) activity was significantly inhibited, accompanied by NOX2 protein increase within MCAO rat infarct area. In vitro, oxygen-glucose deprivation/refusion (OGD/R) stimulation on PC-12 cells significantly increased NOX2 protein levels, ROS production, and the cell apoptosis, while a significant suppression on SOD activity; OGD/R stimulation-induced changes in PC-12 cells described above could be significantly attenuated by NOX2 silence. In vivo, miR-124 overexpression improved, whereas miR-124 inhibition aggravated I/R injury in MCAO rats. miR-124-5p directly bound to the CYBB 3′-untranslated region (UTR) to negatively regulate CYBB expression and NOX2 protein level. In vitro, miR-124 overexpression improved, while NOX2 overexpression aggravated OGD/R-induced cellular injuries; NOX2 overexpression significantly attenuated the effects of miR-124 overexpression. Besides, miR-124 overexpression significantly repressed NF-κB signaling activation and TNFα and IL-6 production through regulating NOX2. In conclusion, miR-124-5p/NOX2 axis modulates NOX-mediated ROS production, the inflammatory microenvironment, subsequently the apoptosis of neurons, finally affecting the cerebral I/R injury.

目的 探讨中国北方汉族人群维生素D受体(VDR)基因单核苷酸多态性与慢性阻塞性肺疾病(COPD)并发骨质疏松的关系.方法 回顾2007年9月-2017年10月收治的COPD急性加重住院患者379例资料,分为非骨质疏松组155例与骨质疏松组224例,提取全血样本的基因组DNA.利用UCSC基因组浏览器和Haploview 4.2软件确定VDR基因的标签单核苷酸多态性(tagSNP).应用Sequenom MassARRAY SNP检测技术对VDR基因的tagSNP进行基因型分析.采用Logistic回归方法研究其共显性、显性、隐性等遗传模式下各SNP的比数比(OR值)和置信区间(CI),评估VDR基因单核苷酸多态性与COPD并发骨质疏松的关系.结果 两组在性别、年龄、是否饮酒、外周血血小板计数、血磷、血肌酐等参数上差异均有统计学意义(P<0.05).在筛选出的VDR基因17个tagSNPs(rs2238140 G/A,rs2228570 G/A,rs2408877 A/T,rs12721370 C/A,rs7299460 T/C,rs2239184 G/A,rs2239186 A/G,rs7136534 C/T,rs12721364 G/A,rs2853561 C/T,rs7965943 T/G,rs11168287 G/A,rs11608702 T/A,rs2239179 T/C,rs2189480 T/G,rs59707231 T/A,rs2853559 C/T)中,rs2853561携带T/C和T/T基因型的COPD患者,发生骨质疏松的风险较C/C更低(在显性遗传模式下,T/C+T/Tvs.C/C,OR=0.34,95％CI 0.18～0.63,P=0.0003539),差异有统计学意义.结论VDR基因中的rs2853561与COPD并发骨质疏松之间存在相关性.VDR基因单核苷酸多态性在COPD并发骨质疏松发病机制中的具体作用有待进一步研究.

目的 探讨老年动脉瘤性蛛网膜下腔出血(aSAH)患者认知损害的特点及相关危险因素.方法 入选2012年12月至2017年12月期间顺义区医院和首都医科大学附属北京天坛医院收治的老年aSAH患者共106例作为aSAH组,收集同期在神经内科门诊就诊的正常患者120例作为对照组.aSAH组患者分别于入院,出院,出院后3、6及12个月时进行神经心理学量表测定,对照组患者就诊时行神经心理学量表测评.应用北京版简明精神状态检查(MMSE)量表进行认知功能评估,同时应用修订版长谷川智能量表和痴呆简易筛选量表进行校正.采用SPSS 17.0软件进行数据处理.依据数据类型,组间比较分别采用t检验或χ2检验.采用多因素logistic回归分析筛选独立危险因素.结果 aSAH组与对照组的MMSE量表评分差异具有统计学意义[(23.51±1.20)vs(27.01±3.72)分,P<0.05].aSAH患者出院3个月时的认知损害发生率最高,执行能力、言语理解及表达力、言语命名能力、言语复述、注意力及计算力和短程记忆力亚项得分最低.多因素logistic回归分析结果显示,动脉瘤的干预方式(OR=1.667,95％CI 0.567～6.468;P=0.027)、H分级(OR=1.126,95％CI 0.518～2.755;P=0.002)和Fish分级(OR=1.297,95％CI 0.477～1.982;P=0.028)与认知损害显著相关.结论 aSAH后的认知损害多在发病后3个月内较明显,主要表现在言语、执行能力、注意力、计算力及短程记忆力方面,临床上应重视Fish分级和H分级的评估,早期识别认知损害的高危人群并进行早期干预可改善预后.

目的 探讨血管性帕金森综合征(vascular pakinsonism,VP)患者的临床特征及可能影响因素.方法 收集2012年1月～2017年12月北京市顺义区医院神经内科收治的VP患者76例(VP组)以及帕金森病(Parkinson'sdisease,PD)患者92例(PD组).比较2组一般临床资料,回顾性分析VP患者临床特点及相关影响因素.结果 VP组年龄、高血压、糖尿病、高脂血症、基底节多发腔隙性脑梗死、脑出血、高同型半胱氨酸血症、认知功能障碍、锥体束征、小便失禁、LDL及血同型半胱氨酸水平明显高于PD组,静止性震颤、嗅觉减退及睡眠障碍比例明显低于PD组,差异有统计学意义(P＜0.05,P＜0.01).多元logistic回归分析显示,年龄(OR=1.246,95％CI:1.010～1.298,P=0.008)、高血压(OR=7.012,95％CI:1.092～30.201,P=0.035)、基底节多发腔隙性脑梗死(OR=11.030,95％CI:3.560～70.542,P=0.002)以及高同型半胱氨酸血症(OR=1.802,95％CI:1.200～2.780,P=0.004)是VP的独立危险因素.结论 VP患者在临床上常合并锥体束征、认知功能障碍及小便失禁,而静止性震颤、睡眠障碍、嗅觉障碍较少合并;老年、高血压、高同型半胱氨酸血症及基底节多发腔隙性脑梗死是VP的相关影响因素.

目的 分析老年非瓣膜性心房颤动(房颤)合并缺血性脑卒中患者的临床特点.方法 选择2015年1月～2018年6月北京市顺义区医院神经内科住院的非瓣膜性房颤合并急性缺血性脑卒中患者162例(房颤组),收集同期不伴房颤的急性缺血性脑卒中患者214例(非房颤组),分析2组患者临床特点及抗凝治疗的现状.结果 房颤组在年龄、女性、意识障碍、出院美国国立卫生研究院卒中量表评分、大面积脑梗死、多发性梗死灶、梗死后出血转化、下呼吸道感染、心力衰竭、下肢静脉血栓、营养障碍、消化道出血、电解质紊乱、泌尿系感染、脑疝、死亡及出院后90 d复发的比例明显高于非房颤组,眩晕、构音障碍、感觉障碍和预后良好比例明显低于非房颤组,差异有统计学意义(P＜0.05,P＜0.01).房颤组高同型半胱氨酸血症、陈旧性心肌梗死、脑卒中或短暂性脑缺血发作史、慢性心力衰竭及冠心病比例明显高于非房颤组,差异有统计学意义(P＜0.05,P＜0.01).多因素logistic回归分析显示,陈旧性心肌梗死(OR=5.206,95％CI:2.906～9.040,P=0.016)、慢性心力衰竭(OR=15.026,95％CI:7.460～30.020,P=0.003)、冠心病(OR=8.920,95％CI:4.200～12.906,P=0.030)及脑卒中或短暂性脑缺血发作史(OR =2.020,95％CI:0.406～1.020,P=0.042)是非瓣膜性房颤合并缺血性脑卒中患者的独立危险因素.房颤组抗凝治疗比例明显低于抗血小板治疗(25.3％ vs 74.7％,P＜0.01).结论 非瓣膜性房颤合并急性缺血性脑卒中患者以高龄老年、女性为主,意识障碍为主要首发症状,脑梗死病灶多发、面积偏大且出血转化较多,慢性心力衰竭、陈旧性心肌梗死及冠心病为显著的危险因素,抗凝现状有所改善,新型抗凝药物选择较多.

Myocardial depression is a hallmark of severe sepsis, which may result from a complex interplay among several factors. However, the mechanisms are still unclear yet. In this study, we aimed to explore if IL-22/IL-22R1 axis plays a role in the myocardial injury during sepsis. A cecal ligation and puncture (CLP) mouse model was established to explore the histopathological changes and to analyze the role of IL-22/IL-22R1 axis in myocardial injury during the process of sepsis. Histopathologically, myocardial injury was apparently observed with the progress of sepsis but it was improved at 72 h after surgery. On the contrary, the heart tissue in the sham group revealed injury at a limited degree at the first 8 h after surgery and then restored to normal. Results from immunohistochemical study and real-time qPCR showed that IL-22, IL-22R1 and IL-22BP had different changing trends in the progress of sepsis at both protein and mRNA levels. The expression of IL-22R1 and IL-22BP was markedly induced after CLP modeling (P < 0.01), while that of IL-22 was sharply reduced in both groups (P < 0.01). The differences in the expression of IL-22, IL-22R1 and IL-22BP between the sham and CLP groups were significant only at 72 h after surgery (P < 0.05) but not at the other time points (P > 0.05). In conclusion, IL-22/IL-22R1 axis is involved and may have a potential immunoprotective role in the cardiac tissue repair, but the immunoprotection on the cardiac tissue of CLP mice was remarkably damaged in the progress of sepsis and even in the recovery phase.