The current status of emergency medical service (EMS) use among patients with acute ischemic stroke (AIS) in China is a concern. We aimed to understand the status of EMS use and influencing factors in patients with AIS in China. In this large-scale prospective multicenter hospital-based registry study, we evaluated the data of 10,856 patients with AIS admitted to 21 hospitals across different economic and geographic regions in China in 2022. The primary outcome was the proportion of patients arriving at the hospital via EMS. In patients with AIS who arrived independently and those who arrived via EMS, 79.9% and 47.1%, respectively, had an onset-to-door time > 3 h; 16.0% and 40.6%, respectively, received intravenous thrombolysis; and 4.0% and 15.5%, respectively, underwent thrombectomy. Factors promoting EMS use included older age, residence in a small city, wake-up stroke, cardioembolic stroke, and National Institutes of Health Stroke Scale scores 5–15 and 16–42 after onset. Conversely, small-artery occlusion was associated with patients arriving to hospital independently. Hospital arrival via EMS significantly reduced prehospital delay and increased thrombolysis rate compared to arriving at the hospital independently. Improving public education regarding the advantages of using EMS is needed.

Although CD20-directed B cell depletion has long been used in neuromyelitis optica spectrum disorder (NMOSD), high-quality, large-scale, randomized controlled trials remain limited. In this multicenter, randomized, double-blind phase 3 trial, we evaluated obinutuzumab β (MIL62), a novel glycoengineered type II anti-CD20 monoclonal antibody, in patients with NMOSD. Eligible participants aged 18-70 years with aquaporin-4-immunoglobulin G (AQP4-IgG)-seropositive NMOSD and an Expanded Disability Status Scale (EDSS) score of 7.0 or lower were randomly assigned (1:1) to receive intravenous obinutuzumab β 1,000 mg (n = 45) or placebo (n = 46). The primary outcome-time to first adjudicated relapse on or before week 52-was met: relapse occurred in two of 45 (4.4%) obinutuzumab β-treated participants and in 21 of 46 (45.7%) placebo-treated participants (hazard ratio = 0.069, 95% confidence interval: 0.016-0.296, P < 0.0001). The incidence of grade 3 or higher treatment-related adverse events was similar between the obinutuzumab β group (6.7%) and the placebo group (6.5%). These findings support obinutuzumab β as a glycoengineered type II anti-CD20 therapeutic option for patients with AQP4-IgG+ NMOSD. ClinicalTrials.gov identifier: NCT05314010 .

Charcot-Marie-Tooth disease type 1A (CMT1A) is the most common inherited peripheral neuropathy and currently lacks disease-modifying therapy. PXT3003, a low-dose oral combination targeting PMP22 overexpression, has shown efficacy in two trials, while one recent confirmatory trial failed to meet its primary efficacy endpoints. In this trial, eligible participants aged 16 to 65 years with genetically confirmed mild-to-moderate CMT1A were randomly assigned to receive oral PXT3003 or placebo twice daily for 15 months. The primary endpoint was the change in the overall neuropathy limitations scale (ONLS) total score from baseline to month 15. At month 15, mean ONLS change from baseline was -0.268 (SD: 0.82) in the PXT3003 group versus 0.013 (SD: 0.65) in the placebo group, with a between-group difference of -0.249 (95% confidence interval [CI]: -0.467 to -0.030; p = 0.0257). Significant improvements were observed in the ONLS leg subscore and ankle-dorsiflexion strength. These findings support PXT3003 as a promising therapeutic option for alleviating limb symptoms in patients with CMT1A.

Intracerebral hemorrhage (ICH) is a significant public health matter that has no effective treatment. ICH-induced destruction of the blood-brain barrier (BBB) leads to neurological deterioration. Astrocytic sonic hedgehog (SHH) alleviates brain injury by maintaining the integrity of the BBB after ICH. Silent information regulator 1 (SIRT1) is neuroprotective in several central nervous system diseases via BBB regulation. It is also a possible influential factor of the SHH signaling pathway. Nevertheless, the role of SIRT1 on BBB and the underlying pathological process associated with the SHH signaling pathway after ICH remain unclear. We established an intracerebral hemorrhagic mouse model by collagenase injection. SRT1720 (a selective agonist of SIRT1) was used to evaluate the effect of SIRT1 on BBB integrity after ICH. SIRT1 expression was reduced in the mouse brain after ICH. SRT1720 attenuated neurobehavioral impairments and brain edema of ICH mouse. After ICH induction, SRT1720 improved BBB integrity and tight junction expressions in the mouse brain. The SHH signaling pathway-related factors smoothened and glioma-associated oncogene homolog-1 were increased with the intervention of SRT1720, while cyclopamine (a specific inhibitor of the SHH signaling pathway) reversed these effects. These findings suggest that SIRT1 protects from ICH by altering BBB permeability and tight junction expression levels. This process is associated with the SHH signaling pathway, suggesting that SIRT1 may be a potential therapeutic target for ICH.

BACKGROUND:Ischemic stroke is a major cause of disability and death worldwide. A narrow therapeutic window profoundly constrained the utilization of alteplase. OBJECTIVES:To investigate therapeutic effects and safety of intravenous recombinant human prourokinase (rhPro-UK) in patients with acute ischemic stroke (AIS) in the 4.5-6 h therapeutic time windows. METHODS:We conducted a phase IIa, randomized, and open-label multicenter clinical trial. Between 4.5 and 6 h after the onset of AIS, patients were randomly administrated to receive intravenous rhPro-UK at a 50 mg or 35 mg dose. The primary endpoint was excellent functional outcome defined as modified Rankin scale (mRS) score of 1 or less at 90 days. The secondary outcome was the treatment response, which was based on an at least 4-point improvement from baseline National Institutes of Health stroke scale (NIHSS) score at 24 h after drug administration. Safety endpoints included death, symptomatic intracerebral hemorrhage (sICH), and other serious adverse events. RESULTS:We enrolled 80 patients in the 4.5-6 h therapeutic time windows at 17 medical centers in China from December 2016 to November 2017. A total of 39 patients were treated with 50 mg rhPro-UK, and 39 were treated with 35 mg rhPro-UK. Compared with the baseline, the NIHSS score at 24 h and days 7, 14, 30, and 90 was decreased significantly among patients treated with either rhPro-UK 50 mg or 35 mg. The mean reduction in the NIHSS from baseline to 90 days after the onset was 3.56 and 5.79 in the rhPro-UK 50 mg group and the rhPro-UK 35 mg group, respectively. The rates of functional independence at 90 days of rhPro-UK 50 mg and 35 mg were 61.54% and 69.23%, respectively (P = 0.475), and the proportion of patients with functional response to treatment at 24 h were 28.21% and 33.33% (P = 0.624). No sICH occurred in the two groups, and death occurred in only one patient in the rhPro-UK 50 mg group. There was no significant difference in mortality at 90 days and the rate of other serious adverse events between two groups. CONCLUSION:In the 4.5-6 h time window, more than 60% of patients at either dose of rhPro-UK (50 mg or 35 mg) achieved functional independence at 90 days without increased mortality and sICH risk. Thus, intravenous rhPro-UK was effective and safe for patients with AIS within 4.5-6 h after stroke onset. While no significant differences were identified between different dosages of rhPro-UK regarding clinical outcomes, it is a logical step to further test the safety and efficacy of the low dose of rhPro-UK in a well-powered phase III study. TRIAL REGISTRATION:http://www.chictr.org.cn . Identifier: ChiCTR1800016519. Date of registration: 6 June 2018.

目的 调查全科医师在神经内科规范化培训和毕业后工作现况.方法 2021 年 1 月—2022 年 1 月通过问卷形式,调查了 2017-2021 级在内蒙古自治区人民医院已完成神经内科规范化培训的全科医师学习、工作等情况,研究分析了全科医师在神经内科规范化培训中及毕业后面临的问题,研究解决方法.结果 全科医师神经内科规范化培训合格率接近 90.0%,临床思维训练(82.0%)、临床用药(76.7%)、诊疗指南(74.6%)是全科住培学员认为在培训中应该重点讲授的内容,92.7%已经毕业的全科医师在县级以下医疗机构工作,他们工作中面临最多的疾病为心脑血管病(46.0%),89.1%学员对现有工作不满意,69.0%的学员有换工作的打算,超过 40.0%的学员有考研或进修的学习需求.结论 神经内科规范化培训解决了基层医疗机构对神经科疾病的诊疗的技术需求,选择合适的教学方法和内容非常有必要,全科医师的继续教育和职业认同感应该得到重视.

2019年中国流行病学调查显示,缺血性卒中是我国第一死亡原因,且仍呈现上升趋势[1].其中,颅内动脉粥样硬化是缺血性卒中的主要原因[2],通过影像学技术对颅内动脉粥样硬化进行评估至关重要.高分辨率核磁共振成像能够清晰显示血管壁,直接可视化动脉粥样硬化斑块成分,为颅内动脉粥样硬化卒中病因分型、治疗效果和预后、未来卒中风险评估和疾病的鉴别提供了很好的参考价值.

Acute ischaemic stroke is the most common type of stroke and has become the leading cause of death and disability in Chinese adults. Current studies have confirmed that the time window is very important for the treatment of AIS, Stroke Emergency Map can improve the treatment delay and shorten the time window. This review aims to explore the research progress of acute phase treatment, treatment delay and Stroke Emergency Map in acute ischemic stroke, and provides a theoretical basis for the important role of Stroke Emergency Map in the treatment of acute ischemic stroke.

IMPORTANCE Recombinant human prourokinase (rhPro-UK) is a thrombolytic agent that has shown promising findings in a phase 2 clinical trial in patients with acute ischemic stroke (AIS). OBJECTIVE To evaluate the efficacy and safety of rhPro-UK thrombolysis within 4.5 hours of symptom onset in patients with AIS. DESIGN, SETTING, AND PARTICIPANTS This randomized, alteplase-controlled, open-label, phase 3 clinical trial was conducted from May 2018 to May 2020 at 35 medical centers in China. A total of 684 patients were screened and 674 patients were enrolled. Included patients were aged 18 to 80 years with a diagnosis of AIS and received treatment within 4.5 hours of stroke onset. Data were analyzed from June to October 2020. INTERVENTIONS Eligible patients were randomly assigned (1:1) to receive intravenous rhPro-UK or alteplase. MAIN OUTCOMES AND MEASURES The primary objective was to assess whether rhPro-UK was noninferior to alteplase. The noninferiority margin was a between-group difference of less than 10%. The primary outcome was a modified Rankin Scale score of 0 to 1 at 90 days. RESULTS Among 663 patients in the modified intention-to-treat population (mean [SD] age, 61.00 [10.20] years; 161 females [24.3%]), there were 330 patients in the rhPro-UK group and 333 patients in the alteplase group. The median (IQR) baseline National Institutes of Health Stroke Scale score was 6.00 (5.00-9.00). There were 23 deaths, and 619 patients (93.4%) completed the 3-month follow-up. The primary outcome occurred in 215 patients (65.2%) in the rhPro-UK group and 214 patients (64.3%) in the alteplase group (risk difference, 0.89; 95.4% CI, -6.52 to 8.29). Symptomatic intracerebral hemorrhage occurred in 5 patients (1.5%) in the rhPro-UK group and 6 patients (1.8%) in the alteplase group (P >.99). Systemic bleeding within 90 days occurred more frequently in the alteplase group (141 patients [42.2%]) than the rhPro-UK group (85 patients [25.8%]) (P <.001). By 90 days, 5 thrombolysis-related deaths each had occurred in the rhPro-UK group (1.5%) and alteplase group (1.5%) (P >.99). CONCLUSIONS AND RELEVANCE This study found that intravenous rhPro-UK within 4.5 hours of AIS onset was noninferior to alteplase. The rhPro-UK group showed a similar rate of symptomatic ICH but fewer cases of systemic bleeding than the alteplase group.

ImportanceRecombinant human prourokinase (rhPro-UK) is a thrombolytic agent that has shown promising findings in a phase 2 clinical trial in patients with acute ischemic stroke (AIS).ObjectiveTo evaluate the efficacy and safety of rhPro-UK thrombolysis within 4.5 hours of symptom onset in patients with AIS.Design, Setting, and ParticipantsThis randomized, alteplase-controlled, open-label, phase 3 clinical trial was conducted from May 2018 to May 2020 at 35 medical centers in China. A total of 684 patients were screened and 674 patients were enrolled. Included patients were aged 18 to 80 years with a diagnosis of AIS and received treatment within 4.5 hours of stroke onset. Data were analyzed from June to October 2020.InterventionsEligible patients were randomly assigned (1:1) to receive intravenous rhPro-UK or alteplase.Main Outcomes and MeasuresThe primary objective was to assess whether rhPro-UK was noninferior to alteplase. The noninferiority margin was a between-group difference of less than 10%. The primary outcome was a modified Rankin Scale score of 0 to 1 at 90 days.ResultsAmong 663 patients in the modified intention-to-treat population (mean [SD] age, 61.00 [10.20] years; 161 females [24.3%]), there were 330 patients in the rhPro-UK group and 333 patients in the alteplase group. The median (IQR) baseline National Institutes of Health Stroke Scale score was 6.00 (5.00-9.00). There were 23 deaths, and 619 patients (93.4%) completed the 3-month follow-up. The primary outcome occurred in 215 patients (65.2%) in the rhPro-UK group and 214 patients (64.3%) in the alteplase group (risk difference, 0.89; 95.4% CI, −6.52 to 8.29). Symptomatic intracerebral hemorrhage occurred in 5 patients (1.5%) in the rhPro-UK group and 6 patients (1.8%) in the alteplase group (P > .99). Systemic bleeding within 90 days occurred more frequently in the alteplase group (141 patients [42.2%]) than the rhPro-UK group (85 patients [25.8%]) (P < .001). By 90 days, 5 thrombolysis-related deaths each had occurred in the rhPro-UK group (1.5%) and alteplase group (1.5%) (P > .99).Conclusions and RelevanceThis study found that intravenous rhPro-UK within 4.5 hours of AIS onset was noninferior to alteplase. The rhPro-UK group showed a similar rate of symptomatic ICH but fewer cases of systemic bleeding than the alteplase group.Trial RegistrationClinicalTrials.gov Identifier: NCT03541668

目的 探究氧糖剥夺影响人脐静脉内皮细胞(HUVEC)紧密连接相关蛋白的机制.方法 本实验时间为2021年5月至2022年1月.将HUVEC分为正常组、氧糖剥夺6 h组和氧糖剥夺24 h组.正常组HUVEC进行正常培养;氧糖剥夺6 h组HUVEC制备氧糖剥夺模型,并在缺氧培养箱中培养6 h;氧糖剥夺24 h组HUVEC制备氧糖剥夺模型,并在缺氧培养箱中培养24 h.在倒置显微镜下观察HUVEC的形态并拍照,采用CCK-8检测孵育1、2、3、4 d细胞增殖水平.将HUVEC分为氧糖剥夺组、空质粒组、排斥导向分子(RGM)a质粒敲减组.氧糖剥夺组HUVEC制备氧糖剥夺模型,并在缺氧培养箱中培养24 h;空质粒组HUVEC在氧糖剥夺组基础上,转染空载体;RGMa质粒敲减组HUVEC在氧糖剥夺组基础上,转染慢病毒.采用Western blot法检测RGMa、紧密连接相关蛋白(Claudin-5和ZO-1)、基质金属蛋白酶(MMP)-9、CDC42.结果 与正常组相比,氧糖剥夺6 h组、氧糖剥夺24 h组细胞体肿胀或变形,光晕消失,细胞边缘不清晰,细胞体内出现空泡,突起缩短,连接断裂,视野内颗粒样物质增多,细胞变形.孵育1、2、3、4 d,正常组和氧糖剥夺6 h组细胞增殖水平比较,差异无统计学意义(P>0.05);孵育1、2、3、4 d,氧糖剥夺24 h组细胞增殖水平均低于正常组(P<0.05).空质粒组ZO-1、MMP-9低于氧糖剥夺组(P<0.05);RGMa质粒敲减组RGMa、ZO-1、CDC42低于氧糖剥夺组,Claudin-5、MMP-9高于氧糖剥夺组(P<0.05).结论 氧糖剥夺24 h可引起HUVEC增殖水平降低,氧糖剥夺引起HUVEC紧密连接相关蛋白改变的机制可能为RGMa通过CDC42而影响血脑屏障的紧密连接.

该文探讨了miR-32-3p通过靶向Smad3调节氧糖剥夺/再灌注损伤中的细胞活力.通过利用SK-N-SH细胞构建了 一个研究脑缺血再灌注损伤(cerebral ischemia reperfusion injury,CIRI)的氧糖剥夺/再灌注(oxygen-glucose deprivation and reperfusion,OGD/R)模型.通过生物信息学预测miR-32-3p的靶基因并进行功能注释和筛选;通过双荧光素酶报告实验、实时定量PCR、Western blot、CCK-8和活/死细胞检测等实验检测miR-32-3p通过靶向Smad3对细胞活力的影响.结果显示,Smad3是miR-32-3p的新靶点,并且在SK-N-SH OGD/R模型中miR-32-3p表达上调.CCK-8分析表明,与miR-32-3p抑制剂对照组和shNC组相比,sh-Smad3和miR-32-3p抑制剂+sh-Smad3组的细胞活力显著降低.随后,活/死细胞活力测定进一步支持了这些结果.与抑制剂NC和shNC组相比,sh-Smad3和miR-32-3p抑制剂+sh-Smad3组中可观察到更多以红色荧光表示的死亡细胞.与SK-N-SH细胞相比,OGD/R细胞的Lats2、Yap/Taz和Smad3水平降低.这些结果表明,缺乏Smad3可能会抑制细胞活力.这些结果说明,Hippo信号通路中的Smad3、Lats2和Yap/Taz可能共同调节细胞活力.

目的 观察并分析黛力新对青年原发性高血压伴随症状的治疗效果.方法 选择西医诊断为原发性高血压病1级或2级的患者80例,入选患者符合正在规律服用西药降血压,但患者的血压得不到良好控制,同时患者均伴有躯体症状.将患者依据抽签数字法分为两组,对照组选择钙通道阻滞剂(CCB)降压,实验组在对照组治疗的基础上加用情绪稳定剂(黛力新).观察30 d后两组患者血压改善情况;观察两组患者1周、2周、1个月后焦虑自评量表(SAS)、抑郁自评量表(SDS)、汉密尔顿焦虑量表(HAMA)及躯体化自评量表的评分变化,根据量表评分分析伴随症状缓解情况,比较两组疗效差异.结果 治疗1个月后实验组比对照组血压达标且平稳;对照组1周后各量表评分无明显改变,差异无统计学意义(P＞0.05),实验组各量表评分1周后显著改变,优于同期对照组,差异有统计学意义(P＜0.05);2周后及1个月后两组各量表评分均有显著改变,同时实验组显著优于同期对照组,比较差异有统计学意义(P＜0.05).结论 西药降血压疗效虽然已经非常明确,但血压容易波动,伴随症状控制不理想,而情绪稳定剂(黛力新)能使患者的血压在达标的基础上更加平稳,同时在改善患者伴随症状方面有明显的优势.

Objective: To investigate the blood pressure change in patients with acute ischemic stroke (AIS) and hypertension treated with cinepazide maleate injection. Methods: This was a subgroup analysis of post-marketing clinical confirmation study of cinepazide maleate injection for acute ischemic stroke: a randomized, double-blinded, multicenter, placebo-parallel controlled trial, which conducted in China from August 2016 to February 2019. Eligible patients fulfilled the inclusive criteria of acute anterior circulation ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 7-25. The primary endpoints were mean blood pressure of AIS patients treated with cinepazide maleate or control, which were assessed during the treatment period (14 days), and the proportion of the patients with normal blood pressure was analyzed after the treatment period. Furthermore, a subgroup analysis was performed to investigate a possible effect of the history of hypertension on outcomes. Results: This analysis included 809 patients with hypertension. There was no significant difference in patients blood pressure and the proportion of patients with normal blood pressure (60.5% vs. 59.0%,P>0.05) between cinepazide maleate group and control group. Conclusion: Administration of cinepazide maleate injection does not affect the management of clinical blood pressure in patients with AIS.

目的 探讨定量脑电图(QEEG)联合经颅多普勒超声(TCD)对动脉瘤蛛网膜下腔出血(aSAH)后迟发性脑缺血(DCI)的诊断价值.方法 选取2019年12月至2021年1月内蒙古自治区人民医院神经内科和神经外科收治的aSAH患者54例.以发病后14 d或出现DCI为观察终点,将患者分为DCI组16例和非DCI组38例.比较两组患者基线资料及入院后24 h内QEEG、TCD检查结果.aSAH患者发生DCI的影响因素分析采用多因素Logistic回归分析;并进一步绘制ROC曲线以评估α/δ比值(ADR)、大脑中动脉平均血流速度(Vm)及其联合对aSAH患者发生DCI的预测价值.结果 两组患者改良Fisher分级、相对δ功率(RDP)、相对α功率(RAP)、ADR、相对α变异及大脑中动脉收缩期血流速度(Vs)、Vm、搏动指数(PI)比较,差异有统计学意义(P<0.05).多因素Logistic回归分析结果显示,ADR〔OR=1.536,95％CI(1.046,2.257)〕及大脑中动脉Vm〔OR=2.543,95％CI(1.440,14.695)〕是aSAH患者发生DCI的影响因素(P<0.05).ROC曲线分析结果显示,ADR联合大脑中动脉Vm预测aSAH患者发生DCI的AUC为0.946〔95％CI(0.888,1.000)〕,分别高于ADR〔AUC=0.844,95％CI(0.714,0.913)〕、大脑中动脉Vm〔AUC=0.771,95％CI(0.624,0.919)〕(P<0.05).结论 ADR、大脑中动脉Vm是aSAH患者发生DCI的影响因素,ADR联合大脑中动脉Vm对aSAH患者发生DCI的预测价值较高.

Acute ischemic stroke (AIS) is the most common type of stroke. Fingolimod is a sphingosine analog that acts on sphingosine-1-phosphate receptors (S1PR). Recently, the safety and efficacy of fingolimod in both patients with intracerebral hemorrhage and patients with AIS have been investigated in proof-of-concept trials. In this review, we performed a meta-analysis to evaluate the efficacy and safety of fingolimod for AIS. This study was conducted according to the PRISMA (Preferred Reporting Items for Systemic review and Meta-Analysis) statement. We searched for publications on the PubMed, Embase, Cochrane Central Register of Controlled Trials, Clinical trials, CNKI, Wanfang Data, VIP, CBM up to August 2021. We compiled five studies; a main meta-analysis forest plots were conducted for the values of the proportion of patients whose modified Rankin scale (MRS) score was 0-1 at day 90. There were heterogeneities in each study; the method of sensitivity analysis was performed. A sensitivity analysis was performed with a mean difference (MD) of the efficacy of fingolimod plus standardized treatment versus standardized treatment alone. Random effect model is used for meta-analysis regardless of the I2 index. The analysis was carried out for categorical variables using the risk ratio (RR), LogRR, and its 95% CI. The methodological quality of each randomized controlled trial (RCTs) was assessed according to the Cochrane Collaboration tool to assess the risk of bias (ROB). A meta-analysis of five studies with 228 participants was conducted. The risk ratio of patients whose MRS score was 0-1 at day 90 between fingolimod plus standardized treatment and standardized treatment alone was 2.59 (95%CI, 1.48-4.56). The Fingolimod plus standard treatment group decreased infarct growth and improved clinical function than the standard treatment.

目的 观察分析早期强化姿势控制训练对伴有高血压病的急性缺血性脑卒中(AIS)偏瘫患者的疗效.方法 选取2020年10月至2021年9月于内蒙古自治区人民医院神经内科收治的伴高血压病的急性缺血性脑卒中偏瘫患者104例为研究对象,分为常规训练组(n=52)和联合训练组(n=52).两组患者均给予早期常规康复治疗,联合训练组在常规训练组基础上给予强化姿势控制训练,两组均治疗4周.4周后分别采用FugI-Meyer运动量表(FMA)、Berg平衡量表(BBS)、Barthel指数表(MBI)以及Holden步行功能分级(FAC)评估并比较两组治疗前后肢体运动功能、平衡能力、日常生活能力和步行能力差异,并分析治疗后两组的差异.结果 与治疗前比较,两组治疗4周后FMA、BBS、MBI评分和FAC分级均显著提高(P均<0.001),且联合训练组FMA、BBS、MBI评分显著高于常规训练组(P<0.001),但治疗后联合训练组FAC分级较常规训练组无显著性差异(P=0.199).结论 早期康复能明显改善伴有高血压病的急性缺血性脑卒中偏瘫患者的运动功能恢复,强化姿势控制训练对其运动功能提高更为显著.

BackgroundAssessment of the risks of stroke and then initiation of primary prevention are crucial to reducing the incidence rate of stroke. Trimethylamine-N-oxide (TMAO) is a recently discovered intestinal microbial metabolite, whose relationships with the risks of stroke have been rarely reported.ObjectiveTo explore the correlation between serum TMAO levels and the risks of acute ischemic stroke (AIS) .MethodsWith the supporting by the project of the National Health Commission (stroke high risk population screening and intervention) , five hundred cases were randomly selected from the stroke screening population in the New Urban Community of Hohhot city of Inner Mongolia from October to December 2020. Finally, 399 cases were included according to the set of standard, and then the 399 cases were divided into normal control group (n=121) , moderate AIS risk group (n=141) , and high AIS risk group (n=137) in accordance with the screening results (score of stroke risk rated using a scoring card) . Demographic and laboratory indices (including serum TMAO detected using ELISA) of all cases were collected. Pearson correlation test and Spearman rank correlation test were conducted to measure the correlation of TMAO with AIS risks. Multinomial and ordinal Logistic regressions were used to explore the influencing factors of AIS risks. ROC analysis was used to estimate the predictive value of TMAO for AIS risk.ResultsCompared with the control group, the serum TMAO level in high-risk group was increased significantly (P<0.05) . Correlation analysis results found that serum TMAO level was negatively associated with increased age, being female, history of hypertension, diabetes history, current smoking and drinking consumption (r=-0.182, rs=-0.130, -0.262, -0.147, -0.178, -0.140, P<0.05) , but positively associated with lack of exercise and increased BMI (rs=0.153, r=0.210, P<0.05) .The multinomial and ordinal Logistic regression analyses showed that increased TMAO was independently associated with increased risk of AIS (B=3.084, SE=0.426, P<0.001) . The AUC of serum TMAO in predicting AIS risk was 0.790 〔95%CI (0.737, 0.837) 〕with 62.0% sensitivity and 91.6% specificity when its optimal cut-off value was determined as 3.28 μmol/L.ConclusionSerum TMAO level may be independently related to AIS, which could be used as a clinical predictor for AIS.