目的:探讨支架取栓术联合替罗非班及丁苯酞治疗急性脑梗死(ACI)的效果.方法:收集2020年6月至2021年12月南阳市中心医院诊治的306例ACI患者的临床资料.根据治疗方式的不同将患者分为A组(给予支架取栓术联合替罗非班及丁苯酞治疗)、B组(给予支架取栓术联合替罗非班治疗)、C组(给予支架取栓术治疗),每组102例,对比3组患者血管再通情况、神经元特异性烯醇化酶(NSE)、6-酮-前列腺素-F1a(6-k-PGF1a)、钙结合蛋白(S100-β)、血栓素B2(TXB2)、美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分、复发率、病死率的差异.结果:术后3组患者的NSE、6-k-PGF1a、S100-β、TXB2、NIHSS评分、mRS评分差异有统计学意义(P均<0.05),A组患者的NSE、S100-β、TXB2、NIHSS评分、mRS评分低于B组和C组,6-k-PGF1a高于B组和C组(P均<0.05).A组的血管再通率高于B组和C组,复发率低于B组和C组(P<0.05).A组的病死率与B组、C组相比差异无统计学意义(P>0.05).结论:支架取栓术联合替罗非班及丁苯酞治疗ACI效果显著,有利于提高血管再通率和改善神经功能.

目的 探讨葛根素对缺氧诱导的大鼠肾上腺髓质嗜铬瘤分化细胞PC12细胞神经损伤及c-Jun氨基末端激酶(JNK)/丝裂原活化蛋白激酶(MAPK)信号通路的影响.方法 体外培养PC12细胞,50 ng/ml神经生长因子(NGF)诱导分化,对高分化的PC12细胞进行缺氧处理,再对缺氧诱导的PC12细胞进行不同浓度(0.1、1.0、10.0μmol/L)葛根素处理,将细胞分为对照组,缺氧组,0.1、1.0、10.0μmol/L葛根素组,葛根素+JNK通路激活剂茴香霉素(AC)组.四甲基偶氮唑蓝(MTT)比色法检测各组细胞活力;流式细胞仪检测各组细胞凋亡情况;2',7'-二氯二氢荧光素二乙酸酯(DCFH-DA)法检测各组PC12细胞活性氧(ROS)水平;试剂盒检测各组细胞丙二醛(MDA)、超氧化物歧化酶(SOD)水平;Western印迹检测各组凋亡蛋白JNK/MAPK信号通路相关蛋白表达情况.结果 低分化PC12细胞多呈椭圆形,聚集成小团簇状;高分化PC12细胞长出类似神经元样突起,培养一段时间后,细胞体积增大突起增多增长,形成网络.与对照组比较,缺氧组PC12细胞活力、SOD水平显著降低,细胞凋亡率、细胞内ROS含量、MDA水平及蛋白p-JNK、caspase-3表达显著升高(P<0.05);与缺氧组比较,0.1、1.0、10.0μmol/L葛根素组PC12细胞活力、SOD水平显著升高,细胞凋亡率、细胞内ROS含量、MDA水平及蛋白p-JNK、caspase-3表达显著降低,且呈剂量依赖性(P<0.05);与10.0μmol/L葛根素处理组比较,葛根素+AC组细胞活力、SOD水平显著降低,细胞凋亡率、细胞内ROS含量、MDA水平及蛋白p-JNK、caspase-3表达显著升高(P<0.05).结论 葛根素能够保护缺氧诱导的PC12细胞神经损伤,可能与抑制JNK/MAPK通路的激活有关.

目的 探讨老年腔隙性脑梗死合并高血压患者认知功能障碍的影响因素及25-羟基维生素D对其预测价值.方法 回顾性分析219例老年腔隙性脑梗死合并高血压患者的临床资料及实验室检测结果,根据蒙特利尔认知评估量表评分将患者分为认知功能障碍组(132例)和认知正常组(87例).采用单因素分析及多因素Logistic回归分析法探讨老年腔隙性脑梗死合并高血压患者发生认知功能障碍的影响因素,并绘制受试者工作特征曲线分析25-羟基维生素D对老年腔隙性脑梗死合并高血压患者发生认知功能障碍的预测价值.结果 219例老年腔隙性脑梗死合并高血压患者发生认知功能障碍132例,发生率为60.27％.不同年龄、高血压病程、收缩压、血压控制效果、糖尿病、头颈动脉狭窄程度、25-羟基维生素D水平患者认知功能比较差异有统计学意义(P＜0.05或0.01).多因素Logistic回归分析显示,年龄(OR=1.841,95％CI为1.079～3.137,P=0.025)、高血压病程(OR=1.887,95％CI 为 1.199～2.968,P=0.006)、入院时收缩压(OR=1.740,95％CI 为 1.194～2.535,P=0.004)、血压控制不达标(OR=2.034,95％CI 为 1.106～3.741,P=0.022)、合并糖尿病(OR=1.840,95％CI 为 1.084～3.124,P=0.024)、头颈动脉中/重度狭窄(OR中度=1.804,95％CI中度为1.149～2.831,P中度=0.011;OR重度=1.985,95％CI重度为 1.293～3.050,P重度=0.002)、25-羟基维生素 D 水平(OR=1.887,95％CI为1.293～2.755,P=0.001)是老年腔隙性脑梗死合并高血压患者发生认知功能障碍的影响因素.受试者工作特征曲线显示,25-羟基维生素D水平预测老年腔隙性脑梗死合并高血压患者认知功能障碍的曲线下面积为0.891,最佳诊断点为66.08 nmol·L-1,此时灵敏度为77.01％,特异度为91.67％.结论 老年腔隙性脑梗死合并高血压患者认知功能障碍发生率较高,其影响因素较多,临床应早期综合评估并采取预防干预措施;25-羟基维生素D水平可作为此类患者发生认知功能障碍的辅助预测指标.

目的 分析急性前循环大血管闭塞性卒中患者超时间窗机械取栓的治疗效果.方法 本研究为回顾性队列研究.选取2019年1月至2022年5月在南阳市中心医院住院治疗的急性前循环大血管闭塞性卒中患者93例,其发病至入院时间均>24 h,且影像学检查显示存在明显的缺血半暗带.根据患者是否接受机械取栓将其分为对照组(n=49)和取栓组(n=44).对照组患者给予常规药物治疗和标准护理,取栓组患者在对照组基础上进行机械取栓.比较两组患者基线资料、影像学资料,记录取栓组患者手术相关情况.所有患者于术后90 d通过电话进行随访,主要结局指标为术后90 d改良Rankin量表(mRS)评分,次要结局指标为术后90 d预后良好(mRS评分为0～2分)、mRS评分为0～3分、死亡、脑梗死复发情况及症状性颅内出血(sICH)发生情况.结果 取栓组患者手术方式:单纯抽吸取栓5例(11％),支架取栓39例(89％);手术相关并发症:动脉夹层2例(5％),新发部位栓塞3例(7％);取栓次数为1(1)次;植入支架19例(43％);mTICI分级:0～1级2例(5％),2a级3例(7％),2b级27例(61％),3级12例(27％);术后造影剂外渗8例(18％).取栓组术后90 d mRS评分低于对照组,预后良好、mRS评分0～3分者占比高于对照组(P<0.05);两组术后90 d死亡率、脑梗死复发率、sICH发生率比较,差异无统计学意义(P>0.05).结论 与常规药物治疗相比,超时间窗(发病24 h以上)机械取栓能更有效改善存在明显缺血半暗带的急性前循环大血管闭塞性卒中患者90 d神经功能预后.

目的 探讨老年脑卒中患者主观认知减退与神经疲劳的现状,并分析二者之间的相关性.方法 采用便利抽样法抽取 168 例老年脑卒中患者,采用一般资料调查表、主观认知减退问卷、脑卒中神经疲劳量表对其进行调查.结果 老年脑卒中患者主观认知减退问卷总分为(12.91±3.03)分,脑卒中神经疲劳量表总分为(19.44±4.58)分.Pearson相关分析结果显示,老年脑卒中患者的脑卒中神经疲劳量表总分与主观认知减退问卷总分及 4 个维度的得分均呈显著正相关(P＜0.01),相关系数为 0.699～0.875.分层回归分析结果显示,控制一般资料后,主观认知减退可解释老年脑卒中患者神经疲劳总变异的 67.10%.结论 老年脑卒中患者主观认知减退水平与神经疲劳程度密切相关,医务工作者应高度关注非首发及缺血型的老年脑卒中患者,积极采取预防性干预措施,以改善神经疲劳,降低死亡率.

Objective To explore the correlation between serum lipoprotein（a）[Lp（a）],galectin3（GAL3）,visceral adipose-specific serine protease inhibitor（vaspin） and the outcome of Trevo stent thrombolectomy in patients with acute ischemic stroke in anterior circulation. Methods A total of 112 patients with circulating acute ischemic stroke admitted to the Department of Neurology,Nanyang Central Hospital from June 2019 to March 2022 were selected as the research objects. All patients were given Trevo stent thrombectomy. According to the modified Rankin Scale（mRS） score on the 14th day after Trevo stent thrombectomy,the patients were divided into the excellent outcome group（76 cases）and the poor outcome group（36 cases）. Serum Lp（a）,GAL3 and vaspin levels in the two groups were measured at admission,immediately after surgery,3 days,1 week and 2 weeks after surgery. Spearmen was used to analyze the correlation between serum Lp（a）,GAL3,vaspin and the outcome of Trevo stent thrombolectomy in patients with acute ischemic stroke in anterior circulation. Results The serum Lp（a）and GAL3 in the excellent outcome group were lower than those in the poor outcome group at 3 days,1 week and 2 weeks after Trevo stent thrombolectomy（t=7.725,10.602,9.578,2.888,5.875,9.45,P＜0.05）. Vaspin level was higher than that in the poor outcome group（t=23.416,14.754,8.428,P＜0.05）. Spearmen correlation analysis showed that the excellent outcome of Trevo stent thrombolectomy in patients with acute ischemic stroke in anterior circulation was positively correlated with serum Lp（a）and GAL3,and negatively correlated with vaspin level.Conclusion Serum Lp（a）,GAL3 and vaspin are correlated with the outcome of Trevo stent thrombolectomy in patients with acute ischemic stroke in anterior circulation. Those results can be referred to the monitoring of patients’ serum Lp（a）,GAL3 and vaspin for timely administration of appropriate clinical measures to improve the outcome of patients after thrombectomy.

目的 探讨显微镜下全切术联合同位素治疗脑胶质瘤的疗效及其对VEGF等指标和患者预后的影响.方法 回顾性分析92例脑胶质瘤的患者,根据治疗方式分为2组.其中研究组患者50例,采用显微镜下全切术联合碘125同位素治疗,而对照组患者42例,则采用单纯的显微镜下全切术治疗,比较2组患者的临床疗效.结果 术后研究组的总有效率(88.0％)显著高于对照组(69.0％)(P<0.05);术前两组的肿瘤相关指标比较无差异(P>0.05),而术后两组的肿瘤相关指标均较术前降低,且研究组降低更为显著(P<0.05);术前两组的ADL评分比较无差异(P>0.05),而术后两组的ADL评分均较术前升高,且研究组升高更为显著(P<0.05);术后1年,研究组的预后情况比对照组优(P<0.05).结论 微镜下全切术联合碘125同位素治疗可显著提高脑胶质瘤患者的疗效,同时降低其肿瘤相关指标并可改善患者的生活治疗及预后,值得临床推广应用.

目的 探究急性后循环供血区缺血性脑梗死患者血管再通术后24 h内Alberta卒中操作早期CT评分(Alberta stroke program early CT score,ASPECTS)联合血清血红素氧合酶-1(Heme oxygenase-1,HO-1)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)水平对患者短期不良预后的预测价值.方法 选取医院2019年1月-2020年1月收治的62例急性后循环供血区缺血性脑梗死患者,均行血管再通术;术后随访3个月,根据改良Rankin量表评分(Modified Rankin scale,mRS)进行神经功能评定,分为预后良好组、预后不良组,采用单因素分析比较2组术后24h内ASPECTS评分、血清HO-1,VEGF水平等可能影响患者短期不良预后的因素;采用Logistic回归分析急性后循环供血区缺血性脑梗死患者血管再通术后影响患者短期不良预后的危险因素,并绘制受试者工作特征(Receiver operating characteristic,ROC)曲线评估术后ASPECTS评分联合血清HO-1,VEGF水平对患者短期不良预后的预测价值.结果 根据随访3个月后mRS评分判定,62例患者中40例归为预后良好组,22例归为预后不良组.单因素分析中2组患者性别、年龄、体质量指数、是否吸烟、酗酒,高脂血症、糖尿病、冠心病、既往脑卒中、高血压病等既往病史、治疗前血压、术后24 h内血压、发病至入院时间、术后24 h内实验室检查指标(白细胞计数、血小板、血糖、血尿素、血肌酐、胱抑素C)水平均无明显差异(P＞0.05);预后良好组既往病史中心房颤动占比(12.50％)低于预后不良组(45.45％)(P＜0.05),术后24 h内NIHSS评分低于预后不良组(P＜0.05),术后24 h内ASPECTS评分高于预后不良组(P＜0.05).术后24 h内实验室检查指标中预后良好组血清HO-1水平高于预后不良组,VEGF水平低于预后不良组(P＜0.05).经Logistic回归分析显示,心房颤动史、术后24 h内NIHSS评分、术后24 h内ASPECTS评分、血清HO-1,VEGF水平是影响急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后的危险因素.ROC曲线分析显示,术后24 h内ASPECTS评分联合血清HO-1,VEGF水平预测急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后的敏感度、准确度、AUC分别为93.67％、84.36％、0.873,均高于血清HO-1水平、VEGF水平、ASPECTS评分单独预测.结论 术后24 h内ASPECTS评分、血清HO-1,VEGF水平与急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后密切相关,三者联合预测的准确性更好.

目的 探讨急性前循环串联闭塞卒中患者行机械取栓治疗中颅外颈动脉病变的治疗方案,评估其有效性和安全性.方法 回顾性分析2018年1月—2019年12月南阳市中心医院收治的18例行血管内治疗的颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者的临床资料.其中男性9例,女性9例,年龄为60～70岁.根据治疗方式的不同,将18例患者分为急诊支架组(11例)和急诊非支架组(7例).术中即刻血管再通情况根据脑梗死溶栓(TICI)分级判断,将卒中发生90d改良Rankin量表(mRS)评分0～2分定义为临床预后良好.结果 2组患者年龄、性别、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前Alberta卒中项目早期CT(ASPECT)评分、病因分型、治疗方式、病变类型、血管闭塞部位等临床基线资料比较,差异均无统计学意义(均P＞0.05);急诊支架组和急诊非支架组的术后血管成功再通率(TICI分级为2b～3级)分别为72.7％和71.4％,组间差异无统计学意义(P＞0.05);2组术后症状性颅内出血率分别为9.1％和0,组间差异无统计学意义(P＞0.05);2组患者术后90 d改良mRS评分及90 d病死率比较差异无统计学意义(均P＞0.05);2组患者术后残余狭窄率差异有统计学意义(P＜0.05).结论 在急性前循环串联闭塞的血管内治疗中,急诊颈动脉颅外段支架置入术可能是有效和安全的.

目的 探讨基于Neuman理论的心理危机干预对新型冠状病毒肺炎患者心理压力、情绪及睡眠质量的影响.方法 将79例新型冠状病毒肺炎患者按照住院时间分为研究组41例,对照组38例,两组均给予常规心理疏导和睡眠护理,研究组在此基础上给予基于Neuman理论的心理危机干预,观察住院全程.干预前后比较两组汉密顿焦虑量表、汉密顿抑郁量表、心理弹性量表、知觉压力量表、艾森克情绪稳定性量表、匹兹堡睡眠质量指数量表评分.结果 干预后两组汉密顿焦虑量表、汉密顿抑郁量表、知觉压力量表评分均较干预前显著降低(P<0.01),心理弹性量表评分较干预前显著升高(P<0.01),研究组较对照组变化更显著(P<0.01).干预后研究组艾森克情绪稳定性量表自卑感、抑郁性维度评分均较干预前显著升高(P<0.01),且显著高于对照组(P<0.01),焦虑、负罪感维度评分均较干预前显著降低(P<0.01),且显著低于对照组(P<0.01).干预后两组匹兹堡睡眠质量指数量表总分及各维度评分均显著低于干预前(P<0.01),研究组显著低于对照组(P<0.01).结论 基于Neuman理论的心理危机干预可有效缓解患者的焦虑、抑郁情绪,提升心理弹性,改善睡眠质量,具有较高的应用价值.

Objective:To investigate the efficacy of different preferred thrombectomy strategies for embolic acute vertebrobasilar artery occlusion (AVBAO).Methods:Forty-four patients with embolic AVBAO who underwent endovascular treatment in Department of Neurology, Nanyang Central Hospital from January 2019 to June 2021 were included in the study. Patients were divided into stent-retriever thrombectomy group ( n=27) and aspiration thrombectomy group ( n=17) according to different preferred thrombectomy strategies. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients 90 d after surgery; the differences of clinical data, surgery-related characteristics, prognoses and complications between the two groups were compared. Results:There was no significant difference between the 2 groups in terms of time from onset to puncture, sites of target vessel occlusion, proportion of patients accepted intraoperative remedial measures, and successful recirculation rate of target vessels ( P>0.05). Compared with the aspiration thrombectomy group, the stent-retriever thrombectomy group had significantly decreased utilization rate of middle catheters, significantly increased retrieval attempts in thrombectomy, statistically lower re-recanalization rate of first-time thrombectomy on the target vessels, significantly longer time from puncture to re-recanalization, and significantly higher incidence of new embolism ( P<0.05). There was no significant difference between the 2 groups in incidences of vascular rupture and postoperative spontaneous intracerebral hemorrhage (sICH), and good prognosis rate 90 d after surgery ( P>0.05). Conclusion:For embolic AVBAO patients, similar recanalization and short-term good prognosis can be obtained by aspiration thrombectomy to those by stent-retriever thrombectomy; besides that, aspiration thrombectomy has advantages as shorter recanalization time, less new embolic complications and higher re-recanalization rate of first-time thrombectomy.

目的 探讨后循环脑梗死患者血管内介入治疗效果及胶质纤维酸性蛋白(GFAP)、中性粒细胞计数和信号素7A(Sema7A)水平变化.方法 选择2019年1月至2021年1月在南阳市中心医院诊治的80例后循环脑梗死患者,均接受血管内介入治疗.在治疗前1 h及治疗结束后第3天参考美国国立卫生研究院卒中量表(NIHSS)积分变化情况进行评价疗效.治疗前1 h及治疗结束后第3天检测GFAP、中性粒细胞计数和Sema7A水平.根据临床疗效结果将临床总有效患者纳入预后良好组,将无效患者纳入预后不良组.结果 80例患者中基本痊愈41例、显著进步20例、进步9例,无效10例.总有效70例,总有效率为87.50％,无效率为12.5％.在治疗前、治疗后,预后良好组患者血清GFAP、中性粒细胞计数均低于预后不良组(P<0.05),Sema7A水平高于预后不良组患者(P<0.05).组内比较发现,预后良好组患者血清GFAP、中性粒细胞计数和Sema7A水平治疗前后差异有统计学意义(P<0.05);预后不良组患者清GFAP、中性粒细胞计数和Sema7A水平治疗前后差异无统计学意义(P>0.05).预后良好组患者治疗前后NIHSS积分均低于预后不良组患者(P<0.05).血清GFAP、中性粒细胞计数与NIHSS积分呈正相关(P<0.05),与临床疗效呈负相关(P<0.05);Sema7A水平与NIHSS积分呈负相关(P<0.05),与临床疗效呈正相关(P<0.05).结论 血清GFAP、中性粒细胞计数和Sema7A水平影响后循环脑梗死患者血管内介入治疗效果,血清GFAP、中性粒细胞计数水平升高不利于预后,而Sema7A水平升高有利于临床疗效及预后.

Objective:To explore whether circular RNA HECTD1 (circ-HECTD1) is involved in oxygen-glucose deprivation (OGD)-induced neuronal cell damage by regulating the expressions of miR-98-5p/ephrin A4 (EPHA4).Methods:Mouse primary cortical neuronal cells were isolated and cultured in vitro. The targeting relations of circ-HECTD1 and miR-98-5p with EPHA4 were detected by dual luciferase reporter assay and RNA binding protein immunoprecipitation assay. These neurons were randomly divided into control group (cultured for 24 h under normal condition) and 6, 12 and 24 h OGD treatment groups (treated with OGD for 6, 12 and 24 h, respectively), OGD+Vector group and OGD+circ-HECTD1 group, OGD+small interfering RNA (siRNA) negative control (si-NC) group and OGD+siRNA circ-HECTD1 (si-circ-HECTD1) group, OGD+micro RNA (miR) negative control (miRNC) group and OGD+miR-98-5p mimic group, OGD+miRNA inhibitor negative control (anti-miRNC) group and OGD+miR-98-5p inhibitor (anti-miR-98-5p) group, OGD+miR-98-5p mimic+pcDNA group and OGD+miR-98-5p mimic+EPHA4 group, OGD+si-circ-HECTD1+anti-miR-NC group and OGD+si-circ-HECTD1+miR-98-5p inhibitor group; pCD5-ciR empty vector, pCD5-ciR-circ-HECTD1, si-NC, si-circ-HECTD1, miR-NC, miR-98-5p mimic, anti-miR-NC or anti-miR-98-5p were transfected into the neurons, and miR-98-5p mimi and pcDNA3.1 empty vector, miR-98-5p mimic and pcDNA3.1-EPHA4 overexpression vector, si-circ-HECTD1 and anti-miR-NC, or si-circ-HECTD1 and anti-miR-98-5p were co-transfected into the neurons. After 24 h of OGD treatment, the circ-HECTD1, miR-98-5p and EPHA4 mRNA expressions were detected by real-time fluorescent quantitative PCR (qRT-PCR), the EPHA4 protein expression was detected by Western blotting, the proliferation activity was detected by MTT assay, the apoptosis rate was detected by flow cytometry, the levels of interleukin (IL)-1β and tumor necrosis factor (TNF)-α in cell culture medium were detected by ELISA, and the activities of superoxide dismutase (SOD) and malondialdehyde (MDA) were detected by kit assay. Results:(1) Targeting relations between circ-HECTD1 and miR-98-5p, and EPHA4 and miR-98-5p were verified. (2) As compared with the control group, the neurons in 6, 12 and 24 h OGD treatment groups had significantly increased circ-HECTD1 and EPHA4 protein expressions and significantly decreased miR-98-5p expression ( P<0.05). (3) As compared with OGD+Vector group, OGD+circ-HECTD1 group had significantly increased circ-HECTD1 expression, and significantly decreased miR-98-5p expression ( P<0.05); as compared with OGD+si-NC group, OGD+si-circ-HECTD1 group had significantly increased miR-98-5p expression, and significantly decreased EPHA4 mRNA and protein expressions ( P<0.05); as compared with OGD+miR-NC group, OGD+miR-98-5p mimic group had significantly increased miR-98-5p expression, and significantly decreased EPHA4 protein expression ( P<0.05); as compared with OGD+anti-miR-NC group, OGD+anti-miR-98-5p group had significantly decreased miR-98-5p expression, and significantly increased EPHA4 protein expression ( P<0.05); as compared with the OGD+si-circ-HECTD1+anti-miR-NC group, OGD+si-circ-HECTD1+anti-miR-98-5p group had significantly increased EPHA4 mRNA and protein expressions ( P<0.05). (4) As compared with the control group, the OGD groups had significantly decreased cell viability and SOD activity, and significantly increased IL-1β and TNF-α levels, apoptosis rate and MDA activity ( P<0.05); as compared with the OGD+si-NC group, the OGD+si-circ-HECTD1 group had significantly decreased cell apoptosis rate, IL-1β and TNF-α levels, and MDA activity, and significantly increased cell viability and SOD activity ( P<0.05); as compared with the OGD+si-circ-HECTD1+anti-miR-NC group, the OGD+si-circ-HECTD1+anti-miR-98-5p group had significantly decreased cell viability and SOD activity, and significantly increased IL-1β and TNF-α levels, apoptosis rate and MDA activity ( P<0.05); as compared with the OGD+miR-NC group, OGD+miR-98-5p mimic group had significantly decreased cell apoptosis rate, IL-1β and TNF-α levels, and MDA activity, and significantly increased cell viability and SOD activity ( P<0.05); as compared with OGD+miR-98-5p mimic+pcDNA group, OGD+miR-98-5p mimic+EPHA4 group has significantly increased cell apoptosis rate, IL-1β and TNF-α levels, and MDA activity, and significantly increased cell viability and SOD activity ( P<0.05). Conclusion:Knockdown of circ-HECTD1 could ameliorate the OGD-induced neuronal cell damage in mice by targeting the expressions of miR-98-5p/EPHA4.

目的 探讨以认知障碍为主要表现的颈内动脉狭窄的临床特点和治疗效果,减少误诊,漏诊.方法 收集2018-01—2020-06在焦煤集团中心医院神经内科接受治疗的13例以认知障碍为主要表现的颈内动脉狭窄患者的临床资料,并进行回顾性分析.结果 13例患者中临床表现为记忆力下降13例(100％),精神症状5例(38.5％),定向障碍7例(53.8％),计算力下降9例(69.2％),社交能力下降11例(84.6％).13例颈部彩超显示颈动脉狭窄;10例头颈CTA显示单侧颈内动脉狭窄,3例头颈CTA显示双侧颈内动脉狭窄;10例DSA显示单侧颈内动脉狭窄,3例DSA显示双侧颈内动脉狭窄,其中1例DSA显示双侧颈内动脉狭窄合并同侧大脑中动脉狭窄.6例行保护伞下颈内动脉狭窄球囊扩张+支架成形术,7例给予阿司匹林肠溶片+氯吡格雷片双抗治疗.13例中6例基本痊愈,2例明显好转,4例遗留不同程度认知障碍,1例进展性脑梗死死亡.结论 以认知障碍为主要临床表现的颈内动脉狭窄发生率低,容易误诊,漏诊,颈部彩超、CTA、DSA确诊率高.一旦确诊及时给予双抗治疗或支架植入可显著改善预后.

目的 探讨颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者血管内治疗方法,评估其疗效和安全性.方法 回顾性分析2015年1月至2019年12月在南阳市中心医院接受血管内治疗的63例颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者临床资料.根据治疗方式不同,分为顺行再通组(n=41)和逆行再通组(n=22).采用改良溶栓治疗脑梗死(mTICI)血流分级判断术后血管再通程度,改良Rankin量表(mRS)评分评估术后90 d临床预后.结果 两组患者年龄、性别、伴高血压病、伴糖尿病、伴心房颤动、吸烟史、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前Alberta卒中项目早期CT评分(ASPECTS)、脑卒中病因等差异均无统计学意义(均P>0.05).顺行再通组、逆行再通组分别有16例(39.0％)、15例(68.2％)接受急诊颈内动脉起始段支架植入(P=0.027),穿刺至再通时间分别为(138+55)min、(120+47)min(P<0.01),90 d恢复良好(mRS评分≤2分)分别有17例(41.5％)、15例(68.2％)(P=0.043),差异均有统计学意义.结论 血管内逆行再通治疗颈内动脉颅外段伴同侧颅内大血管急性串联闭塞,是一种安全有效的治疗选择.

目的 探讨急性脑梗死(acute cerebral infarction,ACI)患者血清微小RNA-493(microRNA-493,miR-493)表达水平及其与溶栓后预后的关系.方法 选取我院70例ACI患者作为研究组,70例健康体检者作为对照组,检测研究组阿替普酶静脉溶栓治疗前、治疗后3 d、7 d血清miR-493水平,并与对照组比较,比较研究组不同神经功能缺损程度患者治疗前血清血管生长因子、炎性因子及miR-493水平,分析血清miR-493与神经功能缺损程度、血清血管生长因子、炎性因子的相关性及与预测预后的价值.结果 研究组治疗前、治疗后3 d、7 d血清miR-493水平均低于对照组(P<0.05);治疗前血清miR-493水平与ACI患者神经功能缺损程度、血清血管内皮生长因子(VEGF)、血管生成素-2(Ang-2)、C反应蛋白(CRP)、白介素-6(IL-6)水平均呈负相关(P<0.05);研究组预后良好患者治疗前、治疗后3 d、7 d血清miR-493水平均高于预后不良患者(P<0.05);治疗前、治疗后3 d、7 d血清miR-493预测ACI患者溶栓治疗预后为不良的曲线下面积(AUC)分别为0.748、0.851、0.879,其中治疗后7 d血清miR-493预测的AUC最大,预测敏感度、特异度分别为73.68％、88.24％.结论 脑梗死急性期患者血清miR-493表达水平明显降低,且与患者溶栓后预后有关,在辅助临床预测患者预后方面具有一定价值.

目的:探讨B超引导下头皮神经阻滞对颅内动脉瘤夹闭术患者术中血流动力学的影响.方法:选择本院2015年3月～2019年11月行颅内动脉瘤夹闭术的76例患者作为研究对象,按照随机数字表法分为观察组与对照组,每组38例.对照组与观察组均接受全身麻醉并且麻醉诱导与麻醉维持方案一致,观察组则在常规全身麻醉的基础上接受头皮神经阻滞.收集患者入院时的一般临床资料及各时间点的平均动脉压(MAP)和心率(HR),并抽取两组患者T0～T4各时间点的动脉血,测定血糖、皮质醇的含量;比较两组患者术中麻醉药物的用量,以及不良反应的发生情况.结果:与对照组相比,观察组患者术中瑞芬太尼用量减少(P<0.05);与T0相比,两组患者在T1～T4时间点MAP与HR均降低(P<0.05),但观察组患者波动幅度小于对照组(P<0.05);与T0相比,两组患者在T1～T4时间点血糖与皮质醇水平均增加(P<0.05);观察组患者在T1～T4时间点血糖与皮质醇水平均优于对照组(P<0.05);与对照组相比,观察组患者需补救镇痛以及恶心呕吐发生率均降低,镇痛持续时间增加(P<0.05).结论:对颅内动脉瘤夹闭术患者实施B超引导下头皮神经阻滞,不仅能够有效地维持术中血流动力学的稳定,还能减少术中的应激反应,减少术后并发症,增加术后镇痛时间,值得临床推广应用.

Objective:This study aimed to explore the efficacy and safety of bridging therapy and direct thrombectomy in the treatment of acute posterior circulation ischemic stroke and analyze the prognostic factors.Methods:This observational study involved 67 patients with acute posterior circulation ischemic stroke in Nanyang City Central Hospital from January 2018 to December 2019. The patients, who comprised 52 males and 15 females aged 51-74 years old, were received the treatment of direct thrombectomy or bridging therapy. The patients were divided into two groups according to different treatment methods. Thirty-four patients who received direct mechanical thrombectomy were included in the direct thrombectomy group, and 33 patients who received intravenous alteplase thrombolysis combined with mechanical thrombectomy and bridging were included in the bridging treatment group. Digital subtraction angiography was used to evaluate the vascular recanalization rate immediately after the operation, and the incidence of intracranial hemorrhage was evaluated by CT 48 hours after the operation. The modified Rankin scale (mRS) was used to evaluate the neurological recovery of the patients before and on the 90th day after the operation. The mortality rate within 90 days after operation was determined. The effectiveness and safety of the two treatment options were evaluated by comparing the clinical baseline data of the two groups of patients and the above-mentioned observation indicators. Multivariate logistic regression analysis was performed to screen independent risk factors for mortality within 90 days after surgery.Results:The data from the two groups of patients were compared with clinical baseline data, such as age, gender distribution, preoperative National Institutes of Health stroke scale (NIHSS) score, etiology classification, onset time, and vascular occlusion location. The difference was not statistically significant (all P values>0.05). The proportion of patients with atrial fibrillation in the bridging treatment group and direct thrombus removal combination was 9.1%(3/33) and 32.4%(11/34), respectively, and the difference was statistically significant (χ 2=5.195, P<0.05). The proportion of patients in the bridging treatment group with good neurological function recovery (mRS class 0-2) 90 days after surgery was higher than that in the direct thrombus removal group (51.5%[17/33] and 29.4%[10/34], respectively), but no significant difference was observed between the groups (χ 2=3.401, P>0.05). The postoperative vascular recanalization rate (75.8% vs. 58.8%) and mortality within 90 days after the operation were determined (27.3%[25/33] vs. 29.4%[10/34]), and no significant difference was noted between the two groups ( P>0.05). One patient (3.03%) in the bridging treatment group had intracranial hemorrhage 48 hours after surgery, whereas no intracranial hemorrhage was observed in the direct thrombus removal group. The difference between the two groups was not statistically significant (χ 2=1.046, P>0.05). Multivariate logistic regression analysis suggested that the NIHSS score at admission was an independent risk factor for mortality within 90 days after surgery. Conclusions:Direct thrombectomy and bridging therapy have similar clinical efficacy and safety for acute posterior circulation ischemic stroke. The degree of neurological deficit at the onset has a certain correlation with the clinical prognosis.

Objective:To explore the predictive value of posterior circulation acute stroke prognosis early CT score on CT angiography(CTA) posterior circulation acute stroke prognosis early CT(pc-ASPECTs) in the outcome of endovascular treatment for acute vertebrobasilar occlusion (AVBO).Methods:Thirty-five patients with AVBO diagnosed by preoperative CTA images from January 2018 to January 2020 in Nanyang Central Hospital were retrospectively analyzed. There were 25 males and 10 females, aged 34-84(62.40±13.46) years. All patients received endovascular treatment. Vascular recanalization was assessed using the blood flow grade after modified thrombolysis in cerebral infarction (mTICI) treatment; the modified Rankin Scale (mRS) score at 3 months after treatment was used to assess the clinical prognosis at 3 months after surgery. According to the prognosis of patients, they were divided into good and poor prognosis groups, and univariate analysis was conducted. Receiver operating characteristic (ROC) curve analysis was performed for the CTA pc-ASPECT score of the good prognosis group to determine the area under the curve and the optimal cut-off point. Multivariate logistic regression analysis was performed to identify independent predictors of the 3-month clinical outcome.Results:Among the 35 patients, 34 patients (97.1%) had successful recanalization, 22 patients (62.9%) had a good clinical prognosis, and 6 patients had intraoperative complications of distal embolization of the target vessel. The National Institute of Health stroke scale and CTA pc-ASPECT scores between the good and poor prognosis groups in univariate analysis (all P values<0.1), and were included into multivariate analysis. ROC analysis of the CTA pc-ASPECT score of the good prognosis group revealed an area under the curve of 0.930 (95% confidence interval [ CI]=0.850-1.000) and optimal cut-off value of 7.5 points (sensitivity=72.7% and specificity=100%). Multivariate logistic regression analysis showed that the CTA pc-ASPECT score ≥8 was an independent predictor of a good 3-month outcome after endovascular treatment of AVBO (odds ratio=23.850, 95% CI=2.005-283.704, P<0.05). Conclusions:The CTA pc-ASPECT score can independently predict the short-term clinical prognosis of patients with AVBO treated with endovascular treatment.

目的 观察醒脑开窍针刺联合高压氧对急性脑梗死(ACI)介入溶栓术后神经功能恢复及氧化应激水平的影响.方法 将102例接受介入溶栓术的ACI患者随机分为研究组、对照A组、对照B组,每组34例.3组均接受介入溶栓术,于此基础上对照A组予以醒脑开窍针刺,对照B组予以高压氧,研究组采取醒脑开窍针刺联合高压氧,3组均治疗2周.比较3组临床疗效、不良反应发生率及治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力(ADL)量表评分、血液流变学指标(全血低切黏度、全血高切黏度、红细胞聚集指数、红细胞压积)、炎症因子指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、总抗氧化能力(TAC)]水平.结果 研究组总有效率为94.1％,高于对照A组和对照B组的73.5％、70.6％(P<0.05).3组治疗后NIHSS评分较治疗前降低,且研究组低于对照A组、对照B组;ADL量表评分较治疗前增高,且研究组高于对照A组、对照B组;全血低切黏度、全血高切黏度、红细胞聚集指数、红细胞压积与血清TNF-α、IL-1β、MDA水平较治疗前降低,且研究组低于对照A组、对照B组;血清SOD、TAC水平较治疗前增高,且研究组高于对照A组、对照B组,差异有统计学意义(P<0.05).3组不良反应发生率比较,差异无统计学意义(P>0.05).结论 ACI介入溶栓术后应用醒脑开窍针刺联合高压氧可改善血液流变学情况,减轻机体炎症与氧化应激反应,促进神经功能恢复,提升日常生活能力,疗效显著.