目的 探讨入院时血清淀粉样蛋白A（SAA）、载脂蛋白A1（ApoA1）、C反应蛋白（CRP）水平联合检测对老年急性脑梗死（ACI）患者规范治疗后3个月内发生预后不良的早期预测效能。方法 前瞻性选取2023年1月～2025年1月于焦作市第五人民医院就诊的108例老年ACI患者作为ACI组，另选取同期健康志愿者108例作为对照组。比较两组血清SAA、ApoA1、CRP水平。老年ACI患者予以规范治疗，根据治疗后3个月内预后情况将其分为预后不良（46例）和预后良好（62例）亚组，比较不同预后ACI患者患者临床资料及入院时血清SAA、ApoA1、CRP水平；Logistic回归分析入院时血清SAA、ApoA1、CRP水平是否为老年ACI患者规范治疗后3个月内发生预后不良的独立影响因素；ROC曲线分析入院时血清SAA、ApoA1、CRP水平联合检测对ACI患者预后不良的预测效能。结果 ACI组入院时血清SAA、CRP水平高于对照组，血清ApoA1水平低于对照组（P＜0.05）；预后不良亚组高血压占比、入院NIHSS评分、梗死体积、入院时血清SAA、CRP水平高于预后良好亚组，血清ApoA1水平低于预后良好亚组（P＜0.05）；剔除存在多重共线性指标高血压、入院NIHSS评分、梗死体积后，入院时血清SAA、ApoA1、CRP水平仍是老年ACI患者规范治疗后3个月内发生预后不良的独立影响因素（P＜0.05）；入院时血清SAA、ApoA1、CRP水平联合预测ACI患者预后不良的AUC值为0.873，显高于各指标单独预测值0.738、0.768、0.749（P＜0.05）。结论 入院时血清SAA、ApoA1、CRP水平是老年ACI患者预后不良的独立影响因素，联合检测对预后不良具有较高的预测效能，可将其作为ACI患者血清敏感指标，协助临床医师早期制定针对性干预措施，减少ACI患者预后不良的发生。
目的 探讨养血清脑颗粒联合银杏叶提取物注射液对脑梗死（CI）恢复期患者神经功能及认知功能的影响。方法 选取我院2024年7月-2025年11月收治的CI恢复期患者120例，按随机数字表法分2组，各组均60例；对照组予银杏叶提取物注射液治疗，治疗组基于对照组予养血清脑颗粒治疗，治疗周期均2周；对比2组疗效、神经功能、脑动脉血流速度、炎症指标、血液流变学指标、认知功能及不良反应。结果 治疗组总治疗有效率（95.00%）较对照组（81.67%）高，治疗后美国国立卫生研究院卒中量表（NIHSS）评分较对照组低（P＜0.05）；治疗组治疗后脑动脉平均血流速度（Vm）较对照组高，搏动指数（PI）、阻力指数（RI）、C反应蛋白（CRP）、同型半胱氨酸（Hcy）水平、血浆黏度、纤维蛋白原（FIB）水平、血小板最大聚集率水平较对照组低（P＜0.05）；治疗组治疗后简明精神状态检查量表（MMSE）评分较对照组高（P＜0.05）；组间不良反应相比无统计学差异（P＞0.05）。结论 养血清脑颗粒联合银杏叶提取物注射液治疗CI恢复期患者效果较好，可减轻神经功能缺损，提高脑动脉血流速度，降低炎症反应，调节血液流变学，改善认知功能。
目的 探讨经颅多普勒超声（TCD）参数联合屏气指数在颈内动脉（ICA）狭窄或闭塞所致急性脑梗死的评估价值。方法 选择2022年1月—2024年12月，在广州市花都区人民医院连续入组发病72 h内ICA狭窄或闭塞所致的急性脑梗死患者。记录患者人口统计学资料、临床资料及TCD相关参数，包括搏动指数（PI）、阻力指数（ RI）、大脑中动脉平均血流速度（Vm）及屏气指数等。依据患者数字减影血管造影（DSA）结果分为侧支循环良好组及侧支循环不良组。比较两组人口统计学、临床资料及TCD相关参数，采用单因素分析、多因素Logistic回归分析及ROC曲线。结果 共纳入ICA狭窄或闭塞所致急性脑梗死共136例，其中侧支循环良好组46例，侧支循环不良组90例。单因素分析提示：侧支循环良好组与侧支循环不良组在PI［0.95（0.80，1.03）vs 1.01（0.88，1.13）］、RI［0.58（0.51，0.62）vs 0.60（0.54，0.65）］、Vm［57（44，65）vs 50.5（41，63）］及屏气指数［0.78（0.75，0.85）vs 0.72（0.59，0.79）］方面，差异具有统计学意义（P＜0.05）。多因素Logistic回归分析提示Vm（OR=1.029，95%CI：1.006~1.053，P=0.014）、屏气指数（OR=723.401，95%CI：14.524~3 6031.859，P＜0.001）是侧支循环不良的独立危险因素。屏气指数和Vm评估侧支循环情况的ROC曲线下面积（AUC）分别为0.713（95%CI：0.627~0.799）和0.605（0.505~0.705），两者的AUC值比较差异无统计学意义（P＞0.05）。结论 屏气指数和Vm可以评估ICA狭窄或闭塞所致急性脑梗死的侧支循环，屏气指数和Vm的评估效能相当。
Objective To explore the evaluation value of transcranial Doppler ultrasound（TCD）in acute cerebral infarction caused by internal carotid artery（ICA）stenosis or occlusion．Methods From January 2022 to December 2024，patients with acute cerebral infarction caused by ICA stenosis or occlusion within 72 hours of onset were enrolled in our hospital．Patient’s demographic data，clinical data，and TCD related parameters，including pulsatility index（PI），resistance index（RI），average blood flow velocity（Vm）of the middle cerebral artery，and breath holding index（BHI）were recorded．According to the results of digital silhouette angiography（DSA），patients were divided into good collateral group and poor collateral group．Demographic，clinical data，and TCD related parameters were compared between two groups using univariate analysis，multivariate Logistic regression analysis and ROC curve．Results A total of 136 cases of acute cerebral infarction caused by ICA stenosis or occlusion were included，including 46 cases in the collateral good group and 90 cases in the collateral poor group．Univariate analysis showed that the good collateral group and the poor collateral group were different in PI（0.95［0.80，1.03］vs 1.01［0.88，1.13］），RI（0.58［0.51，0.62］vs 0.60［0.54，0.65］），Vm（57［44，65］vs 50.5［41，63］），BHI（0.78［0.75，0.85］ vs 0.72［0.59，0.79］）（P＜0.05）．Multivariate Logistic regression analysis showed that Vm（OR=1.029，95%CI：1.006-1.053，P=0.014）and BHI（OR=723.401，95%CI：14.524-36 031.859，P＜0.001）were independent risk factors for collateral circulation disorders．The area under the ROC curve（AUC）for predicting collateral circulation using BHI and Vm were 0.713（95%CI：0.627~0.799）and 0.605（0.505~0.705），respectively．There was no statistically significant difference in AUC values between the BHI and Vm．Conclusions The BHI and Vm can predict the collateral circulation of acute cerebral infarction caused by ICA stenosis or occlusion，and their predictive power is comparable．
目的 分析广州某三甲医院脑梗死患者住院费用的变化以及影响因素,为有效减轻患者疾病经济负担提供参考依据。方法 提取广州某三甲医院2015—2022年出院诊断ICD-10前三位编码为I63的病案首页数据,并采用IBM SPSS 20.0软件对费用结构进行描述性统计分析,以多重线性回归分析患者住院费用的影响因素。结果 2015—2022年脑梗死患者的平均住院费用年均增长率为2.86%;费用结构以药品费为主,占比逐年下降,至2022年占比为27.74%,技术劳务性费用占比逐年增加,至2022年占比为47.41%;住院费用主要受医院感染情况、住院天数以及支付方式等因素影响（F=990.10,P<0.001）。结论 脑梗死患者的住院费用结构显著优化,但患者的疾病经济负担仍然较重,且费用受多种因素的综合影响。建议通过提高医疗质量与服务效能,并严格落实临床路径管理,减少不必要的检查以及耗材使用,以期最大程度地减轻患者的负担。
Objective To analyze the structural changes and influencing factors of the hospitalization expenses for patients with cerebral infarction in a tertiary general hospital in Guangzhou,and provide a scientific basis for reducing economic burden of the patients．Methods The front page data of medical records with the main diagnosis of I63 were collected in the sample hospital．Descriptive statistics analysis of hospitalization expenses structure and multiple linear regression analysis of the influencing factors were carried out by SPSS 20.0．Results The annual growth rate of average hospitalization expenses of cerebral infarction patients from 2015 to 2022 in the sample hospital was 2.86% per year．The highest proportion of hospitalization expenses was medicine fee,the proportion of which declined year by year with a minimum 27.74% in 2022．The proportion of technical labor costs accelerated year by year with a maximum 47.41% in 2022．This study revealed the main factors influencing hospitalization expenses were hospital internal infection or not,length of stay,payment method and so on（F=990.10,P<0.001）．Conclusions The structure of hospitalization expenses for cerebral infarction patients was significantly optimized,but the economic burden of patients was still heavy affected by a combination of factors．In order to minimize the burden of patients,hospitals should improve medical quality and service efficiency and implement clinical pathway management strictly,to reduce unnecessary inspections and consumables．
目的 探究老年脑梗死患者抑郁与共病之间的相关性。方法 选择2021年9月—2023年7月于开封市第五人民医院接受治疗的80例老年脑梗死康复期患者,均使用老年抑郁量表（GDS）对其进行评测,按照评测结果将患者区分为无抑郁组（n=39,GDS≤10分）和抑郁组（n=41,GDS>10分）,并按照受试者是否存在共病区分为不同亚组（如并消化系统疾患、并发循环系统疾患等）,对比不同亚组患者占比差异,并采用Pearson相关性分析的方式,分析入组80例老年脑梗死患者GDS评分与其Charlson共病指数（CCI）评分的相关性。结果 80例患者中抑郁占比为51.25%,对比显示共病循环系统、内分泌系统以及运动系统疾病的老年脑梗死患者抑郁发生率明显更高（P<0.05）;Pearson相关性分析显示老年脑梗死患者GDS评分与其CCI评分呈正相关（r=0.180,P<0.001）。结论 老年脑梗死患者抑郁发生率较高,对并发循环系统疾病、内分泌系统疾病、运动系统疾病的老年脑梗死患者应予以更多关注,预防抑郁的发生。
Objective To explore the correlation between depression and comorbidity in elderly patients with cerebral infarction．Methods A total of 80 elderly patients treated from September 2021 to July 2023 were selected．The patients were evaluated using the Geriatric Depression Scale（GDS）,patients were divided into the non-depression group（n=39,GDS≤10 points）and the depression group（n=41,GDS>10 points）,and they were divided into different subgroups（such as concurrent digestive disorders,concurrent circulatory disorders,etc.）．Comparing the differences in patient proportions in different subgroups,and the correlation between the GDS score and its Charlson comorbidity index（CCI）score in 80 elderly patients with cerebral infarction was analyzed with Pearson correlation analysis．Results The proportion of depression in 80 patients was 51.25%,showing a significantly higher incidence of depression in elderly patients with a comorbid circulatory system,endocrine system and motor system disease（P<0.05）;Pearson correlation analysis showed that GDS score in elderly patients with a cerebral infarction was positively correlated with their CCI score（r=0.180,P<0.001）．Conclusions The incidence of depression in elderly patients with cerebral infarction is relatively high,and more attention should be paid to elderly patients with concurrent circulatory system diseases,endocrine system diseases and motor system diseases to prevent the occurrence of depression．
目的 探讨载脂蛋白E（ApoE）基因多态性与卒中后认知障碍的相关性,即大动脉粥样硬化型脑梗塞的严重程度。方法 采用病例——对照研究的方法,收集九江学院附属医院神经内科的100例急性缺血性脑卒中且病因分型为大动脉粥样硬化型患者（脑梗死组）和50例性别、年龄匹配的非缺血性脑卒中患者（对照组）。检测患者的 ApoE 基因型、血脂、美国国立卫生院卒中量表（NIHSS）、卒中后6个月简易智力状态检查量表（MMSE）等,采用多因素方差分析等统计学方法分析他们之间的关联性。结果 ApoE 3/4基因型频率与Ɛ3、Ɛ4等位基因频率,在脑梗死组别中高于对照组（P<0.05）。同时,携带Ɛ3等位基因患者的低密度脂蛋白水平高于携带Ɛ2、Ɛ4等位基因的患者;进一步分析发现含Ɛ3等位基因的脑梗死患者NIHSS评分更高、卒中后认知障碍更严重（P<0.05）。结论 ApoE基因型为Ɛ3/4、等位基因Ɛ3、Ɛ4更易罹患大动脉粥样硬化型脑梗死,提示该基因型是脑梗死的易感基因,脑梗死后认知障碍患者Ɛ3等位基因的频率较高,可能是卒中后认知障碍的易感因素。
Objective To explore the relationship between ApoE gene polymorphisms and post-stroke cognitive impairment,the severity of large artery atherosclerotic cerebral infarction．Methods A case-control research study was conducted,gathering data from 100 individuals diagnosed with large artery atherosclerotic cerebral infarction according to the TOAST classification,who admitted to the Neurology Department of the Affiliated Hospital of Jiujiang University．Additionally,50 non-ischemic stroke patients,matched for gender and age,were included as the control group．The patients were assessed for ApoE genotype,blood lipid,NIHSS,and MMSE scale at 6 months post-stroke,and statistical methods were used to analyze their associations．Results Significant differences were observed in the ApoE 3/4 genotype frequency and Ɛ3、Ɛ4 allele frequency between patients with cerebral infarction and the control group,with a notably higher incidence of cerebral infarction in the former．Furthermore,patients carrying the Ɛ3 allele exhibited significantly higher LDL levels than those carrying Ɛ2 or Ɛ4．The analysis also revealed that patients with the Ɛ4 allele experienced higher NIHSS and severer post-stroke cognitive impairment．Conclusions The findings suggest that the ApoE genotype Ɛ3/4 and allele Ɛ3、Ɛ4 may predispose individuals to develop large atherosclerotic cerebral infarction,indicating a susceptibility gene for cerebral infarction．Additionally,the Ɛ3 allele was associated with a higher frequency of cognitive deficits after cerebral infarction,implying that it may be a predisposing factor for post-stroke cognitive impairment．
目的 分析常规炎性指标与进展性脑梗死（PCI）患者病灶损害程度的关联,及其对预后水平的预测效能。方法 采用回顾性研究,纳入2021年6月—2023年2月平顶山市第二人民医院收治的100例PCI患者,根据入院时神经功能缺损评分（NIHSS）结果,将NIHSS评分≥21分的30例患者列为重度组,将NIHSS评分15~20分的35例患者列为中度组,将NIHSS评分<15分的35例患者列为轻度组,比较三组患者的神经功能血清学指标及炎症指标,经Pearson相关性分析炎症指标与神经功能血清学指标的相关性;根据是否发生不良预后将入组患者分为预后良好组和预后不良组,比较两组患者各炎症指标及改良Rakin量表（mRS）评分间的差异,并通过绘制受试者操作特征（ROC）曲线、曲线下面积（AUC）评估炎症指标对PCI患者预后水平的预测效能。结果 重度组患者的C-反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）分别为（26.44±5.18）mg/L、（95.28±10.46）ng/L、（45.24±10.31）pg/mL,均高于中度组[（23.12±5.46）mg/L、（90.44±10.17）ng/L、（40.25±10.18）pg/mL],轻度组[（20.28±5.33）mg/L、（84.33±10.27）ng/L、（35.62±8.45）pg/mL],差异具有统计学意义（P<0.05）。重度组的神经元特异性烯醇化酶（NSE）、S100钙结合蛋白β（S100β）分别为（25.45±5.69）μg/L、（60.45±10.31）ng/mL,均高于中度组[（22.18±5.36）μg/L、（55.27±10.46）ng/mL],轻度组[（19.44±5.37）μg/L、（50.49±10.25）ng/mL],差异具有统计学意义（P<0.05）。经Pearson相关性分析,PCI患者的CRP、IL-6、TNF-α等常见炎性指标水平与NSE、S100β等神经功能血清学指标水平正相关（P<0.05）。经检测,预后不良组的CRP、IL-6、TNF-α、mRS分别为（26.62±5.31）mg/L、（96.77±10.24）ng/L、（47.25±10.33）pg/mL、（4.24±1.33）分,均高于预后良好组[（23.75±5.44）mg/L、（91.25±10.37）ng/L、（41.12±10.44）pg/mL,（3.36±0.27）分],差异具有统计学意义（P<0.05）。经ROC曲线验证,CRP、IL-6、TNF-α等常见炎性指标水平越高,PCI患者的mRS评分越高（AUC均>0.85）。结论 CRP、IL-6、TNF-α等常见炎性指标会随PCI患者脑神经功能损伤程度加剧而不断升高,与病灶损害程度正相关;通过检测上述炎性指标能实现对患者不良预后的早期预测。
Objective To analyze the correlation between routine inflammatory indicators and the degree of lesion damage in progressive cerebral infarction（PCI） patients,as well as predictive efficacy of indicators on prognosis levels．Methods This is a retrospective study,with case enrollment from June 2021 to February 2023．The study subjects were 100 PCI patients．Based on the NIHSS score at admission,30 patients with a NIHSS score ≥ 21 were classified as the severe group,35 patients with a NIHSS score of 15~20 were classified as the moderate group,and 35 patients with a NIHSS score <15 were classified as the mild group．The neurological function serological and inflammatory indicators of the three groups of patients were compared．The correlation between inflammatory indicators and neurological serological indicators was verified by Pearson correlation coefficient．According to the occurrence of adverse prognosis,enrolled patients were divided into good prognosis group and poor prognosis group．The differences in inflammatory indicators and mRS scores between the two groups were compared,and the predictive power of inflammatory indicators on the prognosis level of PCI patients was evaluated by plotting ROC and observing AUC．Results After testing,the levels of CRP,IL-6 and TNF in the severe group were（26.44±5.18）mg/L,（95.28±10.46）ng/L and（45.24±10.31）pg/mL,respectively,higher than those in the moderate group[（23.12±5.46）mg/L,（90.44±10.17）ng/L and（40.25±10.18）pg/mL]and the mild group[（20.28±5.33）mg/L,（84.33±10.27）ng/L and（35.62±8.45）pg/mL]（P<0.05）．NSE and S100β in the severe group were（25.45±5.69）μg/L and（60.45±10.31）ng/mL,all higher than those in the moderate group[（22.18±5.36）μg/L,（55.27±10.46）ng/mL]and mild group[（19.44±5.37）μg/L,（50.49±10.25）ng/mL]（P<0.05）．According to Pearson correlation coefficient test,CRP,IL-6,TNF-α and mRS in PCI patients positively correlated with NSE,S100β（P<0.05）．After testing,CRP,IL-6,TNF-α and mRS in the group with poor prognosis were（26.62±5.31）mg/L,（96.77±10.24）ng/L,（47.25±10.33）pg/mL and（4.24±1.33）scores,respectively,which were higher than those in the group with good prognosis[（23.75±5.44）mg/L,（91.25±10.37）ng/L,（41.12±10.44）pg/mL and（3.36±0.27）scores]（P<0.05）．Verified by ROC curve,the higher the levels of CRP,IL-6 and TNF- α,the higher the mRS scores of PCI patients（AUC>0.85）．Conclusions Common inflammatory indicators such as CRP,IL-6 and TNF- α of PCI will continue to increase with the severity of brain nerve function damage in patients,and are positively correlated with the degree of lesions damage．By detecting the aforementioned inflammatory indicators,early prediction of poor prognosis can be achieved for patients．
目的 研究CXC趋化因子配体4（CXCL4）、基质金属蛋白酶-9（MMP-9）、微小RNA-24（miR-24）对急性脑梗死（ACI）早期神经功能恶化（END）的预测价值。方法 分别选择2020年1月—2021年6月我院收治的30例ACI早期END患者（ACI+END组）,30例单纯ACI患者（ACI组）,同时期30例健康人群作为对照组,检测受试者CXCL4、MMP-9、miR-24表达情况及存在的相关性,分析血清CXCL4、MMP-9、miR-24表达情况与ACI早期发生END的关系。结果 CXCL4、MMP-9水平在对照组、ACI组、ACI+END组中依次升高,miR-24相对表达量依次降低（P<0.05）。血清CXCL4、MMP-9、miR-24水平在轻度、重度患者中呈升高趋势,miR-24相对表达呈降低趋势（P<0.05）。Logistic回归分析血清CXCL4、MMP-9、miR-24表达异常与ACI早期发生END独立相关（P<0.05）。经Pearson相关性分析发现,CXCL4与MMP-9之间呈正相关（r=0.584,P=0.001）;CXCL4、miR-24之间呈负相关（r=-0.569,P=0.001）,MMP-9、miR-24之间呈负相关（r=-0.567,P=0.001）。ROC曲线显示,与CXCL4、MMP-9、miR-24单项预测相比,三项联合对ACI的关系及对早期END的预测价值较高（P<0.05）。结论 CXCL4、MMP-9、miR-24在ACI发生END时出现异常表达,检测CXCL4、MMP-9、miR-24水平对ACI早期END具有一定预测价值,可尽早制定相关措施干预,提高治疗效率。
Objective To study the predictive value of CXC chemokine ligand 4（CXCL4）,matrix metalloproteinase-9（MMP-9）,microRNA-24（miR-24）in early neurological deterioration（END）of acute cerebral infarction（ACI）．Methods A total of 30 patients with ACI early END（ACI+END group）and 30 patients with ACI only（ACI group）who were admitted to our hospital from January 2020 to June 2021 were selected,and 30 healthy people（control group）who underwent physical examination in our hospital during the same period were selected．Expressions of CXCL4,MMP-9,and miR-24 were detected and their correlations were analyzed,and the relationship between the expressions of serum CXCL4,MMP-9,miR-24 and the early occurrence of END in ACI were analyzed．Results The levels of CXCL4 and MMP-9 were increased in the control group,ACI group and ACI+END group in turn,and the relative expression of miR-24 was decreased in turn,and the differences among the groups were statistically significant（P<0.05）．The levels of serum CXCL4,MMP-9,and miR-24 increased in mild and severe patients,while the relative expression of miR-24 decreased,and the differences between groups were statistically significant（P<0.05）．Logistic regression analysis showed that abnormal expressions of serum CXCL4,MMP-9 and miR-24 were independently correlated with the early occurrence of END in ACI（P<0.05）．After Pearson correlation analysis,it was found that there was a positive correlation between CXCL4 and MMP-9（r=0.584,P=0.001）,a negative correlation between CXCL4 and miR-24（r=-0.569,P=0.001）;a negative correlation between MMP-9 and miR-24（r=-0.567,P=0.001）．The ROC curve showed that compared with the single prediction of CXCL4,MMP-9 and miR-24,the predictive value of the combined prediction on ACI and early END were higher（P<0.05）．Conclusions CXCL4,MMP-9,and miR-24 are abnormally expressed in ACI when END occurs．Detection of CXCL4,MMP-9,and miR-24 levels has certain predictive value for early END of ACI,and relevant measures can be formulated as soon as possible to improve treatment efficiency．
目的 分析后循环脑梗死（PCCI）患者椎基底动脉狭窄和血清生化指标的相关性。方法 对100例PCCI患者的临床资料进行回顾性分析,依照椎基底动脉狭窄程度将患者分为不稳定斑块组（n=35）、稳定斑块组（n=36）和无斑块组（n=29）。对比3组患者临床一般情况,血清神经细胞因子水平,血清炎症因子水平,并分析PCCI患者椎基底动脉狭窄和血清生化指标的相关性。结果 3组患者再次发病情况与NIHSS评分对比差异有统计学意义,不稳定斑块组高于其他2组（P<0.05）,但稳定斑块组与无斑块组比较差异无统计学意义（P>0.05）;3组患者脑源性神经营养因子（BDNF）、神经元特异性烯醇化酶（NSE）、中枢神经特异蛋白（S100β）水平对比差异有统计学意义,不稳定斑块组BDNF低于稳定斑块组与无斑块组,不稳定斑块组NSE、S100β高于稳定斑块组与无斑块组（P<0.05）,但稳定斑块组与无斑块组对比无差异（P>0.05）;3组患者血清C反应蛋白（CRP）、白细胞介素-37（IL-37）、肿瘤坏死因子（TNF-α）、血管细胞黏附分子-1（VCAM-1）、细胞间黏附分子-1（ICAM-1）、人软骨糖蛋白40（YKL-40）水平对比有差异,不稳定斑块组高于其它2组（P<0.05）,但稳定斑块组与无斑块组比较差异无统计学意义（P>0.05）;Pearson直线相关分析显示,椎基底动脉狭窄与BDNF呈负相关,与NSE、S100β、CRP、IL-37、TNF-α、VCAM-1、ICAM-1、YKL-40呈正相关（P<0.05）;多因素 Logistic 回归分析结果显示,BDNF、NSE、ICAM-1、YKL-40是椎基底动脉狭窄的独立危险因素（P<0.05）。结论 PCCI患者椎基底动脉狭窄程度越严重,再次发病率越高,对患者的神经功能影响越严重。同时血清相关神经细胞因子水平和炎症因子水平与椎基底动脉狭窄严重程度具有明显相关性,其中BDNF、NSE、ICAM-1、YKL-40可作为PCCI患者椎基底动脉狭窄预测的重要指标,因此临床上可以通过监测患者的血清相关生化指标为临床诊断及预后判断提供参考依据。
Objective To investigate the correlation between vertebrobasilar artery stenosis and serum biochemical indexes in patients with posterior circulation cerebral infarction（PCCI）．Methods One hundred patients with PCCI admitted to our hospital were selected as the study objects,and the clinical data of all patients were retrospectively analyzed．The patients were divided into unstable plaque group（n=35）,stable plaque group（n=36）and no plaque group（n=29）according to the degree of vertebrobasilar artery stenosis．The general clinical conditions,serum levels of neurocytokines and inflammatory factors of the patients were compared,the correlation between vertebrobasilar artery stenosis and serum biochemical indicators in patients with PCCI was analyzed．Results The recurrence and NIHSS score of the 3 groups were significantly different,the unstable plaque group was significantly higher than the other 2 groups（P<0.05）,but there was no significant difference between the stable plaque group and the no plaque group（P>0.05）．The levels of brain-derived neurotrophic factor（BDNF）,neuron-specific enolase（NSE）and central nerve specific protein（S100β）in the three groups were significantly different．BDNF in unstable plaque group was lower than that in stable plaque group and no plaque group,while NSE and S100β in unstable plaque group were higher than that in stable plaque group and no plaque group（P<0.05）．There was no significant difference between stable plaque group and no plaque group（P>0.05）．The levels of serum C-reactive protein（CRP）,interleukin-37（IL-37）,tumor necrosis factor-α（TNF-α）,vascular cell adhesion molecule-1（VCAM-1）,intercellular adhesion molecule-1（ICAM-1）and human cartilage glycoprotein 40（YKL-40）in 3 groups were significantly different．The unstable plaque group was higher than the other two groups（P<0.05）,but there was no significant difference between the stable plaque group and the no plaque group（P>0.05）．Pearson Line correlation analysis showed that vertebrobasilar artery stenosis was negatively correlated with BDNF,and positively correlated with NSE,S100β,CRP,IL-37,TNF-α,VCAM-1,ICAM-1,YKL-40（P<0.05）．Multivariate Logistic regression analysis showed that BDNF,NSE,ICAM-1 and YKL-40 were independent risk factors for vertebrobasilar artery stenosis（P<0.05）．Conclusions The more severe degree of vertebrobasilar artery stenosis in patients with PCCI,the higher recurrence rate and more serious the impact on the neurological function of patients．At the same time,the levels of serum related neurocytokines and inflammatory factors were significantly related to the severity of vertebrobasilar artery stenosis．BDNF,NSE,ICAM-1 and YKL-40 can be used as important indicators to predict the severity of vertebrobasilar artery stenosis in patients with PCCI．Therefore,monitoring the patient’s serum biochemical indicators of angiography can provide reference for clinical diagnosis and prognosis judgment．
目的 探讨大脑中动脉(MCA)粥样硬化斑块与脑梗死类型的相关性。方法 收集2018年1月—2020年12月的大脑中动脉粥样硬化患者178例,根据患者的临床表现、病史及诊断将患者分为脑梗死组(77例,按梗死部位分为深穿支梗死组、皮质梗死组和分水岭梗死组)和非脑梗死组(101例)。2组患者使用高分辨率核磁共振成像法(HRMRI)检查患者的双侧MCA粥样硬化斑块的特征,包括形态、信号强度及分布位置,从而统计分析粥样斑块特征与脑梗死类型之间的关系。结果 178例患者中77例为脑梗死患者。脑梗死组患者的强化率为55/77(71.4%),无脑梗死组患者的强化率为53/101(52.5%),相比差异有统计学意义(χ2=2.575,P=0.027)。其中脑梗死组中深穿支梗死组强化率为17/23(73.9%,χ2=8.707,P=0.021),皮质梗死组的强化率为13/19(68.4%,χ2=6.244,P=0.017),分水岭梗死组的强化率为25/35(71.4%,χ2=4.963,P=0.028),较非强化相比差异均有统计学意义。结论 大脑中动脉粥样硬化斑块的特征与脑梗死类型关系密切,斑块特征可反映斑块的稳定性,HRMRI对斑块稳定性的判断可预测脑梗死的发生及梗死位置。
Objective To explore the correlation between middle cerebral artery (MCA) atherosclerotic plaque and cerebral infarction patterns. Methods From January 2018 to December 2020, 178 patients with MCA atherosclerosis were divided into cerebral infarction group (77 cases, divided into deep perforating branch infarction group, cortical infarction group and watershed infarction group according to the infarct location) and non-cerebral infarction group (101 cases) according to their clinical manifestations, medical history and diagnosis.Two groups of patients underwent high-resolution magnetic resonance imaging (HRMRI) to examine the characteristics of bilateral MCA atherosclerotic plaques, including morphology, signal intensity and distribution location, to statistically analyze the relationship between the characteristics of atherosclerotic plaque and the patterns of cerebral infarction. Results Of 178 patients, 77 patients with cerebral infarction.The enhancement rate of the cerebral infarction group was 55/77 (71.4%), and that of the non-cerebral infarction group was 53/101 (52.5%), and difference between the two group had statistical significance(χ2=2.575, P=0.027). In the cerebral infarction group, the enhancement rate of the deep perforating branch infarction group was 17/23 (73.9%,χ2=8.707, P=0.021), that of the cortical infarction group was 13/19 (68.4%,χ2=6.244, P=0.017), and that of the watershed infarction group was 25/35 (71.4%,χ2=4.963, P=0.028), and the difference was statistically significant compared with the non-enhanced group. Conclusion The characteristics of MCA atherosclerotic plaque were closely related to the patterns of cerebral infarction,and the characteristics of plaque can reflect the stability of plaque.The judgment of plaque stability by HRMRI may predict the occurrence and paterrn of cerebral infarction.
