Search

针对脑血管病的危险因素积极进行早期干预管理是减少脑血管病危害最有效的方法。本章节介绍脑血管病高危人群管理的推荐意见，包括对不可干预和可干预血管危险因素的控制，阿司匹林在缺血性卒中一级预防中的应用以及首次卒中风险评估等方面。 Abstract: Early intervention to manage the risk factors of cerebrovascular disease is the most effective way to reduce the harm of cerebrovascular diseases. This chapter presents recommendations for the management of populations at high risk for cerebrovascular disease, including control of non-interventionable and interventionable vascular risk factors, the use of aspirin in the primary prevention of ischaemic stroke, and the risk assessment of first-time stroke.

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

目的 探索血清丙氨酸转氨酶（alanine aminotransferase，ALT）水平与急性缺血性脑血管病不良临床结局的关系。 方法 以中国国家卒中登记研究Ⅱ中丙氨酸转氨酶（alanine aminotransferase，ALT）水平

我国正面临着全球最大的卒中挑战。全球疾病负担（global b urden o f d isease，GBD）研究结果显示，2019年我国新发卒中394万例，卒中患者达到2876万例，卒中死亡人数为219万例。此外，卒中也是我国伤残调整生命年（disability-adjusted life years，DALYs）的首位原因，2019年卒中所致DALYs达到4590万。近期的几项大型流行病学调查对与卒中有关的既往疾病数据进行了更新。2018年我国18～69岁成人的超重和肥胖率分别为34.4%和16.8%；18岁及以上无高血压病史的成人中50.9%处于高血压前期，成人高血压的加权患病率为27.5%。根据美国糖尿病学会诊断标准，2017年我国18岁及以上成人中，总糖尿病和糖尿病前期的加权患病率分别为12.8%和35.2%；45岁以上成人的心房颤动加权患病率为1.8%，患者人数相当于790万人。医院质量监测系统（hospital quality monitoring system，HQMS）中1672家三级公立医院的数据显示，2019年收治卒中病例3 411 168例，其中缺血性卒中（ischemic stroke，IS）2 818 875例（82.6%），脑出血（intracebral hemorrhage，ICH）485 474例（14.2%），蛛网膜下腔出血（subarachnoid hemorrhage，SAH）106 819例（3.1%）。中位年龄为66岁，59.6%为男性。在I S、I CH和SAH中儿童卒中（年龄

目的 调查蛛网膜下腔出血（subarachnoid hemorrhage，SAH）患者继发症状性癫痫的发生率、相关危险因素及其与院内结局的关系。 方法 本研究数据来源于中国卒中联盟（China Stoke Center Alliance，CSCA）登记数据库2015年8月1日-2019年7月31日入组的SAH患者。症状性癫痫限定为住院期间发作。依据是否出现继发症状性癫痫，将研究对象分为SAH继发癫痫组和无继发癫痫组，比较组间的人口学特征、入院GCS评分、血管危险因素、手术以及医院级别和地区的差异。采用多因素Logistic回归，分析SAH继发癫痫的危险因素，以及SAH继发癫痫与院内死亡、缺血性卒中、脑出血及肺炎的相关性。 结果 本研究纳入11 210例SAH患者，女性6623例（59.1%），平均年龄60.0±12.9岁，入院GCS评分的中位数为15分。总计228例（2.0%）继发症状性癫痫。年龄（OR 0.92，95%CI 0.87～0.97）、既往卒中/TIA（OR 1.61，95%CI 1.20～2.17）、颈动脉狭窄（OR 3.17，95%CI 1.27～10.85）、心房颤动（OR 2.64，95%CI 1.12～6.24）、脂代谢紊乱（OR 1.79，95%CI 1.03～3.13）和脑室外分流术（OR 2.30，95%CI 1.31～4.02）是SAH继发症状性癫痫的独立影响因素。SAH继发症状性癫痫可能与更高的院内死亡（OR 1.71，95%CI 0.96～3.05）、缺血性卒中（OR 4.21，95%CI 2.70～6.56）、脑出血（OR 3.87，95%CI 2.81～5.33）及肺炎（OR 2.96，95%CI 2.26～3.86）事件风险相关。 结论 症状性癫痫是SAH患者较为常见的神经系统并发症，低龄、既往卒中/TIA、颈动脉狭窄、心房颤动、脂代谢紊乱以及脑室外分流术是SAH继发症状性癫痫的独立危险因素。SAH继发症状性癫痫增加院内死亡、缺血性卒中、脑出血以及肺炎的风险。 【Abstract】 Objective To investigate the incidence and risk factors of symptomatic seizures after subarachnoid hemorrhage (SAH), and the relationship between secondary seizures and in-hospital outcomes. Methods The in-hospital SAH patients from the China Stoke Center Alliance (CSCA) registry database from August 1, 2015, to July 31, 2019 were enrolled in the retrospective analysis. According to the presence of symptomatic seizures or not after SAH during hospitalization, all the subjects were divided into SAH with seizure group and SAH without seizure group. Differences in demographics, score of Glasgow comma scale (GCS) at admission, vascular risk factors, surgery, and the class and region of hospitals were compared. A multivariate logistic regression model was used to identify risk factors of seizures after SAH and evaluate the association of in-hospital death, ischemic stroke, intracerebral hemorrhage (ICH) and pneumonia with symptomatic seizures after SAH. Results A total of 11 210 SAH patients were enrolled in this study, with the average age of 60.0±12.9 years and 6623 (59.1%) females, and the median GCS score was 15 points. A total of 228 (2.0%) cases had symptomatic seizures after SAH. Age (OR 0.92, 95%CI 0.87-0.97), prior stroke/TIA (OR 1.61, 95%CI 1.20-2.17), carotid stenosis (OR 3.17, 95%CI 1.27-10.85), atrial fibrillation (OR 2.64, 95%CI 1.12-6.24), dyslipidemia (OR 1.79, 95%CI 1.03-3.13), and external ventricular drainage (OR 2.30, 95%CI 1.31-4.02) were independent risk factors for symptomatic seizures after SAH. Symptomatic seizures after SAH may be associated with a higher risk of in-hospital death (OR1.71, 95%CI 0.96-3.05), ischemic stroke (OR 4.21, 95%CI 2.70-6.56), ICH (OR 3.87, 95%CI 2.81-5.33) and pneumonia (OR 2.96, 95%CI 2.26-3.86). Conclusions Symptomatic seizures is a common neurological complication in SAH patients. Younger age, prior stroke/TIA, carotid stenosis, atrial fibrillation, dyslipidemia and external ventricular drainages were independent risk factors for symptomatic seizures after SAH. Symptomatic seizures after SAH increased the risk of in-hospital death, cerebral infarction, ICH pneumonia.

目的 本文旨在通过对临床预后预测模型在中国伴心房颤动的缺血性脑血管病患者中的预测效度 的评估，寻找能够准确预测预后结局的评分工具，更好地指导临床医疗决策。 方法 从中国国家卒中登记（China National Stroke Registry，CNSR）研究中选取连续入组的缺血性卒 中住院患者为本研究的研究人群。收集患者人口学信息、临床特点及用药信息等基本资料，随访时间 为1年，预后结局包括卒中复发及死亡。用χ 2检验比较缺血性卒中伴或不伴心房颤动患者基线资料，P ＜0.01为差异具有统计学意义。采用C值表示的受试者工作特征曲线下面积（area under the curve，AUC） 来评价缺血性卒中风险预测评分（ischemic stroke predictive risk score，IScore），住院前合并症、意识 水平、年龄和局灶性神经功能缺损（preadmission comorbidities，level of consciousness，age，and neurologic deficit，PLAN）评分和洛桑卒中量表（acute stroke registry and analysis of Lausanne，ASTRAL）评分对 1年死亡风险的预测效度。按照各个评分的分层标准计算各层人群死亡和卒中复发的事件发生率。 结果 从CNSR数据库中选取12 415例完成1年随访的缺血性卒中患者作为本研究的研究人群。其 中，10 847例（87.37%）患者不伴心房颤动，1568例（12.63%）患者伴心房颤动。总研究人群1年全因死 亡的事件发生率为13.4%，伴心房颤动患者的1年死亡率为34.6%，不伴心房颤动患者的1年死亡率为 10.3%。随着各评分分数的增高，死亡事件发生率逐渐增加。IScore对于伴心房颤动的缺血性卒中患者 预测死亡的C值为0.784，PLAN评分为0.769，ASTRAL评分为0.793。 结论 IScore、PLAN评分和ASTRAL评分可针对1年死亡风险对缺血性卒中患者进行初步分层。各评分 工具对于中国缺血性卒中伴心房颤动的患者1年死亡风险有较高的预测能力。 Abstract: Objective To compare the predictive value of three scores tool for 1-year death risk in Chinese ischemic stroke patients with atrial fibrillation (AF), to find an optimal scale so as to provide guidance for making clinical decisions. Methods Patients with acute ischemic stroke (AIS) selected from China National Stroke Registry (CNSR) were divided into AF group and non-AF group. Demographic information, clinical characteristics and drug information were collected. The primary outcome was 1-year stroke recurrence and death. Using chi-square test to compare the baseline data of two groups. The predictive value of ischemic stroke predictive risk score (IScore), preadmission comorbidities, level of consciousness, age, and neurologic deficit (PLAN) score and acute stroke registry and analysis of Lausanne (ASTRAL) score for 1-year death risk of two groups were compared using C statistic (expressed by area under the curve). Results A total of 12 415 AIS patients who completed 1-year follow-up from CNSR were included in this study. Of all 12 415 patients, 10 847 (87.37%) were non-AF patients and 1568 (12.63%) were AF patients. The total 1-year all-cause mortality of all subjects was 13.4%, while the 1-year mortality of AF group and non-AF group were 34.6% and 10.3%, respectively. The risk of death increased with elevation of the scores. The C statistic of IScore, PLAN and ASTRAL scores predicting 1-year death risk for AIS patients with AF were 0.784, 0.769 and 0.793, respectively. Conclusions IScore, PLAN and ASTRAL scores could preliminarily stratify the risk of 1-year death for AIS patients with AF, and all three scores tool had a high predictive value of 1-year risk of death for such patients.

目的 探讨颅内外动脉粥样硬化的相关因素是否存在差异。 方法 在中国颅内动脉粥样硬化研究的数据库中，将患者分为4组：无显著颅内外动脉狭窄或闭塞组、 单纯颅内动脉病变组、单纯颅外动脉病变组及颅内合并颅外动脉病变组。以无显著颅内外动脉狭窄 或闭塞组作为参考，应用多元Logistic回归分析，评估颅内外动脉病变的相关因素。 结果 共入组2864例缺血性脑血管病患者，其中无显著颅内外动脉狭窄或闭塞组1388例（48.5%）、 单纯颅内动脉病变组1074例（37.5%）、单纯颅外动脉病变组141例（4.9%）、颅内合并颅外动脉 病变组261例（9.1%）。多因素分析显示，单纯颅内动脉病变的独立相关因素包括：白质病变[比值比 （odds ratio，OR）1.359，95%（confidence interval，CI）1.109～1.666，P =0.0031] 、白细胞计数（OR 1.045， 95%CI 1.007～1.084，P =0.0210）、空腹血糖（OR 1.054，95%CI 1.009～1.101，P =0.0182）、高密度脂 蛋白（OR 0.644，95%CI 0.480～0.864，P =0.0034）；单纯颅外动脉病变的独立相关因素包括：高龄 （OR 1.047，95%CI 1.026～1.069，P

目的 分析大脑中动脉（middle cerebral artery，MCA）分布区非心源性缺血性卒中患者的临床和影像 学特征及复发的危险因素。 方法 连续入选发病7 d以内的MCA分布区非心源性缺血性卒中患者。收集患者的人口学信息、血管 病的危险因素和发病时的主要症状及体征，评价患者的头颅磁共振影像包括急性梗死灶的部位、 数量、分布特征、责任动脉有无狭窄、缺血性卒中的病因分型。随访患者1年内有无缺血性卒中或短暂 性脑缺血发作（transient ischemic attack，TIA）复发，通过多元Logistic回归分析患者复发的危险因素。 结果 研究共入组926例患者，责任MCA狭窄≥70%的患者（447例）常见多发梗死灶（338例，75.6%） 和分水岭梗死（317例，70.9%），而责任MCA无狭窄或狭窄程度

目的 分析非心源性缺血性卒中患者1年复发的危险因素。 方法 连续入选1978例发病7 d内的非心源性缺血性卒中患者。收集患者的人口学信息、血管病危险 因素和发病时的主要症状及体征，评价患者的头颅磁共振成像结果，包括梗死灶的部位、数量、急 性梗死灶的分布特征及责任动脉、责任动脉有无严重狭窄、缺血性卒中的病因分型。随访患者1年内 有无缺血性卒中或短暂性脑缺血发作（transient ischemic attack，TIA）的复发，通过多元Cox回归分析缺 血性卒中患者复发的危险因素。 结果 95例(4.8%)患者1年内缺血性卒中或TIA复发。冠状动脉粥样硬化性心脏病病史、缺血性卒中病 史、缺血性卒中发病前3个月内反复TIA、责任脑动脉狭窄程度≥70%和后循环缺血性卒中是1年内复发 的危险因素。 结论 后循环梗死、有责任脑动脉严重狭窄及缺血性心脑血管病病史的非心源性缺血性卒中患者复 发的风险较高。 Abstract: Objective To investigate the risk factors of noncardiogenic ischemic stroke (IS) recurrence at 1 year after onset of IS. Methods A total of 1978 noncardiogenic IS patients with onset of symptoms