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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 评价丁苯酞氯化钠注射液在真实世界中治疗缺血性卒中的安全性和有效性。 方法 多中心、前瞻性、开放标签Ⅳ期临床试验。研究共纳入2771例发病72 h以内的急性缺血性卒中患者，给予丁苯酞氯化钠注射液静脉滴注，每日2次，每次25 mg（100 mL），疗程14 d。主要安全性终点为（90±7）d的全因死亡，主要有效性终点为（90±7）d的mRS评分，次要有效性终点为（7±2）d、 （14±2）d的NIHSS评分。 结果 本研究共纳入2012年3月-2014年12月全国74家中心的2771例患者（全分析集），其中男性1890例（68.21%），女性881例（31.79%）。2672例受试者（符合方案集）完成90 d随访，脱落率3.39%，剔除率0.18%。全分析集（2771例）中，安全性终点分析：90 d全因死亡率为1.08%，研究者判定与研究药物有关及无法判定的不良事件发生率为3.28%。有效性终点分析：治疗前、治疗第90天的mRS评分0～1分的比例分别为23.29%和63.80%，治疗前后差值均数为（1.36±1.32）分，前后差值具有统计学意义，P

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 评估中国急性缺血性卒中和短暂性脑缺血发作（transient i schemic a ttack，TIA）患者二级预防 药物依从性的现状。 方法 中国国家卒中登记研究Ⅱ（China National Stroke Registry，CNSRⅡ）2012年6月-2013年1月连续 入组急性缺血性卒中和TIA的住院患者25 018例，收集患者人口学信息、临床特点及用药信息等资料， 统计患者发病后3个月、6个月及12个月的药物依从性。按照随访12个月时患者二级预防药物依从性分 为依从组和非依从组，比较两组患者的各因素特点，并对影响因素进行多因素分析。 结果 16 489例急性缺血性卒中和TIA患者完成12个月的随访。缺血性卒中二级预防药物总体依从性 3个月、6个月、12个月分别为47.0%、44.5%和34.9%。出院12个月时二级预防药物依从性最好的为降 糖药（63.86%），之后分别为降压药（61.9%）、抗血小板药（57.58%）、华法林（44.92%）和他汀类药 物（24.36%）。二级预防药物依从性多因素分析结果显示：高龄、女性、既往糖尿病史、本次发病为 TIA是卒中二级预防药物依从性偏低的影响因素，而既往有卒中病史的患者药物依从性相对较好。 结论 中国急性缺血性卒中和TIA患者二级预防药物总体依从性仍偏低，且随时间的延长逐渐下降。 Abstract: Objective To investigate the status of medication compliance in secondary prevention for ischemic stroke (IS) or transient ischemic attack (TIA). Methods From June 2012 to January 2013, 25 018 patients with acute ischemic stroke (AIS) or TIA were admitted in the China National Stroke Registry II (CNSR II). The data of patients’ demographics, clinical features and medications use in secondary prevention at 3, 6 and 12 months were collected. Medication persistence at 3, 6 and 12 months was defined as continuation of prescribed medications from discharge to every follow-up point. According to the drug compliance at 12 months, these patients were divided into compliance and noncompliance groups. The factor feature of both groups were compared, and multifactor analysis was conducted to identify the influence factors of drug compliance. Results 16 489 patients who completed 1-year follow-up were analyzed. The rate of secondary prevention medications compliance at 3, 6 and 12 months were 47.0%, 44.5% and 34.9%, respectively. Drugs compliance at 12 months after discharge as follows: the best compliance was diabetes drugs (63.86%), followed by antihypertensive drugs (61.9%), antiplatelet drugs (57.58%), warfarin (44.92%), and statins (24.36%). Multi-factor analysis showed that elder age, female, history of diabetes mellitus, and TIA of cerebrovascular events were influence factors of poor compliance to secondary prevention drugs treatment, while patients with history of stroke had better compliance to secondary prevention drugs. Conclusion The compliance of secondary prevention medications within 12 months in patients with IS and TIA were relatively low, and declined gradually over time.

目的 探索急性缺血性卒中患者接受阿替普酶静脉溶栓后24 h内给予抗栓治疗的安全性和有效性。 方法 利用计算机检索PubMed、Cochrane Library、EMbase和Web of Science数据库，查找关于阿替普酶 静脉溶栓后早期抗栓（24 h内）与标准抗栓（24 h后）治疗急性缺血性卒中疗效对比的随机对照试验、 匹配对照和非随机对照研究，检索时限均为从建库至2017年10月。由2位评价者按照纳入与排除标 准独立筛选文献、提取资料后，采用Stata 14.0软件进行荟萃分析，从而比较溶栓后早期抗栓与标准 抗栓治疗发生症状性脑出血、90 d死亡和良好预后差异。 结果 最终纳入11项研究（包括4项随机对照试验、2项匹配对照和5项非随机对照研究），共计2082 例患者，早期抗栓组有1219例（58.5%），标准抗栓组有863例（41.5%）。荟萃分析结果显示：与标 准抗栓组相比，接受早期抗栓的患者90 d良好预后的比例更高[比值比（odds ratio，OR）1.41，95%可 信区间（confidence interval，CI）1.15～1.73，P =0.001）]，而两组患者的症状性脑出血发生率（OR 1.08， 95%CI 0.63～1.86，P =0.78）和90 d死亡率（OR 1.13，95%CI 0.81～1.57，P =0.48）无显著性差异。 结论 与标准抗栓相比，急性缺血性卒中患者在接受阿替普酶静脉溶栓后24 h内给予早期抗栓治 疗的90 d功能预后更好，并且不会增加症状性脑出血和死亡风险。 Abstract: Objective To explore the safety and efficacy of antithrombotic therapy in patients with acute ischemic stroke (AIS) in 24 hours after receiving intravenous alteplase thrombolytic therapy. Methods Literature search was carried out in PubMed, Cochrane Library (as of the 10th issue of 2017), EM base and Web of Science data base up to October 2017, for cohort studies on curative effect observation of comparing early antithrombotic therapy (within 24 h) with standard antithrombotic therapy (after 24 h) after altipase thrombolysis in AIS patients in randomized controlled trials, matched controlled trials and non-randomized controlled trials. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed by using Stata 14.0, to compare the 90-day favorable outcome and mortality, and symptomatic intracranial hemorrhage (sICH) between the two groups. Results A total of 11 cohort studies (including 4 randomized controlled trials, 2 matched controlled trials and 5 non-randomized controlled trials) were finally included involving 2082 cases. The early antithrombotic group had 1219 cases (58.5%) and standard antithrombotic group had 863 cases (41.5%). The results of meta-analysis showed that the proportion of 90-day favorite outcome in early antithrombotic group was higher than in standard antithrombotic group [odds ratio (OR) 1.41, 95% confidence interval (CI) 1.15-1.73, P =0.001)]. However, there were no significant difference in sICH (OR 1.08, 95%CI 0.63-1.86, P =0.78) and 90-day mortality between both groups (OR 1.13, 95%CI 0.81-1.57, P =0.48). Conclusion Patients in early antithrombotic group(within 24 hours) after receiving intravenous alteplase thrombolytic therapy had a higher proportion of 90-day favorable outcome than in standard antithrombotic group (after 24 hours), and the risk of sICH and 90-day mortality had no difference between the both groups.

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 探讨院前合并症、意识水平、年龄、神经功能缺损（preadmission c omorbidities，l evel o f consciousness，age，and focal neurologic deficit，PLAN）评分对中国缺血性卒中相关性肺炎发生风险的 预测能力。 方法 从中国国家卒中登记研究（China National Stroke Registry，CNSR）中筛选符合入组条件的缺血 性卒中患者，采集临床信息并应用PLAN评分法对其评分，分析PLAN评分对缺血性卒中相关性肺炎的 预测能力。应用受试者工作特征曲线（receiver operating characteristic curve，ROC）及曲线下面积（area under curve，AUC）评价PLAN评分的辨别能力，应用Hosmer-Lemeshow法评价其校准能力。 结果 共纳入8909例缺血性卒中患者，平均年龄（65.4±12.3）岁，女性3410例（38.3%），合并肺炎 患者共1069例（12.0%）。随着PLAN评分增高，卒中相关性肺炎的发生风险也逐渐增高。PLAN评分预 测缺血性卒中相关性肺炎的ROC曲线下面积为0.78[95%可信区间（confidence interval，CI）0.77～0.80]， Hosmer-Lemeshow检验显示预测卒中后肺炎的显著性水平为0.001（P =0.001）。在男性中，ROC曲线下面 积为0.79（95%CI 0.77～0.81），在女性中，ROC曲线下面积为0.77（95%CI 0.75～0.80）；在70岁以下缺 血性卒中患者中，ROC曲线下面积为0.77（95%CI 0.75～0.80），在70岁及以上患者中，ROC曲线下面积为 0.73（95%CI 0.71～0.75）。 结论 PLAN评分法在中国缺血性卒中患者中能够较好地预测卒中相关性肺炎发生风险。 Abstract: Objective To explore the value of the preadmission comorbidities, level of consciousness, age, and focal neurologic deficit (PLAN) score in predicting the risk of stroke-associated pneumonia after ischemic stroke in China. Methods Patients who were eligible for inclusion criteria from China National Stroke Registry (CNSR) were screened. Their clinical data were collected and assessed by PLAN score. The predictive ability of the PLAN score on ischemic stroke-related pneumonia was analyzed. The receiver operating characteristic curve (ROC) and the area under curve (AUC) were applied to evaluate the identification capacity of PLAN. The calibration of the score was analyzed by using Hosmer-Lemeshow goodness-of-fit test. Results A total of 8909 patients (mean age, 65.4±12.3 years; female: 3410, 38.3%) from CNSR were included into the study. The proportion of patients with post-stroke pneumonia was 12% (1069/8909). The risk of post-stroke pneumonia increased with the increasing of PLAN score. The area under the ROC curve was 0.78 [95% confidence interval (CI) 0.79-0.83], and the P value of Hosmer-Lemeshow χ 2 test was 0.001. The area under the ROC curve was 0.79 (95%CI 0.77-0.81) in male, 0.77 (95%CI 0.75-0.80) in female, 0.77 (95%CI 0.75-0.80)in patients under 70 years old, and 0.73 (95%CI 0.71-0.75) in patients older than 70 years, respectively. Conclusion The PLAN score is a reliable tool to predict the risk of post-stroke pneumonia in Chinese ischemic stroke patients.

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