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目的 本研究旨在比较支架置入与球囊扩张治疗特发性颅内高压（idiopathic intracranial hypertension， IIH）伴静脉窦狭窄的疗效差异。 方法 对2012年1月-2015年12月在首都医科大学附属北京天坛医院接受介入治疗（支架置入或球囊 扩张）的IIH伴静脉窦狭窄患者的基线特征、手术过程、围手术期管理和临床结局进行了前瞻性连续 性登记。介入治疗方案由神经介入医师和患者协商决定。临床结局改善程度分为3级：症状消失、症 状改善、症状无变化或加重。通过比较支架组和球囊扩张组术后3个月、6个月、12个月症状消失的比 例，探讨两种治疗方法的疗效差异。 结果 本研究共纳入45例患者，其中支架组26例，球囊扩张组19例。两组患者的基线人口学 特征差异无统计学意义。支架组术后颅内静脉窦狭窄两端的压力差显著低于球囊扩张组（中位 数：0 vs 7 mm Hg，P

目的 探讨不同胰岛素抵抗状态对无糖尿病史的非致残性缺血性脑血管病（non-disabling ischemic cerebrovascular events，NICE）患者卒中复发风险的影响。 方法 使用稳态模型胰岛素抵抗（homeostasis model assessment of insulin resistance，HOMA-I R）指数 对胰岛素抵抗进行评估。根据不同胰岛素抵抗状态，使用四分位法将无糖尿病史的NICE患者分为4 组。该研究的主要研究终点为90 d新发卒中（包括缺血性和出血性卒中）。利用多元Cox回归模型校正 潜在协变量，评估不同胰岛素抵抗状态与卒中复发风险之间的关系，同时对不同抗血小板聚集治疗、 不同胰岛素抵抗状态与卒中复发之间的交互作用进行统计分析。 结果 本研究共纳入2325例NICE患者。根据患者不同胰岛素抵抗状态分组，4组界值分别为Q1 （HOMA-IR指数﹤1.35）、Q2（1.35≤HOMA-IR指数﹤2.17）、Q3（2.17≤HOMA-IR指数﹤3.39）及Q4（HOMAIR 指数≥3.39），4组患者人数分别为585例、575例、585例及580例。90 d随访时，共出现167例卒中复 发，其中氯吡格雷联合阿司匹林组为68例，阿司匹林组为99例。与Q1组（6.3%）比较，Q2组（9.2%，校 正HR 1.56，95%CI 1.01～2.41，P =0.04）、Q3组（5.6%，校正HR 1.04，95%CI 0.64～1.69，P =0.89）和 Q4组（7.6%，校正HR 1.35，95%CI 0.85～2.15，P =0.21）患者卒中复发风险均未明显上升。 结论 本研究未在NICE患者中发现胰岛素抵抗与卒中复发风险升高相关。 Abstract: Objective To explore the effect of different insulin resistance state on the prognosis of patients with non-disabling ischemic cerebrovascular events (NICE). Methods The homeostasis model HOMA-IR index was used to evaluate insulin resistance. According to different insulin resistance status, patients were divided into four groups by quartile method. The primary endpoint was 90-day new-onset stroke (including ischemic and hemorrhagic stroke). Multivariate Cox regression model was used to assess the relationship between different insulin resistance status and recurrent stroke. The interaction between different antiplatelet therapeutic regimen and different insulin resistance status on recurrent stroke was also analyzed. Results A total of 2325 NICE patients were enrolled in this study. According to different insulin resistance status, all patients were divided into 4 groups: Q1 (HOMA-IR index

目的 探讨特发性颅内高压（idiopathic intracranial hypertension，IIH）患者入院时炎症指标与近期视力 下降的相关性。 方法 对2011年9月-2018年9月在首都医科大学附属北京天坛医院血管神经病学科诊治的58例 IIH患者临床资料进行回顾性分析。根据患者入院时近1个月内是否出现视力下降，分为近期视力 下降组（13例）和非近期视力下降组（45例）。应用秩和检验比较两组患者的血清超敏C反应蛋白 （hypersensitive C reactive protein，hs-CRP）、红细胞沉降率（erythrocyte sedimentation rate，ESR）、白细 胞绝对值、中性粒细胞绝对值、淋巴细胞绝对值、中性粒细胞/淋巴细胞比值等炎症指标的差异。 结果 近期视力下降组血清hs-CRP及ESR水平显著高于非近期视力下降组[5.50（3.35～8.45）vs 2.60（2.10～2.90）mg/L，P＜0.001；18.0（13.0～24.0）vs 11.0（5.0～14.5）mm/h，P＜0.032]；而血清 白细胞绝对值、中性粒细胞绝对值、淋巴细胞绝对值及中性粒细胞/淋巴细胞比值在两组间差异无 统计学意义。 结论 在IIH患者中，存在近期视力下降的患者血清hs-CRP及ESR水平更高，提示炎症反应可能参与 IIH患者视力障碍病程的急性进展。 Abstract: Objective To investigate the correlation between serum inflammatory factor level and recent visual impairment in patients with idiopathic intracranial hypertension (IIH). Methods Clinical data of 58 patients with IIH who were hospitalized in Department of Neurology, Beijing Tian Tan Hospital from September 2011 to September 2018 were retrospectively analyzed. According to whether patients had visual impairment or not within recent 1 month on admission, they were divided into the recent visual impairment group (n =13) and non-recent visual impairment group (n =45). Kruskal-Wallis test was used to compare the difference of serum hypersensitive C reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), white blood cell counts, neutrophile granulocyte cell counts, lymphocyte cell counts and neutrophile granulocyte / lymphocyte cell ratio and other inflammatory indicators between the two groups. Results Serum hs-CRP and ESR level in the recent visual impairment group were significantly higher than that in non-recent visual impairment group [5.50 (3.35-8.45) vs 2.60 (2.10-2.90) mg/L, P

缺血性脑血管病的梗死模式具有多样性，根据梗死数目可分为无梗死、单发梗死和多发 梗死。单发梗死主要根据病灶的位置和大小进行分类，多发梗死则根据血管的供血范围进行分类。 单发梗死和多发梗死的不同梗死模式分别与不同的病因和发病机制相关。 Abstract: The infarct patterns of ischemic cerebrovascular diseases are diverse. Based on the number of infarct, the infarct pattern can be classified as no infarct, single infarct or multiple infarcts. Single infarct can be classified according to the size and location of the infarcts, and multiple infarcts can be classified according to the involved territory of culprit artery. Different patterns of single and multiple infarcts are related to the etiology and mechanism.

【摘要】 目的 探讨多发颅内动脉狭窄对轻型缺血性卒中和TIA早期卒中复发的影响。 方法 纳入氯吡格雷用于急性非致残性脑血管事件高危人群的疗效（Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events，CHANCE）研究影像亚组1089例非心源性高危TIA和轻型缺血性卒中患者。根据患者入院时MRA序列的检查结果分为无颅内动脉狭窄、单发颅内动脉狭窄和多发颅内动脉狭窄3组。随访患者90 d卒中复发（缺血性和出血性卒中）事件。采用Cox回归分析多发颅内动脉狭窄对轻型缺血性卒中和TIA患者90 d卒中复发风险的影响。 结果 无颅内动脉狭窄、单发颅内动脉狭窄和多发颅内动脉狭窄组分别有608例、298例和183例患者；90 d卒中发生风险比例分别为5.43%、9.06%和18.03%。与无颅内动脉狭窄患者相比，伴有颅内动脉狭窄（包含单发和多发颅内动脉狭窄）患者卒中复发风险显著高于非颅内动脉狭窄患者（12.50% vs 5.40%，P＜0001）。其中，多发颅内动脉狭窄卒中复发风险最高（18.03%），是无颅内动脉狭窄患者的3.578倍（HR 3.578，95%CI 2.189～5.850）。 结论 多发颅内动脉狭窄是非心源性TIA和轻型卒中患者早期卒中复发的独立危险因素。 【Abstract】 Objective To investigate the effect of multiple intracranial atherosclerotic stenosis (ICAS) on early stroke recurrence in patients with TIA and minor ischemic stroke. Methods 1089 patients with noncardioembolic high-risk TIA and minor ischemic stroke in the imaging subgroup of the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) randomized clinical trial were included in this study. Based on MRA results after admission, ICAS status were grouped into no ICAS, single ICAS and multiple ICAS. The outcomes were recurrent stroke (including ischemic or hemorrhagic stroke) during 90-day follow-up. Cox proportional hazards models were used to assess the association of ICAS status and stroke recurrence. Results 608 patients had no ICAS, 298 patients had single ICAS and 183 patients had multiple ICAS, and theircorresponding risk of recurrent stroke was 5.43%, 9.06% and 18.03%, respectively. Patients with ICAS (including single and multiple ICAS) had a significantly higher risk of recurrent stroke than patients without ICAS (12.50% vs 5.40%, P

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

【摘要】 脑小血管病是导致认知功能减退、步态情感障碍和痴呆的重要脑血管疾病，脑白质弥漫性损伤是该病的重要影像学特征。结合国内外近年来相关研究内容，本文对不同的脑小血管病白质损伤动物模型制作进行了系统性回顾，包括单一型动物模型如双侧颈总动脉狭窄模型、脑淀粉样血管病模型、Notch3转基因小鼠模型、自发性高血压大鼠模型、易卒中型肾血管性高血压大鼠模型，以及由两个或两个以上单一型动物模型组合而成的复合型动物模型等。 【Abstract】 In recent years, cerebral small vessel disease (CSVD) has been paid more and more concern because it can cause cognitive decline, dementia, gait abnormality, emotion disorder and etc. The important imaging feature of CSVD is diffuse white matter lesions. This article reviewed the advance in the establishment of animal models of CSVD with white matter lesion in different ways. These animal models included bilateral common carotid artery stenosis mouse model, cerebral amyloid angiopathy mouse model, Notch3 transgenic mouse model, spontaneous hypertensive rat model, stroke-prone renovascular hypertensive rat model, and mixed models composed of two or more single animal models.

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 明确我国接诊卒中患者的医疗机构卒中医疗资源配置情况及水平。 方法 2012年对当时的中国卒中研究网络成员单位（China Stroke Research Network，CSRN）的554家 单位进行了关于卒中医疗资源分布的调查。对每家单位发放调查问卷以获取该单位医疗资源分布情 况，包括人力资源情况、设备资源情况、空间资源情况和组织管理情况。调查问卷的内容设置参考欧 洲卒中医疗资源调查（European stroke facilities survey）对高级卒中中心（comprehensive stroke center， CSC）、初级卒中中心（primary stroke center，PSC）和卒中接诊最小机构（any hospital ward，AHW）的定 义标准。 结果 在发放调查问卷的所有医疗机构中，有521家（94.0%）反馈了合格的调查问卷。按照欧洲卒中 医疗资源调查标准，在反馈的医疗机构中有20家（3.8%）达到CSC标准，有179家（34.4%）达到PSC标准， 有64家（12.3%）达到AHW标准，而有258家（49.5%）未达到上述任何一级可收治卒中医疗机构的标准。 上述分别达到CSC、PSC、AHW和未符合标准的各级医疗机构中，在前一年收治卒中患者的数量分别为 70 052例（8.8%）、334 834例（42.2%）、88 364例（11.1%）和299 806例（37.8%）。在未达到标准的机 构中，有11家（4.3%）机构无法提供24 h头颅计算机断层扫描检查，209家（81.0%）机构既不能提供卒 中诊疗成型方案，也无法提供卒中患者接诊的标准化临床路径。 结论 在被调查的接诊急性卒中患者的医疗机构中，只有不足2/5的单位可提供较为理想的卒中诊 疗资源。我国仅有一半的急性卒中患者在CSC和PSC就诊。 Abstract: Objective To investigate the allocation of stroke medical facilities and the level of medical service in hospitals admitting stroke patients in China. Methods A survey of stroke medical facilities in all 554 hospitals from China Stroke Research Network (CSRN) was conducted in 2012. These hospitals were from 31 provinces or municipalities, covering nearly the entire mainland China. The relevant information was obtained by questionnaires, including hardware and software resources and medical service management and etc. The criteria and definitions for comprehensive stroke center (CSC), primary stroke center (PSC), and any hospital ward (AHW) of minimum unit admitting stroke patients in questionnaires were used referring to the relevant criteria and definitions of the European stroke facilities survey. Results Of all the hospitals, 521 (94.0%) completed the questionnaires. Of the 521 hospitals, 20 (3.8%) met CSC criterion, 179 (34.4%) met PSC criterion, 64 (12.3%) met AHW criterion, and 258 (49.5%) didn’t reach any of the above criteria. Hospitals meeting the criteria for CSC, PSC, AHW and none of all the criteria had admitted 70 052 (8.8%), 334 834 (42.2%), 88 364 (11.1%), and 299 806 (37.8%) patients in the last year before the survey, respectively. Of the 258 hospitals at the lowest level of medical service, 11 (4.3%) could not provide 24-hour cerebral computed tomography scanning service, 209 (81.0%) could provide neither the complete stroke diagnosis and treatment scheme nor standard clinical pathway for acute stroke patients. Conclusions Only less than 2/5 of investigated hospitals admitting acute stroke patients had optimal medical facilities for stroke. Only half of acute stroke patients received treatment in CSC and PSC in this survey.

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.

高危非致残性缺血性脑血管事件（high r isk n on-disabling ischemic cerebrovascular events， HR-NICE）具有发病率高、复发率高等特点，国内外指南均建议对HR-NICE人群进行快速评估、早期干 预以及建立专病管理系统等综合管理。同时在治疗方面，多项研究探讨了不同抗血小板药物治疗HRNICE 人群及针对不同病因的患者采用抗凝或溶栓治疗的有效性及安全性。本文就高危非致残性缺 血性脑血管事件的管理和治疗的循证医学证据作一简要综述。 Abstract: The incidence and recurrence rate of high risk of disabling ischemic cerebrovascular events (HR-NICE) are high. The guidelines of both home and abroad suggest that the early comprehensive evaluation, intervention and establishing NICE management system will obtain great benefit. Several studies have revealed the efficacy and safety of antiplatelet medication, and choosing anticoagulation or thrombolysis treatment according to different cause, which may improve the prognosis. This article briefly reviews the evidence-based medicine in management of HR-NICE.

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

分子标记物可使高危非致残性缺血性脑血管事件（high r isk n on-disabling ischemic cerebrovascular events，HR-NICE）患者的临床诊断、危险度分层、治疗方案和预后判断更加精确，但不 同种族人群间存在卒中发生的原因以及基因位点的差异，从而使其对强化抗血小板治疗的获益也 不尽相同。由于基因类型和蛋白存在与否的不同，患者对相同药物可能存在不同的收益，所以在决定 诊疗方案时应充分考虑到这一差异，进行个体化治疗。新型抗凝和抗血小板药物无需代谢、直接起 效，可能为未来的精准化治疗带来新的思路。 Abstract: Molecular markers could help physicians make more accurate clinical diagnosis, risk stratification, treatment plan and prognosis evaluation for patients with high risk non-disabling ischemic cerebrovascular events (HR-NICE). However, race/ethnic difference may influence the stroke etiology and gene locus, so that the effect of aggressive antiplatelet therapy is distinct with different varieties. Due to the different genotyping and protein, patients may gain different benefit from the drug therapy, so that individualized treatment should be adapted to the differences. New anticoagulants and antiplatelet agents can work directly, which may provide new direction for the future.

非致残性缺血性脑血管事件（non-disabling ischemic cerebrovascular events，NICE）包括短暂 性脑缺血发作（transient ischemic attack，TIA）与轻型卒中，在全部缺血性脑血管病中的比例及其流行 病学趋势逐年升高。NICE早期复发风险高，且存在低知晓率、低诊疗率、低住院率的问题。因此，进 一步改进TIA的定义，制定预防早期卒中的最佳策略显得尤为重要。近年来，随着人们对TIA和轻型卒 中认识的深入以及医疗水平的提高，TIA的发病率及卒中复发风险在发达国家存在下降的趋势。 Abstract: The percentage of non-disabling ischemic cerebrovascular events (NICE), including transient ischemic attack (TIA) and minor stroke, in ischemic cerebrovascular diseases has been rising as well as the epidemiological trend of it. High risk of early occurrence coming along with low awareness, low diagnosis and treatment and low hospitalization rate make it important to improve the definition of TIA and establish optimum strategy to prevent early stroke of NICE. In recent years, with the deepening of people's understanding of TIA and minor stroke, and the improvement of medical standards, the incidence of TIA and the risk of stroke recurrence have declined in developed countries.

高危非致残性缺血性脑血管事件（high r isk n on-disabling ischemic cerebrovascular events， HR-NICE）患者处于不稳定状态，早期复发进展为严重卒中的风险较高。目前，不同的临床评分系统是 临床工作者常用的预测模型，但随着近些年对影像及分子标记物研究的深入，发现其同样能够预测 卒中复发风险，进而指导HR-NICE人群的早期干预及个体化治疗，从而改善患者预后、降低致残率， 同时可以降低国家卒中负担。本文根据近年对于卒中复发风险预测模型的相关研究，对HR-NICE的定 义、临床、影像和分子标记物研究进展进行综述，为临床工作者提供其预后评判参考。 Abstract: The patients who have high risk non-disabling ischemic cerebrovascular events are in unstable state, and they have high risks of early recurrent stroke. At present, different clinical scoring systems are widely used, with the development of the imaging and molecular biology, these technology can be used to predict recurrent stroke risk, so that early intervention and individual therapy can be provided for patients. It could improve prognosis and reduce the disability rate and burden of stroke. This paper aims to discuss the definition of HR-NICE and predictors of clinical, imaging and molecule for recurrent stroke prediction models according to recent studies, so as to provide reference for clinical work.

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

目的 探讨以问题为基础教学法（problem-based learning，PBL）的教学模式在传统教学模式基础上对 脑血管病专业硕士研究生科研设计能力提高的作用。 方法 选取首都医科大学附属北京天坛医院脑血管病专业硕士研究生20名，随机分成传统教学组和 PBL教学结合组各10名。分别采用传统的教学模式和PBL结合传统教学模式指导研究生进行课题设 计，并对各组科研能力进行考核评分和比较。 结果 PBL结合传统教学模式能够明显提高研究生科研能力，客观和主观评价指标均优于传统教学 模式。 结论 在传统教学模式基础上结合PBL教学是一种能够有效地提高脑血管病专业研究生科研能力 的教学模式。 Abstract: Objective To investigate the effect of problem-based learning (PBL) based on the traditional method in improving scientific research ability of graduate student in neurology. Methods Grouping by random lottery, 20 students were divided into 2 groups including traditional method group (n =10) and traditional method & PBL group (PBL group) (n =10) to carry out project design. Subjective and objective scores were obtained and compared by using t test. Results PBL integrated with traditional method could obviously improve scientific research ability of gradate students. The objective and subjective scores in PBL & traditional method Group were statistically higher than that in Traditional method Group. Conclusion PBL integrated with traditional method can effectively help the graduates to improve the scientific research ability.

非致残性缺血性脑血管事件（non-disabling ischemic cerebrovascular events，NICE）在我国具 有庞大的人群基础。NICE人群包括短暂性脑缺血发作（transient ischemic attack，TIA）、轻型缺血性卒 中、迅速缓解且未遗留残疾的卒中。其中轻型卒中和TIA患者在临床表现、临床预后和流行病学特征等 方面均较为相似，所以建议统一进行诊疗。考虑我国的经济发展水平、人群健康素质及面临的防治 任务，NICE人群是最为重要的防治对象，也是目前脑血管病的最佳防控窗口人群。 Abstract: Non-Disabling Ischemic Cerebrovascular Events (NICE) has a large population base in China. The NICE group includes transient ischemic attack (TIA), minor ischemic stroke (NIHSS ≤3 or 5), rapid remission and unimpaired stroke. Patients with minor stroke and TIA are similar in clinical manifestations, clinical prognosis and epidemiological characteristics, so it is recommended to conduct a unified diagnosis and treatment. In view of Chinese economic development status, public health awareness and current stroke prevention tasks, the NICE people are the most important target objects within the best window of prevention and control of cerebrovascular diseases.