目的:近年来研究发现中性粒细胞与淋巴细胞比值可以预测急性缺血性卒中(AIS)患者的短期和长期预后。但其变化量(ΔNLR)与患者溶栓后24 h的出血转化(HT)及早期神经功能改善(ENI)的关系仍缺乏研究。本次研究旨在探讨ΔNLR与溶栓后24 h的HT...目的:近年来研究发现中性粒细胞与淋巴细胞比值可以预测急性缺血性卒中(AIS)患者的短期和长期预后。但其变化量(ΔNLR)与患者溶栓后24 h的出血转化(HT)及早期神经功能改善(ENI)的关系仍缺乏研究。本次研究旨在探讨ΔNLR与溶栓后24 h的HT和ENI的关系,及ΔNLR与不同TOAST分型的患者溶栓后早期结局的关系。方法:纳入接受静脉溶栓治疗的AIS患者234例。对患者进行TOAST分型。根据HT和ENI的有无将患者进行分组。结果:发生HT的患者溶栓后NLR升高更明显,出现ENI的患者溶栓后NLR降低更明显。动脉粥样硬化型与心源性栓塞型患者的ΔNLR无明显差异,但小动脉闭塞型患者与大动脉粥样硬化型轻型患者相比,ΔNLR有统计学差异。结论:ΔNLR是AIS患者溶栓后HT和ENI的独立影响因素,且小动脉闭塞型脑卒中患者的ΔNLR大于轻型大动脉粥样硬化型脑卒中患者的ΔNLR。Objective: Recent studies have shown that the neutrophil-to-lymphocyte ratio can predict the short- and long-term prognosis of patients with acute ischemic stroke (AIS). However, the association between the variation of neutrophil-to- lymphocyte ratio(ΔNLR) and the bleeding transformation (HT) as well as early neurological improvement (ENI) at 24 h after thrombolysis is still lacking. The purpose of the study was to investigate the correlation between ΔNLR and HT as well as ENI 24 h after thrombolytic therapy, and the relationship between ΔNLR and early outcomes after thrombolytic therapy in patients with different TOAST classifications. Methods: 234 patients with AIS who received intravenous thrombolysis were included. The patients were classified by TOAST classifications. Patients were grouped according to the presence or absence of HT and ENI. Results: The increase of NLR after thrombolysis was more obvious in patients with HT while the decrease of NLR was more obvious in patients with ENI. There was no significant difference in ΔNLR between patients with atherosclerotic type and those with cardiogenic embolization type, but there was a statistical difference in ΔNLR between patients with small artery occlusion type and those with large artery atherosclerosis mild type. Conclusion: ΔNLR was an independent influencing factor for HT and ENI in AIS patients after thrombolysis, and ΔNLR in small artery occlusive stroke patients was greater than that in patients of minor stroke of LAA group.展开更多
目的应用多模磁共振扩散加权成像-灌注加权成像分析急性脑梗死不同治疗方法的影像学表现特征。材料与方法回顾性分析在我院神经内科住院治疗的急性脑梗死患者110例,所有患者均行多模磁共振检查,记录其影像学表现、临床资料和实验室常规...目的应用多模磁共振扩散加权成像-灌注加权成像分析急性脑梗死不同治疗方法的影像学表现特征。材料与方法回顾性分析在我院神经内科住院治疗的急性脑梗死患者110例,所有患者均行多模磁共振检查,记录其影像学表现、临床资料和实验室常规检查,并根据结果行扩散加权成像(diffusion weighted imaging,DWI)分型及急性卒中治疗Org 10172试验(trial of org 10172 in acute stroke treatment,TOAST)分型,根据不同治疗方法分为静脉溶栓组(43例)、动脉取栓组(34例)及保守治疗组(33例),并对3组的影像学及临床资料进行统计学分析。结果 (1)动脉取栓组患者存在半暗带及血管高信号征的比率均高于静脉溶栓组及保守治疗组,差异均有统计学意义(F=13.713,P=0.001;F=8.108,P=0.017)。(2)在DWI分型构成比方面,静脉溶栓组以小穿支梗死及单侧前循环梗死所占比率较大(25.58%、23.26%),动脉取栓组和保守治疗组以单侧前循环及前-后循环所占比率较大(52.94%、21.43%;30.30%、30.30%)。(3)在TOAST分型构成比方面,静脉溶栓组以大动脉粥样硬化型(largeartery atherosclerosis,LAA)所占比率最高(39.53%),动脉取栓组以不明原因型(undetermined etiology,UND)所占比率最高(73.53%),保守治疗组以小动脉闭塞型(small artery occlusion,SAO)所占比率最高(48.48%)。(4)在磁共振血管造影(magnetic resonance angiography,MRA)影像学表现上,静脉溶栓组及保守治疗组MRA表现正常所占比率最高(72.09%、51.52%),而动脉取栓组MRA表现为大脑中动脉狭窄或闭塞所占比率最高(41.18%)。(5)3组间比较,动脉取栓组的出血转化率最高(26.47%),差异有统计学意义(F=6.462,P=0.040)。(6)入院美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分及高血脂症在3组间比较差异具有统计学意义(t=6.209,P=0.003;F=6.176,P=0.046)。(7)保守治疗组发病时间(6.55±4.70)长于静脉溶栓组(2.93±1.05)及动脉取栓组(3.07±2.51),3组间差异有统计学意义(t=16.246,P=0.000)。结论了解不同治疗方法患者的影像学表现特征,可帮助临床医生根据具体情况选择合理的治疗方案,实现个性化治疗。展开更多
目的评定缺血性卒中A-S-C-O分型、急性卒中治疗Org10172试验(trial of org 10172 in acutestroke treatment,TOAST)分型及中国缺血性卒中亚型(Chinese ischemic stroke subclassfication,CISS)的信度检验。方法连续收集我院新发缺血性...目的评定缺血性卒中A-S-C-O分型、急性卒中治疗Org10172试验(trial of org 10172 in acutestroke treatment,TOAST)分型及中国缺血性卒中亚型(Chinese ischemic stroke subclassfication,CISS)的信度检验。方法连续收集我院新发缺血性卒中患者100例,由两位研究者对其进行分型,对3种分型分别进行信度检验。结果本研究A-S-C-O分型的Kappa值为0.504,P<0.01;TOAST分型的Kappa值为0.769,P<0.01;CISS分型的Kappa值为0.710,P<0.01。结论 A-S-C-O分型的一致性中等,TOAST分型及CISS分型的一致性良好。展开更多
文摘目的:近年来研究发现中性粒细胞与淋巴细胞比值可以预测急性缺血性卒中(AIS)患者的短期和长期预后。但其变化量(ΔNLR)与患者溶栓后24 h的出血转化(HT)及早期神经功能改善(ENI)的关系仍缺乏研究。本次研究旨在探讨ΔNLR与溶栓后24 h的HT和ENI的关系,及ΔNLR与不同TOAST分型的患者溶栓后早期结局的关系。方法:纳入接受静脉溶栓治疗的AIS患者234例。对患者进行TOAST分型。根据HT和ENI的有无将患者进行分组。结果:发生HT的患者溶栓后NLR升高更明显,出现ENI的患者溶栓后NLR降低更明显。动脉粥样硬化型与心源性栓塞型患者的ΔNLR无明显差异,但小动脉闭塞型患者与大动脉粥样硬化型轻型患者相比,ΔNLR有统计学差异。结论:ΔNLR是AIS患者溶栓后HT和ENI的独立影响因素,且小动脉闭塞型脑卒中患者的ΔNLR大于轻型大动脉粥样硬化型脑卒中患者的ΔNLR。Objective: Recent studies have shown that the neutrophil-to-lymphocyte ratio can predict the short- and long-term prognosis of patients with acute ischemic stroke (AIS). However, the association between the variation of neutrophil-to- lymphocyte ratio(ΔNLR) and the bleeding transformation (HT) as well as early neurological improvement (ENI) at 24 h after thrombolysis is still lacking. The purpose of the study was to investigate the correlation between ΔNLR and HT as well as ENI 24 h after thrombolytic therapy, and the relationship between ΔNLR and early outcomes after thrombolytic therapy in patients with different TOAST classifications. Methods: 234 patients with AIS who received intravenous thrombolysis were included. The patients were classified by TOAST classifications. Patients were grouped according to the presence or absence of HT and ENI. Results: The increase of NLR after thrombolysis was more obvious in patients with HT while the decrease of NLR was more obvious in patients with ENI. There was no significant difference in ΔNLR between patients with atherosclerotic type and those with cardiogenic embolization type, but there was a statistical difference in ΔNLR between patients with small artery occlusion type and those with large artery atherosclerosis mild type. Conclusion: ΔNLR was an independent influencing factor for HT and ENI in AIS patients after thrombolysis, and ΔNLR in small artery occlusive stroke patients was greater than that in patients of minor stroke of LAA group.
文摘目的应用多模磁共振扩散加权成像-灌注加权成像分析急性脑梗死不同治疗方法的影像学表现特征。材料与方法回顾性分析在我院神经内科住院治疗的急性脑梗死患者110例,所有患者均行多模磁共振检查,记录其影像学表现、临床资料和实验室常规检查,并根据结果行扩散加权成像(diffusion weighted imaging,DWI)分型及急性卒中治疗Org 10172试验(trial of org 10172 in acute stroke treatment,TOAST)分型,根据不同治疗方法分为静脉溶栓组(43例)、动脉取栓组(34例)及保守治疗组(33例),并对3组的影像学及临床资料进行统计学分析。结果 (1)动脉取栓组患者存在半暗带及血管高信号征的比率均高于静脉溶栓组及保守治疗组,差异均有统计学意义(F=13.713,P=0.001;F=8.108,P=0.017)。(2)在DWI分型构成比方面,静脉溶栓组以小穿支梗死及单侧前循环梗死所占比率较大(25.58%、23.26%),动脉取栓组和保守治疗组以单侧前循环及前-后循环所占比率较大(52.94%、21.43%;30.30%、30.30%)。(3)在TOAST分型构成比方面,静脉溶栓组以大动脉粥样硬化型(largeartery atherosclerosis,LAA)所占比率最高(39.53%),动脉取栓组以不明原因型(undetermined etiology,UND)所占比率最高(73.53%),保守治疗组以小动脉闭塞型(small artery occlusion,SAO)所占比率最高(48.48%)。(4)在磁共振血管造影(magnetic resonance angiography,MRA)影像学表现上,静脉溶栓组及保守治疗组MRA表现正常所占比率最高(72.09%、51.52%),而动脉取栓组MRA表现为大脑中动脉狭窄或闭塞所占比率最高(41.18%)。(5)3组间比较,动脉取栓组的出血转化率最高(26.47%),差异有统计学意义(F=6.462,P=0.040)。(6)入院美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分及高血脂症在3组间比较差异具有统计学意义(t=6.209,P=0.003;F=6.176,P=0.046)。(7)保守治疗组发病时间(6.55±4.70)长于静脉溶栓组(2.93±1.05)及动脉取栓组(3.07±2.51),3组间差异有统计学意义(t=16.246,P=0.000)。结论了解不同治疗方法患者的影像学表现特征,可帮助临床医生根据具体情况选择合理的治疗方案,实现个性化治疗。
