Journal of Stroke & Cerebrovascular Diseases最新文献_第9页

Comparative efficacy and safety of tissue plasminogen activators (tPA) in acute ischemic stroke: A systematic review and network meta-analysis of randomized controlled trials 组织纤溶酶原激活剂（tPA）治疗急性缺血性卒中的比较疗效和安全性：随机对照试验的系统评价和网络荟萃分析。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-01-09 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108230

Sufyan Shahid MBBS , Humza Saeed MBBS , Minahil Iqbal MBBS , Ayesha Batool MBBS , Muhammad Bilal Masood MBBS , Muhammad Husnain Ahmad MD , Aqeeb Ur Rehman MD , Muhammad Aemaz Ur Rehman MD , Fahd Sultan MD

Background

Intravenous alteplase (ALT) is the standard treatment for acute ischemic stroke (AIS). However, recent trials comparing other tissue plasminogen activators (tPAs) like tenecteplase (TNK) and reteplase with ALT have yielded conflicting results. This necessitated a network meta-analysis to compare the efficacy and safety of various tPAs in AIS patients.

Methods

We searched MEDLINE, Embase, and CENTRAL (until September 15, 2024) for randomized controlled trials (RCTs) comparing TNK or reteplase (any dose) with ALT (0.9 mg/kg) in AIS patients. A frequentist network meta-analysis was performed using risk ratio (RR) and 95 % CI for each comparison, and P-scores ranked treatments. Analyses were done using R Software 4.4.1.

Results

Sixteen RCTs (9259 patients, 62.1 % males) were included. Reteplase 18+18 mg significantly improved excellent functional recovery (mRS 0-1) (RR: 1.13; p < 0.01) and independent ambulation (mRS 0-2) at 3 months (RR: 1.07; p < 0.01) compared to ALT. The 0.25 mg/kg TNK group also showed improved functional recovery (mRS 0-1) (RR: 1.06; p < 0.01). For safety, 0.1 mg/kg TNK was associated with a higher incidence of symptomatic intracranial hemorrhage (s-ICH) (RR: 7.27; p < 0.01). No significant differences in ICH or all-cause mortality were found between ALT and other treatments. Reteplase 18+18 mg ranked highest for functional recovery (P-score=0.9638) and ambulation (P-score=0.9749), while ALT ranked highest for s-ICH (P-score=0.8060). No significant differences were observed between reteplase and TNK.

Conclusion

Reteplase 18+18 mg and TNK 0.25 mg/kg demonstrated higher efficacy and comparable safety to ALT. Larger trials are needed to further explore these agents as alternatives to ALT.

背景：静脉注射阿替普酶（ALT）是治疗急性缺血性卒中（AIS）的标准疗法。然而，最近对其他组织纤溶酶原激活剂（tPA）（如替奈替普酶（TNK）和再替普酶）与阿替普酶进行比较的试验得出了相互矛盾的结果。因此，有必要进行网络荟萃分析，比较各种 tPA 对 AIS 患者的疗效和安全性：我们检索了MEDLINE、Embase和CENTRAL（截止到2024年9月15日），以寻找在AIS患者中比较TNK或再普酶（任何剂量）与ALT（0.9 mg/kg）的随机对照试验（RCT）。采用风险比（RR）和 95% CI 对每项比较进行了频数网络荟萃分析，并对治疗进行了 P 值排序。分析使用 R 软件 4.2.3.结果：共纳入 16 项研究数据（9259 名患者，62.1% 为男性）。Reteplase 18+18 mg能显著改善极佳的功能恢复（mRS 0-1）（RR：1.13；pConclusion：Reteplase 18+18 mg和TNK 0.25 mg/kg与ALT相比，疗效更高，安全性相当。需要进行更大规模的试验，以进一步探索这些药物作为 ALT 替代品的可能性。

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引用次数: 0

Investigating causal associations of gut microbiota and blood metabolites on stroke and its subtypes: A Mendelian randomization study 研究肠道微生物群和血液代谢物与中风及其亚型的因果关系：一项孟德尔随机研究。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-01-09 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108233

Ruijie Zhang , Liyuan Han , Liyuan Pu , Guozhi Jiang , Qiongfeng Guan , Weinv Fan , Huina Liu

Background

The causal relationships between gut microbiota, blood metabolites, and stroke and its subtypes remain unclear. This study aims to uncover the causal associations using Mendelian randomization.

Methods

We initially identify Single-Nucleotide Polymorphisms (SNPs) correlated with gut microbiota and blood metabolites as instrumental variables (IVs) from the summary statistics in Genome-Wide Association Study (GWAS) to evaluate their potential causal associations with stroke and its subtypes. We proceed with a two-step Mendelian randomization analysis aiming to determine whether blood metabolites mediate the relationships between gut microbiota and stroke or its subtypes.

Results

We identified the genetic predictions of 12, 11, and 10 particular gut microbiota were associated with stroke, ischemic stroke, and intracerebral hemorrhage respectively. Inverse variance weighted (IVW) analysis disclosed Alistipes (OR [95%CI]: 1.11[1.00,1.23]), Streptococcus (OR [95%CI]: 1.17[1.05,1.30]), and Porphyromonadaceae (OR [95%CI]: 2.41[1.09,5.31]) as the primary causal effects on stroke, ischemic stroke, and ICH, respectively. We determined that 8, 11, and 1 blood metabolites were causally related to stroke, ischemic stroke, and ICH, respectively. Among these metabolites, Citrate (OR [95%CI]: 2.39[1.32,4.34]) and Beta-hydroxyisovalerate (OR [95%CI]: 2.54[1.62,3.97]) had the foremost causal effect on stroke and ischemic stroke, respectively, whereas Glutaroyl carnitine evidenced a causal effect on ICH. Furthermore, our study revealed that Tetradecanedioate marginally mediated the causal effects of Paraprevotella on stroke and ischemic stroke.

Conclusions

This study established a causal link between gut microbiota, plasma metabolites, and stroke. It revealed a marginal pathway, shedding new light on the intricate interactions among gut microbes, blood metabolites, stroke, and their underlying mechanisms.

背景：肠道微生物群、血液代谢物与中风及其亚型之间的因果关系尚不清楚。本研究旨在揭示孟德尔随机化的因果关系。方法：我们首先从全基因组关联研究（GWAS）的汇总统计数据中确定与肠道微生物群和血液代谢物相关的单核苷酸多态性（snp）作为工具变量（IVs），以评估它们与中风及其亚型的潜在因果关系。我们进行了两步孟德尔随机化分析，旨在确定血液代谢物是否介导肠道微生物群与中风或其亚型之间的关系。结果：我们分别确定了与中风、缺血性中风和脑出血相关的12、11和10种特定肠道微生物群的遗传预测。逆方差加权（IVW）分析显示，Alistipes （OR [95%CI]: 1.11[1.00,1.23]）、Streptococcus （OR [95%CI]: 1.17[1.05,1.30]）和Porphyromonadaceae （OR [95%CI]: 2.41[1.09,5.31]）分别是脑卒中、缺血性卒中和脑出血的主要致病因素。我们确定8、11和1种血液代谢物分别与中风、缺血性中风和脑出血有因果关系。在这些代谢物中，柠檬酸盐（OR [95%CI]: 2.39[1.32,4.34]）和β -羟基异戊酸盐（OR [95%CI]: 2.54[1.62,3.97]）分别对中风和缺血性中风有最重要的因果影响，而戊二酰肉碱对脑出血有最重要的因果影响。此外，我们的研究表明，四戊二酸在Paraprevotella对脑卒中和缺血性脑卒中的因果效应中起到了微弱的介导作用。结论：本研究建立了肠道菌群、血浆代谢物和中风之间的因果关系。它揭示了一个边缘途径，为肠道微生物、血液代谢物、中风及其潜在机制之间复杂的相互作用提供了新的线索。

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引用次数: 0

Predictors of outcome in patients with presumed reversible cerebral vasoconstriction syndrome (RCVS) 推定可逆脑血管收缩综合征（RCVS）患者预后的预测因素。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-01-09 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108234

Adrusht Madapoosi MS , Laura Stone McGuire MD , Angelica Fuentes MD , Anthony Sanchez-Forteza MS , Mpuekela Tshibangu , Peter Theiss MD , Tatiana Abou Mrad MD , Sepideh Amin-Hanjani MD , Ali Alaraj MD

Introduction

Reversible cerebral vasoconstriction syndrome (RCVS) is thought to be benign by nature, but a proportion of patients still suffer from neurological deficits on follow-up.

Objective

To understand what factors may influence a patient's recovery from RCVS.

Methods

The Clinical Research Data Warehouse at this institution was employed to search the medical records for patients with diagnosis and treatment of RCVS (2010–2021). After screening, 85 patients met inclusion criteria for a presumed diagnosis of RCVS with reported follow-up data. Patients were assessed by discharge modified Rankin Scale (mRS), which was grouped as lower (0 or 1) (n = 54) and higher (2 to 6) (n = 31). Clinical and radiographic data were analyzed.

Results

Median follow-up time was 80.0 (36.3–136) days for the lower discharge mRS group and 89.0 (39.0–179) days for the higher discharge mRS group. There were more females in the lower discharge mRS group (p = 0.027). Multivariate analysis selected sex (OR 0.220, 95% CI 0.068–0.709) and headache on presentation (OR 0.071, 95% CI 0.017–0.288) as predictive of lower discharge mRS, and a history hypertension (HTN) ([OR], 5.24 [95% CI, 1.65 - 16.7]), IPH on presentation ([OR], 8.21 [95% CI, 1.65 - 40.8]), and AMS on presentation ([OR], 25.8 [95% CI, 4.75 - 140]) as predictive of higher discharge mRS.

Conclusion

Female sex and headache are associated with lower discharge mRS, while a history of HTN, IPH, and altered mental status are associated with higher discharge mRS. Future studies with larger sample size may help elucidate factors associated with poor neurological outcome.

导读：可逆性脑血管收缩综合征（RCVS）本质上被认为是良性的，但在随访中仍有一部分患者出现神经功能缺损。目的：了解影响RCVS患者康复的因素。方法：采用该院临床研究数据仓库检索2010-2021年诊断和治疗RCVS患者的病历。筛选后，85例患者符合纳入标准，根据随访资料报道推定诊断为RCVS。采用出院改良Rankin量表（mRS）对患者进行评分，评分分为低（0或1）（n=54）和高（2 ~ 6）（n=31）。分析临床及影像学资料。结果：低出院mRS组中位随访时间为80.0（36.3-136）天，高出院mRS组中位随访时间为89.0（39.0-179）天。低流量mRS组女性患者较多（p=0.027）。多因素分析选择性别（OR 0.220, 95% CI 0.068-0.709）和首发头痛（OR 0.071, 95% CI 0.017-0.288）作为较低出院mRS的预测因素，高血压病史（HTN）（[OR], 5.24 [95% CI, 1.65 - 16.7]）、首发IPH （[OR], 8.21 [95% CI, 1.65 - 40.8]）和首发AMS （[OR], 25.8 [95% CI, 4.75 - 140]）作为较高出院mRS的预测因素。女性性别和头痛与较低的放电mRS有关，而HTN、IPH病史和精神状态改变与较高的放电mRS有关，未来更大样本量的研究可能有助于阐明与神经预后不良相关的因素。

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引用次数: 0

Thromboelastography may assess the effect of anticoagulation reversal in intracranial hemorrhage 血栓弹性成像可评价颅内出血抗凝逆转的效果。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-01-08 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108228

A Zepeski , BA Faine , M Ghannam , HM Olalde , L Wendt , A Naidech , NM Mohr , EC Leira

Background

Intracranial hemorrhage (ICH) is a complication of oral anticoagulation and is associated with significant morbidity and mortality. Clinical need exists for biomarkers to measure anticoagulation in patients with factor Xa inhibitor-associated ICH to assess the hemostatic effect of reversal agents. This study explored the utility of thromboelastography (TEG) to assess anticoagulation in emergency department (ED) patients who received activated prothrombin complex concentrate (aPCC) reversal for factor Xa-inhibitor-associated ICH.

Methods

This was a prospective, single-center, cohort study in a convenient sample of adult patients presenting to the ED with acute factor Xa-associated ICH. Exclusion criteria included pregnancy, incarceration, polytrauma, hepatic failure, or other known coagulopathic conditions. TEG samples were collected prior to anticoagulation reversal, as well as at 30-minutes, 12-hours, and 24-hours post-reversal. Only patients who received aPCC reversal were included in the final analysis.

Results

Pre-reversal TEG was collected on 10 participants prior to aPCC administration. A significant decrease in TEG R-time was observed at 30 minutes post-aPCC reversal (Beta = -0.91, p = 0.035). R-time increased at 12- and 24-hours post-aPCC reversal to baseline levels. Significant changes were not observed in K-time, clot strength, maximum amplitude, or coagulation index.

Conclusions

TEG R-time decreases acutely after anticoagulation reversal with aPCC and rebounds at 12- and 24-hours post-reversal. TEG R-time may serve as a potential sensitive biomarker of the residual anticoagulation activity of factor Xa inhibitors in patients with ICH that undergo anticoagulation reversal with aPCCs.

背景：颅内出血（ICH）是口服抗凝治疗的一种并发症，其发病率和死亡率都很高。临床需要生物标志物来测量Xa因子抑制剂相关脑出血患者的抗凝作用，以评估逆转药物的止血效果。本研究探讨了血栓弹性成像（TEG）在急诊科（ED）接受活化凝血酶原复合物（aPCC）逆转治疗xa因子抑制剂相关脑出血的患者中的抗凝作用。方法：这是一项前瞻性、单中心、队列研究，选取了就诊于急诊科的急性xa因子相关性脑出血的成年患者作为样本。排除标准包括妊娠、嵌顿、多发外伤、肝功能衰竭或其他已知凝血功能障碍。在抗凝逆转前、逆转后30分钟、12小时和24小时采集TEG样本。只有接受aPCC逆转的患者被纳入最终分析。结果：10名受试者在aPCC给药前收集逆转前TEG。apcc逆转后30分钟TEG r时间显著减少（Beta = -0.91,p = 0.035）。在apcc逆转至基线水平后12和24小时，R-time增加。在k -时间、凝块强度、最大振幅或凝血指数方面未观察到显著变化。结论：aPCC抗凝逆转后TEG R-time急剧减少，并在逆转后12和24小时反弹。TEG R-time可作为脑出血患者在apcc抗凝逆转后Xa因子抑制剂剩余抗凝活性的潜在敏感生物标志物。

{"title":"Thromboelastography may assess the effect of anticoagulation reversal in intracranial hemorrhage","authors":"A Zepeski , BA Faine , M Ghannam , HM Olalde , L Wendt , A Naidech , NM Mohr , EC Leira","doi":"10.1016/j.jstrokecerebrovasdis.2025.108228","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108228","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial hemorrhage (ICH) is a complication of oral anticoagulation and is associated with significant morbidity and mortality. Clinical need exists for biomarkers to measure anticoagulation in patients with factor Xa inhibitor-associated ICH to assess the hemostatic effect of reversal agents. This study explored the utility of thromboelastography (TEG) to assess anticoagulation in emergency department (ED) patients who received activated prothrombin complex concentrate (aPCC) reversal for factor Xa-inhibitor-associated ICH.</div></div><div><h3>Methods</h3><div>This was a prospective, single-center, cohort study in a convenient sample of adult patients presenting to the ED with acute factor Xa-associated ICH. Exclusion criteria included pregnancy, incarceration, polytrauma, hepatic failure, or other known coagulopathic conditions. TEG samples were collected prior to anticoagulation reversal, as well as at 30-minutes, 12-hours, and 24-hours post-reversal. Only patients who received aPCC reversal were included in the final analysis.</div></div><div><h3>Results</h3><div>Pre-reversal TEG was collected on 10 participants prior to aPCC administration. A significant decrease in TEG R-time was observed at 30 minutes post-aPCC reversal (Beta = -0.91, p = 0.035). R-time increased at 12- and 24-hours post-aPCC reversal to baseline levels. Significant changes were not observed in K-time, clot strength, maximum amplitude, or coagulation index.</div></div><div><h3>Conclusions</h3><div>TEG R-time decreases acutely after anticoagulation reversal with aPCC and rebounds at 12- and 24-hours post-reversal. TEG R-time may serve as a potential sensitive biomarker of the residual anticoagulation activity of factor Xa inhibitors in patients with ICH that undergo anticoagulation reversal with aPCCs.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 3","pages":"Article 108228"},"PeriodicalIF":2.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Letter to the editor, regarding “Iatrogenic cerebral amyloid angiopathy: Two case reports to explore clinical heterogeneity and pathological patterns” recently published by Vera-Cáceres and colleagues 致编辑的信，关于最近由Vera-Cáceres及其同事发表的“医源性脑淀粉样血管病：两个病例报告探讨临床异质性和病理模式”。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-01-08 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108232

Matija Zupan , Janja Pretnar Oblak , Senta Frol

引用次数: 0

Trajectory of depressive symptoms in a longitudinal stroke cohort 纵向卒中队列中抑郁症状的发展轨迹

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-01-07 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108197

Katherine Sewell PhD , Tamara Tse PhD , Leonid Churilov PhD , Thomas Linden PhD , Sheila Crewther PhD , Henry Ma PhD , Stephen M. Davis MD , Geoffrey A. Donnan MD , Leeanne M. Carey PhD

Objectives

Knowledge of the trajectory of post-stroke depression is important to identify high-risk patients, develop precise management programs and enhance prognosis. We aimed to characterise the course of depressive symptoms within the first year post-stroke and to evaluate associations with time.

Materials and Methods

Depressive symptoms were measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) within the first week, and at 3 and 12 months post-stroke. Scores were dichotomised into symptoms ‘present’ (MADRS ≥ 7) or ‘absent’ (MADRS < 7). The course of depressive symptoms within individuals was mapped and categorised using a trajectory diagram. The association between time and the presence of depressive symptoms was investigated using random effects logistic regression. Logistic regression was also used to assess the likelihood of participants having depressive symptoms later, given their status at earlier time points.

Results

Of 142 ischaemic stroke survivors included for analysis, almost half (47.9%) experienced a change in depressive symptom status over time. Depressive symptoms were common at each timepoint (35-43%), although an association between time and frequency of depressive symptoms was not evident. Stroke survivors with depressive symptoms at 3 months were more likely to have depressive symptoms at 12 months, compared to those without symptoms at 3 months.

Conclusion

Our findings provide evidence for a dynamic trajectory of depressive symptoms in individuals in the first year post-stroke. The importance of repeated screening for depression is highlighted, though most necessary at 3 months post-stroke.

目的：了解脑卒中后抑郁的发展轨迹对识别高危患者、制定精确的治疗方案和提高预后具有重要意义。我们的目的是描述中风后一年内抑郁症状的病程，并评估其与时间的关系。材料和方法：使用Montgomery-Åsberg抑郁评定量表（MADRS）在卒中后第一周、第3个月和第12个月测量抑郁症状。得分分为症状“存在”（MADRS≥7）或“不存在”（MADRS < 7）。个体抑郁症状的过程被绘制出来，并使用轨迹图进行分类。使用随机效应逻辑回归研究时间与抑郁症状之间的关系。考虑到参与者在早期时间点的状态，Logistic回归也被用于评估他们后来出现抑郁症状的可能性。结果：纳入分析的142例缺血性卒中幸存者中，近一半（47.9%）经历了抑郁症状状态的改变。抑郁症状在每个时间点都很常见（35-43%），尽管抑郁症状的时间和频率之间的关联并不明显。与没有抑郁症状的中风幸存者相比，在3个月时出现抑郁症状的中风幸存者在12个月时更有可能出现抑郁症状。结论：我们的研究结果为中风后第一年个体抑郁症状的动态轨迹提供了证据。反复筛查抑郁症的重要性被强调，尽管在中风后3个月是最必要的。

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引用次数: 0

Association between prognostic nutritional index and stroke: A nationally representative cross-sectional study from NHANES 预后营养指数与中风之间的关系：一项来自NHANES的全国代表性横断面研究。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108165

Linshan Pan , Yongjun Peng , Lihua Jiang

Background

The correlation between the prognostic nutritional index (PNI) and the risk of stroke has become a hot spot within the medical research community. The available evidence from a large sample regarding the correlation between PNI and stroke is inadequate. There is also a need for more research analysis from national surveys.

Objective

The principal goal of this research is to improve our understanding of the relationship between PNI and the risk of stroke. This study also intends to investigate the potential synergistic influence of PNI on stroke in combination with other interacting variables.

Methods

A cross-sectional study was conducted with 35,549 participants selected from the National Health and Nutrition Examination Survey (NHANES) 2005–2018 cycle. Information was gathered from all participants regarding the following: lymphocyte count, albumin levels, stroke occurrence, age, sex, race/ethnicity, education level, poverty income ratio (PIR), marital status, body mass index (BMI), smoking habits, drinking status, physical activity measured in total metabolic equivalents (PA_total_MET), diabetes status, glycohemoglobin levels, total cholesterol, direct high-density lipoprotein cholesterol(direct HDL-cholesterol), hypertension, and coronary heart disease. Curve fitting, subgroup analysis, and multifactor weighted logistic regression analysis were used to examine the relationship between PNI and stroke.

Results

The overall prevalence of stroke was found to be 3.9%, PNI quartile 4(Q4) had an increased prevalence of stroke than quartile 1, 2, and 3(Q1,2,3). Our research suggested a negative association between PNI and the risk of stroke, as indicated by the odds ratio (OR=0.98) with a 95% confidence interval (CI=0.97∼0.99) and a p-value <0.05 (P=0.005), even after adjusting for all confounders. Subsequent subgroup analysis indicated a significant difference in the impact of PNI on stroke between individuals with different body mass index(BMI) levels (p for interaction = 0.02).

Conclusion

Our findings underscore that lower PNI in US adults is associated with an increased stroke risk, shedding light on a potential interrelationship between nutrition, inflammatory parameters, and stroke.

背景：预后营养指数（PNI）与脑卒中风险的相关性已成为医学界关注的热点。从大样本中获得的关于PNI和中风之间相关性的证据是不充分的。还需要从国家调查中进行更多的研究分析。目的：本研究的主要目的是提高我们对PNI与卒中风险之间关系的理解。本研究还旨在探讨PNI与其他相互作用变量联合对脑卒中的潜在协同影响。方法：从2005-2018年国家健康与营养检查调查（NHANES）周期中选择35,549名参与者进行横断面研究。从所有参与者收集以下信息：淋巴细胞计数、白蛋白水平、中风发生率、年龄、性别、种族/民族、教育水平、贫困收入比（PIR）、婚姻状况、体重指数（BMI）、吸烟习惯、饮酒状况、总代谢当量体力活动（PA_total_MET）、糖尿病状况、糖蛋白水平、总胆固醇、直接高密度脂蛋白胆固醇（directHDL-cholesterol）、高血压、还有冠心病。采用曲线拟合、亚组分析和多因素加权logistic回归分析来检验PNI与脑卒中的关系。结果：卒中的总患病率为3.9%，PNI四分位数4（Q4）的卒中患病率高于四分位数1、2和3（Q1、2,3）。我们的研究表明，PNI与卒中风险之间存在负相关，比值比（OR=0.98）为95%可信区间（CI=0.97 ~ 0.99）， p值为p值。结论：我们的研究结果强调，美国成年人较低的PNI与卒中风险增加相关，揭示了营养、炎症参数和卒中之间的潜在相互关系。

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引用次数: 0

Cross-sectional analysis of non-HDL/HDL cholesterol ratio as a marker for cardiovascular disease risk in middle-aged and older adults: Evidence from the CHARLS study 非高密度脂蛋白/高密度脂蛋白胆固醇比率作为中老年人心血管疾病风险标志的横断面分析：来自CHARLS研究的证据

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108168

Changxing Liu , Zhirui Zhang , Tianwei Meng , Chengjia Li , Boyu Wang , Xulong Zhang

Background

While cardiovascular disease is linked to abnormal lipid metabolism, the relationship between NHHR (non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio), a new lipid metric, and cardiovascular disease in middle-aged and older adults in China is still unclear.

Methods

This cohort study, based on a population sample, examined the incidence of cardiovascular disease (CVD) events, including stroke and heart disease. It utilized self-reported diagnoses from the study's inception and during Wave 4, involving 9259 participants from the China Health and Retirement Longitudinal Study (CHARLS). The research employed restricted cubic spline models and multivariate logistic regression to investigate possible non-linear relationships. Additionally, subgroup analyses were conducted to assess the influence of socio-demographic factors on the outcomes.

Result

During the seven-year follow-up period, 1,139 participants developed CVD, including 742 cases of heart problems and 582 strokes. In Model 3, it was observed that for each unit increase in the highest NHHR group, the risk of developing CVD increased by 98%, the risk of stroke increased by 48%, and the risk of heart problems increased by 115%. Subgroup analyses indicated that this correlation was more pronounced among individuals under 60 years of age and those with hypertension.

Conclusions

According to the current study, elevated NHHR ratio is an important risk factor for CVD in middle-aged and elderly Chinese. Early intervention in patients with higher NHHR ratios may help to further reduce the incidence of CVD.

背景：虽然心血管疾病与脂质代谢异常有关，但在中国中老年人群中，一种新的脂质指标NHHR（非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇之比）与心血管疾病之间的关系尚不清楚。方法：本队列研究基于人群样本，检查心血管疾病（CVD）事件的发生率，包括中风和心脏病。它利用了研究开始时和第四波期间的自我报告诊断，涉及来自中国健康与退休纵向研究（CHARLS）的9259名参与者。研究采用限制三次样条模型和多元逻辑回归分析可能存在的非线性关系。此外，进行亚组分析以评估社会人口因素对结果的影响。结果：在7年的随访期间，1139名参与者患上了心血管疾病，其中包括742例心脏病和582例中风。在模型3中观察到，NHHR最高组每增加一个单位，发生CVD的风险增加98%，卒中的风险增加48%，心脏问题的风险增加115%。亚组分析表明，这种相关性在60岁以下和高血压患者中更为明显。结论：根据目前的研究，NHHR比值升高是中国中老年心血管疾病的重要危险因素。对NHHR比值较高的患者进行早期干预可能有助于进一步降低心血管疾病的发病率。

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引用次数: 0

Intertwined destinies - Acute ischemic stroke and neurogenic stress cardiomyopathy. 命运交织-急性缺血性中风和神经源性应激性心肌病。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108222

M Kruska, A Alonso, I Akin, C Fastner

引用次数: 0

Hirudin promotes cerebral angiogenesis and exerts neuroprotective effects in MCAO/R rats by activating the Wnt/β-catenin pathway 水蛭素通过激活Wnt/β-catenin通路，促进MCAO/R大鼠脑血管生成，发挥神经保护作用。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108218

Linrong He , Ruolan Lei , Shuangyang Li , Xiaoying Zhao , Xinying He , Xinyue Yang , Ping Liu , Dechou Zhang , Yu Jiang

Objective

Hirudin has shown potential in promoting angiogenesis and providing neuroprotection in ischemic stroke; however, its therapeutic role in promoting cerebrovascular angiogenesis remains unclear. In this study, we aimed to investigate whether hirudin exerts neuroprotective effects by promoting angiogenesis through the regulation of the Wnt/β-catenin signaling pathway.

Methods

An in vitro model of glucose and oxygen deprivation/reperfusion (OGD/R) was established using rat brain microvascular endothelial cells (BMECs). The effects of hirudin on OGD/R cell viability were assessed using the cell counting kit-8 (CCK-8) assay. The angiogenic potential of hirudin was evaluated using Transwell and tube formation assays. In vivo, a middle cerebral artery occlusion/reperfusion (MCAO/R) model was created in rats. The neuroprotective effects of hirudin were assessed using the modified neurological severity score (mNSS), Hematoxylin and eosin (H&E) staining, 2,3,5-Triphenyltetrazolium chloride (TTC) staining, and immunofluorescence staining. Dickkopf-1 (DKK1), a specific inhibitor of this pathway, was introduced in order to investigate the role of the Wnt/β-catenin pathway. The effects of hirudin on the Wnt/β-catenin pathway were examined through immunohistochemistry, western blotting, and reverse transcription quantitative polymerase chain reaction (RT-qPCR).

Results

Hirudin significantly improved BMEC survival and enhanced both cell migration and tube formation in the OGD/R model. In the MCAO/R model, hirudin reduced the mNSS score, alleviated pathological damage, decreased infarction volume, and increased the expression of key angiogenic factors, including CD34, vascular endothelial growth factor (VEGF), and angiopoietin-2 (Ang-2). In addition, hirudin activated the Wnt/β-catenin pathway, leading to elevated levels of Wnt3a and β-catenin.

Conclusion

Hirudin has substantial neuroprotective effects associated with the promotion of angiogenesis in the ischemic penumbra. This mechanism is mediated by the regulation of the Wnt/β-catenin pathway.

目的：水蛭素在缺血性脑卒中中具有促进血管生成和神经保护的作用；然而，其促进脑血管血管生成的治疗作用尚不清楚。在本研究中，我们旨在探讨水蛭素是否通过调节Wnt/β-catenin信号通路促进血管生成而发挥神经保护作用。方法：采用大鼠脑微血管内皮细胞（BMECs）建立体外葡萄糖缺氧再灌注（OGD/R）模型。采用CCK-8法评价水蛭素对OGD/R细胞活力的影响。水蛭素的血管生成潜能通过Transwell和管形成试验进行评价。在体内建立大鼠大脑中动脉闭塞/再灌注（MCAO/R）模型。采用改良神经系统严重程度评分（mNSS）、苏木精伊红（H&E）染色、氯化三苯四唑（TTC）染色和免疫荧光染色评估水蛭素的神经保护作用。为了研究Wnt/β-catenin通路的作用，我们引入了该通路的特异性抑制剂DKK-1。采用免疫组化、western blotting、逆转录定量聚合酶链反应（RT-qPCR）检测水蛭素对Wnt/β-catenin通路的影响。结果：水蛭素显著改善OGD/R模型BMEC存活，促进细胞迁移和小管形成。在MCAO/R模型中，水蛭素降低mNSS评分，减轻病理损伤，减小梗死体积，增加关键血管生成因子CD34、VEGF、Ang-2的表达。此外，水蛭素激活Wnt/β-catenin通路，导致Wnt3a和β-catenin水平升高。结论：水蛭素具有促进缺血半暗区血管生成的神经保护作用。这一机制是通过调节Wnt/β-catenin通路介导的。

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