Serum lipoprotein-associated phospholipase A2 level is positively correlated with the recurrence risk of acute ischemic cerebral infarction in hypertensive patients / 南方医科大学学报

OBJECTIVE@#To explore the relationship between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level and the risk of acute ischemic stroke (AIS) recurrence in hypertensive patients.@*METHODS@#This retrospective case-control study was conducted among 211 hypertensive patients with AIS treated in Foshan First People's Hospital, including 35 patients with recurrence of AIS during the 1-year follow-up as confirmed by head CT/MR. In the overall patients, 60 had grade 1 hypertension (including 5 recurrent cases), 76 had grade 2 hypertension (with 11 recurrent cases), and 75 had grade 3 hypertension (with 19 recurrent cases). Univariate analysis, multivariate logistic regression analysis, trend analysis, and smooth curve fitting analysis were performed to explore the correlation between serum Lp-PLA2 level within 24 h after admission and the risk of AIS recurrence. The predictive efficacy of serum Lp-PLA2 level for AIS recurrence in different hypertension grades was evaluated using ROC curve analysis.@*RESULTS@#Serum Lp-PLA2 level, age, NIHSS score at admission, mRS scores at 7 days, homocysteine level and smoking status differed significantly between patients with and without AIS recurrence (P < 0.05). After adjustment for confounding factors, multivariate regression analysis showed that the highest tertile of Lp-PLA2 level was associated with a 4.13-fold increase of AIS recurrence risk compared with the lowest tertile (OR=5.13, 95% CI: 1.35-19.40), and each 1 ng/mL increase of Lp-PLA2 level was associated with a 1% increase of AIS recurrence risk (OR= 1.01, 95% CI: 1.01-1.02). Serum Lp-PLA2 level was shown to positively correlate with AIS recurrence risk, and in patients with grade 3 hypertension, its areas under the ROC curve for predicting AIS recurrence was 0.869 with a specificity of 0.893 and a sensitivity of 0.737.@*CONCLUSION@#Serum Lp-PLA2 concentration is an independent risk factor and potentially an effective predictor for AIS recurrence in patients with grade 3 hypertension.

Changes of cognitive function and its correlated factors in patients with first acute cerebral ischemic stroke / 中华神经医学杂志

Objective To investigate the changes of cognitive impairment and its correlated factors in patients with first acute cerebral ischemic stroke.Methods Five hundred and sixty-eighty patients,admitted to our hospital from July 2010 to June 2011 and met the diagnostic criteria of first acute cerebral ischemic stroke,were chosen in our study; neuropsychological evaluation was conducted within 1 week of acute cerebral ischemic stroke.The comprehensive neuropsychological evaluation battery included mini-mental state examination (MMSE),Digit span,Mattis dementia scale,Rey complex figure test,stroop test,World Health Organization and University of California-Los Angeles auditory verbal learning test,semantic category verbal fluency test and clock drawing test,which contained tests for memory,attention,executive function,information processing capability,visuospatial and visuo constructive functions.Gender,age,histories of hypertension and smoking,and levels of blood pressure,random blood glucose,fasting blood glucose and 2-hour postprandial blood glucose,cholesterin,triglyceride,low density lipoprotein-C (LDL-C) and high density lipoprotein-C (HDL-C) were noted and the relations between cognitive function and both blood sugar and blood lipid levels were analyzed.Results (1) The abnormal rates of these patients in MMSE,Mattis dementia scale,attention deficit disorder,immediate logical memory disorder,delayed logical memory disorder,instant auditory memory disorder,delayed auditory memory disorder,visual memory disorder,executive function disorder,information processing disorder,and visuospatial and visuo constructive disorder were 78.2％,72.5％,26.5％,56.3％,60.9％,74.6％,98.2％,83.8％,62.7％,4.9％ and 77.7％,respectively.In patients with different blood glucose levels,significant differences were found on scores of MMSE,Mattis dementia scale,attention scale (P＜ 0.05); furthermore,the scores ofMMSE,Mattis dementia scale,attention scale in patients with impaired fasting glucose were obviously lower as compared with those in other groups (P＜0.05).The scale of above cognitive domains showed no significant difference in patients with different types of hyperlipidemias (P＞0.05); the scores of execution ability and visual space structure capability in patients with HDL-C were higher than those in normal density lipoprotein-C and LDL-C (P＜0.05),and the higher level of density lipoprotein-C,the higher scores of visual space structure capability (P＜0.05).Logistic regression analysis found that the total MMSE scores were associated with gender,age,and levels of fasting blood glucose and 2-hour postprandial blood glucose; the independent risk factors of executive function were gender,age and HDL-C level; the ability of memory was correlated with age and HDL-C level.Visuospatial and visuo constructive function was associated with gender,age and mRS scores; the information processing ability was only correlated with HDL-C level.Conclusion In patients with acute cerebral ischemic stroke,the cognitive impairment is extensive and severe,with a prevalence of about 75％,mainly having disorders in memory,executive ability,spatial structure; glucose levels,especially impaired fasting glucose level show most obvious influence in cognitive impairment;HDL-C level helps keep normal cognitive function; age,gender,HDL-C level are the most important factors of cognitive function.

Correlation between impaired glucose tolerance and carotid atberomatous plaque in patients with acute cerebral infarction / 中华神经医学杂志

Objective To investigate the relationship between impaired glucose tolerance(IGT)and carotid atheromatous plague in patients with acute cerebral infarction and analyze the risk factors for plaque formation.Methods The 326 patients hospitalized in our department for acute cerebral infarction were divided into diabetes mellitus(DM)group,IGT group and normal glucose tolerance (NGT)group.The clinical features,biochemical indices and results of Doppler ultrasound examination of the carotid artery were compared between the 3 groups.Results The body mass index(BMI),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C)of IGT group were markedly higher than those in NGT group(P＜0.05).Both the IGT and DM group showed significantly increased carotid intimal-medial thickness,plaque detection rate and the incidence of carotid scleratheroma in comparison with the NGT group(P＜0.05).Logistic regressive analysis identified age,TC,LDL-C and 2-h postprandial serum glucose as the independent risk factors for carotid scleratheroma.Conclusion In patients with acute cerebral infarction,those having impaired glucose often show obvious carotid scleratheroma with a severity similar to that in the DM patients.

Relationship between intermediate hyperglycemia and acute cerebrovascular disease / 中华神经医学杂志

Objective To study the relationship between intermediate hyperglycemia and acutece rebrovascular disease. Methods 365 consecutive patients with acute cerebrovascular disease were enrolled. The fasting, non-fasting plasma glucose levels and lipid levels were measured. The non-diabetes patients undergone oral glucose tolerance test (OGTT) 1 week after the onset of the disease. All were classified as having normal glucose tolerance (NGT), intermediate hyperglycemia [IFG(impaired fasting glucose), IGT(impaired glucose tolerance), and co-existence of IFG and IGT] and diabetes mellitus (DM). The rates of the accepted risk factors for atherosclerosis (AS), the severity of the stroke and AS on B scan were compared among the groups. Results The rates of IFG, IGT, and co-existence of IFG and IGT were 1.37%, 24.66%, and 3.01%, respectively. The rate of hypertension was higher in DM subjects (P= 0.007) than in NGT subjects, while the rates in NGT subjects and in DM subjects compared with that in intermediate hyperglycemia subjects were not of statistical significance (P>0.05). And there were no statistical significances in the rates of smoking, drinking and dyslipidemia. Meanwhile no statistical significances were found in the severity of the stroke and the signs of AS detected by duplex scanning (P>0.05). Conclusion Intermediate hyperglycemia is common in the patients with acute cerebrovascular disease. R is important in the pathogenesis of cerebrovascular disease when combined with the other risk factors for AS.

Study on blood lipids of patients with ischemic cerebral vascular disease / 中华神经科杂志

Objective To study blood lipids levels of patients with ischemic cerebral vascular disease (ICVD).Methods The blood lipids levels were measured in 2886 subjects with ICVD enrolled from 1991 to 2004,in which 1430 subjects from 2000 to 2004 were classified into a sub-group;400 healthy persons receiving physical examination were enrolled as controls.Results The blood TC,TG and LDL-C levels were significantly higher in the sub-group than those in the control group.Both in males and females, the morbidity of abnormal blood lipid metabolism and blood lipids level gradually increased with the age and the lapse of decades.Total cholesterol level of male younger than fifty,averaging (4.43?0.51) mmol/L, increased to (4.96?0.85) mmol/L after fifty years old.The same thing happened to females,from (4.30?0.49) mmol/L to (5.01?0.90) mmol/L.TG and LDL-C increased in patients older than fifty compared with those younger than fifty.In the groups above 50 years old,the blood lipids levels of females were significantly higher than those of males.The morbidity of abnormal blood lipid metabolism of male increased from 24.5% in (1991 to 1994) to 38.1% (2001 to 2004) and of female from 22.3% (1991 to 1994) to 38.5% (2001 to 2004).Conclusions Abnormal blood lipid in Foshan is one of the most important reasons to ICVD.