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OBJECTIVE：To sy stematically evaluate the efficacy and safety of a spirin combined with clopidogrel in the treatment of progressing stroke. METHODS ：Retrieved from the Cochrane library ，PubMed，Embase，Clinical trials.gov ，CBM， VIP，Wanfang database and CNKI databases ，randomized controlled trials （RCTs）about aspirin combined with clopidogrel （trial group）versus aspirin or clopidogrel alone （control group ）in the treatment of progressing stroke were collected. After literature screening and data extraction ，the quality of literatures were evaluated with bias risk assessment tool recommended by Cochrane system evaluator manual 5.2. Meta-analysis was performed by using Rev Man 5.3 software. RESULTS ：A total of 27 RCTs involving 2 854 patients were enrolled. The results of Meta-analysis showed that response rate of trial group was significantly higher than aspirin group [RR ＝1.31，95％CI（1.26，1.37），P＜0.000 01]；Neurological deficit score （NDS）of trial group was significantly lower than control group [MD ＝－3.80，95％CI（－5.30，－2.30），P＜0.000 01]；National Institutes of Health Stroke Scale Score in trial group was significantly lower than aspirin group [MD ＝－3.72，95％CI（－5.25，－2.20），P＜0.000 01] and clopidogrel group [MD ＝－2.44，95％CI（－4.14，－0.73），P＝0.005]. Results of subgroup analysis showed that NDS score of trial group was significantly lower than control group after 14 d of treatment [MD ＝－2.19，95％CI（－3.11，－1.27），P＜0.000 01]，15 d of treatment [MD ＝－5.73，95％CI（－10.65，－0.81），P＝0.02] and 28 d of treatment [MD ＝－3.45，95％CI（－4.24，－2.67），P＜ 0.000 01]. Compared with trial group ，there was no statistical significance in response rate with clopidogrel group ，the incidence of ADR with clopidogrel group ，the incidence of bleeding event with clopidogrel group ，and mortality with control group （P＞0.05）. CONCLUSIONS：Aspirin combined with clopidogrel in the ； treatment of progressive stroke ，can improve the efficacy and improve neurological deficit symptoms in the short term ，but can not reduce the incidence of ADR or the mortality during E-mail：wuyanzi89@126.com the treatment.
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BACKGROUND: Progressing stroke (PS) variably develops from initially the same size and severity, and is most frequently observed in lacunar infarctions. We investigated fractional anisotrophy (FA), mean diffusivity (MD) and infarct volume by using diffusion tensor imaging during the acute phase of ischemic stroke to determine whether these parameters are useful in characterizing and predicting PS. METHODS: In this study, 55 consecutive patients admitted within 24 hours of the onset of their first ischemic stroke were included. NIH stroke scale (NIHSS) and Canadian Neurological scale (CNS) were performed upon admission, twice a day, and at discharge. Modified Rankin scale and Barthel index were also evaluated. PS was defined as a 2-point drop in NIHSS and a 1-point drop in CNS from admission to day 3. A correlation analysis was performed between clinical scale scores and imaging parameters, and the distribution of those values was compared between the two groups with and without PS. RESULTS: Significant correlations were observed between clinical scale scores and infarct volumes. The FA ratio in 14 patients with PS was lower than the patients without PS (p=0.004). Other characteristics including infarct volume and MD ratio were not different. The FA ratio remained as an independent predictor of PS (OR, 1.055; p=0.011). CONCLUSIONS: In acute ischemic stroke within the first 24 hours, only infarct volume was correlated with clinical status. However, patients with PS showed lower FA values, which accounts for rapid and severe vasogenic edema involving the disruption of the cell membrane and axonal fibers. Moreover, FA may be a predictor of PS.
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Humans , Anisotropy , Axons , Cell Membrane , Diffusion Tensor Imaging , Diffusion , Edema , Stroke , Stroke, LacunarABSTRACT
@#ObjectiveTo investigate the relationship between complement-3(C3) and progression of early cerebral infarction.Methods168 consecutive patients with acute cerebral infarction within the first 24 hours from onset were recruited.Fasting venous blood sample was drawn on the morning of the second or the third day after admission.C3 and other clinical chemistry variables were measured.The relationship of C3 and progressing stroke(PS) was analyzed by Logistic regression.Results68 cases(40.48%) were considered as PS.Level of serum C3 in PS patients was 1.28±0.20 g/L higher than in those with non-PS(1.16±0.25 g/L,P=(0.000)).A higher C3 accompanied a higher tendency of prevalence of PS(P=0.001).Logistic regression analysis showed that C3 was significantly correlated with PS(OR for each 1.0 g/L=7.27;95% CI=1.52～36.39; P=0.013).ConclusionElevated serum C3 may play an important role in the prevalence of PS.
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@#ObjectiveTo investigate the relationship between carotid atherosclerosis and progressing stroke.Methods103 patients with acute cerebral infarction within the first 24 hours from onset were tested with carotid color doppler ultrasonography during the first week from admission. Univariate and multiple logistic regression analyses were performed to examine the relationship between carotid intima media thickness (IMT), plaque structure, the degree of artery stenosis and the early deterioration of cerebral infarction.ResultsPrevalence of carotid plaque and thickness of IMT in patients with progressing stroke were higher than that in non progressing patients. In logistic regression, presence of carotid plaque was independent predictors of progressing stroke. Plaque size, extent of artery stenosis and IMT were not included in the regression model.ConclusionPlaque structure and its chemical feature may be the cause of progressing stroke.