新聞動態(tài)
經(jīng)顱（TCD）常規(guī)應用主要包含：
腦動脈狹窄與閉塞的診斷，側(cè)枝代償?shù)呐袛啵?/span>
腦血流微栓子監(jiān)測；
蛛網(wǎng)膜下腔出血（SAH）腦動脈痙攣的監(jiān)測；
卵圓孔未閉篩查（發(fā)泡試驗）
......
--北京協(xié)和醫(yī)院徐蔚海教授（德力凱臺歷TCD應用章節(jié)）
《HindawiDisease MarkersVolume 2019, Article ID 3090364, 7 pages》
作者：Yanyan Cao, Congxian Cui, Hongqin Zhao , Xudong Pan , Wenjian Li, Kun Wang , and Aijun Ma
【Abstract】
Background Instability of atherosclerotic plaques is associated with the occurrence of stroke. Microembolic signals (MESs) are anindicator of unstable plaque. A relationship between plasma osteoprotegerin (OPG) and ischemic stroke has already beenidentifified. The aim of this study was to investigate whether plasma OPG levels have a relationship with MESs and to evaluatethe feasibility of OPG as a biomarker of stroke severity and occurrence of MESs.
Methods Our study consisted of 127 patientswith large artery atherosclerosis stroke and 56 controls. Patients were classifified into subgroups based on stroke severity andthe occurrence of MESs. MES-monitoring was performed for 60 min using transcranial Doppler 【Delica EMS-9EB】within 72 h of strokeonset. Stroke severity at admission was assessed by the National Institutes of Health Stroke Scale.
Results Plasma OPGlevels were signifificantly associated with stroke, MESs, and stroke severity at admission (adjusted OR [95% CI]: 1.002[1.001–1.003] p < 0 001; 1.002 [1.001–1.003] p = 0 001; 1.001 [1.000–1.002] p = 0 028). When plasma OPG levels were used todetermine the stroke severity, the area under the receiver-operating characteristic curve (AUC) was 0.734 (95% CI: 0.625-0.843)based on a cutoffff value of 1998.44 pg/ml; the sensitivity and specifificity of this test were 80.6% and 65.6%, respectively.Furthermore, when the levels of OPG were used to distinguish the presence of MESs, the AUC was 0.766 (95% CI: 0.672-0.860);the cutoffff value was 2107.91 pg/ml. The sensitivity of this cutoffff value was 68.8% and the specifificity was 73.7%.
Conclusions Plasma OPG levels correlate with stroke severity and the occurrence of MESs.
（Interactive CardioVascular and Thoracic Surgery 26 (2018) 834–839）
作者：Rudolf W.M. Keunen-Department of Neurology, Haga Teaching Hospitals, Leyweg 275, 2545 CH The Hague, Netherlands
OBJECTIVES: Reducing the rate of postoperative stroke after cardiac surgery remains challenging, especially in patients with occlusive cerebrovascular disease. Angioplasty in all patients with high-grade carotid artery stenosis has not been shown to be effective in reducing thepost-surgical stroke rate. In this study, we present the initial results of a different approach using selective carotid angioplasty only inpatients with poor intracranial collaterals.
METHODS: We conducted a single-centre study to assess the safety of this procedure. The postangioplasty complication rate of the studygroup was compared to that of patients who were scheduled for symptomatic carotid artery angioplasty. To determine the effectiveness ofthis procedure, the post-cardiac surgery complication rate of the study group was compared with that of the matched case controls.
RESULTS: Twenty-two patients were treated with selective carotid angioplasty without developing persistent major neurological complications. All patients except 1 patient subsequently underwent surgery without developing persistent major neurological disabilities. Twopatients died of cardiogenic shock within 30 days.
CONCLUSIONS: Selective carotid angioplasty prior to cardiac surgery in patients with a presumed high risk of stroke was relatively safeand effective in this study group. Although this strategy does not prevent stroke in these high-risk patients, data suggest that this approachshifts the postoperative type of stroke from a severe haemodynamic stroke towards a minor embolic stroke with favourable neurologicaloutcomes. Larger studies are needed to determine whether this strategy can effectively eliminate the occurrence of haemodynamic strokeafter cardiac surgery.
（Echocardiography.2014 Nov;31(10):1283-92）
作者：He Yitao, M.D；Guo Yi, M.D., Ph.D., Department of Neurology, ShenzhenPeople’s Hospital
（中國組織化學與細胞化學雜志第22卷第４期2013年８月）
作者：陸首玲 梅志忠 李龍宣 彭蘭芬
〔摘要〕
目的 探討 ＴＣＤ微栓子（ＭＥＳ）監(jiān)測及超敏 Ｃ反應蛋白和白介素－６檢測在２型糖尿病合并急性腦梗死發(fā)病中的意義。
方法 序貫收集２０１１年１月至２０１２年６月在我院神經(jīng)內(nèi)科住院的首次前循環(huán)腦梗死患者９０例，根 據(jù) 是 否 合 并２型糖尿病分為糖尿病合并腦梗死組（觀察組）４５例，單純急性腦梗死組４５例（腦梗死組），另外，隨機收集同期我院內(nèi)分泌科首次住院的單純２型糖尿病患者４５例（糖尿病組），監(jiān)測三組患者病灶側(cè)大腦中動脈（ＭＣＡ）微栓子陽性率及微栓子數(shù)目，血 清超敏 Ｃ反應蛋白及白介素－６值，分析三組患者中微栓子及相關炎性因子檢測的意義。
結(jié) 果 觀察組腦血管微栓子監(jiān)測數(shù)量和 Ｈｓ－ＣＲＰ血清檢測水平較腦梗死組和糖尿病組均顯著增高（Ｐ＜０．０５和Ｐ＜０．０１）。觀察組和腦梗死組血清白介素－６檢測水平與糖尿病組相比顯著增高（Ｐ＜０．０５），但觀察組與腦梗死組相比無統(tǒng)計學意義（Ｐ＞０．０５）。
結(jié)論 糖尿病合并急性腦梗死患者微栓子數(shù)目和血清 Ｈｓ－ＣＲＰ、白介素－６水平明顯增高，提示糖尿病腦梗死患者血管內(nèi)炎性斑塊不穩(wěn)定程度增加，再發(fā)卒中的風險明顯增高。
