Neurocrit Care:严重心源性卒中发病2h内输注高剂量白蛋白有获益的趋势

2018-03-29 杨中华 脑血管病及重症文献导读

2018年2月来自美国的Rakesh Khatri等在Neurocrit Care上发表了他们的研究结果,他们利用ALIAS试验的数据,分析了NIHSS >=15分的心源性卒中患者(n=189)采用高剂量白蛋白的疗效。

临床前研究和II期临床研究显示高剂量白蛋白能够降低神经功能缺损,改善预后。ALIAS(Albumin in Acute Ischemic Stroke)试验的第1和2部分评价了25%人血白蛋白是否能够改善急性缺血性卒中的临床预后(vs标准治疗)。为了纳入更多的患者,该研究的纳入标准比较广泛,并评价了不同亚组的疗效。在第1部分研究中,因为安全性问题被提前终止;在第2部分研究中,因为未发现白蛋白优越性(vs 盐水)也被提前结束。

2018年2月来自美国的Rakesh Khatri等在Neurocrit Care上发表了他们的研究结果,他们利用ALIAS试验的数据,分析了NIHSS >=15分的心源性卒中患者(n=189)采用高剂量白蛋白的疗效。

他们发现高剂量白蛋白静脉输注者(n = 100)3个月的优良预后(mRS 0-1)与安慰剂(n = 89)相比没有显著性差异(OR 1.632, 0.719–3.708;p = 0.2419)。当作者按照输注时间进行分类并调整混淆因素后,他们发现发病2h内输注高剂量白蛋白者(vs 安慰剂)3个月优良预后具有显著性(OR 9.369 CI 1.040–84.405, p = 0.0461)。

最终作者认为该研究发现NIHSS>=15分的心源性卒中患者于发病2h内输注高剂量白蛋白有获益的趋势。

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    2018-10-19 amy0550
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    2019-01-20 linlin2312
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    2018-07-11 tree211

    脑缺血早期通过白蛋白扩容改善脑血流量可能是获益的原因

    0

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createdTime=Sun Apr 01 08:32:27 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301570, encodeId=3e5c3015e050, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5KiblTyxD95ExbzUoCVcRuhPibXboL28wicFMTXUhCA0RWCyQZYC5Na3ap7CxjialMkB50VEJ0XToQQTC/0, createdBy=470c1945776, createdName=方舒, createdTime=Sat Mar 31 22:54:15 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304615, encodeId=c6e9130461505, content=<a href='/topic/show?id=cd37e1767b5' target=_blank style='color:#2F92EE;'>#白蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71767, encryptionId=cd37e1767b5, topicName=白蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25d7319, createdName=珙桐, createdTime=Sat Mar 31 13:03:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593471, encodeId=b59c15934e154, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Sat Mar 31 13:03:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301302, encodeId=f0a630130201, content=不错.提高临床思维.多多学习., beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Mar 30 23:56:41 CST 2018, time=2018-03-30, status=1, ipAttribution=)]
    2018-04-04 大爰

    学习了谢谢分享学习!!

    0

  5. 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createdTime=Sun Apr 01 08:32:27 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301570, encodeId=3e5c3015e050, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5KiblTyxD95ExbzUoCVcRuhPibXboL28wicFMTXUhCA0RWCyQZYC5Na3ap7CxjialMkB50VEJ0XToQQTC/0, createdBy=470c1945776, createdName=方舒, createdTime=Sat Mar 31 22:54:15 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304615, encodeId=c6e9130461505, content=<a href='/topic/show?id=cd37e1767b5' target=_blank style='color:#2F92EE;'>#白蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71767, encryptionId=cd37e1767b5, topicName=白蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25d7319, createdName=珙桐, createdTime=Sat Mar 31 13:03:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593471, encodeId=b59c15934e154, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Sat Mar 31 13:03:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301302, encodeId=f0a630130201, content=不错.提高临床思维.多多学习., beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Mar 30 23:56:41 CST 2018, time=2018-03-30, status=1, ipAttribution=)]
    2018-04-02 张新亮1853311252142e2fm

    很实用的文献.学习了

    0

  6. 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createdTime=Sun Apr 01 08:32:27 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301570, encodeId=3e5c3015e050, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5KiblTyxD95ExbzUoCVcRuhPibXboL28wicFMTXUhCA0RWCyQZYC5Na3ap7CxjialMkB50VEJ0XToQQTC/0, createdBy=470c1945776, createdName=方舒, createdTime=Sat Mar 31 22:54:15 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304615, encodeId=c6e9130461505, content=<a href='/topic/show?id=cd37e1767b5' target=_blank style='color:#2F92EE;'>#白蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71767, encryptionId=cd37e1767b5, topicName=白蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25d7319, createdName=珙桐, createdTime=Sat Mar 31 13:03:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593471, encodeId=b59c15934e154, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Sat Mar 31 13:03:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301302, encodeId=f0a630130201, content=不错.提高临床思维.多多学习., beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Mar 30 23:56:41 CST 2018, time=2018-03-30, status=1, ipAttribution=)]
    2018-04-01 yfjms

    学习

    0

  7. 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createdTime=Sun Apr 01 08:32:27 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301570, encodeId=3e5c3015e050, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5KiblTyxD95ExbzUoCVcRuhPibXboL28wicFMTXUhCA0RWCyQZYC5Na3ap7CxjialMkB50VEJ0XToQQTC/0, createdBy=470c1945776, createdName=方舒, createdTime=Sat Mar 31 22:54:15 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304615, encodeId=c6e9130461505, content=<a href='/topic/show?id=cd37e1767b5' target=_blank style='color:#2F92EE;'>#白蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71767, encryptionId=cd37e1767b5, topicName=白蛋白)], 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    2018-03-31 方舒

    学习

    0

  8. 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createdTime=Sun Apr 01 08:32:27 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301570, encodeId=3e5c3015e050, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5KiblTyxD95ExbzUoCVcRuhPibXboL28wicFMTXUhCA0RWCyQZYC5Na3ap7CxjialMkB50VEJ0XToQQTC/0, createdBy=470c1945776, createdName=方舒, createdTime=Sat Mar 31 22:54:15 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304615, encodeId=c6e9130461505, content=<a href='/topic/show?id=cd37e1767b5' target=_blank style='color:#2F92EE;'>#白蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71767, encryptionId=cd37e1767b5, topicName=白蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25d7319, createdName=珙桐, createdTime=Sat Mar 31 13:03:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593471, encodeId=b59c15934e154, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Sat Mar 31 13:03:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301302, encodeId=f0a630130201, content=不错.提高临床思维.多多学习., beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Mar 30 23:56:41 CST 2018, time=2018-03-30, status=1, ipAttribution=)]
    2018-03-31 珙桐
  9. [GetPortalCommentsPageByObjectIdResponse(id=1942086, encodeId=74c01942086b3, content=<a href='/topic/show?id=065b1022341a' target=_blank style='color:#2F92EE;'>#高剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102234, encryptionId=065b1022341a, topicName=高剂量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=010d202, createdName=amy0550, createdTime=Fri Oct 19 11:03:00 CST 2018, time=2018-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1976947, encodeId=1bba19e694795, content=<a href='/topic/show?id=b9f11560065' target=_blank style='color:#2F92EE;'>#ROC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15600, encryptionId=b9f11560065, topicName=ROC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d590125, 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createdTime=Sun Apr 01 08:32:27 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301570, encodeId=3e5c3015e050, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5KiblTyxD95ExbzUoCVcRuhPibXboL28wicFMTXUhCA0RWCyQZYC5Na3ap7CxjialMkB50VEJ0XToQQTC/0, createdBy=470c1945776, createdName=方舒, createdTime=Sat Mar 31 22:54:15 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304615, encodeId=c6e9130461505, content=<a href='/topic/show?id=cd37e1767b5' target=_blank style='color:#2F92EE;'>#白蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71767, encryptionId=cd37e1767b5, topicName=白蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25d7319, createdName=珙桐, createdTime=Sat Mar 31 13:03:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593471, encodeId=b59c15934e154, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Sat Mar 31 13:03:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301302, encodeId=f0a630130201, content=不错.提高临床思维.多多学习., beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Mar 30 23:56:41 CST 2018, time=2018-03-30, status=1, ipAttribution=)]
    2018-03-31 mhm295
  10. 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createdTime=Sun Apr 01 08:32:27 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301570, encodeId=3e5c3015e050, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5KiblTyxD95ExbzUoCVcRuhPibXboL28wicFMTXUhCA0RWCyQZYC5Na3ap7CxjialMkB50VEJ0XToQQTC/0, createdBy=470c1945776, createdName=方舒, createdTime=Sat Mar 31 22:54:15 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304615, encodeId=c6e9130461505, content=<a href='/topic/show?id=cd37e1767b5' target=_blank style='color:#2F92EE;'>#白蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71767, encryptionId=cd37e1767b5, topicName=白蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25d7319, createdName=珙桐, createdTime=Sat Mar 31 13:03:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593471, encodeId=b59c15934e154, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Sat Mar 31 13:03:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301302, encodeId=f0a630130201, content=不错.提高临床思维.多多学习., beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Mar 30 23:56:41 CST 2018, time=2018-03-30, status=1, ipAttribution=)]
    2018-03-30 1de3b290m83(暂无匿称)

    不错.提高临床思维.多多学习.

    0

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背景:心源性脑卒中(CES)患者比其它原因脑卒中预后更差。在CES患者中,心房颤动(AF)是一种常见的合并症。越来越多的数据显示,房颤可能与急性脑血栓栓塞卒中的病理机制相关。研究者试图确定房颤是否是CES患者卒中严重程度和预后的独立预测因素。方法:研究者回顾性分析学术医疗中心卒中登记的急性大脑半球CES的患者。应用缺血性脑卒中的病因分类系统的确定CES的发生。应用多因素逻辑回归分析确定房颤与90天

JAMA N:心源性卒中早期利伐沙班vs华法林

在卒中早期阶段,房颤相关急性缺血性卒中的复发缺血性卒中和脑出血的风险很高,包括出血转化。因为增加症状性颅内出血的风险,不推荐使用肝素。然而,如果使用阿司匹林治疗,房颤相关缺血性卒中2周内发生复发性缺血性卒中的几率为5%。临床上卒中后最常用的抗栓药物是阿司匹林,几天后或1-2周后当颅内出血的风险下降后开始给予口服抗凝剂治疗。但是,对于急性缺血性卒中,何时何人选择何种药物进行口服抗凝药物治疗尚不清

Stroke: 脑白质高信号与腔隙性脑梗死风险增加相关

背景:腔隙性脑梗死的患者脑白质高信号(WMH)增加。这两者是否有共同的发病机制尚不清楚。研究者利用遗传数据,评估WMH相关遗传易感性因素是否与腔隙性脑梗死的风险一致,因此判断两者是否有共同的机制。方法:研究者应用遗传风险评分的方法来探讨社区人群WMH相关的单核苷酸多态性是否与MRI证实存在腔隙性脑梗死(n = 1373),心源性栓塞(n = 1331)和大血管性梗死(n = 1472)相关。急性脑