JNNP: 不明原因栓塞性卒中患者的心房心脏病和非狭窄性颅内复杂动脉粥样硬化斑块

2021-12-09 MedSci原创 MedSci原创

未确定来源的栓塞性卒中(ESUS)一词用于描述在无明显近端动脉狭窄、主要心源性栓塞或其他特定病因的情况下发生的非腔隙性梗死。 隐匿性心房颤动最初被认为是ESUS的主要机制;然而,越来越多的证据表明,这

未确定来源的栓塞性卒中(ESUS)一词用于描述在无明显近端动脉狭窄、主要心源性栓塞或其他特定病因的情况下发生的非腔隙性梗死。 隐匿性心房颤动最初被认为是ESUS的主要机制。目前的证据表明,心房心脏病(AC)独立于心房颤动,在ESUS中是一个重要的潜在栓塞源。AC相关心电图(如V1导联P波终末力(PTFV1)、室上性早搏)、生化(如C反应蛋白、N端前体钠尿肽(NT-proBNP)和高敏心肌肌钙蛋白T(Hs-cTnT))和结构异常(如左房直径(LAD))与隐源性卒中/ESUS独立相关。主动脉、颅外和颅内非狭窄性动脉粥样硬化斑块,统称为心上动脉粥样硬化,作为ESUS中另一个显著的潜在栓塞源出现。最近研究报告,非狭窄性颅内复杂动脉粥样硬化斑块(NICAP)在梗死的同侧比对侧更普遍,支持NICAP在ESUS中的病因作用。

如果AC和同侧NICAP确实与ESUS有因果关系,则可以假设ESUS人群中存在这两种实体之间的负相关,但在其他中风人群中不存在这种负相关,这些人群在病因上与该实体无关,如因小血管疾病(SVD)导致的中风患者。本文旨在评估(1)在ESUS患者和SVD患者中AC和NICAP之间的相关性,以及(2)先前提出的生物标记物在确定AC为ESUS潜在病因方面的表现本文发表在《神经病学,神经外科学和精神病学杂志》上()。

403名受试者(243名ESU和160名SVD)被纳入最终分析。所有患者均接受颅内HR-MRI以评估同侧NICAP的存在。入院后24小时内收集AC的生物标志物(即心电图上V1导联的P波终末力(PTFV1)、N-终末普罗布林钠尿肽(NT-proBNP)、高敏心肌肌钙蛋白T和左心房直径)。

SVD和ESUS患者PTFV1增加和HR-MRI结果

结果显示AC在ESUS患者和SVD患者中更为普遍,进一步支持了AC和ESUS之间的关系。此外,在ESUS患者中,与同侧NICAP患者相比,无同侧NICAP患者的AC更为普遍,这一发现在SVD患者中并不明显,进一步支持了ESUS中AC与动脉粥样硬化斑块的明显关系。此外,排除同侧NICAP患者后,AC/AC相关生物标记物在区分ESU和SVD方面的表现显著改善。此外,排除具有AC/AC相关生物标记物的患者后,同侧NICAP区分ESU和SVD的能力明显增强。总的来说,这些结果支持这样的观点,即AC是ESUS患者的一个重要病因,而非同侧NICAP。此外,,AC唯一信息量最大的生物标志物是PTFV1。

总之,与患有同侧NICAP的患者相比,患有ESUS但未患同侧NICAP的患者AC更为普遍,这意味着AC和同侧NICAP是ESUS的两种不同的的病因。 

 

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    2021-12-27 ms6890017061391861

    写的真好

    0

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    2021-12-09 1244c0ebm28暂无昵称

    希望早日找到来源

    0

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    2021-12-09 sodoo

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动脉粥样硬化斑块破裂是心脑血管疾病如心肌梗死、脑卒中发病和死亡的主要原因,阐明动脉粥样硬化斑块稳定性的病理生理机制,寻找可干预和治疗的新靶点一直是国内外心血管领域的热点和难点。

Circulation:将LDL-C浓度控制在70 mg/dL以下或以上对颈动脉粥样硬化斑块发生的影响

TST试验显示,在2860例伴有脑血管粥样硬化性狭窄的缺血性卒中患者中,将低密度脂蛋白胆固醇浓度控制在70 mg/dL以下可降低主要心血管事件风险。但该策略对颈动脉粥样硬化演变的影响尚不明确

Stroke:软骨寡聚基质蛋白能够提示动脉粥样硬化斑块的易损性!

细胞外基质蛋白不仅能够影响斑块的稳定性,而且还能通过调整炎性反反应影响细胞内活动,其在动脉粥样硬化性疾病中非常重要。软骨寡聚基质蛋白(COMP)由平滑肌细胞表达并存在于健康人血管中。近期有研究发现将COMP表达缺失的骨髓移植到apoE-/- 小鼠上会导致动脉粥样硬化斑块形成增加,这表明骨髓中COMP的作用。尽管已有COMP在小鼠动脉粥样硬化性斑块形成的作用的证据,但尚无COMP在人类动脉粥样硬化性

Blood:口服Bruton酪氨酸激酶抑制剂可选择性阻滞动脉粥样硬化斑块触发的血栓形成

血管性血友病因子(VWF)和血小板糖蛋白(GP)Ib的相互作用,以及胶原蛋白和GPVI的相互作用,对创伤处血栓形成或侵蚀性动脉粥样硬化斑块形成均至关重要。GPIb和GPVI信号均是通过Bruton酪氨酸激酶(Btk)发挥作用;口服依鲁替尼,一种具有良好的长期安全性治疗慢性淋巴细胞白血病(CLL)的药物,能不可逆的抑制Btk。Kristina Busygina等人发现依鲁替尼和新型Btk抑制剂aca

JACC:人类动脉粥样硬化斑块中的血管滋养管

背景:以往的研究表明,血管滋养管(VV)与动脉粥样斑块的进展和脆弱性相关。    意义:本研究的目的是调查冠状动脉血管形成的结构和斑块特性之间的关系。    方法:该研究包括接受光学相干断层扫描来观察冠状动脉左前降支近端的53例患者。患者根据病变的特点分为5组:正常、纤维斑(FP)、纤维斑块(FA)、斑块破裂(PR)和纤维钙化斑块(FC)

拓展阅读

Neurology:卒中患者想要获得好预后,血管内治疗开始时间很重要

对于AIS患者,早上开始EVT可以改善中期功能,而在下班时段进行EVT可以降低患者中期功能预后。

J Clin Endocr Metab :卒中患者使用他汀 “骨足勇气”不是梦

卒中后骨密度(BMD)大量损失、步态障碍、平衡障碍和跌倒风险增加,因此卒中是骨质疏松和骨折的重要风险因素。骨折是卒中的常见并发症,可进一步阻碍卒中患者功能恢复、加重残疾和增加死亡率,并造成相当大的社会经济负担。因此,制定卒中幸存者骨质疏松和骨折预防策略势在必行。

J Nutr Health Aging:天坛医院研究称,卒中患者若维生素D不足,复发和死亡风险增加

北京天坛医院赵继宗院士等开展的一项2年随访研究提示,对于缺血性卒中患者,血清维生素D水平高一点比较好,血清维生素D水平较低的患者卒中复发和死亡的风险明显升高。 该研究对216例缺血性卒中患者随访了2年,卒中复发率为18.5%,死亡率为30.1%。 研究者指出,该研究表明,维生素D可能是我国缺血性卒中患者的独立保护因素。维生素D缺乏导致卒中复发和死亡风险升高的机制尚不明确。 校正已知危险因素后