JNNP:脑卒中缺血中心区发病进展的昼夜节律

2021-05-28 MedSci原创 MedSci原创

了解急性脑梗死进展的决定因素对大血管闭塞(LVO)卒中患者的最佳治疗和随机对照试验的设计至关重要。最近研究发现,实验性脑卒中后,卒中发作的时间会影响梗死进展和神经保护策略的治疗效果。具体来说,在啮齿动

了解急性脑梗死进展的决定因素对大血管闭塞(LVO)卒中患者的最佳治疗和随机对照试验的设计至关重要。最近研究发现,实验性脑卒中后,卒中发作的时间会影响梗死进展和神经保护策略的治疗效果。具体来说,在啮齿动物的非活动期(即白天)诱发的中风与活动期诱导相比,表现出更快的梗死进展和更明显的神经保护治疗益处,

在夜间。考虑到啮齿动物和人类相反的休息-活动周期,这可能解释了临床试验中神经保护策略的局限性,而临床试验主要在白天招募患者。发病时间是否真的影响了人类中风的急性梗死进展尚不清楚。这些发现将有助于调整急性中风试验的设计,本文通过荟萃分析来自三个独立和前瞻性招募的前LVO卒中患者队列的数据,探讨了缺血侧中心区和半影体积是否显示24小时左右的(“昼夜节律”)节律。

患者入院时进行CT成像。CT数据使用syngo Neuro Perfusion CT(Siemens Healthineers,Forchheim,Germany)进行处理,包括基于阈值的缺血侧中心区和半影体积。错配率计算为总体积与中心区体积之比。如果没有在每个患者的不同时间点进行多次测量,本文假设核心生长呈线性函数,并将其计算为中心区体积和发病时间与成像时间的比值(单位:mL/h)。由经验丰富的放射科医生在所有部位评估CT血管造影区域软脑膜侧枝评分的4个方面。

采用单变量或多变量线性回归分析,将症状出现的时间分为“早晨”(上午3:00-9:00)、“白天”(上午9:00-下午3:00)三组,探讨影像学参数的昼夜节律,根据年龄、开始成像时间、侧枝评分和中心调整分析。为了检测不受时间窗选择影响的连续时间尺度的昼夜节律,在线性回归出混杂因素年龄、侧枝评分、开始成像时间和中心后,进一步使用“R”软件包“DiscoRhymatch”7进行回归分析。

Figure 1

缺血性脑卒中后中心区体积和生长的昼夜节律

分析了来自三个队列(慕尼黑:N=314,巴塞尔:N=155;戈廷根:N=114)。患者的中位年龄为76岁,入院时美国国立卫生研究院卒中量表(NIHSS)评分中位数为15分,中位发病至影像学时间为139分钟 起病时间最短的是上午19.2%,白天32.6%,晚上27.3%,晚上20.9%。与白天发病的患者相比,夜间发病的患者入院时的缺血中心区体积更大。为了确定这种模式是否依赖于总缺血体积的变化,我们探讨了错配率(总体积除以中心心体积)的潜在昼夜节律性。夜间发作时的失配率最低。午夜前后发病的患者与中午前后发病的患者相比,表现出更大的缺血中心区容量和更快的发病进展。与白天发病相比,夜间发病患者的治疗窗口可能关闭得更快。因此,对于夜间发病的患者,血管内治疗和静脉溶栓的时间可能更为重要。

本文为夜间发病的患者入院时缺血中心区体积的昼夜节律以及梗死进展较快的中心区生长提供了证据。需要进一步的研究来更好地理解潜在的病理生理学以及这些节律是否也会影响急性中风治疗的疗效。

Reidler PBrehm ASporns PB, et al Circadian rhythm of ischaemic core progression in human stroke

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    2021-06-02 124292adm29暂无昵称

    了解病因,预防卒中

    0

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    2021-05-29 1464fd54m95暂无昵称

    👍👍

    0

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    2021-05-29 学医无涯

    发生时间有规律

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=970214, encodeId=860c9e02146b, content=了解病因,预防卒中, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/vyAkV8zQqYbLSIGQRrZmSqLvwibFDXpiaOuvIibCUFSwLp2ID4nTOupHSU2ygjh7vUqoibglOLZwQrrF8SdchMVIibg/132, createdBy=02b72465928, createdName=124292adm29暂无昵称, createdTime=Wed Jun 02 06:31:32 CST 2021, time=2021-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=969504, encodeId=4ddf96950488, content=<a href='/topic/show?id=c19159e1570' target=_blank style='color:#2F92EE;'>#昼夜节律#</a><a href='/topic/show?id=b64035999ca' target=_blank style='color:#2F92EE;'>#卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59715, encryptionId=c19159e1570, topicName=昼夜节律), TopicDto(id=35999, encryptionId=b64035999ca, topicName=卒中)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=小小医者, createdTime=Sat May 29 19:05:14 CST 2021, time=2021-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=969473, encodeId=3c839694e39a, content=👍👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cf515128783, createdName=1464fd54m95暂无昵称, createdTime=Sat May 29 17:18:22 CST 2021, time=2021-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=969342, encodeId=ab209693426f, content=发生时间有规律, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Sat May 29 07:09:46 CST 2021, time=2021-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=969340, encodeId=43cf96934078, content=👍👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b90a5483480, createdName=保永亮, createdTime=Sat May 29 07:03:21 CST 2021, time=2021-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026869, encodeId=8291102686988, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sat May 29 01:49:53 CST 2021, time=2021-05-29, status=1, ipAttribution=)]
    2021-05-29 保永亮

    👍👍

    0

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    2021-05-29 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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