脑卒中是当代社会人类第二大死因,每年全球大约有550万人因脑卒中死亡,尤以缺血性脑卒中最为常见。在我国,脑卒中是成人致死、致残的首位病因,给患者及其家庭造成巨大的经济负担。医学影像学在急性脑卒中的诊疗中起到至关重要的辅助作用。随着计算机技术的快速发展,近年来人工智能广泛应用于医学影像领域,在缺血性脑卒中的早期筛查、梗死灶识别和缺血半暗带评估、血管闭塞识别、疗效评估和预后预测方面显示出巨大的应用价值。本文旨在讨论人工智能在缺血性脑卒中诊疗中应用及优缺点。Stroke is the second leading cause of death in contemporary society. There are about 5.5 million people die of stroke in the world every year, especially ischemic stroke. Stroke is the leading cause of adult death and disability in China, which brings huge economic burden to patients and their families. Medical imaging plays an important auxiliary role in the diagnosis and treatment of acute stroke. With the rapid development of computer technology, artificial intelligence has been widely used in the field of medical imaging in recent years, which has shown great application value in the early screening of ischemic stroke, identification of infarction and ischemic penumbra, identification of vascular occlusion, efficacy evaluation and prognosis prediction. This article aims to discuss the application, advantages and disadvantages of artificial intelligence in the diagnosis and treatment of ischemic stroke.
卒中后抑郁(post stroke depression, PSD)是脑卒中患者非常常见的并发症,其三大核心症状是:心情低落、兴趣减退及易疲劳,卒中后抑郁可发生在卒中后急性期,中期和恢复期,其发生率均在30%左右。目前卒中后抑郁的发病机制尚不清楚。犬尿氨酸代谢途径(kynurenine pathway, KP)被认为是连接神经系统免疫炎性反应等多个系统与抑郁症的主要途径。本文就犬尿氨酸代谢途径参与卒中后抑郁的病理生理学机制及其调控对抑郁症状的影响的研究做一综述,旨在为进一步研究抑郁的形成机制提供参考。Post stroke depression (PSD) is a very common complication in stroke patients, with three core symptoms: depressed mood, loss of interest and fatigue. PSD can occur in the acute, middle and recovery periods after stroke, with an incidence rate of about 30%. The pathogenesis of post-stroke depression is still unclear. The kynurenine pathway (KP) is thought to be a major pathway linking multiple systems, including the immune-inflammatory response of the nervous system, to depression. In this paper, we present a review on the pathophysiological mechanisms of kynurenine pathway involved in post-stroke depression and its modulation on depressive symptoms, with the aim of providing a reference for further research on the formation mechanisms of depression.
目的探讨尿激酶和阿替普酶治疗超高龄急性缺血性脑卒中(AIS)患者的效果。方法回顾性分析重庆医科大学附属永川医院2017年6月至2020年10月收治的106例超高龄AIS患者的临床资料。根据溶栓药物不同将其分为尿激酶组(44例)和阿替普酶组(62例)。使用倾向性评分匹配筛选出两组29对患者,其中尿激酶组含大血管闭塞(LVO)患者17例和非LVO患者12例,阿替普酶组含LVO患者20例和非LVO患者9例。比较两组的基线资料及观察指标[良好预后率、90 d改良Rankin量表(mRS)评分、美国国立卫生研究院卒中量表评分变化、死亡率、脑出血率、症状性脑出血率和颅外出血率]。结果匹配前,尿激酶组的发病至溶栓时间长于阿替普酶组,差异有统计学意义(P<0.05),其他基线资料和观察指标比较,差异无统计学意义(P>0.05)。匹配后,两组基线资料和观察指标比较,差异无统计学意义(P>0.05)。在LVO患者中尿激酶组良好预后率低于阿替普酶组,90 d mRS评分高于阿替普酶组,差异有统计学意义(P<0.05)。在非LVO患者中两组观察指标比较,差异无统计学意义(P>0.05)。结论尿激酶静脉溶栓治疗超高龄患者AIS相对安全有效。在超高龄非LVO卒中患者中,尿激酶与阿替普酶静脉溶栓的治疗效果相当,可作为阿替普酶的替代药物。
