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April 2013, Volume 16, No.11 Abstracts

 Research Progress of Stroke-associated Pneumonia

WU Ji-xiang, CHENG Ou-mei.Department of Neurology, the Frist Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

Abstract Stroke is one of the diseases with high morbidity, disability and mortality rate.It is seriously harmful for human health.Infection is the most common serious complications in stroke patients.It is reported that more than 30% stroke patients are complicated by respiratory tract, urinary tract and digestive tract infection, etc.Pneumonia with high incidence (10%) is closely connected with stroke patients deaths.The new studies have found that the central nervous system injury-induced immune deficiency syndromeCIDSmay be considered the main mechanism of infection after a stroke.However, many risk factors such as older age, dysphagia, neurological damage and combination of other basic diseases (chronic obstructive pulmonary disease and diabetes, etc) also increase the probability of stroke-associated pneumonia.This article analyses the mechanism and risk factors of stroke-associated pneumonia in order to facilitate the clinical prophylaxis and treatment.

Key words Stroke; Respiratory tract infection; Stroke-associated pneumonia; Risk factors; Central nervous system injury-induced immune deficiency syndrome

Study of Relationship of Stroke-associated Pneumonia to Post-stroke Acute Hypertension in Elderly Patients with Ischemic Stroke

XIAO Wen, XUE Hai-long,JIA Xiu-li.Department of Internal Medicine-Neurology, PLA 3rd Hospital, Baoji 721004, China

Abstract Objective To investigate the relationship of stroke-associated pneumonia (SAP) to post-stroke acute hypertension in elderly patients with ischemic stroke.

Methods A total of 134 patients with acute ischemic stroke admitted to this hospital from 2010 to 2011 were divided, based on acute blood pressure values, into groups control (with normal or mild hypertension, n=65), moderate (with moderate hypertension, n=44), severe (with severe hypertension, n=25).At admission all patients had routine blood and biochemical tests, 12-lead ECG, X-ray, transthoracic echocardiography and brain MRI, and dysphagia examined by pulse oximetry and water gurgle test.The complications including previous histories of stroke, ischemic heart diseases, chronic congestive heart failure, diabetes and hypertension were recorded.Univariate and multivariate Logistic regression analysis was used to analyze the risk factors of SAP.

Results There was significant difference in levels of SBP, WBC, CRP and GCS scores and dysphagia incidence between groups SAP and non-SAPP0.05.There was difference in WBC, GCS and incidences of dysphagia and SAP between groups control,moderate and severeP0.05, thereinto groups moderate and severe were different from control group in GCS scores, dysphagia and SAP incidencesP0.05, severe group from control group in WBC (P0.05).Multivariate undonditional logistic regression found WBCOR=1.325, 95%CI1.073, 1.811, P=0.024, serum CRPOR=1.356, 95%CI1.082, 1.914, P=0.021, GCS scoreOR=0.842, 95%CI0.563, 0.924, P=0.015, dysphagiaOR=1.735, 95%CI1.154, 2.761, P=0.007 and hypertensionOR=2.185, 95%CI1.321, 4.368, P=0.003 into the regression equation.There was difference in SAP risk between groups severe and controlP0.05, adjusted OR=2.747, 95%CI1.161, 7.452.

Conclusion Post-ischemic-stroke acute severe hypertension, an independent risk factor, is important for SAP prevention and provides some theoretical basis for its treatment and drug choice.

Key words Stroke; Respiratory tract infection; Stroke-associated pneumonia; Hypertension

Relationship between Stroke-associated Pneumonia and Severity and Prognosis of Ischemic Stroke

WANG Shu-mei,LI Hai-ying,YUAN Jun-liang,et al.Department of Neurology,Beijing Chaoyang Hospital of Capital Medical University,Beijing 100020,China

Abstract Objective To investigate the relationship between stroke-associated pneumonia (SAP) and the severity and prognosis of ischemic stroke.

Methods 94 patients with ischemic stroke admitted to Beijing Chaoyang Hospital of Capital Medical University from February 2012 to June 2012 were divided into SAP group (49 cases) and non-SAP group (45 cases).General clinical data (age,gender,histories of hypertension,diabetes,hyperlipidemia,coronary heart disease,atrial fibrillation,remote cerebral infarction,malignant tumor and smoking),clinical manifestations (severity of focal nerve defect,disturbance of consciousness and dysphagia),neuroimaging results (stroke area and location),disease assessment and prognosis assessment (hospitality,NIHSS score on admission,NIHSS after confirming SAP,APACHEscore and Rankin score on discharge),laboratory test results and etiological examination results.The related factors of SAP and the relationship between SAP and stroke severity (NIHSS score),health condition (APACHE),prognosis (improved Rankin score) and hospitality,as well as the laboratory testing results and etiology distribution were all analyzed.

Results Occurrence of age75 years,disturbance of consciousness,dysphagia,cerebral infarction in multiple parts,NIHSS15 and APACHEⅡ>20 between SAP group and control group showed statistically significant differences (P0.05).The NIHSS score and Apache score on admission,Rankin score on discharge,hospitality and mortality between SAP group and non-SAP group showed statistically significant differences (P0.05).The NIHSS on admission and NIHSS on discharge in SAP group also showed statistically significant difference (P0.05).The levels of C reactive protein,brain natriuretic peptide,prealbumin,albumin and erythrocyte sedimentation rate between SAP group and non-SAP group showed statistically significant differences (P0.05).Etiology examination showed that 39 cases were positive and 10 cases were negative with a positive rate of 80%.The results showed 31 strains of gram negative bacilli (9 strains of Acinetobacter baumanii),9 strains of gram positive coccus (8 strains of staphylococcus aureus) and 23 strains of fungi (9 strains of Candida albicans).

Conclusion SAP can aggravate the symptoms of ischemic stroke,extend hospitality,increase mortality and lead to poor prognosis.The understanding of SAP should be enhanced and appropriate prevention should be given to the patients.

Key words Stroke; Respiratory tract infection; Stroke-associated pneumonia; Severity of illness; Prognosis

Relationship between Blood Pressure Variability and Carotid Atherosclerosis in Patients with Essential Hypertension

XU Yan, WANG Meng-lin, GAO Xu-guang.Department of Neurology, Peking University Peoples Hospital, Beijing 100044, China

Abstract Objective To explore the relationship between blood pressure variabilityBPVand carotid atherosclerosisCAin patients with essential hypertensionEH.Methods A total of 158 EH patients and 35 normal subjectscontrol groupunderwent 24 h non-invasive ambulatory blood pressureBPmonitoring, and intima-media thicknessIMTevaluated by carotid ultrasonography.Standard deviationSDof BP readings was taken as BPV values.EH patients were divided, according to Percentile 50P50of daytime SBP SD, into groups low BPVn=76and high BPVn=82.Ambulatory BP parameters, carotid IMT were analyzed comparatively.Taking IMT as dependent variable, multiple linear regression analysis was performed in EH patients.Results The mean SBP, DBP in varying periods, nighttime SBP SD were higher in EH groups than in control groupP0.01, the 24 h mean SBP, IMT of bilateral carotid artery higher in high BPV group than in low BPV groupP0.05.Multiple linear regression analysis showed that 24 h mean SBP and daytime SBP SD were positively correlated with carotid IMTP0.05.Conclusion EH patients have high BPV, independent of mean BP.BPV is an important influencing factor for CA.

Key words Hypertension; Ambulatory blood pressure monitoring; Blood pressure variability; Atherosclerosis; Intima-media thickness

Relationship of High Sensitive C-reactive Protein with Blood Pressure and Blood Pressure Variability in Patients with Essential Hypertension

XU Yan,WANG Meng-lin, GAO Xu-guang.Department of Neurology,Peking University Peoples Hospital,Beijing 100044,China

Abstract Objective To explore the relationship high sensitive C-reactive protein (hs-CRP) with blood pressureBPand BP variabilityBPV in patients with essential hypertension.

Methods A total of 178 hypertensive outpatients and inpatients of our hospital between October 2011 and June 2012 were included.24 h ambulatory blood pressure monitoring was conducted.Plasma level of hs-CRP,fasting blood glucose and lipids were also examined.Patients were grouped into quartiles according to hs-CRP level.Average BP and standard deviationSD, as the index of BPV in different time intervals (24-hour,daytime,nighttime) were compared among four groups.The correlations between hs-CRP and BP or BPV were analyzed with multiple linear regression.

Results Compared to the lowest quartile of hs-CRP,systolic and diastolic BPV were significant higher in the highest quartile during the nighttime (P0.05).By contrast,there was no difference in mean BP among the hs-CRP quartile groups during any of the time periods (P0.05).Multiple linear regression models revealed that nighttime SBP-SD(β=0.228, P0.01) and high density lipoprotein cholesterol (β=-0.190, P0.05) were significantly related to hs-CRP.

Conclusion Hs-CRP is closely related with BPV in hypertensive patients,suggesting that inflammation may be one of the mechanisms underlying the link between BPV and target organ damage.

Key words Hypertension; Blood pressure variability; Inflammation; C-reactive protein; Blood pressure determination

Relationship between Visit-to-Visit Variability in SBP and Diastolic Heart Falure in Elderly Hypertensive Patients

CAO Da-ping, JIA Ling, WANG Ying.Department of Geriatrics,the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,China

Abstract Objective To analyze the relationship of visit-to-visit variability in systolic blood pressure (SBP) with diastolic heart failure (DHF).Methods The follow-up blood pressure (BP) of 40 elderly hypertensive patients visiting department of cardiology of this hospital from July 2010 to July 2012 were observed and at the end of follow-ups ventricular septal thickness,left ventricular end-diastolic volume,left ventricular end-systolic volume,left ventricular posterior wall thickness,early diastolic mitral flow velocity (E),early diastolic mitral annular velocity(E),carotid intima-media thickness (IMT) were determined by color Doppler ultrasound,and serum brain natriuretic peptide (BNP) detected,follow-up SBP variation and left ventricular mass index (LVMI) and E/E calculated.Taking follow-up SBP standard deviation (SD) as BPV indicator,E/E represented left ventricular diastolic (LVD) function.Results The follow-up SBP SD was (9±4) mm Hg,positively correlated with E/E,LVMI,IMT(r= 0.3890.3180.512, P0.05),BNP negatively with E/E(r=-0.869, P0.05),positively with LVMI,IMT(r=0.5820.488, P0.05).Multiple linear regression analysis showed that SD and BNP have significant impact on the E/E P0.05.Conclusion Follow-up BPV,related to LVD function and independent risk factors of DHF in elderly hypertension patients,can both predict occurrence of DHF.

Key words Hypertension; Natriuretic peptide, brain; Heart failure, diastolic; Risk factors

Relationship between Angiopoietin-2 A1087G Polymorphism and Type 2 Diabetic Nephropathy

HE Quan, LUO Hai-ming, ZHU Bao-sheng, et al.Department of Emergency, the First Peoples Hospital of Yunnan Province, Kunming 650032, China

Abstract Objective To investigate the correlation between angiopoietin-2Ang-2 A1087G polymorphism and type 2 diabetic nephropathyDN.Methods 1A total of 1 021 patients with type 2 diabetes mellitusT2DM groupand 254 healthy peopleNC group visiting the First Peoples Hospital of Yunnan Province and the Second Affiliated Hospital of Kunming Medical University between January 2010 and January 2012 were selected.According to urinary albumin excretion rateUAER, the T2DM group was divided into three subgroupsT2DM without DN groupDN0 group, 431 cases, T2DM with microalbuminuria groupDN1 Group, 322 cases, and T2DM with massive proteinuria groupDN2 group, 268 cases.Clinical and biochemical indicators of subjects in each group were collected.The exon 4 of Ang -2 A1087G was tested for polymorphism.Results 1Ang-2 A1087G gene frequency and allele frequency of subjects in each group were significantly differentP0.05.The DN0, DN1, and DN2 groups AG+GG frequency39.0%, 41.9% and 44.8% and the G allele frequency37.8%, 30.3% and 33.6% were significantly higher than those of the NC group24.4% and 19.1%, P0.05.2Significant differences were observed among the groups in blood pressure, glycosylated hemoglobinHbA1c, glomerular filtration rateeGFR, fasting blood glucoseFBG, fasting insulinFINS, β-cell function indexHOMA-IS, insulin resistance indexHOMA-IR, monocyte chemoattractant protein-1MCP-1, and Ang-2 levelP0.05.3Multiple Logistic regression analysis showed that Ang-2 A1087G AG+GG genotype, G allele, serum Ang-2 level, systolic blood pressure, HbA1c, FBG, MCP-1, HOMA-IS, and eGFR had correlation with DN(P0.05).After adjusting for age, sex, disease course, HbA1c, blood pressure, and other factors, AG+GG genotype had 2.823 times the risk of developing DN095%CI1.557, 4.221, P=0.011, 2.778 times the risk of DN195%CI2.356, 5.220, P=0.010, and 2.991 times the risk of DN295%CI3.560, 6.229, P=0.001 compared with AA genotype.G allele had 1.442 times the risk of developing DN0r=1.321, OR=1.442, 95%CI2.320, 4.178, P=0.030, 1.984 times the risk of DN1r=1.021, OR=1.984, 95%CI2.621, 4.574, P=0.027, 1.881 times the risk of DN2r=1.338, OR=1.881, 95%CI3.321, 5.173, P=0.001 compared with that for allele A.

Conclusion Ang-2 A1087G gene polymorphism was associated with the incidence of type 2 diabetic nephropathy.G allele may be genetic risk factors for the development of diabetic nephropathy.

Key words Angiopoietin-2; Polymorphism, single nucleotide; Diabetes mellitus, type 2; Diabetic nephropathy

Serum Adiponectin, B-type Brain Natriuretic Peptide and Tumor Necrosis Factor in Heart Failure Patients with Normal Ejection Fraction

GONG Wei-qi, JIANG Hua, CHEN Wei, et al.Department of Cardiology, Shanghai Dongfang Hospital of Tongji University, Shanghai 200136, China

Abstract Objective To measure the levels of adiponectinApN, B-type brain natriuretic peptideBNP, and tumor necrosis factor-α(TNF-α)in chronic heart failureCHFpatients with normal left ventricular ejection fractionLVEF, to explore their correlation with CHF.Methods ApN, BNP, TNF-α, fasting blood glucose

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