Chinese Journal of Stroke

Cherish the Memory of Qian Zhongshu

WANG Yong-Jun

2016, 11(06): 425-426.

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Stress on the Study of Prognosis of Acute Ischemic Stroke

NIE Zhi-Yu

2016, 11(06): 427-430.

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The Value of ASTRAL Score in Predicting Three Months Prognosis of Acute Ischemic Stroke

ZHANG Qing-Jun, WANG Qing-Hua, GUO Yan, et al.

2016, 11(06): 431-437.

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Objective To explore the value of ASTRAL score in predicting prognosis of patients with the different gender, different infarction parts and disease severity at 3-months after onset of acute ischemic stroke (AIS), and compare with the value of predicting of Preadmission Comorbidities, Level of Consciousness, Age, Neurologic Deficit (PLAN) score, and Totaled Health Risks in Vascular Events (THRIVE) score. Methods Related baseline data were recorded and ASTRAL score, PLAN score and THRIVE score were calculated respectively based on different groups according to gender, infarction area, and disease severity, to compare the predictive value of ASTRAL score with PLAN score and THRIVE score in patients with AIS at three months after onset. Model discrimination was quantified by calculating the area under the receiver operating characteristic curve (AUC), and compared their predictive value by conducting Z test. Results (1) A total of 513 patients with AIS were enrolled, including 309 cases of male and 204

cases of female; Infarction parts: there were 305 cases of anterior circulation infarction, 153 cases of posterior, and 55 cases of mixed anterior and posterior; Illness severity: there were 260 cases of minor strokes, and 253 cases of non-minor stroke. (2) The AUC of ASTRAL predicting 3 months prognosis in all patients is 0.845. AUC in male group was 0.804, and in female group was 0.878, which showed the Z value of 1.86 (P >0.05); the AUC of predicting anterior, posterior and mixed circulation group were 0.843, 0.814 and 0.857 respectively, with Z values <1.98 (P >0.05). The AUC of predicting minor stroke and non-minor stroke were 0.714 and 0.855 respectively, and the Z value was 4.03 (P =0.000). The AUC of ASTRAL score, PLAN score and THRIVE score predicting all patients were 0.845, 0.783, 0.740, respectively, with Z value >1.98 (P values were 0.000, 0.010, 0.000). Conclusion ASTRAL score could predict 3 months prognosis in patients with AIS, which performs better in predicting minor stroke than PLAN score and THRIVE score.

Analysis of the Relationship between 90 Days Prognosis of Patients with Minor Stroke and Drug Compliance

WANG Qing-Hua, ZHANG Qing-Jun, LI Yun-Xia, et al.

2016, 11(06): 438-442.

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Objective To explore the relationship between 90 days prognosis of patients with minor stroke and drug compliance. Methods A consecutive patients with minor stroke (NIHSS≤3) hospitalized in Tongji Hospital from August 1, 2014 to July 31, 2015 were enrolled in this study. Drug compliance for stroke secondary prevention, stroke recurrence and modified Rankin Scale (mRS) were investigated by telephone or outpatient service at 90 days after onset. mRS≤2 was defined as good prognosis and mRS>2 was defined as poor prognosis. The chi-square test or Fisher's exact test was used statistically to analyze the early neurological deterioration (END), stroke recurrence within 90 days and the impact of drug compliance on prognosis at 90 day of minor stroke. Results A total of 292 cases were successfully followed up at 90 days after onset. Good prognosis rate (mRS≤2) of minor stroke at 90 days was 81.6%, and recurrence rate was 10.4% within 90 days after onset. END rate was 8.2%. The rate of poor outcomes in END group was higher (58.3%) than no-END group (14.9%, P <0.001). The rate of poor outcomes in the recurrence group was higher (86.7%) than the no-recurrence group other group (6.7%, P <0.001). END and stroke recurrence were closely related to the poor prognosis. The rate of good prognosis of compliance of antithrombotic and hypolipidemic agents were 83.5% and 78.1% respectively. The result showed there was no significant correlation between the bad compliance of stroke secondary prevention and unfavorable outcomes.

Conclusion Minor stroke has good prognosis at 90 days after onset and lower recurrence. END and stroke recurrence are closely related to the poor outcomes of minor stroke at 90 days. There is no significant correlation between the bad compliance of stroke secondary prevention and unfavorable 90-day outcomes.

Prevalence and Predictive Factors Analysis of Spasticity after Ischemic Stroke

LI Ning, TENG Fei, CHEN Yu-Hui, et al.

2016, 11(06): 443-448.

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Objective To investigate the prevalence and predictive factors of spasticity six months after onset of ischemic stroke in China. Methods All patients with acute ischemic stroke hospitalized in Affiliated Tongji Hospital of Tongji University between April 1st and July 31st 2013 were followed-up for six months after newlyonset of stroke. Spasticity was evaluated with the modified Ashworth Scale (MAS) by the same person. Results A total of 185 patients were recruited and 114 patients were followed-up, among whom, 32 patients showed spasticity. Among these 32 patients, 22 cases had both upper and lower limb spasm. Spasm appeared most frequently at the elbow (26 cases), then at the ankle (22 cases), the finger (20 cases), the wrist (19 cases), the knee (18 cases), the shoulder (15 cases) and the hip (7 cases). The NIHSS score on admission in the patients with spasticity (4.64, 0~23) was higher than the patients without spasticity (2.41, 0~7, P =0.001). The paralysis part of NIHSS score in the patients with spasticity (3, 2~6) was higher than the patients without spasticity (1, 0~2, P <0.001). The Barthel Index (BI) at discharge in the patients with spasticity (71.2, 5~100) was lower than the patients without spasticity (91.7, 45~100, P <0.001). Multi-factor logistic regression analysis showed that the paralysis part of NIHSS score and the BI at discharge was related to the presence of spasticity. Conclusion Post-stroke spasticity often occurs in both the upper and the lower limb. The upper limb is more frequently involved than the lower limb, while the elbow is the most frequently involved joint. The paralysis part of NIHSS score and the BI could be used as a predictive factor of post-stroke spasm.

Association between Cognitive Impairment and Corpus Callosum Network Connectivity in Leukoaraiosis

HE Yu-Sheng, JIANG Hong, LI Yun-Xia, et al.

2016, 11(06): 449-454.

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Objective To study the changes of corpus callosum network connectivity in leukoaraiosis (LA) patients by diffusion tensor imaging (DTI), and investigate the association between this change and cognitive impairment. Methods This study is a single-center prospective cohort study. The subjects were divided into two groups: (1) LA group (n =30) who had extensive LA according to Fazekas scale, including two subgroups with normal cognition and mild cognitive impairment; (2) Control group (n =20) who had normal brain magnetic resonance images (MRI). All subjects underwent baseline examinations, including a questionnaire about the risk factors of cerebrovascular disease, blood tests, cognitive assessments and 3.0T brain MRI scan, including fluid attenuated inversion recovery (FLAIR) and DTI sequences. DTI datum were processed by PANDA software and the quantitative values about fractional anisotropy (FA) and mean diffusivity (MD) in corpus callosum were extracted. The relationship between cognitive impairment and the changes of FA & MD was analyzed by Pearson’s correlation analysis. Results There were no significant differences of the baseline levels in two group, including sex, age, education, risk factors of cerebrovascular disease and some blood biochemical indexes, P >0.05.

The scores about Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were significantly lower in LA group than in control’s, P values were 0.002 and 0.008 respectively. The FA values in the genu (P =0.000), body (P =0.000) and splenium (P =0.026) of corpus callosum were significantly lower in LA group than in control’s, but the MD’s were just to the contrary, P values were 0.013, 0.006 and 0.007 respectively. There was positive relation between cognitive impairment and lower FA value of corpus callosum, and the correlation coefficients declined gradually from the genu (r =0.78) to splenium (r =0.41) of corpus callosum. Conclusion The changes of network connectivity in corpus callosum exist in LA patients, and FA decline in corpus callosum is positively related to cognitive impairment.

The Study of Individualized Treatment of Antiplatelet in Secondary Prevention of Ischemic Stroke

LIU Yue, HOU Chen, TANG Peng, et al.

2016, 11(06): 455-461.

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Objective To observe the therapeutic effect of individualized treatment of antiplatelet in secondary prevention of ischemic stroke. Methods A prospective study was carried out in the 207 inpatients of ischemic stroke in Shanxi Provincial People’s Hospital from March, 2013 to May, 2014. The inpatients were randomly divided into individual treatment group and conventional treatment group which used 100 mg/d aspirin in antiplatelet treatment. The individual treatment group adopted Essen Stroke Risk Score (ESRS) and divided the patients into high risk group (treated with 75 mg/d clopidogrel) and low risk group (treated with 100 mg/d aspirin). The antiplatelet protocol was determined based on the result of thromboela stogram (TEG) and CYP2C19 genotype detection after the 7th day. They all were followed up for 1 year to observe their clinical end point events. Results The platelet inhibition rate of clopidogrel was significantly higher in inpatients of CYP2C19 fast metabolism genotype and medium metabolism genotype than that in poor metabolism genotype, which had significant difference in outcome (P =0.018, P =0.015). The clinical end point event had no statistical significance between individualized treatment group (112 cases) and conventional treatment group (n =95) (P >0.01). Conclusion The platelet inhibition rate of application of clopidogrel of CYP2C19 fast metabolism genotype and medium metabolism genotype is obviously higher than that of CYP2C19 poor metabolism. The individualized treatment based on the CYP2C19 gene polymorphisms and TEG, compared the application of conventional treatment by aspirin, fails to reduce the incidence of end point events after ischemic stroke, which may require a larger scale and longer follow-up period study.

Cost-Utility Analysis of rt-PA Thrombolysis within 3 Hours of Acute Ischemic Stroke

PAN Yue-Song, WANG Yi-Long, LIAO Xiao-Ling, et al.

2016, 11(06): 462-467.

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Objective To determine the cost-utility of recombinant tissue-type plasminogen activator (rt-PA) treatment within 3 hours after onset of acute ischemic stroke in China. Methods A combination of decision tree and Markov model was developed to determine the costutility of rt-PA treatment versus non-rt-PA treatment within 3 hours after stroke onset. Outcomes, costs, utility and transfer proportion of the model were derived from the database and the literatures. Incremental cost-effectiveness ratio (ICER) was estimated in both short term (2 years) and long term (30 years). Results Compared to non-rtPA treatment, rt-PA treatment within 3 hours had ICER of CNY 93,796 per quality-adjusted life-year (QALY) gained in 1 year which was lower than a willingness-to-pay threshold of CNY 105,000 (3 GDP of China) per QALY. Thrombolysis also had an ICER of CNY 5,953 per QALY gained in 30 years which was lower than a willingness-to-pay threshold of CNY 35,100 (1 GDP of China) per QALY. Conclusion Intravenous rt-PA treatment within 3 hours is highly cost-effective for acute ischemic strokes in China.

Effects of Quality Control Circle on Improvment of the Ward Management in Stroke Patients

HUANG Yan-Nan, WU Mei-Ru

2016, 11(06): 468-472.

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Objective To investigate the effect of the quality control circle (QCC) in the stroke unit so as to develop improvement measures and standardized process of satisfaction survey in stroke patients, which ultimately improve patients' satisfaction. Methods In April 2014, QCC teams were established by the use of voluntary registration method. The team learnt relevant knowledge of QCC and carried out patient’s satisfaction survey, so as to set the baseline indicator of improvement of QCC. Plan-Do-Check-Action (PDCA) cycle method was used for understanding status quo, goal setting, analysis and the development of counter measures. The patient’s satisfaction survey was carried out again 4 months later to compare the results with baseline indicators and observe the improvement status of patient’s satisfaction by QCC. Results A total of 78 effective baseline survey questionnaires and 80 survey questionnaires after QCC were collected. After the implementation of quality control circle activities, the satisfaction of patients was obviously improved in ward, which rised from 72% to 93%. Among which, the satisfaction rate for ward cleanness and quietness were improved significantly (P =0.002, 0.006). The target yield rate of quality management circle activity was 116.6% and the progress rate was 29.1%. Stroke patient satisfaction had improved significantly through the circle part involvement in the activity. Conclusion The quality control circle on management of stroke unit has significant effects.

The Research Progress of Prognostic Score of Acute Ischemic Stroke

ZHANG Qing-Jun, GUO Yan, NIE Zhi-Yu

2016, 11(06): 474-480.

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Acute ischemic stroke (AIS) is harmful to human life and health greatly. The morbidity and mortality of AIS have been at the top three in the spectrum of disease, which bring heavy life problems and economic burden to patients and their families. If we can judge the prognosis of patients with AIS at early stage, intervene actively, which can reduce the risk of poor prognosis effectively. Recent domestic and foreign scholars have been committed to the development and application of prognostic score of AIS. In this paper, we summarized the progress of the prognosis score of AIS, so as to help clinical neurologist to conduct rapid evaluation and guide decisions for patient prognosis when they receive the patients with AIS.

Guideline for Management of Patients with High-risk Non-disabling Ischemic Cerebrovascular Events

WANG Yi-Long, ZHAO Xing-Quan, LIU Xin-Feng, et al.

2016, 11(06): 481-491.

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Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke(Part 5)

SHEN Dong-Chao, WANG Zi-Xuan, XIAO Fu-Long, et al.

2016, 11(06): 492-493.

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