目的:探讨≥80岁的穿支动脉粥样硬化病(branch atheromatous disease,BAD)患者静脉溶栓治疗的安全性及疗效。方法:回顾性收集2021年1月—2024年6月南京医科大学附属脑科医院收治的BAD老年患者,按照年龄分为60~79岁组和≥80岁组,比较两组临床资料、早期神经功能缺损情况以及90 d的疗效和安全性。结果:本研究共纳入156例患者,60~79岁组114例,≥80岁组42例。基线信息中,≥80岁组患者的B型钠尿肽、凝血酶原时间、D-二聚体明显高于60~79岁组(P均<0.05)。治疗有效性分析中,≥80岁组患者溶栓后24 h和7 d美国国立卫生院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分均高于60~79岁组,差异有统计学意义(P均<0.05),同时,≥80岁组更容易出现早期神经功能恶化(38.1%vs.12.3%,P=0.025)。两组患者的90 d改良Rankin量表(modified Rankin scale,mRs)评分和NIHSS评分、m Rs≤2分和mRs≥4分比例的差异均无统计学意义(P均>0.05)。安全性分析中,两组患者的颅内出血转化和消化道出血差异无统计学意义(P均>0.05),而≥80岁组患者出现黏膜出血和卒中相关肺炎的比例明显高于60~79岁组(P均<0.05)。结论:≥80岁的BAD患者仍能从静脉溶栓中获益,但需要关注早期神经功能恶化和并发症。
Objective To clarify the role of vitamin D receptor (VDR) expression in parathyroid proliferation and resistance of parathyroid glands to 1,25(OH) 2D 3 with secondary hyperparathyroidism (SHPT) Methods This study...
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Objective To clarify the role of vitamin D receptor (VDR) expression in parathyroid proliferation and resistance of parathyroid glands to 1,25(OH) 2D 3 with secondary hyperparathyroidism (SHPT) Methods This study used archive parathyroid with 7 uremic patients The expression of proliferation cell nuclear antigen (PCNA) and VDR was evaluated in nineteen surgically excised parathyroid tissues, including 11 diffuse hyperplasia (DH type) and 8 nodular hyperplasia (NH type) of parathyroid glands, by immunohistochemistry (avidin biotin complex method) Results The weight of parathyroid in SHPT was remarkably increased by 16 1 times The numbers of parathyroid cells were increased by 1 86 times The rate of PCNA was remarkably increased in parathyroid hyperplasia with SHPT compared with that in control group [(6 35±3 36)‰ vs (1 73±1 31)‰, P <0 001] The number of PCNA in DH type was lower than that in NH type ( P <0 001) The density of VDR in the parathyroid with SHPT was significantly decreased [(40 28±13 13)% vs (83 79±3 77)%, P <0 001], VDR immunoreactivity expression in NH type was lower than that in DH type [(27 14±4 12)% vs (49 84±7 33)%, P <0 001] A significantly negative correlation was found between VDR density and the weight of the parathyroid ( r =-0 46, P <0 05), the same as VDR and PCNA ( r = -0 75, P <0 001) Conclusion VDR density was significantly decreased in parathyroid tissue of uremic patients showing nodular hyperplasia compared with that in diffuse hyperplasia and there was significantly negative correlation between VDR density and the weight of the parathyroid, and this may contribute to the progression of SHPT Furthermore, VDR deficiency may cause the resistance of parathyroid cells to 1, 25(OH) 2D 3, in part
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