Highlights of Selected Articles July 2020.
Highlights of Selected Articles July 2020.
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2020 年 7 月精选文章要点。
DOI：
10.1161/strokeaha.120.030909
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发表时间：
2020
期刊：
影响因子：
8.3
通讯作者：
Romero,JoséRafael
中科院分区：
文献类型：
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作者：
Romero,JoséRafael
Yaghi及其同事进行了一项回顾性研究，以描述2019年冠状病毒病（COVID-19）感染和成像证实的中风患者的急性缺血性中风特征。当代和历史中风对照用于比较。该研究纳入了3556名经鼻咽拭子样本逆转录聚合酶链反应确诊的COVID-19感染患者，这些患者在症状、暴露或胸片筛查呈阳性后。急性缺血性脑卒中32例（0.9%）。中风是43.8%的患者的主要症状，56.2%的患者在因呼吸道症状入院后发生了院内中风。大多数病例（81.3%）患有严重呼吸道疾病。大多数卒中为隐源性卒中（65.6%），34.4%为不明原因的栓塞性卒中。最接近卒中时间的D-二聚体和C-反应蛋白水平中位数（四分位距）分别为3913 ng/mL（2549-10 000）和101.1 ng/mL（38.8-214.3）。在单变量分析中，与当代对照相比，COVID-19卒中病例更年轻，美国国立卫生研究院卒中量表评分更高，D-二聚体峰值更高，更有可能接受抗凝治疗，发生隐源性卒中，死亡率更高。与历史对照相比，病例更可能为男性，沉降率更高，肌钙蛋白阳性、大血管闭塞、抗凝治疗、不明原因卒中机制和死亡率更高。在经年龄和美国国立卫生研究院卒中量表评分调整后的多变量分析中，卒中和COVID-19患者的死亡率高于当代和历史对照，尽管由于事件数量较少，估计不准确。作者承认在危重患者中检测缺血性卒中的局限性，并与回顾性研究设计相关。这项研究增加了关于COVID-19感染相关缺血性卒中患者的临床特征、卒中机制和血液标志物的重要信息。临床试验正在评估抗凝治疗在预防这些患者血栓性并发症（包括缺血性卒中）中的作用。参见2003年第2003页。
Yaghi and colleagues conducted a retrospective study to characterize acute ischemic stroke characteristics in patients with coronavirus disease 2019 (COVID-19) infection and stroke confirmed on imaging. Contemporary and historical stroke controls were used for comparisons. The study included 3556 patients with COVID-19 infection confirmed by reverse-transcriptase polymerase chain reaction of nasopharyngeal swab sample after a positive screening for symptoms, exposure or chest radiograph. Acute ischemic stroke occurred in 32 cases (0.9%). Stroke was the presenting syndrome in 43.8%, and 56.2% had in-hospital incident strokes following admission for respiratory symptoms. Most cases (81.3%) had severe respiratory illness. Most strokes were cryptogenic (65.6%), and 34.4% were embolic strokes of unknown source. The median (interquartile range) D-dimer and C-reactive protein levels at the time closest to the stroke were 3913 ng/mL (2549–10 000) and 101.1 ng/mL (38.8–214.3), respectively. In univariate analyses, compared with contemporary controls, stroke cases with COVID-19 were younger, had higher National Institutes of Health Stroke Scale scores, higher peak D-dimer, were more likely to be treated with anticoagulation, to have cryptogenic stroke, and higher mortality. Compared with historical controls, cases were more likely men, had higher sedimentation rate, more likely to have positive troponin, large vessel occlusion, treatment with anticoagulation, cryptogenic stroke mechanism, and higher mortality. In multivariable analyses adjusted for age and National Institutes of Health Stroke Scale score, patients with stroke and COVID-19 had higher mortality than both contemporary and historical controls, though estimates were imprecise due to small number of events. The authors acknowledged limitations to detect ischemic stroke in critically ill patients and related to the retrospective study design. This study adds important information about the clinical characteristics, stroke mechanism, and blood markers in patients with ischemic stroke associated with COVID-19 infection. Clinical trials are evaluating the role of anticoagulation to prevent thrombotic complications, including ischemic stroke, in these patients. See p 2003.