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【摘要】 目的 探讨西安地区伴心房颤动老年急性缺血性卒中（acute ischemic stroke，AIS）患者临床特征及1 年预后情况。 方法 通过西安卒中数据库平台，收集西安市4所三级甲等医院2015年1-12月连续入院的老年AIS （年龄≥65岁）患者的临床资料，比较分析伴心房颤动老年AIS患者的临床特征；登记随访1年的结局 事件（包括卒中复发、死亡和预后不良），通过多因素Logistic回归分析，探讨西安地区伴心房颤动老 年AIS患者1年不良预后的独立危险因素。 结果 研究最终纳入老年AIS患者1239例，其中伴心房颤动者133例（10.7%）。与不伴心房颤动组相比， 伴心房颤动老年AIS患者的年龄大[（77.7±6.3）岁 vs（74.0±6.1）岁，P=0.019]、出院mRS评分高（2.0 分 vs 1.0分，P0.05）。 结论 相比不伴心房颤动组，西安地区伴心房颤动老年AIS患者年龄更大、卒中所致残障及神经功 能缺损更重、合并肺炎和入院48 h不能行走的患者比例较高；伴心房颤动老年AIS患者1年死亡风险显 著升高。 【Abstract】 Objective To investigate the clinical characteristics and 1-year prognosis of elderly acute ischemic stroke (AIS) patients with atrial fibrillation (AF) in Xi'an area. Methods Clinical data of elderly patients with AIS (≥65 years) who were consecutively admitted to four tertiary-grade A class hospitals from January 2015 to December 2015 in Xi'an Stroke Data Bank were collected. The clinical characteristics of elderly AIS patients with and without AF were compared, and the outcome events of 1 year follow-up (including stroke recurrence, death and poor prognosis) were analyzed. Multivariate logistic regression analysis was used to find the independent risk factors for poor prognosis of 1 year in elderly AIS patients with AF in Xi'an area.Results Total 1239 elderly AIS patients were enrolled in this study, including 133 (10.7%) patients with AF. Comparing with the non-AF group, the elderly AIS patients in AF group showed older [(77.7±6.3) years vs (74.0±6.1) years, P=0.019], higher mRS score at discharge (median 2.0 vs 1.0, P0.05). Conclusions Comparing with the elderly AIS patients without AF, the elderly AIS patients with AF in Xi'an area were older, had more severe stroke, higher rate of pneumonia and higher rate of losing the ability to walk within 48h at admission, and higher risk of death at 1 year.

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Objective ：To investigate the efficacy and safety of intravenous thrombolysis with alteplase in advanced-age patients (80 years old) with acute cerebral infarction. Methods: The patients with acute cerebral infarction who were treated with alteplase in Xi'an No. 1 Hospital were selected as research subjects in a retrospective analysis, and were divided by age into the advanced-age group (80 years old), the elderly group (65-79 years old), and the young and medium-age group (18-64 years old). The general conditions and adverse drug reactions (ADRs) were recorded for the patients of the 3 groups. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate neurological deficits before and after thrombolysis at 1 h, 24 h and the 7th day. The total effective rates on the 7th day after thrombolysis were compared among the 3 groups. The short--term efficacy was evaluated by modified Rankin s (mRS) scores. Results: There were no significant differences in bleeding complications, to tai effective rates and the proportions of the patients with poor prognosis in the 3 groups (0.05). The NIHSS scores of the patients in the advanced-age group and the young and medium-age group significantly decreased at 24 h and the 7th day after thrombolysis. 05), but the proportion of the patients with good prognosis in the advanced-age group was lower than that in the young and medium-age group (P<0.05). Conclusion ： Intravenous thrombolysis with alteplase is safe and effective for the treatment of advanced-age patients with acute cerebral infarction. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of the COSSH-ACLFs model in predicting the short-term( 90-day) prognosis of patient with hepatitis B virus-related acute-on-chronic liver failure( HBV-ACLF). Methods A total of 573 patients who were diagnosed with HBV-ACLF in The Affiliated Hospital of Southwest Medical University, The First People’s Hospital of Neijiang, and The Second People’s Hospital of Yibin were enrolled, and their general information and laboratory markers were collected. According to the outcome on day90 after diagnosis, the patients were divided into survival group with 339 patients and death group with 234 patients. The t-test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups, and the Wilcoxon rank sum test was used for comparison of ranked data between two groups. The area under the receiver operating characteristic curve( AUC) was used to compare the value of different models in predicting 90-day prognosis. Results Compared with the survival group, the death group had significantly higher age( Z =-0. 304, P = 0. 002), bilirubin( Z =-5. 961, P < 0. 001), peripheral white blood cell count( Z =-6. 027, P < 0. 001), and creatinine( Z =-4. 638, P < 0. 001), significantly lower hemoglobin( Z =-2. 012, P = 0. 044), albumin( Z =-4. 007, P < 0. 001), and Na( Z =-4. 558, P < 0. 001), and significantly higher incidence rates of hepatic encephalopathy( Z =-7. 859, P < 0. 001), peritonitis( Z =-2. 310, P = 0. 021), and upper gastrointestinal bleeding( χ2= 11. 697, P =0. 001). Compared with the death group, the survival group had significantly better coagulation markers, prothrombin time, international normalized ratio, and prothrombin time activity( Z =-7. 737, -7. 672, and-7. 867, all P < 0. 001). MELD, MELD-Na, CLIF-COFs, CLIF-CACLFs, and COSSH-ACLFs had an area under the ROC curve( AUC) of 0. 726, 0. 587, 0. 712, 0. 735, and 0. 750, respectively, and the COSSH-ACLFs model had a significantly larger AUC than the other four models( Z = 7. 89, 18. 83, 12. 49, and 5. 05, all P < 0. 001). Conclusion The COSSH-ACLFs model has a better value than CLIF-C ACLFs, MELD, CLIF-C OFs, and MELD-Na in predicting the short-term prognosis of patients with HBV-ACLF. [ABSTRACT FROM AUTHOR]