McConnell J P, Cheryk L A, Durocher A, Bruno A, Bang N U, Fleck J D, Williams L, Biller J, Meschia J F
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
Neurosci Lett. 2001 Nov 2;313(1-2):88-92. doi: 10.1016/s0304-3940(01)02260-1.
The aim of this study was to determine the extent of change in platelet and coagulation markers in the acute phase of ischemic stroke and to assess the utility of marker measurement in stroke subtype classification. Urinary 11-dehydro-thromboxane B(2) (11-dTXB2), a marker of in vivo platelet activation, and markers of coagulation activation, including prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), and fibrinogen, were measured in 25 patients with ischemic stroke within 24 h of onset of symptoms. Marker levels in patients with ischemic stroke were compared with those in 19 age-matched controls who had not taken aspirin for at least 2 weeks before sampling and 25 healthy controls. Median marker levels were significantly increased in stroke over those in age-matched controls for fibrinogen (344 vs. 289 mg/dl; P=0.030), F1+2 (1.40 vs. 0.80 nmol/l; P=0.003), and TAT (6.65 vs. 2.20 microg/l; P<0.0001). Median marker levels for seven patients with cardioembolic stroke and 18 with non-cardioembolic stroke were not significantly different for any marker test. Eight patients taking aspirin at the time of the stroke had significantly lower 11-dTXB2 values than patients not taking aspirin (964 vs. 4,314 pg/mg of creatinine; P=0.007). Stroke patients not taking aspirin had significantly higher 11-dTXB2 concentration than age-matched controls (4,314 vs. 1,788 pg/mg of creatinine; P=0.006). Coagulation and platelet activation markers are increased in the acute phase of stroke regardless of the clinical mechanism. This finding suggests that the markers may not be useful for predicting clinical subtype of ischemic stroke in the acute phase.
本研究的目的是确定缺血性卒中急性期血小板和凝血标志物的变化程度，并评估标志物检测在卒中亚型分类中的效用。在25例缺血性卒中患者症状发作后24小时内，检测了体内血小板活化标志物尿11-脱氢血栓素B2（11-dTXB2）以及凝血活化标志物，包括凝血酶原片段1+2（F1+2）、凝血酶-抗凝血酶复合物（TAT）和纤维蛋白原。将缺血性卒中患者的标志物水平与19例年龄匹配的对照者（在采样前至少2周未服用阿司匹林）以及25例健康对照者进行比较。与年龄匹配的对照者相比，卒中患者纤维蛋白原（344 vs. 289 mg/dl；P=0.030）、F1+2（1.40 vs. 0.80 nmol/l；P=0.003）和TAT（6.65 vs. 2.20 μg/l；P<0.0001）的中位标志物水平显著升高。7例心源性栓塞性卒中患者和18例非心源性栓塞性卒中患者的中位标志物水平在任何标志物检测中均无显著差异。8例卒中时服用阿司匹林的患者11-dTXB2值显著低于未服用阿司匹林的患者（964 vs. 4314 pg/mg肌酐；P=0.007）。未服用阿司匹林的卒中患者11-dTXB2浓度显著高于年龄匹配的对照者（4314 vs. 1788 pg/mg肌酐；P=0.006）。无论临床机制如何，卒中急性期凝血和血小板活化标志物均升高。这一发现表明，这些标志物可能无助于预测缺血性卒中急性期的临床亚型。
