Ovbiagele Bruce, Buck Brian H, Liebeskind David S, Starkman Sidney, Bang Oh Young, Ali Latisha K, Villablanca J Pablo, Salamon Noriko, Yun Susan W, Pineda Sandra, Saver Jeffrey L
Stroke Center, Department of Neurology, University of California, Los Angeles 90095, USA.
J Neurol Sci. 2008 Jan 15;264(1-2):140-4. doi: 10.1016/j.jns.2007.08.033. Epub 2007 Sep 12.
Conflicting data exist on the role of antiplatelet agents in reducing incident ischemic stroke magnitude, but most prior studies used clinically-assessed neurologic deficit as the index of stroke extent rather than more precise volumetric measurements of infarct size. We assessed the relation of premorbid antiplatelet use to initial diffusion-weighted MRI (DWI) lesion volumes among acute ischemic stroke patients.
Consecutive patients presenting within 24 h of ischemic stroke over an 18-month period were studied. DWI lesions were outlined using a semi-automated threshold technique. Subjects were categorized into two groups: antiplatelet (AP) or no antithrombotic (NA). The relationship between prestroke antithrombotic status and DWI infarct volumes was examined using multivariate quantile regression.
One hundred sixty-six individuals met study criteria: 75 AP and 91 NA patients. Median DWI volume was lower in the AP group than in the NA group (1.5 cc vs. 5.4 cc, p=0.031). A multivariable model (adjusting for age, history of transient ischemic attack, admission temperature, admission blood pressure, admission serum glucose, stroke onset to imaging interval, stroke mechanism, premorbid statin and antihypertensive use) demonstrated smaller infarcts in the AP vs. NA group (adjusted volume difference: -1.3 cc, 95% CI=-0.09, -2.5, p=0.037). Prior statin use, no history of TIA, large vessel atherosclerosis and microvascular ischemic disease stroke mechanism were also independently associated with reduced infarct volume.
Prior antiplatelet treatment is independently associated with reduced cerebral infarct volume among acute ischemic stroke patients. Premorbid statin use, TIA history and stroke mechanism also predict infarct volume in ischemic stroke.
关于抗血小板药物在降低缺血性卒中发作严重程度方面的作用，存在相互矛盾的数据，但大多数先前的研究使用临床评估的神经功能缺损作为卒中严重程度的指标，而非更精确的梗死灶体积测量。我们评估了急性缺血性卒中患者病前使用抗血小板药物与初始扩散加权磁共振成像（DWI）病变体积之间的关系。
研究了在18个月期间内发病24小时内就诊的连续患者。使用半自动阈值技术勾勒DWI病变。受试者分为两组：抗血小板组（AP）和非抗栓组（NA）。使用多变量分位数回归研究卒中前抗栓状态与DWI梗死体积之间的关系。
166例个体符合研究标准：75例AP患者和91例NA患者。AP组的DWI体积中位数低于NA组（1.5立方厘米对5.4立方厘米，p = 0.031）。多变量模型（校正年龄、短暂性脑缺血发作病史、入院体温、入院血压、入院血糖、卒中发作至成像间隔、卒中机制、病前他汀类药物和抗高血压药物使用情况）显示，AP组的梗死灶较NA组小（校正体积差异：-1.3立方厘米，95%可信区间=-0.09，-2.5，p = 0.037）。病前使用他汀类药物、无短暂性脑缺血发作病史、大动脉粥样硬化和微血管缺血性疾病卒中机制也与梗死体积减小独立相关。
病前抗血小板治疗与急性缺血性卒中患者脑梗死体积减小独立相关。病前他汀类药物使用、短暂性脑缺血发作病史和卒中机制也可预测缺血性卒中的梗死体积。
