Mehta Nidhi, Uchino Ken, Fakhran Saeed, Sattar M Abdus, Branstetter Barton F, Au Karen, Navratil Jeannine S, Paul Barbara, Lee Melissa, Gallagher Katie M, Manzi Susan, Ahearn Joseph M, Kao Amy H
University of Pittsburgh School of the Health Sciences, University of Pittsburgh, PA, USA.
Stroke. 2008 Dec;39(12):3236-41. doi: 10.1161/STROKEAHA.108.514687. Epub 2008 Oct 16.
Platelets bearing complement C4d were recently reported to be 99% specific for a diagnosis of systemic lupus erythematosus (SLE) and associated with neuropsychiatric lupus. We compared the prevalence of platelet C4d and investigated the clinical associations of platelet C4d in patients with acute ischemic stroke.
We recruited 80 patients hospitalized for acute ischemic stroke. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIH-SS). Infarct volume was determined by MRI. Platelet C4d was measured by flow cytometry.
Mean age was 57.9 years (range: 24.6 to 86.8 years), 58% were male, and 91% were white. Eight patients (10%) with acute ischemic stroke were platelet C4d-positive, which was significantly higher in prevalence compared to healthy controls (0%, P<0.0001) and non-SLE patients with immune/inflammatory disease (2%, P=0.004). The median NIH-SS score and infarct volume for acute stroke patients were 6 (interquartile range [IQR]: 2 to 13) and 3.4 cc (IQR: 1.1 to 16.6), respectively. Platelet C4d-positive patients were more likely to have a severe stroke compared to those with negative platelet C4d (NIH-SS median: 17.5 versus 5, P=0.003). Positive platelet C4d was independently associated with stroke severity (P=0.03) after controlling for age, anticardiolipin antibody (aCL) status, and total anterior circulation of stroke involvement, and also with infarct volume (P=0.005) after controlling for age, aCL status, and old stroke by MRI.
Platelet C4d is associated with severe acute ischemic stroke. Platelet C4d may be a biomarker as well as pathogenic clue that links cerebrovascular inflammation and thrombosis.
近期有报道称，携带补体C4d的血小板对系统性红斑狼疮（SLE）诊断的特异性为99%，且与神经精神性狼疮相关。我们比较了急性缺血性脑卒中患者血小板C4d的患病率，并研究了其临床相关性。
我们招募了80例因急性缺血性脑卒中住院的患者。采用美国国立卫生研究院卒中量表（NIH-SS）评估卒中严重程度。通过磁共振成像（MRI）测定梗死体积。采用流式细胞术检测血小板C4d。
患者平均年龄为57.9岁（范围：24.6至86.8岁），58%为男性，91%为白人。8例（10%）急性缺血性脑卒中患者血小板C4d呈阳性，其患病率显著高于健康对照组（0%，P<0.0001）和非SLE免疫/炎症性疾病患者（2%，P=0.004）。急性脑卒中患者的NIH-SS评分中位数和梗死体积分别为6（四分位间距[IQR]：2至13）和3.4立方厘米（IQR：1.1至16.6）。与血小板C4d阴性患者相比，血小板C4d阳性患者发生严重卒中的可能性更大（NIH-SS评分中位数：17.5对5，P=0.003）。在控制年龄、抗心磷脂抗体（aCL）状态和卒中累及的全前循环后，血小板C4d阳性与卒中严重程度独立相关（P=0.03）；在控制年龄、aCL状态和MRI显示的陈旧性卒中后，血小板C4d阳性也与梗死体积相关（P=0.005）。
血小板C4d与严重急性缺血性脑卒中相关。血小板C4d可能是一种生物标志物，也是连接脑血管炎症和血栓形成的致病线索。
