Tsai Nai-Wen, Chang Wen-Neng, Shaw Chen-Fu, Jan Chung-Ren, Chang Hsueh-Wen, Huang Chi-Ren, Chen Shang-Der, Chuang Yao-Chung, Lee Lian-Hui, Wang Hung-Chen, Lee Tsong-Hai, Lu Cheng-Hsien
Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Thromb Res. 2009 Jun;124(2):213-8. doi: 10.1016/j.thromres.2009.01.012. Epub 2009 Feb 23.
Platelet activation and its interaction with leukocytes are important in the pathophysiology of ischemic stroke. This study aimed to evaluate the value of platelet activation and platelet-leukocyte interaction in different subtypes of acute, non-cardio-embolic ischemic stroke.
Fifty-four patients with acute, non-cardio-embolic ischemic stroke, including 32 small-vessel and 22 large-vessel diseases, were evaluated. Platelet activation markers (CD62P, CD63, and CD40L) and platelet-leukocyte interaction were measured by flow cytometry at different time points (<48 hours and Days 7, 30, and 90 post-ischemic stroke). Markers were also evaluated in 28 other stroke patients in the convalescent stage (3 to 9 months after acute stroke) and in 28 control subjects.
Patients with ischemic stroke had significantly increased circulating CD62P, CD63, platelet-monocyte interaction, and platelet-lymphocyte interaction in the acute stage compared with the convalescent stage and control groups. Levels of CD62P and CD63 were significantly higher in the large-vessel disease group than in the small-vessel disease group, and differences in CD62P were significant even at one month. The CD40L level in the poor outcome group was significantly higher than that in the good outcome group. Stroke patients with diabetes mellitus and large-vessel disease were associated with poor outcome.
Patients with large-vessel cerebral infarction elicit higher platelet activation and platelet-leukocyte interaction compared to small-vessel infarction. Further large scale trials are warranted to evaluate the relationship between platelet activation markers and outcome in stroke patients under different anti-platelet therapies, and to clarify optimal treatment.
血小板活化及其与白细胞的相互作用在缺血性卒中的病理生理学中具有重要意义。本研究旨在评估血小板活化及血小板 - 白细胞相互作用在不同亚型急性非心源性缺血性卒中中的价值。
对54例急性非心源性缺血性卒中患者进行评估，其中包括32例小血管疾病患者和22例大血管疾病患者。在不同时间点（缺血性卒中后<48小时、第7天、第30天和第90天）通过流式细胞术检测血小板活化标志物（CD62P、CD63和CD40L）以及血小板 - 白细胞相互作用。还对28例处于恢复期（急性卒中后3至9个月）的其他卒中患者和28例对照者的标志物进行了评估。
与恢复期患者和对照组相比，缺血性卒中患者在急性期循环中的CD62P、CD63、血小板 - 单核细胞相互作用及血小板 - 淋巴细胞相互作用显著增加。大血管疾病组中CD62P和CD63水平显著高于小血管疾病组，甚至在1个月时CD62P的差异仍很显著。预后不良组的CD40L水平显著高于预后良好组。患有糖尿病和大血管疾病的卒中患者预后较差。
与小血管梗死相比，大血管脑梗死患者的血小板活化及血小板 - 白细胞相互作用更高。有必要进行进一步的大规模试验，以评估不同抗血小板治疗下血小板活化标志物与卒中患者预后之间的关系，并明确最佳治疗方案。
