Bugnicourt Jean-Marc, Roussel Bertrand, Garcia Pierre-Yves, Canaple Sandrine, Lamy Chantal, Godefroy Olivier
Department of Neurology, Amiens University Hospital, and Laboratoire de Neurosciences Fonctionnelles et Pathologies, Place V Pauchet, 80000 Amiens, France.
Clin Neurol Neurosurg. 2011 Apr;113(3):196-201. doi: 10.1016/j.clineuro.2010.11.004. Epub 2010 Dec 8.
In acute ischemic stroke, early neurological deterioration (END) has a severe impact on patient outcome. We tested the hypothesis that initial biological aspirin non-responder status (ANRS) helps predict END.
A total of 85 patients with acute ischemic stroke on 160mg aspirin daily were prospectively included. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) ≥4 points in the first 72h after admission. Platelet responsiveness to aspirin was assessed using the PFA-100 system, and ANRS was defined as a collagen/epinephrine closure time <165ms.
END was observed in 10 patients (11.8%). The presumed reasons for END were progressive stroke (40%), recurrent cerebral ischemia (30%), malignant middle cerebral artery infarction (20%) and secondary acute hydrocephalus (10%). Patients with END had a non-significant worse neurological status on the NIHSS at hospital admission (8.4 vs. 4.2; p=0.15). Initial impaired consciousness (30% vs. 3%), visual disturbance (60% vs. 23%) and ANRS (60% vs. 20%) were observed more frequently in patients with END. In multivariate analysis, impaired consciousness (OR: 17.3; 95% CI: 2.0-149.5; p=0.01) and ANRS (OR: 6.4; 95% CI: 1.4-29.6; p=0.017) were found to be independently associated with END.
ANRS is common in acute ischemic stroke patients and is predictive of END. The clinical significance of these findings requires further evaluation in larger longitudinal studies.
在急性缺血性卒中中，早期神经功能恶化（END）对患者预后有严重影响。我们检验了初始生物阿司匹林无反应状态（ANRS）有助于预测END这一假设。
前瞻性纳入85例每日服用160mg阿司匹林的急性缺血性卒中患者。END定义为入院后72小时内美国国立卫生研究院卒中量表（NIHSS）评分增加≥4分。使用PFA-100系统评估血小板对阿司匹林的反应性，ANRS定义为胶原/肾上腺素封闭时间<165毫秒。
10例患者（11.8%）出现END。END的推测原因包括进展性卒中（40%）、复发性脑缺血（30%）、恶性大脑中动脉梗死（20%）和继发性急性脑积水（10%）。END患者入院时NIHSS神经功能状态较差，但差异无统计学意义（8.4对4.2；p=0.15）。与无END患者相比，END患者更常出现初始意识障碍（30%对3%）、视觉障碍（60%对23%）和ANRS（60%对20%）。多因素分析发现，意识障碍（OR：17.3；95%CI：2.0-149.5；p=0.01）和ANRS（OR：6.4；95%CI：1.4-29.6；p=0.017）与END独立相关。
ANRS在急性缺血性卒中患者中常见，且可预测END。这些发现的临床意义需要在更大规模的纵向研究中进一步评估。
