CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Av Infante D Henrique, 6200-506 Covilhã, Portugal.
J Neurol Neurosurg Psychiatry. 2011 Sep;82(9):986-92. doi: 10.1136/jnnp.2010.230870. Epub 2011 Feb 4.
Classification defined in the Trial of Org10172 in Acute Ischaemic Stroke (TOAST) is widely used in trials and practice. Previous studies on pathophysiology suggest a role for endothelial inflammation in atherothrombotic strokes and intracardiac thrombosis in cardioembolic strokes. Data on lacunar and undetermined strokes are limited. The aim of the study was to assess non-specific inflammatory and thrombogenic parameters in patients with ischaemic stroke.
This was a prospective controlled clinical study involving 200 patients with ischaemic stroke and 50 controls. Patients were classified following the TOAST criteria. Plasma levels of fibrinogen, D-dimer, C reactive protein and values for D-dimer/fibrinogen ratio and erythrocyte sedimentation rate were assessed over 48 h after admission. Clinical severity was measured using the National Institutes of Health Stroke Scale and the Oxfordshire Community Stroke Project classification. Patients with severe systemic disorders were excluded.
The assessed parameters were significantly higher in patients versus controls. Cardioembolic stroke patients showed increased D-dimer, fibrinogen and D-dimer/fibrinogen ratio. Patients with atherothrombotic stroke showed raised fibrinogen and erythrocyte sedimentation rate. Patients with lacunar and undetermined stroke showed intermediate values of markers. Total anterior cerebral infarction syndrome was related to D-dimer.
Patients showed analytical modifications during the acute phase of stroke, both related to acute response and mechanism. The results suggest that the biochemical profile may be prothrombotic in patients with cardioembolism and inflammatory in those with atherothrombotic stroke. Patients with lacunar and undetermined stroke showed intermediate profiles. Assessment of the studied parameters is not expensive, widely available and may proportionate information about pathophysiology in stroke patients without severe systemic conditions.
在急性缺血性中风试验（TOAST）中定义的分类在临床试验和实践中被广泛应用。先前关于病理生理学的研究表明，内皮炎症在动脉粥样硬化血栓形成性中风和心源性血栓形成性中风中的作用。关于腔隙性和未确定类型中风的数据有限。本研究旨在评估缺血性中风患者的非特异性炎症和血栓形成参数。
这是一项涉及 200 例缺血性中风患者和 50 例对照的前瞻性对照临床研究。患者根据 TOAST 标准进行分类。入院后 48 小时内评估纤维蛋白原、D-二聚体、C 反应蛋白以及 D-二聚体/纤维蛋白原比值和红细胞沉降率的值。使用国立卫生研究院中风量表和牛津郡社区中风项目分类评估临床严重程度。排除患有严重全身性疾病的患者。
与对照组相比，评估参数在患者中显著升高。心源性栓塞性中风患者的 D-二聚体、纤维蛋白原和 D-二聚体/纤维蛋白原比值升高。动脉粥样硬化血栓形成性中风患者的纤维蛋白原和红细胞沉降率升高。腔隙性和未确定类型中风患者的标志物值处于中间水平。总前脑梗死综合征与 D-二聚体相关。
患者在中风的急性阶段表现出分析性改变，这些改变既与急性反应有关，也与机制有关。结果表明，生化谱在伴心源性栓塞的患者中可能具有促血栓形成作用，在伴动脉粥样硬化血栓形成的患者中具有炎症作用。腔隙性和未确定类型中风患者的表现处于中间水平。评估所研究的参数并不昂贵，广泛可用，并且可以为无严重系统性疾病的中风患者提供有关病理生理学的信息。
