急性脑卒中转归、阿司匹林抵抗与体液因素的关系。

Relationship between acute stroke outcome, aspirin resistance, and humoral factors.

机构信息

Department of Internal Medicine, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, ROC.

出版信息

J Chin Med Assoc. 2012 Oct;75(10):513-8. doi: 10.1016/j.jcma.2012.07.005. Epub 2012 Sep 18.

DOI:10.1016/j.jcma.2012.07.005

PMID:23089403

Abstract

BACKGROUND

The relationship between biochemical aspirin resistance (AR) and functional outcome of acute ischemic stroke is uncertain.

METHODS

Prospectively, 269 patients with acute ischemic stroke were recruited. Their responsiveness to aspirin was evaluated by platelet function analyzer (PFA-100). All patients received blood tests for fibrinogen, high-sensitivity C-reactive protein (hs-CRP), CD40-ligand, P-selectin, intercellular adhesion molecule -1, von Willebrand factor (vWF), and D-dimer. The patients' National Institutes of Health Stroke Scale and modified Rankin Scale scores were recorded on admission, at 30 days, and at 90 days after stroke.

RESULTS

Closure-time measured by PFA-100 equipped with epinephrine/collagen cartridge (Epi-CT) was <193 seconds (defined as AR) in 83 patients (30.9%). Patients with AR were less likely to have favorable outcome at 30 days (47.0%, p = 0.047; odds ratio: 0.69, 0.48-0.99) and 90 days (57.8%, p = 0.037; odds ratio: 0.69, 0.47-0.97) after stroke compared with those of patients without AR (60.2% and 71.0%, respectively). The Epi-CT correlated with closure-time measured by adenosine diphosphate/collagen cartridge (r = 0.241, p < 0.001), blood white cell count (r = -0.125, p = 0.041), low density lipoprotein cholesterol (r = 0.120, p = 0.050), hs-CRP (r = -0.150, p = 0.015), vWF (r = -0.134, p = 0.028), and body mass index (r = 0.143, p = 0.019). Multivariate logistic regression analysis showed that higher National Institutes of Health Stroke Scale at admission, atrial fibrillation, increased plasma levels of hs-CRP, and D-dimer were independent predictors for unfavorable stroke outcome at 90 days.

CONCLUSION

Aspirin resistance evaluated by PFA-100 test was associated with unfavorable 90-day outcome. However, AR determined by PFA-100 dose not predict 90-day functional outcome. The results of PFA-100 testing represented a complex interaction between drug effect, inflammatory reaction, and prothrombotic activity.

摘要

背景

生化阿司匹林抵抗（AR）与急性缺血性脑卒中的功能预后之间的关系尚不确定。

方法

前瞻性地招募了 269 例急性缺血性脑卒中患者。通过血小板功能分析仪（PFA-100）评估其对阿司匹林的反应性。所有患者均接受纤维蛋白原、高敏 C 反应蛋白（hs-CRP）、CD40 配体、P-选择素、细胞间黏附分子-1、血管性血友病因子（vWF）和 D-二聚体的血液检查。患者入院时、第 30 天和第 90 天记录国立卫生研究院卒中量表和改良 Rankin 量表评分。

结果

用肾上腺素/胶原试剂盒（Epi-CT）测量的 PFA-100 闭合时间<193 秒（定义为 AR）的患者 83 例（30.9%）。与无 AR 患者相比，AR 患者在 30 天（47.0%，p=0.047；比值比：0.69，0.48-0.99）和 90 天（57.8%，p=0.037；比值比：0.69，0.47-0.97）的预后较差（分别为 60.2%和 71.0%）。Epi-CT 与用二磷酸腺苷/胶原试剂盒（ADP/CT）测量的闭合时间呈正相关（r=0.241，p<0.001），与白细胞计数（r=-0.125，p=0.041）、低密度脂蛋白胆固醇（r=0.120，p=0.050）、hs-CRP（r=-0.150，p=0.015）、vWF（r=-0.134，p=0.028）和体重指数（r=0.143，p=0.019）。多变量逻辑回归分析表明，入院时较高的国立卫生研究院卒中量表评分、心房颤动、hs-CRP 和 D-二聚体血浆水平升高是 90 天不良卒中结局的独立预测因素。