Furlan Julio C, Fang Jiming, Silver Frank L
Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada, M4G 3V9; Department of Medicine, Division of Physical Medicine and Rehabilitation, Lyndhurst Centre, Toronto, Ontario, Canada, M4G 3V9; Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada, M4G 3V9.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, M4G 3V9.
J Neurol Sci. 2016 Mar 15;362:198-203. doi: 10.1016/j.jns.2016.01.044. Epub 2016 Jan 23.
Thrombocytopenia may be associated with a greater risk of cerebral hemorrhage and thrombocytosis may be associated with a greater risk of cerebral thrombosis. There is a paucity of studies focused on the potential association between blood platelet count (BPC) and outcomes after acute ischemic stroke (AIS). We hypothesized that abnormal BPC is associated with poorer outcomes after AIS.
This study included data from the Ontario Stroke Registry on consecutive patients with AIS admitted between July 2003 and March 2008. Patients were divided into groups as follows: low BPC (<150,000/mm(3)), normal BPC (150,000 to 450,000/mm(3)) and high BPC (>450,000/mm(3)). Primary outcome measures were the frequency of moderate/severe strokes on admission (Canadian Neurologic Scale: <8), greater degree of disability at discharge (modified Rankin score: 3-6), and 30-day and 90-day mortality.
We included 9230 patients. Both low and high BPC were associated with higher 30-day mortality (p≤0.0335) and 90-day mortality (p≤0.048) following AIS. The Kaplan-Meier curves indicate that abnormal BPC is associated with greater mortality after AIS (p=0.0002). Nonetheless, abnormal BPC was not associated with initial stroke severity (p≥0.225), degree of disability (p≥0.3761), or length of stay in the acute stroke care center (p≥0.7818) after adjustment for major potential confounders.
Thrombocytopenia and thrombocytosis on the initial admission are associated with higher mortality after AIS. Abnormal BPC does not adversely affect the degree of initial impairment, disability at discharge, or length of stay in the acute care hospital after AIS.
血小板减少症可能与脑出血风险增加有关，而血小板增多症可能与脑血栓形成风险增加有关。目前针对血小板计数（BPC）与急性缺血性卒中（AIS）后预后之间潜在关联的研究较少。我们假设异常的BPC与AIS后较差的预后相关。
本研究纳入了安大略省卒中登记处2003年7月至2008年3月期间连续收治的AIS患者的数据。患者分为以下几组：低BPC（<150,000/mm³）、正常BPC（150,000至450,000/mm³）和高BPC（>450,000/mm³）。主要结局指标为入院时中度/重度卒中的发生率（加拿大神经功能量表：<8）、出院时残疾程度加重（改良Rankin评分：3 - 6）以及30天和90天死亡率。
我们纳入了9230例患者。AIS后，低BPC和高BPC均与30天死亡率升高（p≤0.0335）和90天死亡率升高（p≤0.048）相关。Kaplan - Meier曲线表明，异常BPC与AIS后更高的死亡率相关（p = 0.0002）。然而，在对主要潜在混杂因素进行调整后，异常BPC与初始卒中严重程度（p≥0.225）、残疾程度（p≥0.3761）或急性卒中护理中心的住院时间（p≥0.7818）无关。
初次入院时的血小板减少症和血小板增多症与AIS后更高的死亡率相关。异常的BPC不会对AIS后的初始损伤程度、出院时的残疾情况或急性护理医院的住院时间产生不利影响。
