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止血因素并不能解释C反应蛋白浓度较高的缺血性中风患者预后较差的原因。

Haemostatic factors do not account for worse outcomes from ischaemic stroke in patients with higher C-reactive protein concentrations.

作者信息

Słomka Artur, Świtońska Milena, Sinkiewicz Władysław, Żekanowska Ewa

机构信息

1 Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.

2 Neurology and Stroke Care Unit, Jan Biziel University Hospital No. 2, Bydgoszcz, Poland.

出版信息

Ann Clin Biochem. 2017 May;54(3):378-385. doi: 10.1177/0004563216663775. Epub 2016 Jul 22.

Abstract

Background Although the role of microparticles was recently implicated in stroke pathophysiology, the association between microparticles and inflammation is still not fully understood. The aim of this cohort study of 66 patients was to assess a relation between haemostatic factors, C-reactive protein and clinical outcome of ischaemic stroke. Methods Plasma microparticles procoagulant activity, concentrations of tissue factor-bearing microparticles, tissue factor and tissue factor pathway inhibitor in ischaemic stroke patients were determined with enzyme-linked immunosorbent assays at the time of initial diagnosis, along with serum C-reactive protein concentrations. Patients were divided into two groups depending on their C-reactive protein concentrations (C-reactive protein <3 mg/L; n = 28 vs. C-reactive protein ≥3 mg/L; n = 38). The analysed clinical outcome measures included the National Institutes of Health Stroke Scale and the Barthel Index. Results The two C-reactive protein groups did not differ significantly in terms of microparticles procoagulant activities, tissue factor-bearing microparticles, tissue factor and tissue factor pathway inhibitor concentrations. A significant correlation was observed between tissue factor pathway inhibitor and National Institutes of Health Stroke Scale score at admission ( R = 0.3, P = 0.03). Patients with C-reactive protein ≥3 mg/L presented with significantly higher National Institutes of Health Stroke Scale scores (median, 9.00 vs. 5.50, P = 0.002) and lower Barthel Index scores (median, 20.00 vs. 65.00, P = 0.002) than individuals with C-reactive protein <3 mg/L. The C-reactive protein concentrations correlated positively with National Institutes of Health Stroke Scale scores ( R = 0.3, P = 0.02) and inversely with Barthel Index scores ( R = - 0.4, P = 0.002). Conclusions Altogether, these findings imply that haemostatic parameters (microparticles, tissue factor-bearing microparticles, tissue factor, tissue factor pathway inhibitor) do not account for elevated C-reactive protein concentrations in ischaemic stroke patients.

摘要

背景 尽管微粒在中风病理生理学中的作用最近受到关注,但微粒与炎症之间的关联仍未完全明确。这项针对66例患者的队列研究旨在评估止血因子、C反应蛋白与缺血性中风临床结局之间的关系。方法 在缺血性中风患者初诊时,采用酶联免疫吸附测定法测定血浆微粒促凝活性、含组织因子微粒的浓度、组织因子和组织因子途径抑制剂,同时测定血清C反应蛋白浓度。根据C反应蛋白浓度将患者分为两组(C反应蛋白<3mg/L;n=28 vs C反应蛋白≥3mg/L;n=38)。分析的临床结局指标包括美国国立卫生研究院卒中量表和巴氏指数。结果 两个C反应蛋白组在微粒促凝活性、含组织因子微粒、组织因子和组织因子途径抑制剂浓度方面无显著差异。入院时组织因子途径抑制剂与美国国立卫生研究院卒中量表评分之间存在显著相关性(R=0.3,P=0.03)。C反应蛋白≥3mg/L的患者比C反应蛋白<3mg/L的患者表现出显著更高的美国国立卫生研究院卒中量表评分(中位数,9.00对5.50,P=0.002)和更低的巴氏指数评分(中位数,20.00对65.00,P=0.002)。C反应蛋白浓度与美国国立卫生研究院卒中量表评分呈正相关(R=0.3,P=0.02),与巴氏指数评分呈负相关(R=-0.4,P=0.002)。结论 总之,这些发现表明止血参数(微粒、含组织因子微粒、组织因子、组织因子途径抑制剂)不能解释缺血性中风患者C反应蛋白浓度的升高。

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