Oji Satoru, Tomohisa Dembo, Hara Wataru, Tajima Takashi, Suzuki Masato, Saito Akane, Yoshida Norihito, Nomura Kyoichi
Saitama Medical Center, Saitama Medical University Kawagoe, Saitama, Japan.
Saitama Medical Center, Saitama Medical University Kawagoe, Saitama, Japan.
J Stroke Cerebrovasc Dis. 2018 Jun;27(6):1624-1631. doi: 10.1016/j.jstrokecerebrovasdis.2018.01.012. Epub 2018 Feb 7.
The most attentive clinical problem in patients with branch atheromatous disease (BAD) is early neurological deterioration (END). Although the platelet activation (PA) is involved in pathogenesis, the relationship between PA and END has remained unclear. We investigated clinical data including mean platelet volume (MPV, fL) as a marker for PA to identify clinically useful biomarkers for END.
A total of 64 patients with BAD were investigated retrospectively, and divided into 2 groups based on whether neurologic symptoms deteriorated or not: BAD with and without END (END and non-END). The END was defined as patients with point increase of 1 or greater in the National Institutes of Health Stroke Scale (NIHSS); non-END was defined as those without such increase. Clinical features such as NIHSS, modified Rankin scale (mRS), laboratory data including MPV, lesion size (LS, mm) on admission, and treatments were compared between the 2 groups.
Of 64 patients, 17 cases had an END. The median values of NIHSS, mRS, MPV, and LS on admission were significantly greater in END than in non-END (P < .05, respectively). There was no correlation of MPV with NIHSS, mRS and LS, respectively. The median values of MPV were significantly higher in END than in non-END and control (P < .05, respectively). A receiver operating characteristic curve indicated a value of 10.1 as cutoff level for MPV to discriminate between END and non-END.
High MPV values on admission may be an independent biomarker for END. Physicians should pay more careful attention to END in BAD showing MPV values higher than 10.1 on admission.
分支动脉粥样硬化疾病（BAD）患者最需要关注的临床问题是早期神经功能恶化（END）。尽管血小板活化（PA）参与了其发病机制，但PA与END之间的关系仍不明确。我们研究了包括平均血小板体积（MPV，fL）作为PA标志物的临床数据，以确定END的临床有用生物标志物。
对64例BAD患者进行回顾性研究，并根据神经症状是否恶化分为两组：有和无END的BAD（END组和非END组）。END定义为美国国立卫生研究院卒中量表（NIHSS）评分增加1分或更高的患者；非END定义为无此类增加的患者。比较两组患者的临床特征，如NIHSS、改良Rankin量表（mRS）、包括MPV在内的实验室数据、入院时的病变大小（LS，mm）以及治疗情况。
64例患者中，17例出现END。END组入院时NIHSS、mRS、MPV和LS的中位数显著高于非END组（P均<0.05）。MPV与NIHSS、mRS和LS之间均无相关性。END组MPV的中位数显著高于非END组和对照组（P均<0.05）。受试者工作特征曲线表明，MPV的截断值为10.1时可区分END组和非END组。
入院时较高的MPV值可能是END的独立生物标志物。对于入院时MPV值高于10.1的BAD患者，医生应更加密切关注END。
