Kudoh Risa, Mikami Kasumi, Kitajima Maiko, Aizu Keiko, Kitajima Yui, Hagii Joji, Metoki Hirofumi, Seino Satoshi, Baba Yoshiko, Yasujima Minoru, Osanai Tomohiro
Department of Nursing Science, Hirosaki University Graduate School of Health Science, Hirosaki, Japan.
Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
J Stroke Cerebrovasc Dis. 2018 Aug;27(8):2074-2081. doi: 10.1016/j.jstrokecerebrovasdis.2018.03.004. Epub 2018 Apr 4.
Spontaneous micro-aggregation of platelets (SMAP) is frequently observed in stroke patients and is a trigger for the additional development of larger thrombi. We tested the hypothesis that SMAP may predict clinical outcome in acute ischemic stroke patients.
Consecutive acute ischemic stroke patients (n = 358) who were transferred to our hospital within 24 hours after its onset were enrolled. Peripheral venous blood was sampled to measure various parameters when they arrived. SMAP was correlated with plasma brain natriuretic peptide and diastolic blood pressure positively, and with serum albumin and body weight negatively. Multivariable Cox regression analysis showed that only serum albumin was an independent predictor of the SMAP (P = .0023). The proportion of patients who were functionally independent (score 0-2 on the modified Rankin Scales) at discharge was lower in the third tertile of SMAP (higher level) as compared with the first and the second tertiles in ischemic stroke (odds ratio [OR], 5.76; 95 % confidence interval [CI], 3.31-10.05; P < .0001) and atherothrombotic stroke (P = .02 by chi-square test). The lower proportion of patients achieving independence was found in the first tertile of serum albumin (lower level) as compared with the second and third tertiles in ischemic (OR, 4.60; 95% CI, 2.66-7.95; P < .0001), atherothrombotic, and cardioembolic stroke (P = .004 and P < .0001 by chi-square test). On logistic regression analysis, SMAP and serum albumin remained independent predictors of poor outcome in ischemic stroke.
SMAP within 24 hours after stroke onset is a novel independent predictor of clinical outcome in acute ischemic stroke patients.
血小板自发微聚集（SMAP）在中风患者中经常被观察到，并且是更大血栓进一步形成的触发因素。我们检验了SMAP可能预测急性缺血性中风患者临床结局的假设。
纳入发病后24小时内转入我院的连续急性缺血性中风患者（n = 358）。患者到达时采集外周静脉血以测量各种参数。SMAP与血浆脑钠肽和舒张压呈正相关，与血清白蛋白和体重呈负相关。多变量Cox回归分析显示，只有血清白蛋白是SMAP的独立预测因子（P = 0.0023）。在缺血性中风中，SMAP处于第三个三分位数（较高水平）的患者出院时功能独立（改良Rankin量表评分为0 - 2分）的比例低于第一个和第二个三分位数（优势比[OR]，5.76；95%置信区间[CI]，3.31 - 10.05；P < 0.0001）以及动脉粥样硬化血栓形成性中风（卡方检验P = 0.02）。与缺血性中风（OR，4.60；95% CI，2.66 - 7.95；P < 0.0001）、动脉粥样硬化血栓形成性中风和心源性栓塞性中风（卡方检验P = 0.004和P < 0.0001）的第二个和第三个三分位数相比，血清白蛋白处于第一个三分位数（较低水平）的患者实现独立的比例更低。逻辑回归分析显示，SMAP和血清白蛋白仍然是缺血性中风不良结局的独立预测因子。
中风发作后24小时内的SMAP是急性缺血性中风患者临床结局的一种新的独立预测因子。
