Kirkpatrick Angelia C, Stoner Julie A, Dale George L, Rabadi Meheroz, Prodan Calin I
Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma.
Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
J Stroke Cerebrovasc Dis. 2019 Sep;28(9):2398-2406. doi: 10.1016/j.jstrokecerebrovasdis.2019.06.033. Epub 2019 Jul 13.
Coated-platelets are a subset of highly procoagulant platelets observed after dual agonist stimulation with collagen and thrombin. Coated-platelet levels are increased in acute stroke compared to controls, and higher levels are associated with stroke recurrence. We examined whether coated-platelet levels measured at the time of the stroke correlate with cognitive scores at 3 months following the brain infarction.
Coated-platelets were assayed in consecutive patients with nonlacunar stroke. Cognitive screening was performed using the Mini-Mental State Examination (MMSE) at 3 months after discharge. Linear regression, with adjustment for individual covariates, was used to model the association between coated-platelet levels and MMSE scores.
One hundred and twenty-eight patients with a mean MMSE score of 26 points (range 14-30, standard deviation [SD] 3.1) and mean coated-platelet levels of 40.9% (range 5.2-76.2, SD 13.3), completed cognitive screening. An inverse linear association was found between coated-platelet levels and MMSE score, with higher levels seen in patients with lower MMSE scores (r = -.34, R = .12, P < .0001). This association remained despite adjustment for potential confounding factors. In the final model, higher coated-platelet levels (coefficient -.078, 95% confidence interval [CI]: -.12 to -.041, P < .0001), presence of hypertension (coefficient -2.42, 95% CI: -3.90 to -.95, P = .0015), and anticoagulant use at discharge (coefficient -1.48, 95% CI: -2.56 to -.39, P = .0079) were predictive of lower MMSE.
These findings support a link between increased platelet procoagulant potential at the time of the stroke and development of cognitive impairment following cerebral infarction.
包被血小板是在用胶原蛋白和凝血酶双重激动剂刺激后观察到的高度促凝血小板的一个亚群。与对照组相比，急性中风患者的包被血小板水平升高，且较高水平与中风复发相关。我们研究了中风时测得的包被血小板水平是否与脑梗死后3个月的认知评分相关。
对连续性非腔隙性中风患者检测包被血小板。出院后3个月使用简易精神状态检查表（MMSE）进行认知筛查。采用线性回归，并对个体协变量进行调整，以建立包被血小板水平与MMSE评分之间的关联模型。
128例患者完成了认知筛查，其MMSE评分平均为26分（范围14 - 30分，标准差[SD] 3.1），包被血小板水平平均为40.9%（范围5.2 - 76.2，SD 13.3）。发现包被血小板水平与MMSE评分呈负线性相关，MMSE评分较低的患者包被血小板水平较高（r = -0.34，R = 0.12，P < 0.0001）。尽管对潜在混杂因素进行了调整，这种关联仍然存在。在最终模型中，较高的包被血小板水平（系数 -0.078，95%置信区间[CI]：-0.12至 -0.041，P < 0.0001）、高血压的存在（系数 -2.42，95% CI：-3.90至 -0.95，P = 0.0015）以及出院时使用抗凝剂（系数 -1.48，95% CI：-2.56至 -0.39，P = 0.0079）可预测较低的MMSE评分。
这些发现支持中风时血小板促凝潜能增加与脑梗死后认知障碍发展之间存在联系。
