D'Angelo A, Landi G, Vigano'D'Angelo S, Nobile Orazio E, Boccardi E, Candelise L, Mannucci P M
Coagulation Service, Istituto Scientifico Ospedale S. Raffaele, Milano, Italy.
Stroke. 1988 May;19(5):579-83. doi: 10.1161/01.str.19.5.579.
The plasma concentrations of protein C, an anticoagulant protein, and fibrinopeptide A were measured in 37 patients with acute hemispheric stroke and in age-matched controls with nonvascular neurologic diseases. In 11 stroke patients who died within 15 days after the onset (nonsurvivors) protein C antigen concentration on admission was lower than in the control group (p less than 0.005), with a mean value of 63% of the concentrations found in the 26 survivors (p less than 0.001). The difference in protein C concentrations was not associated with different prothrombin time ratios and serum albumin concentration in survivors and nonsurvivors of stroke and was independent of the size of the cerebral lesion. Increased fibrinopeptide A concentration on admission was found in all stroke patients (p less than 0.001), but it was higher in nonsurvivors than in survivors (p less than 0.01), suggesting that lower protein C concentrations in nonsurvivors might be due to increased thrombin-dependent protein C activation. In survivors, protein C concentration was slightly but significantly higher than in controls (p less than 0.05) and was unchanged 2 months after stroke, a time when fibrinopeptide A concentrations had returned to normal. These results show that protein C is involved in the hemostatic derangement caused by stroke and provide a rationale for clinical trials evaluating the therapeutic supplementation with protein C of patients with acute ischemic stroke.
对37例急性半球性卒中患者以及年龄匹配的非血管性神经系统疾病对照者，测定了抗凝蛋白C和纤维蛋白肽A的血浆浓度。在11例发病后15天内死亡的卒中患者（非存活者）中，入院时蛋白C抗原浓度低于对照组（p<0.005），其平均值为26例存活者中所测浓度的63%（p<0.001）。卒中存活者与非存活者之间蛋白C浓度的差异，与不同的凝血酶原时间比值及血清白蛋白浓度无关，且与脑损害的大小无关。所有卒中患者入院时纤维蛋白肽A浓度均升高（p<0.001），但非存活者高于存活者（p<0.01），提示非存活者中蛋白C浓度较低可能是由于凝血酶依赖性蛋白C激活增加所致。在存活者中，蛋白C浓度略高于对照组且具有显著差异（p<0.05），卒中后2个月时该浓度无变化，此时纤维蛋白肽A浓度已恢复正常。这些结果表明，蛋白C参与了卒中所致的止血紊乱，并为评估急性缺血性卒中患者补充蛋白C进行治疗的临床试验提供了理论依据。
