糖尿病合并入院高血糖对急性缺血性脑卒中患者血栓组织学成分和超微结构的影响。
Effects of diabetes mellitus complicated by admission hyperglycemia on clot histological composition and ultrastructure in patients with acute ischemic stroke.
机构信息
Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
Graduate School of Peking Union Medical College, Beijing, China.
出版信息
BMC Neurol. 2022 Apr 5;22(1):130. doi: 10.1186/s12883-022-02660-y.
BACKGROUND
Type 2 diabetes mellitus (T2DM) affects the occurrence and prognosis of acute ischemic stroke (AIS). However, the impact of diabetes on thrombus characteristics is unclear. The relationship between the composition and ultrastructure of clots and DM with admission hyperglycemia was investigated.
METHODS
Consecutive patients with AIS who underwent endovascular thrombus retrieval between June 2017 and May 2021 were recruited. The thrombus composition and ultrastructure were evaluated using Martius scarlet blue stain and scanning electron microscopy. Clot perviousness was evaluated via thrombus attenuation increase on computed tomography angiography (CTA) versus non-contrast CT. Patients with admission hyperglycemia DM (ahDM) and those without DM (nonDM) were compared in terms of thrombus composition, ultrastructure, and perviousness.
RESULTS
On admission, higher NIHSS scores (17 vs. 12, respectively, p = 0.015) was evident in ahDM patients. After the 90-day follow-up, the rates of excellent outcomes (mRS 0-1) were lower in patients with ahDM (16.6%, p = 0.038), but functional independence (mRS 0-2) and handicapped (mRS 3-5) were comparable between patients with ahDM and nonDM. The outcome of mortality was higher in patients with ahDM (33.3%, p = 0.046) than in nonDM patients. Clots in patients with ahDM had more fibrin (39.4% vs. 25.0%, respectively, p = 0.007), fewer erythrocyte components (21.2% vs. 41.5%, respectively, p = 0.043), equivalent platelet fraction (27.7% vs. 24.6%, respectively, p = 0.587), and higher WBC counts (4.6% vs. 3.3%, respectively, p = 0.004) than in nonDM patients. The percentage of polyhedral erythrocytes in thrombi was significantly higher in ahDM patients than in nonDM patients (68.9% vs. 45.6%, respectively, p = 0.007). The proportion of pervious clots was higher in patients nonDM than in patients with ahDM (82.61% vs. 40%, respectively, p = 0.026).
CONCLUSION
Patients with ahDM presented with greater stroke severity on admission and poorer functional outcomes after 3 months. Clots in patients with ahDM had more fibrin, leucocytes, and fewer erythrocyte components than in patients nonDM. The content of polyhedral erythrocytes and impervious clots proportion were significantly higher in thrombi of patients with AIS and ahDM. Further research is required to validate these findings.
背景
2 型糖尿病（T2DM）会影响急性缺血性脑卒中（AIS）的发生和预后。然而，糖尿病对血栓特征的影响尚不清楚。本研究旨在探讨糖尿病与入院高血糖与血栓成分和超微结构之间的关系。
方法
连续纳入 2017 年 6 月至 2021 年 5 月期间接受血管内血栓切除术的 AIS 患者。采用 Martius 猩红蓝染色和扫描电子显微镜评估血栓成分和超微结构。通过血栓衰减增加在计算机断层血管造影（CTA）与非对比 CT 上评估血栓通透性。比较入院高血糖糖尿病（ahDM）和无糖尿病（nonDM）患者的血栓成分、超微结构和通透性。
结果
ahDM 患者入院时 NIHSS 评分更高（17 分 vs. 12 分，p=0.015）。90 天后随访时，ahDM 患者的良好预后（mRS 0-1）比例较低（16.6%，p=0.038），但功能独立性（mRS 0-2）和残疾（mRS 3-5）与 nonDM 患者无差异。ahDM 患者的死亡率（33.3%，p=0.046）高于 nonDM 患者。ahDM 患者的血栓中纤维蛋白含量更高（39.4% vs. 25.0%，p=0.007），红细胞成分更少（21.2% vs. 41.5%，p=0.043），血小板比例相当（27.7% vs. 24.6%，p=0.587），白细胞计数更高（4.6% vs. 3.3%，p=0.004）。ahDM 患者血栓中多角形红细胞比例明显高于 nonDM 患者（68.9% vs. 45.6%，p=0.007）。nonDM 患者的通透血栓比例高于 ahDM 患者（82.61% vs. 40%，p=0.026）。
结论
ahDM 患者入院时卒中严重程度更高，3 个月后功能结局更差。ahDM 患者的血栓中纤维蛋白、白细胞和红细胞成分较少。ahDM 患者血栓中的多角形红细胞含量和不透血栓比例显著高于 nonDM 患者。需要进一步研究来验证这些发现。
Zotero 插件