Department of Neurology, Shaoxing Hospital Affiliated to China Medical University, Shaoxing 312030, Zhejiang Province, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2024 Apr 25;53(2):160-167. doi: 10.3724/zdxbyxb-2023-0424.
To analyze the relationship of thrombus composition and regulatory T cell expression with clinical outcome in acute ischemic stroke (AIS) patients with thrombectomy.
A total of 44 AIS patients who underwent thrombectomy in the Department of Neurology of Shaoxing Hospital from June 2021 to October 2022 were enrolled. All thrombus specimens were subjected to hematoxylin-eosin staining and immunohistochemistry. Semi-quantitative analysis was performed to determine the content of red blood cells, fibrinogen/platelets, and regulatory T (CD4CD25) cells. Clinical data, vascular recanalization status, and neurologic outcomes at 3 months after thrombectomy were collected. A modified Rankin Scale score of 0-2 was defined as a favorable outcome.
Among 44 patients with complete thrombus data there were 15 cases of red cell type, 11 cases of mixed type and 18 cases of fibrin/platelet type. There was a significant difference in trial of ORG 10172 in acute stroke treatment (TOAST) etiological classification among the three groups (<0.01), while no significant differences were found in other general clinical and surgical data (all >0.05). According to the TOAST etiology, 28 cases were classified as large atherosclerosis type and 16 cases as cardioembolic type. The proportion of red blood cells in thrombus was significantly higher in patients with large atherosclerosis type than that in those with cardioembolic type [58.0% (44.2%, 72.5%) 24.5% (12.7%, 48.0%), <0.01]. The ratio of fibrin to platelet in patients with cardiogenic embolism was significantly higher than that in patients with large atherosclerosis [73.0% (49.2%, 84.5%) 40.0% (25.2%, 54.5%), <0.01). Among the 44 patients, 19 had good while 25 had poor neurological outcomes. Univariate binary logistic regression analysis showed that age, operation time, CD4CD25T cell number were correlated with the functional outcomes of the patients (all <0.05). Multivariate binary logistic regression analysis showed that thrombus CD4CD25T cell count was an independent factor affecting the functional outcome of patients (=1.369, 95%: 1.101-1.701, <0.01).
There is no significant correlation of erythrocyte and fibrin/platelet components in thrombus with functional outcome in AIS patients, but an increased count of regulatory T cells associates with good functional outcome.
分析急性缺血性脑卒中（AIS）患者取栓术后血栓成分和调节性 T 细胞表达与临床结局的关系。
连续纳入 2021 年 6 月至 2022 年 10 月在绍兴市人民医院神经内科接受取栓术的 44 例 AIS 患者。所有血栓标本均进行苏木精-伊红染色和免疫组织化学染色。采用半定量分析方法确定红细胞、纤维蛋白原/血小板和调节性 T（CD4CD25）细胞的含量。收集取栓术后 3 个月的临床资料、血管再通情况和神经功能结局。改良 Rankin 量表评分 0-2 定义为预后良好。
44 例患者中，完全血栓数据的红细胞型 15 例，混合型 11 例，纤维蛋白/血小板型 18 例。三组间试验性急性卒中治疗组织分型（TOAST）病因分类有显著差异（<0.01），而其他一般临床和手术数据无显著差异（均>0.05）。根据 TOAST 病因，28 例为大动脉粥样硬化型，16 例为心源性栓塞型。大动脉粥样硬化型患者血栓中红细胞比例明显高于心源性栓塞型[58.0%（44.2%，72.5%）比 24.5%（12.7%，48.0%），<0.01]。心源性栓塞型患者的纤维蛋白与血小板的比值明显高于大动脉粥样硬化型[73.0%（49.2%，84.5%）比 40.0%（25.2%，54.5%），<0.01]。44 例患者中，19 例预后良好，25 例预后不良。单因素二项逻辑回归分析显示，年龄、手术时间、CD4CD25T 细胞数量与患者的功能结局相关（均<0.05）。多因素二项逻辑回归分析显示，血栓 CD4CD25T 细胞计数是影响患者功能结局的独立因素（=1.369，95%：1.101-1.701，<0.01）。
急性缺血性脑卒中患者血栓中红细胞和纤维蛋白/血小板成分与功能结局无显著相关性，但调节性 T 细胞计数增加与良好的功能结局相关。
