凝血因子 XIII 浓度评估在接受溶栓治疗的缺血性中风急性期患者中的应用价值
The Usefulness of Factor XIII Concentration Assessment in Patients in the Acute Phase of Ischaemic Stroke Treated with Thrombolysis.
作者信息
Wiszniewska Małgorzata, Włodarczyk Urszula, Sury Magdalena, Słomka Artur, Piekuś-Słomka Natalia, Żdanowicz Anna, Żekanowska Ewa
机构信息
Emergency Medical Services, University of Applied Sciences, 64-920 Piła, Poland.
Neurological Department with Stroke Unit, Specialist Hospital, 64-920 Piła, Poland.
出版信息
Neurol Int. 2024 May 10;16(3):551-560. doi: 10.3390/neurolint16030041.
BACKGROUND AND AIMS
In recent years, there has been a growing interest in factor XIII in ischaemic stroke. The study's main aim was to assess the usefulness of factor XIII concentration determination in patients with acute ischaemic stroke (AIS) treated with thrombolysis with recombinant tissue plasminogen activator (t-PA).
METHODS
The study was conducted in two groups of 84 patients with AIS: group I-with thrombolytic therapy and group II-without thrombolysis. A physical examination, neurological status (using the National Institutes of Health Stroke Scale, NIHSS), daily patients' activities measured with the Barthel Index and Modified Rankin Scale (mRS), and blood parameters were conducted on day 1 and day 7. The following parameters were assessed: highly sensitive C-reaction protein (CRP), fibrinogen, D-dimers (DD), neutrophil-lymphocyte ratio (NLR index), and the concentration of factor XIII-A.
RESULTS
In group I, the concentration of XIII-A decreased significantly between day 1 and 7 ( < 0.001). In group I, the concentration of XIII-A on day 7 in Total Anterior Circulation Infarct (TACI) was significantly lower than in non-TACI stroke. XIII-A concentration in group I was significantly lower in patients < 31 points with Acute Stroke Registry and Analysis of Lausanne (ASTRAL). A greater decrease in XIII-A between the first sampling on day 1 and the second sampling on day 7 was associated with a worse patient neurological state in group I.
CONCLUSIONS
In patients with AIS treated with t-PA, factor XIII concentrations decrease in the acute phase of stroke, and the largest decrease occurs in the TACI stroke. Determination of factor XIII concentration in patients with AIS can be used in clinical practice as an additional parameter supporting the assessment of stroke severity and may play a role in the prognosis; lower factor XIII-A activity may be a predictor of a worse prognosis.
背景与目的
近年来，缺血性卒中患者体内的凝血因子 XIII 越来越受到关注。本研究的主要目的是评估测定急性缺血性卒中（AIS）患者接受重组组织型纤溶酶原激活剂（t-PA）溶栓治疗时凝血因子 XIII 浓度的作用。
方法
本研究纳入两组各 84 例 AIS 患者：第一组接受溶栓治疗，第二组未接受溶栓治疗。在第 1 天和第 7 天进行体格检查、神经功能状态评估（采用美国国立卫生研究院卒中量表，NIHSS）、用巴氏指数和改良 Rankin 量表（mRS）评估患者日常活动能力以及检测血液参数。评估以下参数：高敏 C 反应蛋白（CRP）、纤维蛋白原、D - 二聚体（DD）、中性粒细胞 - 淋巴细胞比值（NLR 指数）以及凝血因子 XIII - A 的浓度。
结果
在第一组中，第 1 天至第 7 天 XIII - A 的浓度显著降低（<0.001）。在第一组中，全前循环梗死（TACI）患者第 7 天的 XIII - A 浓度显著低于非 TACI 卒中患者。第一组中，急性卒中登记与洛桑分析（ASTRAL）评分<31 分的患者 XIII - A 浓度显著较低。第一组中，第 1 天首次采样至第 7 天第二次采样期间 XIII - A 下降幅度越大，患者神经功能状态越差。
结论
接受 t-PA 治疗的 AIS 患者，凝血因子 XIII 浓度在卒中急性期降低，且在 TACI 卒中中下降幅度最大。测定 AIS 患者凝血因子 XIII 浓度可在临床实践中作为辅助参数支持评估卒中严重程度，可能对预后有一定作用；较低的凝血因子 XIII - A 活性可能是预后较差的预测指标。
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