Uygun Gursan Gunes, Caglar Sena Ebru, Tutkavul Kemal, Kosem Esra Gurdal, Karakoc Yunus
Department of Neurology, University of Health Sciences, Istanbul Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey.
Department of Physiology, University of Health Sciences, Hamidiye Faculty of Medicine, Istanbul, Turkey.
Int J Lab Hematol. 2025 Feb;47(1):166-174. doi: 10.1111/ijlh.14373. Epub 2024 Oct 8.
The aim of this study is to determine whether there are any changes in hemorheological parameters, including whole blood viscosity (WBV), plasma viscosity, erythrocyte aggregation, and erythrocyte deformability, in acute ischemic stroke patients, and to establish their relationship with stroke etiology. The study also aims to observe the changes in these parameters, if any, over time and after treatment, and to assess the correlation between risk factors for ischemic stroke and neuroimaging findings.
This was a prospective observational study including 70 patients diagnosed with acute ischemic stroke within the first 3 days of the onset of symptoms and 96 healthy controls. Stroke patients were categorized based on TOAST criteria, and hemorheological parameters were measured at admission and on the fifth day post-treatment. Erythrocyte aggregation and deformability were measured using a laser ektacytometer, and viscosity assessment was conducted with a rotational viscometer.
Stroke patients exhibited significant differences from the control group in aggregation amplitude, aggregation index, and aggregation half-time (p = 0.001, p = 0.013, p = 0.009, respectively) and showed elevated maximum value of elongation index (p = 0.000). No significant differences in WBV and plasma viscosity were observed between the groups. Post-treatment, the small vessel occlusion subgroup demonstrated a notable reduction in WBV. Additionally, homocysteine levels showed a positive correlation with scattered white matter lesions in basal ganglia and infratentorial regions (p = 0.002, p = 0.039, respectively).
Increased predisposition to erythrocyte aggregation may contribute to the occurrence of acute ischemic stroke. Moreover, gaining the ability of erythrocytes to deform and increase blood flow may serve as a compensatory mechanism in the chronic vascular disease process. The risk factors for ischemic stroke may exhibit connections to specific areas within the brain.
本研究的目的是确定急性缺血性脑卒中患者的血液流变学参数（包括全血粘度、血浆粘度、红细胞聚集性和红细胞变形性）是否有任何变化，并确定它们与脑卒中病因的关系。该研究还旨在观察这些参数随时间和治疗后的变化情况，并评估缺血性脑卒中危险因素与神经影像学检查结果之间的相关性。
这是一项前瞻性观察性研究，纳入了70例在症状发作后3天内被诊断为急性缺血性脑卒中的患者和96例健康对照者。脑卒中患者根据TOAST标准进行分类，并在入院时和治疗后第5天测量血液流变学参数。使用激光衍射血细胞分析仪测量红细胞聚集性和变形性，并用旋转粘度计进行粘度评估。
脑卒中患者与对照组在聚集幅度、聚集指数和聚集半衰期方面存在显著差异（分别为p = 0.001、p = 0.013、p = 0.009），并且伸长指数最大值升高（p = 0.000）。两组之间全血粘度和血浆粘度无显著差异。治疗后，小血管闭塞亚组的全血粘度显著降低。此外，同型半胱氨酸水平与基底节和幕下区域的散在白质病变呈正相关（分别为p = 0.002、p = 0.039）。
红细胞聚集倾向增加可能导致急性缺血性脑卒中的发生。此外，红细胞获得变形能力并增加血流可能是慢性血管疾病过程中的一种代偿机制。缺血性脑卒中的危险因素可能与脑内特定区域有关。
