Coagulation markers and functional outcome in acute ischemic stroke: Impact of intensive versus standard hyperglycemia control.
Coagulation markers and functional outcome in acute ischemic stroke: Impact of intensive versus standard hyperglycemia control.
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DOI：
10.1002/rth2.12563
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发表时间：
2021-07
影响因子：
4.6
通讯作者：
iSPOT, Neurological Emergencies Treatment Trials Network (NETT) Investigators
中科院分区：
文献类型：
--
作者：
Gentile NT;Rao AK;Reimer H;Del Carpio-Cano F;Ramakrishnan V;Pauls Q;Barsan WG;Bruno A;iSPOT, Neurological Emergencies Treatment Trials Network (NETT) Investigators
急性缺血性卒中(AIS)后高血糖患者的凝血功能改变可影响其功能转归。我们前瞻性地研究了强化血糖控制与标准血糖控制对AIS患者凝血标志物的影响及其与功能预后的关系。《对选定的凝血标志物和卒中试验结果的洞察》测量了参加卒中高血糖胰岛素网络努力试验的患者在AIS后3个月的凝血生物标志物：全血组织因子促凝活性(TFPCA)；血浆因子VII(FVII)、VIIa(FVIIa)和VIII(FVIII)；凝血酶-抗凝血酶(TAT)复合体；D-二聚体；组织因子途径抑制物和纤溶酶原激活物抑制物-1(PAI-1)抗原。通过双向方差分析分析生物标记物随时间的变化(从卒中发病12小时后的基线≈到48小时)的变化，以及治疗组之间的生物标记物的变化、功能结果及其相互作用。共纳入125例患者(强化治疗组57例，标准治疗组68例)。总体平均年龄为66岁；42%是女性。TFPCA(P=0.02)、PAI-1(P=0.04)和FVIIa(P=0.04)治疗组的凝血标志物从基线到48小时的变化有显著差异。FVIIa的增加和FVIII的减少与良好的功能结果相关(P值分别为9.04和0.04)。在强化治疗组中，预后良好的患者TFPCA和FVIIa的减少和FVIIa的增加明显大于预后不良的患者(P值分别为0.02、0.002、0.03)。在标准治疗组中，功能结果不同，FVII的变化也不同(P=0.006)。强化的血糖控制导致凝血生物标志物的改变比标准治疗更大，这些改变与AIS后3个月的良好功能结局有关。
Alterations in coagulation could mediate functional outcome in patients with hyperglycemia after acute ischemic stroke (AIS). We prospectively studied the effects of intensive versus standard glucose control on coagulation markers and their relationships to functional outcomes in patients with AIS. The Insights on Selected Procoagulation Markers and Outcomes in Stroke Trial measured the coagulation biomarkers whole blood tissue factor procoagulant activity (TFPCA); plasma factors VII (FVII), VIIa (FVIIa), and VIII (FVIII); thrombin‐antithrombin (TAT) complex; D‐dimer; tissue factor pathway inhibitor, and plasminogen activator inhibitor‐1 (PAI‐1) antigen in patients enrolled in the Stroke Hyperglycemia Insulin Network Effort trial of intensive versus standard glucose control on functional outcome at 3 months after AIS. Changes in biomarkers over time (from baseline ≈12 hours after stroke onset) to 48 hours, and changes in biomarkers between treatment groups, functional outcomes, and their interaction were analyzed by two‐way analysis of variance. A total of 125 patients were included (57 in the intensive treatment group and 68 in the standard treatment group). The overall mean age was 66 years; 42% were women. Changes from baseline to 48 hours in coagulation markers were significantly different between treatment groups for TFPCA (P = 0.02) and PAI‐1 (P = .04) and FVIIa (P = .04). Increases in FVIIa and decreases in FVIII were associated with favorable functional outcomes (P = .04 and .04, respectively). In the intensive treatment group, reductions in TFPCA and FVIII and increases in FVIIa were greater in patients with favorable than unfavorable outcomes (P = .02, 0.002, 0.03, respectively). In the standard treatment group, changes in FVII were different by functional outcome (P = .006). Intensive glucose control induced greater alterations in coagulation biomarkers than standard treatment, and these were associated with a favorable functional outcome at 3 months after AIS.
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