Von Willebrand factor, P-selectin and fibrinogen levels in patients with acute ischaemic and haemorrhagic stroke, and their relationship with stroke sub-type and functional outcome
Von Willebrand factor, P-selectin and fibrinogen levels in patients with acute ischaemic and haemorrhagic stroke, and their relationship with stroke sub-type and functional outcome
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DOI：
10.1080/09537109876618
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发表时间：
1998-01-01
期刊：
影响因子：
3.3
通讯作者：
Butterworth, RJ
中科院分区：
文献类型：
--
作者：
Bath, PMW;Blann, A;Butterworth, RJ
虽然缺血性卒中与血小板功能增强有关，但尚不清楚这是否适用于所有亚型，尤其是腔隙性梗死，其病理病因与皮质梗死不同。同样，相互矛盾的证据表明，出血性卒中可能与血栓形成状态有关，也可能无关。对163例急性缺血性脑卒中患者和40例急性原发性脑出血患者以及33例年龄、性别和种族匹配的对照组在发病48小时内测定血管性血友病因子（VWF）、纤维蛋白原和P-选择素水平。与对照组相比，皮质和腔隙性缺血性卒中以及出血性卒中患者vWF（IU/dl）均显著升高，中位数（半四分位数范围）分别为158（25）vs 144（19）vs 147（24）vs 114（16）。同样，纤维蛋白原（g/L）增加：4.80（0.90）vs 4.65（0.70）vs 4.35（0.83）vs 3.70（0.70）。相比之下，皮质性卒中患者的可溶性P-选择素（ng/ml）较腔隙性脑梗死患者或对照组升高：分别为408（101）vs 300（108）vs 324（121）;出血性卒中患者的P-选择素没有升高，360（153）。vWF和纤维蛋白原均与3个月功能结局（改良兰金评分）相关：r = 0.371（2 P = 0.0006）和r = 0.195（2 P = 0.042）;然而，P-选择素与结局无关：r = 0.188（2 P = 0.084）。结果表明，vWF和纤维蛋白原的增加，在所有类型的中风反映了急性期的反应，相反，增加可溶性P-选择素水平皮质卒中，但不腔隙性梗死，表明血小板有助于缺血性中风的某些亚型的病理病因。
Although ischaemic stroke is associated with accentuated platelet function, it remains unclear whether this applies to all sub-types, especially lacunar infarcts, which differ from cortical infarction in their patho-aetiology. Similarly, conflicting evidence suggests that haemorrhagic stroke may, or may not, be associated with a hypothrombotic state. Levels of von Willebrand factor (VWF), fibrinogen, and P-selectin were measured within 48 h of ictus in 163 patients with acute ischaemic stroke and 40 patients with acute primary intracerebral haemorrhage, and 33 age, gender and race matched-controls. vWF (IU/dl) was significantly increased in both cortical and lacunar ischaemic stroke, and haemorrhagic stroke, as compared with controls, median (semi-quartile range): 158 (25) vs 144 (19) vs 147 (24) vs 114 (16), respectively. Similarly, fibrinogen (g/litre) was increased: 4.80 (0.90) vs 4.65 (0.70) vs 4.35 (0.83) vs 3.70 (0.70). In contrast, soluble P-selectin (ng/ml) was increased in cortical stroke as compared with lacunar infraction patients or controls: 408 (101) vs 300 (108) vs 324 (121), respectively; P-selectin was not increased in haemorrhagic stroke, 360 (153). Both vWF and fibrinogen correlated with 3-month functional outcome (modified Rankin score): r = 0.371 (2P = 0.0006), and r = 0.195 (2P = 0.042), respectively; however, P-selectin was not associated with outcome: r = 0.188 (2P = 0.084). The results suggest that increases in vWF and fibrinogen in all types of stroke reflect an acute phase response; in contrast, increased soluble P-selectin levels in cortical stroke, but not lacunar infarction, suggest that platelets contribute to the patho-aetiology of some subtypes of ischaemic stroke.