Higher levels of serum fibrin-monomer reflect hypercoagulable state and thrombus formation in the left atrial appendage in patients with acute ischemic stroke
Higher levels of serum fibrin-monomer reflect hypercoagulable state and thrombus formation in the left atrial appendage in patients with acute ischemic stroke
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DOI：
10.1253/circj.70.971
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发表时间：
2006-08-01
影响因子：
3.3
通讯作者：
Kubota, Isao
中科院分区：
文献类型：
--
作者：
Okuyama, Hidenobu;Hirono, Osamu;Kubota, Isao
背景：由于经食道超声心动图显示的心内栓子源的飞溅和消失，在卒中监护病房对心源性栓塞的诊断有时是困难的。血清纤维蛋白单体（FM）是一种新的凝血活性标志物，可用于识别缺血性卒中风险增加的老年人。方法与结果244例急性缺血性脑卒中患者入院时进行血清凝血和纤溶活性检查，并于发病7 d内行经食管超声心动图检查。左心耳（LAA）血栓形成患者（n=24）血清FM水平显著高于无血栓形成患者（88 +/- 52 vs 14 +/- 9 mu g/ml, p < 0.0001）。多因素logistic回归分析显示，FM是LAA血栓形成的独立预测因子（RR 2.975, 95%可信区间1.114 ~ 4.820,p = 0.0214）。在LAA血栓阴性组中，心房收缩期LAA空血流速度缺失或小于舒张早期的患者，其FM水平明显高于速度较大的患者（42 +/- 12 vs 8 +/- 5 mu g/ml, p < 0.0001）。结论血清FM水平升高反映急性缺血性脑卒中患者LAA血流模式改变和血栓形成。
Background It is sometimes difficult to make a diagnosis of cardioembolic stroke in the stroke care unit, because of the splashing and vanishing of the intracardiac source of the emboli on transesophageal echocardiography. Serum fibrin-monomer (FM) is a new marker for coagulation activity that is useful for identifying older individuals at increased risk of ischemic stroke.Methods and Results Two hundred and four patients with acute ischemic stroke were examined for serum coagulation and fibrinolytic activity on admission, and underwent transesophageal echocardiography within 7 days of onset. Serum levels of FM was significantly higher in patients with left atrial appendage (LAA) thrombus formation (n=24) than in those with no thrombus (88 +/- 52 vs 14 +/- 9 mu g/ml, p < 0.0001). On multivariate logistic regression analysis, FM was an independent predictor for LAA thrombus (RR 2.975, 95% confidence interval 1.114 to 4.820, p = 0.0214). In patients with LAA thrombus negative group, cases with LAA emptying flow velocity at atrial systole that was absent or smaller than at early diastole had significantly higher FM levels as compared to cases with larger velocity (42 +/- 12 vs 8 +/- 5 mu g/ml, p < 0.0001).Conclusion Higher levels of serum FM reflect LAA flow pattern alterations and thrombus formation in patients with acute ischemic stroke.