目的:近年来,缺血性卒中患者对因子XIII的兴趣与日俱增.该研究的主要目的是评估XIII因子浓度测定在接受重组组织纤溶酶原激活剂(t-PA)溶栓治疗的急性缺血性中风(AIS)患者中的有用性。
方法:本研究在两组84例AIS患者中进行:I组接受溶栓治疗,II组不溶栓。体检,神经状态(使用美国国立卫生研究院卒中量表,NIHSS),用Barthel指数和改良的Rankin量表(mRS)测量患者的日常活动,和血液参数在第1天和第7天进行。评估了以下参数:高度敏感的C反应蛋白(CRP),纤维蛋白原,D-二聚体(DD),中性粒细胞-淋巴细胞比率(NLR指数),和因子XIII-A的浓度
结果:在第一组中,XIII-A的浓度在第1天和第7天之间显着降低(p<0.001)。在第一组中,完全前循环梗死(TACI)患者在第7天的XIII-A浓度显著低于非TACI卒中患者.根据急性中风登记和洛桑分析(ASTRAL),第一组患者的XIII-A浓度明显低于31分。在第1天的第一次取样和第7天的第二次取样之间,XIII-A的下降幅度更大,与I组患者的神经系统状态更差有关。
结论:在接受t-PA治疗的AIS患者中,中风急性期因子XIII浓度降低,最大的减少发生在TACI卒中。AIS患者中因子XIII浓度的测定可在临床实践中用作支持中风严重程度评估的额外参数,并可能在预后中起作用;较低的因子XIII-A活性可能是预后较差的预测因子。
OBJECTIVE: 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 (p < 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.