醒后卒中患者的凝血特征分析

Coagulation Characteristics in Patients with Wake-up Stroke

目的 探讨醒后卒中(wake-up stroke,WUS)与非WUS患者凝血功能的差异,以探索WUS的病理生理学机制。方法 回顾性收集2018年1月-2020年5月就诊于西安交通大学第二附属医院,发病72 h内的首次急性缺血性卒中(acute ischemic stroke,AIS)患者的临床资料,以同期非卒中入院、既往无卒中病史且性别、年龄(±5岁)匹配的患者为对照组。根据是否为WUS将AIS组分为WUS组和非WUS组。收集入组患者入院第2日的凝血功能检测结果。比较AIS组和对照组以及WUS组和非WUS组间的凝血功能差异。在AIS患者中,进一步采用二元logistic回归分析判断凝血功能与WUS的相关性。结果 AIS组和对照组各342例,AIS患者中WUS67例(19.6%),非WUS275例(80.4%)。单因素分析显示,与对照组比较,AIS组的活化部分凝血活酶时间(activated partial thromboplastin time,APTT)[23.2(20.7~26.3)s vs.24.0(21.6~26.8)s,P=0.019]和凝血酶时间[18.4(17.9~19.1)s vs.18.9(18.3~19.4)s,P<0.001]缩短,而D-二聚体[270.0(170.0~460.0)ng/mL vs.220.0(137.5~352.5)ng/mL,P<0.001]、纤维蛋白原[287.0(243.8~331.0)g/L vs.255.0(221.0~292.3)g/L,P<0.001]及纤维蛋白降解产物[1.1(0.6~1.6)μg/mL vs.0.7(0.4~1.1)μg/mL,P<0.001]水平升高。在AIS患者中,WUS组较非WUS组的入院时神经功能缺损更严重[NIHSS3(2~6)分vs.2(1~4)分,P=0.005]、采血前使用他汀类药物的比例更高(94.0%vs.84.0%,P=0.034),2组的发病到采血时间分布的差异也有统计学意义(P=0.011)。凝血功能方面,WUS组的APTT较非WUS组延长[24.8(21.5~27.5)s vs.22.9(20.5~25.9)s,P=0.004],其余凝血功能参数的差异无统计学意义。二元logistic回归分析显示,APTT延长与WUS独立相关(OR 2.082,95%CI 1.156~3.751,P=0.015)。结论 WUS患者的APTT较非WUS患者延长,提示WUS患者可能具有更差的内源性凝血活性。

Objective To compare the difference of coagulation function between wake-up stroke(WUS) patients and non-WUS patients, in order to further clarify the pathophysiological mechanism of WUS.Methods Patients with first-ever acute ischemic stroke(AIS) within 72 hours from symptom onset who were admitted to the Second Afliated Hospital of Xi’an Jiaotong University between January 2018 and May 2020 were included in this retrospective study.Sex-and age-matched(±5 years old) inpatients without stroke history during the same period were selected as the control group.According to having WUS or not, the patients with AIS were divided into WUS subgroup and nonWUS subgroup.The differences of coagulation function were compared between AIS group and control group and between WUS group and non-WUS group.Binary logistic regression analysis was used to evaluate the relationship between coagulation function and WUS.Results A total of 342 AIS patients and 342 controls were included, with 67 WUS patients(19.6%) and 275 non-WUS patients(80.4%) in AIS patients.Compared with control group, activated partial thromboplastin time(APTT) [23.2(20.7-26.3) s vs.24.0(21.6-26.8) s, P=0.019] and thrombin time [18.4(17.9-19.1) s vs.18.9(18.3-19.4) s, P<0.001] were shorter and D-dimer [270.0(170.0-460.0) ng/mL vs.220.0(137.5-352.5) ng/mL, P <0.001], fibrinogen [287.0(243.8-331.0) g/L vs.255.0(221.0-292.3) g/L, P<0.001], and fibrin degradation product [1.1(0.6-1.6) μg/mL vs.0.7(0.4-1.1) μg/mL, P<0.001] were higher in patients with AIS.Among AIS group, compared with non-WUS patients, WUS patients were more inclined to have higher NIHSS scores at admission [3(2-6) vs.2(1-4), P=0.005] and higher percentage of taking statins [94.0% vs 84.0%, P=0.034].The APTT in WUS subgroup was longer than that in non-WUS subgroup [24.8(21.5-27.5) s vs.22.9(20.5-25.9) s, P=0.004], and the other coagulation parameters had no statistical differences between the two subgroups.Logistic regression analysis showed that APTT prolongation was independently associated with WUS(OR 2.082, 95%CI 1.156-3.751, P=0.015).Conclusions The WUS patients had longer APTT than non-WUS patients, which indicated that WUS patients had worse intrinsic coagulation function.