- 學位論文
高纖維蛋白及血小板之血栓與癌症病人經動脈血栓移除術後中風復發及死亡之相關性研究
High fibrin+platelet thrombus is associated with early stroke recurrence and mortality after endovascular thrombectomy in patients with active cancer
摘要
高纖維蛋白及血小板之血栓常見於癌症中風病人發生大血管中風後取出的血栓表徵，癌症引起之高凝血狀態(hypercoagulable state)被認為為主要之病生理機轉。高纖維蛋白及血小板之血栓是否能反映癌症中風病人之臨床預後及作為評估短期內再中風及死亡之風險為此篇研究目的。 本研究之個案來自台大醫院自2015年3月至2021年11月因大血管阻塞且接受取栓術之缺血性中風之病人，並分為活躍性癌症(active cancer), 非活躍性癌症及非癌症三組。將所有取出的血栓進行常規Hematoxylin and eosin染色並針對高纖維蛋白及血小板占血栓區域之比例進行定量，並與90天內發生中風復發或死亡之臨床預後進行關聯性分析。 在本研究納入之420位接受取拴術且含血栓供組織分析的個案中，有50位為活躍性癌症(active cancer), 23位非活躍性癌症(non-active cancer)及347位非癌症病人。取出之血栓中，在活躍性癌症病人中的纖維蛋白及血小板之比例較其他兩組為高(P<0.001)。在活躍性癌症病人中， 90天內發生中風復發或死亡之病人，其纖維蛋白及血小板之血栓比例也較未發生中風復發或死亡之病人較高 (血栓內纖維蛋白及血小板比例：86.4% vs. 55.8%, P= 0.008)；在非癌症病人則並未觀察到此現象。 經校正年齡、性別及遠處轉移後，高纖維蛋白及血小板之血栓於活躍性癌症之病人仍顯著與90天內之中風復發或死亡相關。(adjusted odds ratio=1.03, 95% CI: 1.00-1.06, P=0.028) 本研究顯示，高纖維蛋白及血小板之血栓可能為癌症病人併中風接受動脈血栓移除術後之中風復發或死亡之重要預後指標。
並列摘要
Background and Purpose Fibrin+platelet-rich clot is characteristic of cancer related stroke. Cancer-related hypercoagulability state is considered the main patho-mechanism. The main purpose of this study is to investigate the correlation between clot composition and short-term clinical outcomes in patients with active cancer after stroke. Methods Acute ischemic stroke patients receiving endovascular thrombectomy between March 2015 and November 2021 were included, and were divided into active cancer, non-active cancer and without cancer groups. Clots underwent hematoxylin and eosin staining and the percentages of fibrin+platelet were quantified. Stroke recurrence was defined as newly developed neurological deficits 90 days from the index stroke event. Results A total of 420 patients with retrieved clots were included, which comprised of 50 patients with active cancer, 23 patients with non-active cancer and 347 patients with-out cancer. Higher fibrin+platelet composition was observed in active cancer group compared to the other two groups. (all P<0.001) In patients with active cancer, fi-brin+platelet percentage in retrieved thrombi was higher in those with composite out-come than those without (86.4% vs. 55.8%, P= 0.008), while no such difference was ob-served in patients without cancer. After adjustment of age, sex and distant metastases, the fibrin+platelet percentage was significantly associated with stroke recurrence or mor-tality at 90 days in active cancer group [adjusted odds ratio=1.03 (1.00-1.06], P=0.028]. Conclusions Thrombi with higher percentage of fibrin+platelet may predict stroke re-currence or mortality at 90 days among stroke patients with active cancer after EVT.