Ş. DEVECİ, A. ÇELEBİ, A.E. GÜRSOY, M. KOLUKISA, S. AŞKIN, A. HAKYEMEZ

Akut iskemik inme ile ortalama trombosit hacmi ilişkisi

Amaç: Trombosit aktivasyonu iskemik serebrovasküler hastalığın gelişmesinde majör role sahiptir. Ortalama trombosit hacminin (OTH) trombosit aktivitesinin iyi bir göstergesi olduğu bildirilmektedir. Bu çalışmada OTHnin iskemik inme patogenezindeki yerinin belirlenmesi amaçlandı. Gereç ve Yöntem: Çalışmada risk faktörleri ve inme alt tiplerine göre değerlendirilen, ilk ve rekürren inme tanısı ile yatırılarak tetkik ve tedavi edilen 110 olgu yaş ve cinsiyet eşleştirilmiş 58 kontrol hastası OTH açısından karşılaştırıldı. Hastaların OTH değerlerine inmenin akut döneminde, ilk 24 saatte bakıldı. Ortalama trombosit hacminin inme geçiren hastalarda risk faktörleri, inme alt tipleri, hematolojik ve biyokimyasal parametreler (lökosit, trombosit, kolesterol, trigliserid, LDL kolesterol, glukoz, eritrosit sedimentasyon hızı (ESR), parsiyel tromboplastin zamanı (aPTT), C-reaktif protein (CRP) ile ilişkisi araştırıldı. Bulgular: Olgu grubunun OTH değerleri kontrol grubuna göre anlamlı yüksek bulundu. (p

Relationship of mean platelet volume to an acute ischemic stroke

Aim: Platelet activation has a major role to play in the development of ischemic cerebrovascular disease. Mean platelet volume (MPV) is reported to be a good indicator of platelet activity. In this study, we aimed to determine the position of MPV in the pathogenesis of ischemic strokes. Materials and Methods: This study compared MPV values in 110 patients who were hospitalized with the diagnosis of the first and recurrent stroke with the risk factors and stroke subtypes, and 58 control patients who were age and sex matched to patients. MPV parameters are measured in the acute period of the stroke and 24 hours later. We nvestigated the relationship between the mean platelet volume and risk factors, stroke subtypes, haematological and biochemical parameters, white blood cell, platelet, cholesterol, triglycerides, LDL cholesterol, glucose, erythrocyte sedimentation ratio (ESR), partial thromboplastin time (aPTT), and C-reactive protein (CRP). Results: The MPV parameter was found to be higher in the case group than the control group (p <0.001). In the case group, we found a weak significant negative correlation between platelet count (r = -0.20 p <0.05) and MPV parameter measured upon admission in the case group. Conclusion: In acute stroke patients, the MPV value was significantly higher compared to the acute stroke patients within the control group, so that a high MPV value may be one of the factors that play a role in the development of schemic strokes and cerebrovascular disease, suggesting a rise in a secondary phenomenon.

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1. Warlow C, Sudlow C, Dennis M, Wardlaw J, Sandercock P. Stroke. Lancet 2003; 362(9391):1211-24.
2. Feigin VL, Lawes CMM, Bennett DA, Anderson CS. Stroke epidemiology: A review of population-based studies of incidenceprevelence and case fatality in the 20th century. Lancet Neurol 2003; 2(1): 43-53.
3. Özdemir G, Özkan S, Uzuner N, Özdemir Ö, Gücüyener D. Türkiyede beyin damar hastalıkları için majör risk faktörleri. TürÇok Merkezli Strok Çalışması. Türk Beyin Damar Hastalıkları Dergisi 2000; 6(2): 31-5.
4. Utku U, Çelik Y. İnmede etiyoloji, sınıflandırma ve risk faktörleri. In: Balkan S (ed). Serebrovasküler Hastalıklar, 2.BaskAntalya: Öncü Basımevi; 2005: 61-7.
5. Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med 1999; 340(2):115-26.
6. Jakubowski JA, Thomson CB, Vaillaincourt R, Valeri CR, Deykin D. Arachidonic acid metabolism by platelets of differing sizeBr J Haematol 1983;53(3):503-11.
7. Martin JF, Trowbridge EA, Salmon G, Plumb J. The biological significance of platelet volume: Its relationship to bleeding timeplatelet tromboxane B2 production and megakaryocyte nuclear DNA concentration. Thromb Res 1983: 32(5):443-60.
8. Haver VM, Gear AR. Functional fractionation of platelets. J Lab Clin Med 1981;97(2):187-204.
9. Hekimsoy Z, Payzin B, Ornek T, Kandoğan G. Mean platelet volume in Type 2 diabetic patients. J Diabetes Complication2004;18(3):173-6.
10. Senaran H, İleri M, Altınbaş A, Kosar A, Yetkin E, Ozturk M, Karaaslan Y, Kirazlı S. Thrombopoietin and mean platelet volumin coronary artery disease. Clin Cardiol 2001;24(5):405-8.
11. O'Malley T, Langhorne P, Elton RA, Stewart C. Platelet size in stroke patients. Stroke 1995;26(6):995-9.
12. Bath P, Algert C, Chapman N, Neal B (PROGRESS Collaborative Group). Assosiation of mean platelet volume with risk ostroke among 3134 individuals with history of cerebrovascular disease. Stroke 2004;35(3):622-6.
13. Bath PM, Butterworth RJ. Platelet size: Measurement, physiology and vascular disease. Blood Coagul Fibrinolysi1996;7(2):157-61.
14. Sharp DS, Benowitz NL, Bath PM, Martin JF, Beswick AD, Elwood PC. Cigarette smoking sensitizes and desensitizeimpedance-measured ADP-induced platelet aggregation in whole blood. Thromb Haemost 1995;74(2):730-5.
15. Tschoepe D, Roesen P, Esser J, Schwippert B, Nieuwenhuis HK, Kehrel B, Gries FA. Large platelets circulate in an activatestate in diabetes mellitus. Semin Thromb Hemost 1991;17(4):433-8.
16. Zuberi BF, Akhtar N, Afsar S. Comparison of mean platelet volume in patients with diabetes mellitus, impaired fasting glucosand non-diabetic subjects. Singapore Med J 2008;49(2):114-6.
17. Martin JF, Bath PM, Burr ML. Influence of platelet size on outcome after myocardial infarction. Lancet 1991;338(8780):1409-11
18. Cameron HA, Philips R, Ibbotson RM, Carson PH. Platelet size in myocardial infarction. Br Med J (Clin Res Ed1983;287(6390):449-51.
19. Kario K, Matsuo T, Nakao K. Cigarette smoking increases the mean platelet volume in elderly patients with risk factors foatherosclerosis. Clin Lab Haematol 1992;14(4):281-7.
20. Bath PM, Missouris CG, Buckenham T, MacGregor GA. Increased platelet volume and platelet mass in patients witatherosclerotic renal artery stenosis. Clin Sci (Lond) 1994;87(2):253-7.
21. Elkind MSV, Sacco RL. Pathogenesis, classification and epidemiology of cerebrovascular disease. In: Rowland LP, Pedley L(eds). Merrits Neurology. 12th ed. Philadelphia; Lippincott Williams & Wilkins 2010: 251-63.
22. Furiozzi F. Mean platelet volume and acute ischemic stroke. Stroke 1996;27(5):1010-1.
23. Greisenegger S, Endler G, Hsieh K, Tentschert S, Mannhalter C, Lalouschek W. Is elevated mean platelet volume assosiatewith a worse outcome in patients with acute ischemic cerebrovascular events? Stroke 2004;35(7):1688-91.
24. Thomson CB, Love DG, Quinn PG, Valeri CR. Platelet size does not correlate with platelet age. Blood 1983;62(2):487-94.
25. Martin JF, Penington DG. The relationship between the age and density of circulating 51-Cr labelled platelets in the sub-humaprimate. Thromb Res 1983;30(2):157-64.
26. Martin JF, Plumb J, Kilby RS, Kishk YT. Changes in volume and density of platelets in myocardial infarction. Br Med J (Clin R eEd) 1983;287(6390) :456-9.
27. Tschoepe D, Roesen P, Esser J, Schwippert B, Nieuwenhuis HK, Kehrel B, Gries FA. Large platelets circulate in an activatestate in diabetes mellitus. Semin Thromb Hemost 1991;17(4):433-8.
28. Burstein SA, Downs T, Friese P, et al. Thrombocytopoiesis in normal and sublethally irradiated dogs: response to humainteleukin-6. Blood 1992;80(2):420-8.
29. Debili N, Massé JM, Katz A, Guichard J, Breton-Gorius J, Vainchenker W. Effects of the recombinant hematopoietic growtfactors interleukin-3, interleukin-6, stem cell factor and leukemia inhibitory factor on the megakaryocytic differentiation of CD34cells. Blood 1993;82(1):84-95.
30. Sinzinger H, Virgolini I, Fitscha P. Platelet kinetics in patients with atherosclerosis. Thromb Res. 1990;57(4):507-16.
31. Senaran H, Ileri M, Altinbaş A, et al. Thrombopoietin and mean platelet volume in coronary artery disease. Clin Cardio2001;24(5):405-8.
32. Nadar SK, Lip GY, Blann AD. Platelet morpholgy, soluble P-selectin and platelet P-selectin in acute ischaemic stroke. The WesBirmingham Stroke Project. Thromb Haemost 2004;92(6):1342-8.
33. Pathansali R, Smith N, Bath P. Altered megakaryocyte-platelet haemostatic axis in hypercholesterolemia. Platelet2001;12(5):292-7.
34. Butterworth R, Bath PM. The relationship between mean platelet volume, stroke subtype and clinical outcome. Platelet1998;9(6):359-64.
35. Bath PM. The routine measurement of platelet size using sodium citrate alone as the anticoagulant. Thromb Haemos1993;70(4):687-90.