Elkind Mitchell S V
Department of Neurology, Columbia University, New York, New York 10032, USA.
Neurologist. 2006 May;12(3):140-8. doi: 10.1097/01.nrl.0000215789.70804.b0.
Inflammation has received increasing attention in recent years as a cause of atherosclerosis, coronary artery disease, and stroke. Basic and animal research has implicated inflammatory mechanisms in the pathogenesis and progression of atherosclerosis, as well as in clinical events related to plaque rupture and other atherothrombotic events.
The literature on the association of inflammatory markers with risk of stroke was reviewed and a clinical example provided. Several inflammatory biomarkers, and particularly high-sensitivity C-reactive protein (hsCRP), have been identified as likely predictors of the risk of a future stroke. Medications, particularly hydroxymethylglutaryl coenzyme A reductase inhibitors, or statins, have been demonstrated to reduce levels of inflammatory markers independently of effects on cholesterol. Most recently, the ability of these agents to reduce risk of myocardial infarction and other coronary events in patients with acute coronary artery disease has been demonstrated to correlate with their ability to lower levels of hsCRP. Whether reduction of hsCRP would have similar benefits in stroke patients remains unsettled, as does whether other drugs may be similarly used to lower hsCRP levels.
Inflammatory biomarkers, especially hsCRP, may allow improved prediction of the risk of stroke in primary and secondary stroke prevention. Modalities to reduce inflammation are becoming available that may help to modify this risk. Further studies, however, are needed before inflammatory markers become a routine part of the evaluation of stroke patients.
近年来，炎症作为动脉粥样硬化、冠状动脉疾病和中风的一个病因受到了越来越多的关注。基础研究和动物研究表明，炎症机制在动脉粥样硬化的发病机制和进展中起作用，在与斑块破裂及其他动脉粥样硬化血栓形成事件相关的临床事件中也起作用。
对关于炎症标志物与中风风险相关性的文献进行了综述，并提供了一个临床实例。几种炎症生物标志物，特别是高敏C反应蛋白（hsCRP），已被确定为未来中风风险的可能预测指标。药物，特别是羟甲基戊二酰辅酶A还原酶抑制剂或他汀类药物，已被证明可独立于对胆固醇的影响而降低炎症标志物水平。最近，已证明这些药物降低急性冠状动脉疾病患者心肌梗死和其他冠状动脉事件风险的能力与其降低hsCRP水平的能力相关。hsCRP的降低在中风患者中是否会有类似益处仍未确定，其他药物是否可同样用于降低hsCRP水平也未确定。
炎症生物标志物，尤其是hsCRP，可能有助于在一级和二级中风预防中更好地预测中风风险。降低炎症的方法正在出现，可能有助于改变这种风险。然而，在炎症标志物成为中风患者评估的常规部分之前，还需要进一步研究。
