Elkind Mitchell S V, Tai Wanling, Coates Kristen, Paik Myunghee C, Sacco Ralph L
Department of Neurology, College of Physicians and Surgeons, and Divisions of Biostatistics, Joseph P. Mailman School of Public Health, Columbia University, New York, New York, USA.
Arch Intern Med. 2006 Oct 23;166(19):2073-80. doi: 10.1001/archinte.166.19.2073.
Inflammatory markers have been associated with ischemic stroke risk and prognosis after cardiac events. Their relationship to prognosis after stroke is unsettled.
A population-based study of stroke risk factors in 467 patients with first ischemic stroke was undertaken to determine whether levels of high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A(2) (Lp-PLA2) predict risk of stroke recurrence, other vascular events, and death.
Levels of Lp-PLA2 and hs-CRP were weakly correlated (r = 0.09; P = .045). High-sensitivity CRP, but not Lp-PLA2, was associated with stroke severity. After adjusting for age, sex, race and ethnicity, history of coronary artery disease, diabetes mellitus, hypertension, hyperlipidemia, atrial fibrillation, smoking, and hs-CRP level, compared with the lowest quartile of Lp-PLA2, those in the highest quartile had an increased risk of recurrent stroke (adjusted hazard ratio, 2.08; 95% confidence interval, 1.04-4.18) and of the combined outcome of recurrent stroke, MI, or vascular death (adjusted hazard ratio, 1.86; 95% confidence interval, 1.01-3.42). After adjusting for confounders, hs-CRP was not associated with risk of recurrent stroke or recurrent stroke, myocardial infarction, or vascular death but was associated with risk of death (adjusted hazard ratio, 2.11; 95% confidence interval, 1.18-3.75).
Inflammatory markers are associated with prognosis after first ischemic stroke and may offer complementary information. Lipoprotein-associated phospholipase A(2) may be a stronger predictor of recurrent stroke risk. Levels of hs-CRP, an acute-phase reactant, increase with stroke severity and may be associated with mortality to a greater degree than recurrence.
炎症标志物与心脏事件后的缺血性中风风险及预后相关。它们与中风后预后的关系尚不确定。
对467例首次发生缺血性中风的患者进行了一项基于人群的中风危险因素研究，以确定高敏C反应蛋白（hs-CRP）和脂蛋白相关磷脂酶A2（Lp-PLA2）水平是否能预测中风复发、其他血管事件及死亡风险。
Lp-PLA2和hs-CRP水平呈弱相关（r = 0.09；P = 0.045）。高敏CRP与中风严重程度相关，而Lp-PLA2则不然。在调整年龄、性别、种族和族裔、冠状动脉疾病史、糖尿病、高血压、高脂血症、心房颤动、吸烟及hs-CRP水平后，与Lp-PLA2最低四分位数组相比，最高四分位数组的患者中风复发风险增加（调整后风险比为2.08；95%置信区间为1.04 - 4.18），中风复发、心肌梗死或血管死亡的复合结局风险增加（调整后风险比为1.86；95%置信区间为1.01 - 3.42）。在调整混杂因素后，hs-CRP与中风复发风险或中风复发、心肌梗死或血管死亡风险无关，但与死亡风险相关（调整后风险比为2.11；95%置信区间为1.18 - 3.75）。
炎症标志物与首次缺血性中风后的预后相关，可能提供补充信息。脂蛋白相关磷脂酶A2可能是中风复发风险更强的预测指标。hs-CRP作为一种急性期反应物，其水平随中风严重程度增加，与死亡率的关联可能大于与复发的关联。
