Stott David J, Welsh Paul, Rumley Ann, Robertson Michele, Ford Ian, Sattar Naveed, Westendorp Rudi G J, Jukema J Wouter, Cobbe Stuart M, Lowe Gordon D O
Division of Cardiovascular and Medical Sciences, Faculty of Medicine, University of Glasgow, Scotland, UK.
Int J Epidemiol. 2009 Feb;38(1):253-61. doi: 10.1093/ije/dyn215. Epub 2008 Oct 24.
Inflammation may play an important role in atherothrombosis and in promoting cerebral damage after stroke. We hypothesized that plasma adipocytokine concentrations would be associated with risk of stroke in older people.
Nested case-control study from the Prospective Study of Pravastatin in the Elderly (PROSPER). Subjects were aged 70-82 years and followed up for a mean of 3.2 years: 266 incident stroke cases (179 confirmed as ischaemic) were compared with 532 controls matched for age, gender and treatment allocation (pravastatin or placebo). Adipocytokines [adiponectin, interleukin- (IL-)18 and tumour necrosis factor (TNF)alpha] were measured on stored baseline plasma samples.
Elevated plasma adiponectin was associated with lower risk of ischaemic stroke on univariate analysis: odds ratio (OR) 0.78 per 1 SD increase (95% CI 0.62-0.97). There were no associations of IL-18 or TNFalpha with risk for ischaemic or total strokes. In multivariate models the independent predictors of ischaemic stroke were prior cerebrovascular accident (OR 2.68, 95% CI 1.60-4.50), any alcohol use (1.98, 1.33-2.94), triglycerides (1.40, 1.11-1.77), Barthel score (0.75, 0.58-0.96) and known diabetes (1.72, 1.04-2.83); adiponectin, IL-18 and TNFalpha did not contribute. A similar pattern of risk was seen for total stroke.
Reduced adiponectin may have a modest role in the aetiology of ischaemic stroke in older people, however IL-18 and TNFalpha are unlikely to play any important part. These adipocytokines do not have clinical predictive utility; history of prior cerebrovascular accident, known diabetes mellitus, prior disability and higher alcohol intake explain much of the stroke risk.
炎症可能在动脉粥样硬化血栓形成以及中风后促进脑损伤方面发挥重要作用。我们推测血浆脂肪细胞因子浓度与老年人中风风险相关。
来自老年普伐他汀前瞻性研究（PROSPER）的巢式病例对照研究。受试者年龄在70 - 82岁之间，平均随访3.2年：将266例新发中风病例（179例确诊为缺血性中风）与532例按年龄、性别和治疗分配（普伐他汀或安慰剂）匹配的对照进行比较。在储存的基线血浆样本上测量脂肪细胞因子[脂联素、白细胞介素 -（IL -）18和肿瘤坏死因子（TNF）α]。
单因素分析显示，血浆脂联素升高与缺血性中风风险降低相关：每增加1个标准差，比值比（OR）为0.78（95%可信区间0.62 - 0.97）。IL - 18或TNFα与缺血性或总体中风风险无关联。在多变量模型中，缺血性中风的独立预测因素为既往脑血管意外（OR 2.68，95%可信区间1.60 - 4.50）、任何饮酒情况（1.98，1.33 - 2.94）、甘油三酯（1.40，1.11 - 1.77）、巴氏指数（0.75，0.58 - 0.96）和已知糖尿病（1.72，1.04 - 2.83）；脂联素、IL - 18和TNFα无贡献。总体中风也呈现类似的风险模式。
脂联素降低可能在老年人缺血性中风病因中起适度作用，然而IL - 18和TNFα不太可能起任何重要作用。这些脂肪细胞因子不具有临床预测效用；既往脑血管意外史、已知糖尿病、既往残疾和较高的酒精摄入量可解释大部分中风风险。
