Nambi Vijay, Hoogeveen Ron C, Chambless Lloyd, Hu Yijuan, Bang Heejung, Coresh Josef, Ni Hanyu, Boerwinkle Eric, Mosley Thomas, Sharrett Richey, Folsom Aaron R, Ballantyne Christie M
Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, Texas 77030, USA.
Stroke. 2009 Feb;40(2):376-81. doi: 10.1161/STROKEAHA.107.513259. Epub 2008 Dec 18.
Inflammation plays a critical role in the development of vascular disease, and increased levels of the inflammatory biomarkers, lipoprotein-associated phospholipase A(2) (Lp-PLA(2)), and high-sensitivity C-reactive protein (hs-CRP) have been shown to be associated with an increased risk for ischemic stroke.
In a prospective case-cohort (n=949) study in 12 762 apparently healthy, middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study, we first examined whether Lp-PLA(2) and hs-CRP levels improved the area under the receiver operator characteristic curve (AUC) for 5-year ischemic stroke risk. We then examined how Lp-PLA(2) and hs-CRP levels altered classification of individuals into low-, intermediate-, or high-risk categories compared with traditional risk factors.
In a model using traditional risk factors alone, the AUC adjusted for optimism was 0.732, whereas adding hs-CRP improved the AUC to 0.743, and adding Lp-PLA(2) significantly improved the AUC to 0.752. Addition of hs-CRP and Lp-PLA(2) together in the model improved the AUC to 0.761, and the addition of the interaction between Lp-PLA(2) and hs-CRP further significantly improved the AUC to 0.774. With the use of traditional risk factors to assess 5-year risk for ischemic stroke, 86% of participants were categorized as low risk (<2%); 11%, intermediate risk (2% to 5%); and 3%, high risk (>5%). The addition of hs-CRP, Lp-PLA(2), and their interaction to the model reclassified 4%, 39%, and 34% of the low-, intermediate- and high-risk categories, respectively.
Lp-PLA(2) and hs-CRP may be useful in individuals classified as intermediate risk for ischemic stroke by traditional risk factors.
炎症在血管疾病的发展中起关键作用，炎症生物标志物脂蛋白相关磷脂酶A2（Lp-PLA2）和高敏C反应蛋白（hs-CRP）水平升高已被证明与缺血性中风风险增加相关。
在社区动脉粥样硬化风险（ARIC）研究中，对12762名看似健康的中年男性和女性进行了一项前瞻性病例队列（n = 949）研究，我们首先检查Lp-PLA2和hs-CRP水平是否改善了5年缺血性中风风险的受试者工作特征曲线下面积（AUC）。然后，我们研究了与传统风险因素相比，Lp-PLA2和hs-CRP水平如何改变个体分为低、中、高风险类别的分类。
在仅使用传统风险因素的模型中，经乐观性调整后的AUC为0.732，而添加hs-CRP将AUC提高到0.743，添加Lp-PLA2显著将AUC提高到0.752。在模型中同时添加hs-CRP和Lp-PLA2将AUC提高到0.761，添加Lp-PLA2和hs-CRP之间的相互作用进一步显著将AUC提高到0.774。使用传统风险因素评估5年缺血性中风风险时，86%的参与者被分类为低风险（<2%）；11%为中度风险（2%至5%）；3%为高风险（>5%）。将hs-CRP、Lp-PLA2及其相互作用添加到模型中，分别对4%、39%和34%的低、中、高风险类别进行了重新分类。
Lp-PLA2和hs-CRP可能对通过传统风险因素分类为缺血性中风中度风险的个体有用。
