Castillo J, Alvarez-Sabín J, Martínez-Vila E, Montaner J, Sobrino T, Vivancos J
Dept. of Neurology, Clinical Neuroscience Research Laboratory, Hospital Clínico Universitario, 15706 Santiago de Compostela, A Coruña, Spain.
J Neurol. 2009 Feb;256(2):217-24. doi: 10.1007/s00415-009-0058-4. Epub 2009 Feb 27.
Vascular disease recurrence following stroke is the main cause of morbidity and mortality. The MITICO study was designed to assess the prognostic value of markers of inflammation in relation to the risk of recurrence of vascular disease.
Multi-centered prospective observational study, in patients with ischemic stroke not receiving anti-coagulation therapy and who were recruited within 1-3 months from stroke onset. Blood samples were obtained at baseline and follow- up for the determination of high-sensitive C reactive protein (CRP), IL-6, IL-10, ICAM-1, VCAM- 1, MMP-9 and cellular fibronectin. Four follow-up visits within the first year were to rule out recurrence.
Of 965 patients from 65 hospitals, 780 (aged 67.5+/-11.2 years, 33.6 % female) were valid for main analysis. One-hundred and three patients (13.2 %) had a new adverse vascular event and 116 patients (14.9 %) a vascular event or vascular death (66.4 % stroke, 21.5 % coronary and 12.1 % peripheral). Levels of IL-6 > 5 pg/mL and VCAM-1 > 1350 ng/mL (ROC curve analyses) were associated with vascular disease recurrence risk (OR: 28.7; 95 % CI: 14.2-58.0 vs. OR: 4.1; 95 % CI: 2.4-7.1, respectively) following adjustment for confounding variables. Risk of adverse vascular event or death from vascular disease were associated with IL-6 (OR: 21.2; 95 % CI: 11.6-38.7) and VCAM-1 (OR: 3.8; 95 % CI: 2.3-6.4).
Baseline values of IL-6 > 5 pg/mL and VCAM-1 > 1350 ng/mL increase 21-fold and 4-fold, respectively, the risk of new vascular disease event or death from vascular disease in patients with ischemic stroke not receiving anti-coagulation treatment.
中风后血管疾病复发是发病和死亡的主要原因。MITICO研究旨在评估炎症标志物与血管疾病复发风险相关的预后价值。
多中心前瞻性观察性研究，纳入未接受抗凝治疗且在中风发作后1 - 3个月内招募的缺血性中风患者。在基线和随访时采集血样，以测定高敏C反应蛋白（CRP）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）、基质金属蛋白酶-9（MMP-9）和细胞纤连蛋白。在第一年进行四次随访以排除复发情况。
来自65家医院的965例患者中，780例（年龄67.5±11.2岁，女性占33.6%）可用于主要分析。103例患者（13.2%）发生了新的不良血管事件，116例患者（14.9%）发生了血管事件或血管性死亡（中风占66.4%，冠心病占21.5%，外周血管疾病占12.1%）。在校正混杂变量后，IL-6>5 pg/mL和VCAM-1>1350 ng/mL水平（ROC曲线分析）与血管疾病复发风险相关（分别为OR：28.7；95%CI：14.2 - 58.0与OR：4.1；95%CI：2.4 - 7.1）。不良血管事件或血管性死亡风险与IL-6（OR：21.2；95%CI：11.6 - 38.7）和VCAM-1（OR：3.8；95%CI：2.3 - 6.4）相关。
对于未接受抗凝治疗的缺血性中风患者，基线时IL-6>5 pg/mL和VCAM-1>1350 ng/mL分别使新的血管疾病事件或血管性死亡风险增加21倍和4倍。
