Andersson Jonas, Johansson Lars, Ladenvall Per, Wiklund Per-Gunnar, Stegmayr Birgitta, Jern Christina, Boman Kurt
Department of Medicine and Geriatrics, Skellefteå County Hospital, Skellefteå, Sweden.
Cerebrovasc Dis. 2009;27(6):544-51. doi: 10.1159/000214217. Epub 2009 Apr 24.
C-reactive protein (CRP) is a determinant of stroke, but there are no prospective studies on CRP and first ischemic stroke divided into etiologic subtypes. Our primary aim was to study CRP as a determinant of ischemic stroke, classified according to Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria, and intracerebral hemorrhage (ICH) in a prospective study. A secondary aim was to study the relationship between the 1444C>T polymorphism, plasma levels of CRP and stroke.
The study was a prospective population-based case-referent study nested within the Northern Sweden Cohorts. We defined 308 cases of ischemic stroke and 61 ICH. Two controls for each case were defined from the same cohort.
The OR for the highest (>3 mg/l) versus lowest group (<1 mg/l) of CRP was 2.58 (95% CI 1.74-3.84) for ischemic stroke and 1.63 (95% CI 0.67-3.93) for ICH. In a multivariate model including traditional risk factors, CRP remained associated with ischemic stroke (OR 2.06; 95% CI 1.29-3.29). Small-vessel disease was associated with CRP in the multivariate model (OR 3.88; 95% CI 1.10-13.7). The CRP 1444 (CC/CT vs. TT) polymorphism was associated with plasma levels of CRP but neither with ischemic stroke nor with ICH.
This prospective population-based study shows that CRP is significantly associated with the risk of having a first ischemic stroke, especially for small-vessel disease. No significant associations were found between the CRP 1444C>T polymorphism and any stroke subtype.
C反应蛋白（CRP）是卒中的一个决定因素，但尚无关于CRP与分为病因亚型的首次缺血性卒中的前瞻性研究。我们的主要目的是在一项前瞻性研究中，研究CRP作为根据急性卒中治疗中ORG 10172试验（TOAST）标准分类的缺血性卒中和脑出血（ICH）的决定因素。次要目的是研究1444C>T多态性、CRP血浆水平与卒中之间的关系。
该研究是一项基于人群的前瞻性病例对照研究，嵌套于瑞典北部队列中。我们定义了308例缺血性卒中和61例ICH病例。从同一队列中为每个病例定义两个对照。
对于缺血性卒中，CRP最高组（>3mg/l）与最低组（<1mg/l）的比值比（OR）为2.58（95%可信区间[CI]1.74 - 3.84），对于ICH为1.63（95%CI 0.67 - 3.93）。在包括传统危险因素的多变量模型中，CRP仍与缺血性卒中相关（OR 2.06；95%CI 1.29 - 3.29）。在多变量模型中，小血管病与CRP相关（OR 3.88；95%CI 1.10 - 13.7）。CRP 1444（CC/CT与TT）多态性与CRP血浆水平相关，但与缺血性卒中和ICH均无关。
这项基于人群的前瞻性研究表明，CRP与首次缺血性卒中的风险显著相关，尤其是对于小血管病。未发现CRP 1444C>T多态性与任何卒中亚型之间存在显著关联。
