Golledge Jonathan, Clancy Paula, Maguire Jane, Lincz Lisa, Koblar Simon, McEvoy Mark, Attia John, Levi Chris, Sturm Jonathan, Almeida Osvaldo P, Yeap Bu B, Flicker Leon, Norman Paul E, Hankey Graeme J
From the Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia (J.G., P.C.); Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia (J.G.); Faculty of Health and Medicine, School of Nursing and Midwifery (J.M.) and Faculty of Health, School of Health Sciences (C.L., J.S.), The University of Newcastle, Newcastle, Australia; The Hunter Medical Research Institute, Newcastle, New South Wales, Australia (J.M., L.L., M.M., J.A.); Hunter Haematology Research Group, Calvary Mater Newcastle, Waratah, New South Wales, Australia (L.L.); Stroke Research Programme, University of Adelaide, The Queen Elizabeth Hospital campus, Adelaide, Australia (S.K.); The Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, New South Wales, Australia (M.M., J.A.); Department of Neurosciences, Central Coast Health District, Gosford, New South Wales, Australia (J.S.); School of Psychiatry and Clinical Neurosciences (O.P.A.), School of Medicine and Pharmacology (B.B.Y.), Western Australian Centre for Health and Ageing, Centre for Medical Research (L.F.), School of Surgery (P.E.N.), and School of Medicine and Pharmacology (G.J.H.), University of Western Australia, Perth, Western Australia, Australia; and Department of Endocrinology and Diabetes, Fremantle Hospital, Fremantle, Australia (B.B.Y.).
Stroke. 2014 Apr;45(4):1064-8. doi: 10.1161/STROKEAHA.113.004339. Epub 2014 Feb 25.
Studies in rodent models suggest that upregulating angiopoietin-1 (Angpt1) improves stroke outcomes. The aims of this study were to assess the association of plasma Angpt1 with stroke occurrence and outcome.
Plasma Angpt1 was measured in 336 patients who had experienced a recent stroke and 321 healthy controls with no stroke history. Patients with stroke (n=285) were reassessed at 3 months and plasma Angpt1 concentration on admission compared between those with severe and minor disability as assessed by the modified Rankin scale. In a separate cohort of 4032 community-acquired older men prospectively followed for a minimum of 6 years, the association of plasma Angpt1 with stroke incidence was examined.
Median plasma Angpt1 was 3-fold lower in patients who had experienced a recent stroke (6.42, interquartile range, 4.26-9.53 compared with 17.36; interquartile range, 14.01-22.46 ng/mL; P<0.001) and remained associated with stroke after adjustment for other risk factors. Plasma Angpt1 concentrations on admission were lower in patients who had severe disability or died at 3 months (median, 5.52; interquartile range, 3.81-8.75 ng/mL for modified Rankin scale 3-6; n=91) compared with those with minor disability (median, 7.04; interquartile range, 4.75-9.92 ng/mL for modified Rankin scale 0-2; n=194), P=0.012, and remained negatively associated with severe disability or death after adjusting for other risk factors. Plasma Angpt1 was not predictive of stroke incidence in community-dwelling older men.
Plasma Angpt1 concentrations are low after ischemic stroke particularly in patients with poor stroke outcomes at 3 months. Interventions effective at upregulating Angpt1 could potentially improve stroke outcomes.
啮齿动物模型研究表明，上调血管生成素-1（Angpt1）可改善卒中预后。本研究旨在评估血浆Angpt1与卒中发生及预后的相关性。
检测336例近期发生卒中的患者及321例无卒中病史的健康对照者的血浆Angpt1水平。对285例卒中患者在3个月时进行重新评估，并比较改良Rankin量表评估为重度残疾和轻度残疾患者入院时的血浆Angpt1浓度。在另一组4032例社区获得性老年男性中进行前瞻性随访至少6年，研究血浆Angpt1与卒中发病率的相关性。
近期发生卒中的患者血浆Angpt1中位数比健康对照者低3倍（6.42，四分位间距4.26 - 9.53，而健康对照者为17.36；四分位间距14.01 - 22.46 ng/mL；P<0.001），在调整其他危险因素后仍与卒中相关。3个月时重度残疾或死亡患者入院时的血浆Angpt1浓度（中位数5.52；改良Rankin量表3 - 6级的四分位间距3.81 - 8.75 ng/mL；n = 91）低于轻度残疾患者（中位数7.04；改良Rankin量表0 - 2级的四分位间距4.75 - 9.92 ng/mL；n = 194）（P = 0.012），在调整其他危险因素后仍与重度残疾或死亡呈负相关。血浆Angpt1不能预测社区居住老年男性的卒中发病率。
缺血性卒中后血浆Angpt1浓度较低，尤其是3个月时卒中预后较差的患者。有效上调Angpt1的干预措施可能改善卒中预后。
