糖化白蛋白预测双联和单联抗血小板治疗对复发性卒中的影响。

Glycated albumin predicts the effect of dual and single antiplatelet therapy on recurrent stroke.

机构信息

From the Department of Neurology (J.L., Y.W., J.L., A.W., X.Z., L.L., C.W., Y.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W.), Beijing; Center of Stroke (Y.W.), Beijing Institute for Brain Disorders, China; and the Illinois Neurological Institute Stroke Network (D.W.), Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria.

出版信息

Neurology. 2015 Mar 31;84(13):1330-6. doi: 10.1212/WNL.0000000000001421. Epub 2015 Mar 4.

DOI:10.1212/WNL.0000000000001421

PMID:25740863

Abstract

OBJECTIVE

To determine the relationship of glycated albumin (GA) and the recurrence of stroke in patients on either dual or single antiplatelet therapy.

METHODS

The Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial randomized minor ischemic stroke or TIA patients to antiplatelet therapy of clopidogrel plus aspirin or aspirin alone. A subgroup of 3,044 consecutive patients with baseline GA levels from 73 (64%) prespecified clinical sites was analyzed. Patients were categorized into 2 groups based on GA level of 15.5%, the cut point for development of diabetes. The primary outcome was stroke recurrence during 90-day follow-up. Cox proportional hazards models were used to assess the interaction of GA with randomized antiplatelet therapy on their risk of recurrent stroke.

RESULTS

Significant interaction of GA levels with the 2 antiplatelet therapy groups was found after adjustment for age, sex, and other conventional confounding factors (p = 0.009). The interaction remained consistent after further adjustment for history of diabetes (p = 0.010). In patients with lower GA level, stroke occurred in 5.5% of patients in the clopidogrel-aspirin group, and 12.7% in the aspirin group (adjusted hazard ratio [HR] 0.40; 95% confidence interval [CI] 0.26-0.61; p < 0.001). Furthermore, in patients with elevated GA level, stroke occurred in 9.2% of patients in the clopidogrel-aspirin group, and 11.4% in the aspirin group (adjusted HR 0.79; 95% CI 0.60-1.05; p = 0.103).

CONCLUSIONS

GA could be a potential biomarker to predict the effects of dual and single antiplatelet therapy in patients with minor stroke or TIA.

摘要

目的

确定糖化白蛋白（GA）与接受双联或单联抗血小板治疗的患者中风复发之间的关系。

方法

氯吡格雷用于急性非致残性脑血管事件高危患者试验将小缺血性中风或 TIA 患者随机分为氯吡格雷加阿司匹林或单独使用阿司匹林的抗血小板治疗组。对来自 73 个（64%）预先指定临床站点的 3044 例连续患者的基线 GA 水平进行了亚组分析。根据 GA 水平为 15.5%（糖尿病发生的切点）将患者分为 2 组。使用 Cox 比例风险模型评估 GA 与随机抗血小板治疗对复发性中风风险的交互作用。

结果

调整年龄、性别和其他常规混杂因素后，发现 GA 水平与 2 种抗血小板治疗组之间存在显著交互作用（p = 0.009）。进一步调整糖尿病史后，这种交互作用仍然一致（p = 0.010）。在 GA 水平较低的患者中，氯吡格雷-阿司匹林组有 5.5%的患者发生中风，阿司匹林组有 12.7%（调整后的危险比 [HR] 0.40；95%置信区间 [CI] 0.26-0.61；p < 0.001）。此外，在 GA 水平升高的患者中，氯吡格雷-阿司匹林组有 9.2%的患者发生中风，阿司匹林组有 11.4%（调整后的 HR 0.79；95%CI 0.60-1.05；p = 0.103）。