脂蛋白磷脂酶A2-A与短暂性脑缺血发作和轻度卒中后血管事件早期复发的关联。
Association of Lp-PLA2-A and early recurrence of vascular events after TIA and minor stroke.
作者信息
Lin Jinxi, Zheng Hongwei, Cucchiara Brett L, Li Jiejie, Zhao Xingquan, Liang Xianhong, Wang Chunxue, Li Hao, Mullen Michael T, Johnston S Claiborne, Wang Yilong, Wang Yongjun
机构信息
From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
出版信息
Neurology. 2015 Nov 3;85(18):1585-91. doi: 10.1212/WNL.0000000000001938. Epub 2015 Aug 26.
OBJECTIVE
To determine the association of lipoprotein-associated phospholipase A2 (Lp-PLA2) measured in the acute period and the short-term risk of recurrent vascular events in patients with TIA or minor stroke.
METHODS
We measured Lp-PLA2 activity (Lp-PLA2-A) in a subset of 3,201 participants enrolled in the CHANCE (Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events) trial. Participants with TIA or minor stroke were enrolled within 24 hours of symptom onset and randomized to single or dual antiplatelet therapy. In the current analysis, the primary outcome was defined as the composite of ischemic stroke, myocardial infarction, or death within 90 days.
RESULTS
The composite endpoint occurred in 299 of 3,021 participants (9.9%). The population average Lp-PLA2-A level was 209 ± 59 nmol/min/mL (95% confidence interval [CI] 207-211). Older age, male sex, and current smoking were associated with higher Lp-PLA2-A levels. Lp-PLA2-A was significantly associated with the primary endpoint (adjusted hazard ratio 1.07, 95% CI 1.01-1.13 for every 30 nmol/min/mL increase). Similar results were seen for ischemic stroke alone. Adjustment for low-density lipoprotein cholesterol attenuated the association between Lp-PLA2-A and the primary endpoint (adjusted hazard ratio 1.04, 95% CI 0.97-1.11 for every 30 nmol/min/mL increase).
CONCLUSIONS
Higher levels of Lp-PLA2-A in the acute period are associated with increased short-term risk of recurrent vascular events.
目的
确定急性期测量的脂蛋白相关磷脂酶A2（Lp-PLA2）与短暂性脑缺血发作（TIA）或轻度卒中患者复发性血管事件的短期风险之间的关联。
方法
我们在参与CHANCE（急性非致残性脑血管事件高危患者的氯吡格雷）试验的3201名参与者的一个子集中测量了Lp-PLA2活性（Lp-PLA2-A）。TIA或轻度卒中患者在症状发作后24小时内入组，并随机接受单药或双药抗血小板治疗。在当前分析中，主要结局定义为90天内缺血性卒中、心肌梗死或死亡的复合事件。
结果
3021名参与者中有299名（9.9%）发生了复合终点事件。总体人群的Lp-PLA2-A水平为209±59 nmol/分钟/毫升（95%置信区间[CI]207-211）。年龄较大、男性和当前吸烟与较高的Lp-PLA2-A水平相关。Lp-PLA2-A与主要终点显著相关（每增加30 nmol/分钟/毫升，调整后的风险比为1.07，95%CI为1.01-1.13）。仅缺血性卒中也观察到类似结果。对低密度脂蛋白胆固醇进行校正后，Lp-PLA2-A与主要终点之间的关联减弱（每增加30 nmol/分钟/毫升，调整后的风险比为1.04，95%CI为0.97-1.11）。
结论
急性期较高水平的Lp-PLA2-A与复发性血管事件的短期风险增加相关。
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