Katan Mira, Moon Yeseon P, Paik Myunghee C, Mueller Beat, Huber Andreas, Sacco Ralph L, Elkind Mitchell S V
From the Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (M.K., Y.P.M., M.S.V.E.); Department of Neurology, University Hospital of Zurich, Zurich, Switzerland (M.K.); Department of Biostatistics (M.C.P.) and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Internal Medicine and Laboratory Medicine, Medical University Clinic, Kantonsspital Aarau, Switzerland (B.M., A.H.); and Departments of Neurology (R.L.S.) and Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, Coral Gables, FL.
Stroke. 2016 Jul;47(7):1714-9. doi: 10.1161/STROKEAHA.115.011392. Epub 2016 May 19.
Chronic infections and neuroendocrine dysfunction may be risk factors for ischemic stroke (IS). We hypothesized that selected blood biomarkers of infection (procalcitonin [PCT]), hypothalamic-pituitary-axis function (copeptin), and hemodynamic dysfunction (midregional proatrial natriuretic peptide [MRproANP]) are associated with incident IS risk in the multiethnic, urban Northern Manhattan Study (NOMAS) cohort.
A nested case-control study was performed among initially stroke-free participants. Cases were defined as first IS (n=172). We randomly selected controls among those who did not develop an event (n=344). We calculated Cox proportional hazards models with inverse probability weighting to estimate the association of blood biomarkers with risk of stroke after adjusting for demographic, behavioral, and medical risk factors.
Those with PCT and MRproANP, but not copeptin, in the top quartile, compared with the lowest quartile, were associated with IS (for PCT adjusted hazard ratio [HR], 1.9; 95% confidence interval [CI], 1.0-3.8 and for MRproANP adjusted HR, 3.5; 95% CI, 1.6-7.5). The associations of PCT and MRproANP differed by stroke etiology; PCT levels in the top quartile were particularly associated with small vessel stroke (adjusted HR, 5.1; 95% CI, 1.4-18.7) and MRproANP levels with cardioembolic stroke (adjusted HR, 16.3; 95% CI, 3.7-70.9).
Higher levels of PCT, a marker of infection, and MRproANP, a marker for hemodynamic stress, were independently associated with IS risk. PCT was specifically associated with small vessel and MRproANP with cardioembolic stroke risk. Further study is needed to validate these biomarkers and determine their significance in stroke risk prediction and prevention.
慢性感染和神经内分泌功能障碍可能是缺血性卒中（IS）的危险因素。我们假设，在多民族的曼哈顿北部城市研究（NOMAS）队列中，选定的感染血液生物标志物（降钙素原 [PCT]）、下丘脑 - 垂体轴功能（ copeptin）和血流动力学功能障碍（中段心房利钠肽原 [MRproANP]）与IS发病风险相关。
在最初无卒中的参与者中进行了一项巢式病例对照研究。病例定义为首次发生IS（n = 172）。我们在未发生事件的人群中随机选择对照（n = 344）。我们计算了具有逆概率加权的Cox比例风险模型，以估计在调整人口统计学、行为和医学风险因素后血液生物标志物与卒中风险的关联。
与最低四分位数相比，PCT和MRproANP处于最高四分位数的人群与IS相关，但copeptin并非如此（PCT的调整风险比 [HR] 为1.9；95%置信区间 [CI] 为1.0 - 3.8，MRproANP的调整HR为3.5；95% CI为1.6 - 7.5）。PCT和MRproANP的关联因卒中病因而异；最高四分位数的PCT水平与小血管卒中特别相关（调整HR为5.1；95% CI为1.4 - 18.7），MRproANP水平与心源性栓塞性卒中相关（调整HR为16.3；95% CI为3.7 - 70.9）。
感染标志物PCT和血流动力学应激标志物MRproANP的较高水平与IS风险独立相关。PCT与小血管卒中特异性相关，MRproANP与心源性栓塞性卒中风险相关。需要进一步研究以验证这些生物标志物，并确定它们在卒中风险预测和预防中的意义。
