Li Jiejie, Zhao Xingquan, Meng Xia, Lin Jinxi, Liu Liping, Wang Chunxue, Wang Anxin, Wang Yilong, Wang Yongjun
From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China.
Stroke. 2016 Aug;47(8):2025-30. doi: 10.1161/STROKEAHA.116.012901. Epub 2016 Jun 21.
Minor stroke and transient ischemic attack are common disorders with high rate of subsequent disabling stroke. We aim to investigate the role of high-sensitive C-reactive protein (hsCRP) in predicting recurrent stroke and poor functional outcome.
In the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) trial, 3044 (59%) consecutive patients from 73 (64%) prespecified centers had hsCRP levels measured. The primary outcome was any stroke within 90 days. The secondary outcome included combined vascular events and dependence or death defined as modified Rankin Scale score of 2 to 6 at 90 days and a new vascular event during 1-year follow-up. The associations of hsCRP with recurrent stroke and functional outcome were analyzed by using Cox proportional hazards and logistic regression models.
Elevated hsCRP (>3.0 mg/L) was observed in 32% of the study population. Patients with hsCRP >3 mg/L had an increased risk of recurrent stroke (adjusted hazard ratio, 1.46; 95% confidence interval, 1.08-1.98; P=0.039), ischemic stroke and combined vascular events, and poor functional outcome (adjusted odds ratio, 1.68; 95% confidence interval, 1.22-2.32; P=0.002) compared with those with hsCRP <1 mg/L within 90-day follow-up period. High hsCRP levels also independently predicted recurrent stroke during 1-year follow-up. There was no interaction of hsCRP levels with randomized antiplatelet therapy.
High hsCRP levels predict recurrent stroke and poor functional outcome in acute patients with minor stroke or transient ischemic attack.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589.
轻度卒中与短暂性脑缺血发作是常见疾病，随后发生致残性卒中的几率很高。我们旨在研究高敏C反应蛋白（hsCRP）在预测复发性卒中和不良功能结局中的作用。
在急性非致残性脑血管事件高危患者的氯吡格雷治疗（CHANCE）试验中，来自73个（64%）预先指定中心的3044例（59%）连续患者检测了hsCRP水平。主要结局是90天内发生的任何卒中。次要结局包括复合血管事件以及90天时改良Rankin量表评分为2至6分且在1年随访期间发生新的血管事件所定义的依赖或死亡。采用Cox比例风险模型和逻辑回归模型分析hsCRP与复发性卒中和功能结局的相关性。
32%的研究人群hsCRP升高（>3.0 mg/L）。与hsCRP<1 mg/L的患者相比，hsCRP>3 mg/L的患者在90天随访期内复发性卒中风险增加（校正风险比，1.46；95%置信区间，1.08 - 1.98；P=0.039），缺血性卒中和复合血管事件以及不良功能结局风险增加（校正优势比，1.68；95%置信区间，1.22 - 2.32；P=0.002）。高hsCRP水平在1年随访期间也独立预测复发性卒中。hsCRP水平与随机抗血小板治疗无相互作用。
高hsCRP水平可预测轻度卒中或短暂性脑缺血发作急性患者的复发性卒中和不良功能结局。
