脂蛋白相关磷脂酶 A 质量对急性缺血性脑卒中后一年内全因死亡率和血管事件的预后价值。
Prognostic value of lipoprotein-associated phospholipase A mass for all-cause mortality and vascular events within one year after acute ischemic stroke.
机构信息
Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
出版信息
Atherosclerosis. 2017 Nov;266:1-7. doi: 10.1016/j.atherosclerosis.2017.09.013. Epub 2017 Sep 14.
BACKGROUND AND AIMS
We performed a prospective investigation of the longer-term prognostic value of lipoprotein-associated phospholipase A (Lp-PLA) mass for all-cause mortality and vascular events within one year after acute ischemic stroke.
METHODS
We examined the Lp-PLA mass among 3401 participants enrolled in the China Antihypertensive Trial in Acute Ischemic Stroke. The primary outcome was all-cause mortality. Cox proportional hazard ratios (HRs) and 95% confidence intervals (95% CIs) were constructed to assess the independent associations between the baseline Lp-PLA mass and the outcomes after adjustment for variables in models 1, 2, and 3 [further adjusted for low-density lipoprotein cholesterol (LDL-C)].
RESULTS
Overall, 3278 patients completed the follow-up, during which, 188 all-cause death events occurred. The Kaplan-Meier survival curve showed that the cumulative incidence rate of all-cause mortality increased across quartiles of Lp-PLA mass (log-rank p = 0.018). Compared with the lowest quartile of Lp-PLA, the HRs (95% CIs) for the highest quartile of Lp-PLA were 1.89 (1.22-2.91), 2.16 (1.31-3.55), and 2.17 (1.32-3.58) for all-cause mortality after adjusting for the covariables in models 1, 2, and 3, respectively. In addition, patients in the highest quartile of Lp-PLA mass coupled with higher LDL-C had significantly highest risk of all-cause mortality (HR, 1.81; 95% CI, 1.05 to 3.11; p = 0.032).
CONCLUSIONS
The elevated Lp-PLA mass was associated with all cause-death independently of other risk factors within one year after acute ischemic stroke.
背景与目的
我们对 3401 名急性缺血性脑卒中患者进行了前瞻性研究，以探究脂蛋白相关磷脂酶 A（Lp-PLA）质量对卒中后一年内全因死亡率和血管事件的长期预后价值。
方法
我们检测了中国急性缺血性脑卒中降压试验（CATIS）中 3401 名参与者的 Lp-PLA 质量。主要结局为全因死亡率。采用 Cox 比例风险比（HR）和 95%置信区间（95%CI）构建模型 1、2 和 3，以评估基线 Lp-PLA 质量与结局之间的独立相关性。模型 1 中的变量进行了调整，模型 2 和 3 中的变量进一步调整为低密度脂蛋白胆固醇（LDL-C）。
结果
共有 3278 例患者完成了随访，在此期间，发生了 188 例全因死亡事件。Kaplan-Meier 生存曲线显示，随着 Lp-PLA 质量四分位的升高，全因死亡率的累积发生率增加（对数秩检验，p=0.018）。与 Lp-PLA 质量最低四分位相比，Lp-PLA 质量最高四分位的 HR（95%CI）分别为 1.89（1.22-2.91）、2.16（1.31-3.55）和 2.17（1.32-3.58），分别调整了模型 1、2 和 3 中的协变量。此外，Lp-PLA 质量最高四分位且 LDL-C 较高的患者全因死亡率的风险显著更高（HR，1.81；95%CI，1.05-3.11；p=0.032）。
结论
在急性缺血性脑卒中后一年内，升高的 Lp-PLA 质量与其他危险因素独立相关，与全因死亡有关。
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