From the 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, China (Z.Z., T.X., D.G., X.H., C.Z., J.Y., A.W., T.X., H.P., Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (C.Z., C.-S.C., J.C., J.H.); Department of Epidemiology, School of Public Health, Guizhou Medical University, Guiyang, China (J.Y.); Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Hebei, China (Y.P.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (T.X.); Department of Neurology, Yutian County Hospital, Hebei, China (J.W.); Department of Cardiology, the First Affiliated Hospital of China Medical University, Liaoning (Y.S.); Department of Epidemiology, School of Public Health, Taishan Medical College, Shandong, China (Q.L.); Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Inner Mongolia, China (Z.J.); Department of Neurology, Affiliated Hospital of Xuzhou Medical College, Jiangsu, China (D.G.); and Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., J.H.).
Stroke. 2018 Feb;49(2):377-383. doi: 10.1161/STROKEAHA.117.019476. Epub 2018 Jan 10.
Serum hepatocyte growth factor (HGF) is positively associated with poor prognosis of heart failure and myocardial infarction, and it can also predict the risk of ischemic stroke in population. The goal of this study was to investigate the association between serum HGF and prognosis of ischemic stroke.
A total of 3027 acute ischemic stroke patients were included in this post hoc analysis of the CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). The primary outcome was composite outcome of death or major disability (modified Rankin Scale score ≥3) within 3 months.
After multivariate adjustment, elevated HGF levels were associated with an increased risk of primary outcome (odds ratio, 1.50; 95% confidence interval, 1.10-2.03; =0.015) when 2 extreme quartiles were compared. Each SD increase of log-transformed HGF was associated with 14% (95% confidence interval, 2%-27%) increased risk of primary outcome. Adding HGF quartiles to a model containing conventional risk factors improved the predictive power for primary outcome (net reclassification improvement: 17.50%, <0.001; integrated discrimination index: 0.23%, =0.022). The association between serum HGF and primary outcome could be modified by heparin pre-treatment (=0.001), and a positive linear dose-response relationship between HGF and primary outcome was observed in patients without heparin pre-treatment (<0.001) but not in those with heparin pre-treatment.
Serum HGF levels were higher in the more severe stroke at baseline, and elevated HGF levels were probably associated with 3-month poor prognosis independently of stroke severity among ischemic stroke patients, especially in those without heparin pre-treatment. Further studies from other samples of ischemic stroke patients are needed to validate our findings.
血清肝细胞生长因子（HGF）与心力衰竭和心肌梗死不良预后呈正相关，也可预测人群中缺血性卒中的风险。本研究旨在探讨血清 HGF 与缺血性卒中预后的关系。
本研究为 CATIS（中国急性缺血性卒中降压试验）的事后分析，共纳入 3027 例急性缺血性卒中患者。主要结局为 3 个月内死亡或主要残疾（改良 Rankin 量表评分≥3）的复合结局。
经多变量校正后，与最低和最高两个四分位组相比，HGF 水平升高与主要结局风险增加相关（比值比，1.50；95%置信区间，1.10-2.03；=0.015）。HGF 的自然对数值每增加 1 个标准差，主要结局的风险增加 14%（95%置信区间，2%-27%）。在包含传统危险因素的模型中加入 HGF 四分位，可改善主要结局的预测能力（净重新分类改善：17.50%，<0.001；综合判别指数：0.23%，=0.022）。HGF 与主要结局的关系可被肝素预处理所修饰（=0.001），在未接受肝素预处理的患者中观察到 HGF 与主要结局之间呈正线性剂量反应关系（<0.001），但在接受肝素预处理的患者中则无此关系。
基线时卒中严重程度越重，血清 HGF 水平越高，在缺血性卒中患者中，HGF 水平升高可能与 3 个月不良预后独立相关，而与卒中严重程度无关，尤其在未接受肝素预处理的患者中。需要来自其他缺血性卒中患者样本的进一步研究来验证我们的发现。
