Zheng Xiaowei, Zeng Nimei, Wang Aili, Zhu Zhengbao, Zhong Chongke, Xu Tan, Xu Tian, Peng Yanbo, Peng Hao, Li Qunwei, Ju Zhong, Geng Deqin, Zhang Yonghong, He Jiang
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.
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States.
Curr Neurovasc Res. 2018;15(3):226-233. doi: 10.2174/1567202615666180712100440.
C-reactive protein is an established marker of inflammation that can impair the protective function of High Density Lipoprotein Cholesterol (HDL-C). The combined effect of Creactive protein and HDL-C on long-term outcomes in patients with stroke remains uncertain.
A total of 3124 acute ischemic stroke subjects from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) were included in this analysis. Participants were divided into four groups according to CRP and HDL-C levels on admission. The primary outcome was a combination of death and major disability (modified Rankin Scale score ≥3) at one year after stroke.
Compared to participants with low CRP/ high HDL-C, adjusted odd ratios for primary outcome for those with low CRP /low HDL-C, high CRP /high HDL-C and high CRP /low HDL-C were 1.06(0.81-1.39),1.78(1.31-2.41) and 2.03(1.46-2.80), respectively, after multiple adjustments. Adding serum CRP and HDL-C status to a model containing conventional stroke risk factors significantly improve risk reclassification for the combined outcome of death and major disability (NRI: 6.85%, P=0.005; IDI: 2.57%, P=0.002). Moreover, no interaction was observed between CRP and HDL-C in relation to stroke outcomes (P-interaction >0.05 for all).
High CRP with low HDL-C levels was associated with death and major disability within one year after ischemic stroke. The findings suggest that the ischemic patients with both high CRP and low HDL-C should be treated with reducing CRP and promoting HDL-C levels.
C反应蛋白是一种已确定的炎症标志物，它会损害高密度脂蛋白胆固醇（HDL-C）的保护功能。C反应蛋白和HDL-C对中风患者长期预后的联合影响仍不确定。
本分析纳入了中国急性缺血性中风降压试验（CATIS）中的3124例急性缺血性中风患者。参与者根据入院时的CRP和HDL-C水平分为四组。主要结局是中风后一年时死亡和严重残疾（改良Rankin量表评分≥3）的综合情况。
与低CRP/高HDL-C的参与者相比，在进行多次调整后，低CRP/低HDL-C、高CRP/高HDL-C和高CRP/低HDL-C的参与者发生主要结局的校正比值比分别为1.06（0.81-1.39）、1.78（1.31-2.41）和2.03（1.46-2.80）。将血清CRP和HDL-C状态添加到包含传统中风危险因素的模型中，可显著改善死亡和严重残疾综合结局的风险重新分类（净重新分类改善：6.85%，P=0.005；综合鉴别改善：2.57%，P=0.002）。此外，未观察到CRP和HDL-C之间在中风结局方面存在相互作用（所有P相互作用>0.05）。
高CRP与低HDL-C水平与缺血性中风后一年内的死亡和严重残疾相关。研究结果表明，同时具有高CRP和低HDL-C的缺血性患者应接受降低CRP和提高HDL-C水平的治疗。
