Institute of Radiation Medicine, China Academy of Medical Science and Peking Union Medical College, No. 238, Baiti Road, Tianjin, 300192, People's Republic of China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6. Tiantan Xili, Beijing, 100050, People's Republic of China.
Neurotherapeutics. 2018 Oct;15(4):1158-1167. doi: 10.1007/s13311-018-0651-2.
Irisin was discovered as a PGC-1a-activated messenger of myocytes that links sedentary lifestyle, obesity, and diabetes. In this study, we investigated the short-term prognostic value of early measurement of irisin concentration in 1530 Han Chinese patients with acute ischemic stroke (AIS) from three stroke centers. The subjects were the first-ever AIS patients who were hospitalized at three stroke centers during the period from January 2015 to December 2016. Clinical information and stroke severity were collected at admission. Neurological evaluations were conducted at the 6-month follow-up. Serum levels of irisin, National Institutes of Health Stroke Scale (NIHSS), and conventional risk factors were evaluated to determine their value to predict functional outcome and mortality within 6 months. Multivariate analyses were performed using logistic regression models. During follow-up, a poor functional outcome was found in 588 patients (38.4%; 95% confidence interval (CI), 36.0-40.9%), and 325 patients died (21.2%; 95% CI, 19.2-23.3%). The stroke patients included in the study were divided into four groups according to irisin quartiles (first is the lowest level). Poor outcome across the irisin quartiles ranged from 54.5% (first quartile) to 21.7% (fourth quartile), and mortality rate ranged from 39.3% (first quartile) to 6.3% (fourth quartile). In a multivariate model using the first quartile (Q1) of irisin vs. Q2-Q4 together with the clinical variables, the marker displayed prognostic information and increased odds ratios of poor outcome by 58% (OR for Q1, 1.58 [95% CI, 1.12-2.43]) and mortality by 185% (OR for Q1, 2.85 [95% CI, 1.79-4.02]). In addition, a model containing known risk factors plus irisin compared with a model containing known risk factors without irisin showed a greater discriminatory ability to predict poor outcome (the area under the curve (AUC) with an increase from 0.73 to 0.75 [95% CI, 0.70-0.81]) and mortality (the AUC increased from 0.80 to 0.83 [95% CI, 0.78-0.87]). Irisin is a novel, independent prognostic marker improving currently used risk stratification of stroke patients. Further studies are needed to confirm this association, which may pave the way to new therapeutic options. Trial registration: ChiCTR-OPC- 17013501.
鸢尾素最初被发现是一种肌细胞中 PGC-1a 激活的信使，它将久坐不动的生活方式、肥胖和糖尿病联系在一起。在这项研究中，我们调查了来自三个中风中心的 1530 名汉族急性缺血性中风（AIS）患者早期测量鸢尾素浓度的短期预后价值。这些患者是 2015 年 1 月至 2016 年 12 月期间三个中风中心首次住院的 AIS 患者。入院时收集临床信息和中风严重程度。在 6 个月的随访中进行神经学评估。评估血清鸢尾素、美国国立卫生研究院中风量表（NIHSS）和常规危险因素，以确定它们对预测 6 个月内功能结局和死亡率的价值。使用逻辑回归模型进行多变量分析。随访期间，588 名患者（38.4%；95%置信区间（CI），36.0-40.9%）出现不良功能结局，325 名患者死亡（21.2%；95%CI，19.2-23.3%）。根据鸢尾素四分位数（第一分为最低水平），将纳入研究的中风患者分为四组。鸢尾素四分位数的不良结局范围从 54.5%（第一四分位数）到 21.7%（第四四分位数），死亡率范围从 39.3%（第一四分位数）到 6.3%（第四四分位数）。在使用第一四分位数（Q1）与 Q2-Q4 联合临床变量的多变量模型中，该标志物显示了预后信息，并使不良结局的优势比增加了 58%（Q1 的 OR，1.58[95%CI，1.12-2.43]），死亡率增加了 185%（Q1 的 OR，2.85[95%CI，1.79-4.02]）。此外，包含已知危险因素加鸢尾素的模型与不包含已知危险因素但包含鸢尾素的模型相比，具有更大的预测不良结局的区分能力（曲线下面积（AUC）增加 0.02，从 0.73 增加到 0.75[95%CI，0.70-0.81]）和死亡率（AUC 从 0.80 增加到 0.83[95%CI，0.78-0.87]）。鸢尾素是一种新的独立预后标志物，可改善目前用于中风患者的风险分层。需要进一步研究来证实这种关联，这可能为新的治疗选择铺平道路。试验注册：ChiCTR-OPC-17013501。
