Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China.
Curr Neurovasc Res. 2019;16(4):301-309. doi: 10.2174/1567202616666190906110204.
Less is known about the prognostic value of serum cystatin C in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). The aim of the present study was to examine the association between serum cystatin C levels and prognosis of AIS patients after IVT.
Serum cystatin C was measured within 24 hours after recombinant tissue plasminogen activator (rt-PA) treatment in 280 consecutively recruited patients with AIS. The main outcomes included combination of death and major disability, death, major disability (modified Rankin Scale score 3-5) and vascular events at 3-month follow-up.
During the 3-month follow-up, 94 patients (33.6%) experienced death or major disability (28 deaths and 66 major disability) and 49 patients (17.5%) experienced vascular events. After multivariate adjustment, serum cystatin C was significantly associated with an increased risk of the combined outcome of death and major disability (OR=4.51, P = 0.006). Adding serum cystatin C quartiles to a model containing conventional risk factors improved the predictive power for the combined outcome of death and major disability (continuous net reclassification index 43.88%, P < 0.001; categorical net reclassification index 9.15%, P = 0.013; integrated discrimination improvement 2.31%, P = 0.025). Similar phenomena were also observed in major disability and vascular events.
Higher levels of serum cystatin C in AIS patients after IVT were independently associated with increased risks of poor functional outcomes and vascular events, especially combining conventional risk factors, suggesting that serum cystatin C might improve risk prediction for poor prognosis in AIS patients receiving rt-PA treatment.
接受静脉溶栓（IVT）治疗的急性缺血性脑卒中（AIS）患者的血清胱抑素 C 预后价值知之甚少。本研究旨在探讨 AIS 患者 IVT 后血清胱抑素 C 水平与预后的关系。
在 280 例连续招募的 AIS 患者中，在重组组织型纤溶酶原激活剂（rt-PA）治疗后 24 小时内测量血清胱抑素 C。主要结局包括 3 个月随访时的死亡和主要残疾、死亡、主要残疾（改良 Rankin 量表评分 3-5）和血管事件的组合。
在 3 个月的随访期间，94 例患者（33.6%）经历了死亡或主要残疾（28 例死亡和 66 例主要残疾），49 例患者（17.5%）经历了血管事件。经过多变量调整后，血清胱抑素 C 与死亡和主要残疾的联合结局风险增加显著相关（OR=4.51，P=0.006）。将血清胱抑素 C 四分位数加入包含常规危险因素的模型中，提高了死亡和主要残疾联合结局的预测能力（连续净重新分类指数 43.88%，P<0.001；分类净重新分类指数 9.15%，P=0.013；综合区分改善 2.31%，P=0.025）。在主要残疾和血管事件中也观察到类似的现象。
IVT 后 AIS 患者血清胱抑素 C 水平升高与不良功能结局和血管事件风险增加独立相关，尤其是结合常规危险因素，表明血清胱抑素 C 可能改善接受 rt-PA 治疗的 AIS 患者不良预后的风险预测。
