Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University.
Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University.
Circ J. 2021 Jan 25;85(2):213-219. doi: 10.1253/circj.CJ-20-0771. Epub 2020 Nov 19.
This study explored the value of cystatin C (CysC) in predicting stroke recurrence in patients with acute ischemic stroke.
This was a post hoc analysis of the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) on 3,474 acute ischemic stroke patients with documented serum CysC and high-sensitivity C-reactive protein (hsCRP) concentrations. Study outcomes included stroke recurrence and combined vascular events within 2 years after stroke. In stroke patients with higher (i.e., ≥4.8ng/mL), but not lower, hsCRP concentrations, a higher CysC concentration (i.e., ≥0.78 mg/L) was associated with a 2.48-fold increase in the risk of recurrent stroke (95% confidence interval [CI] 1.37-4.51; P=0.003) and a 2.04-fold increase in the risk of vascular events (95% CI 1.27-3.28; P=0.003). Serum hsCRP concentrations significantly modified the association of serum CysC with recurrent stroke (P=0.001) and vascular events (P=0.007). Moreover, CysC may improve reclassification of stroke recurrence (net reclassification improvement [NRI] 42.9%, P=0.001; integrated discrimination improvement [IDI] 1.2%, P=0.001) and vascular events (NRI 35.8%, P=0.001; IDI 1.1%, P=0.004).
In ischemic stroke patients with high hsCRP concentrations, higher CysC concentrations increased the risk of stroke recurrence and vascular events. This indicates that the predictive value of CysC on stroke recurrence may depend on the inflammation status of patients.
本研究旨在探讨胱抑素 C（CysC）在预测急性缺血性脑卒中患者卒中复发中的价值。
这是中国急性缺血性脑卒中降压试验（CATIS）的事后分析，共纳入 3474 例有血清胱抑素 C 和高敏 C 反应蛋白（hsCRP）检测值的急性缺血性脑卒中患者。研究结局包括卒中后 2 年内卒中复发和复合血管事件。在 hsCRP 浓度较高（即≥4.8ng/mL）的卒中患者中，较高的 CysC 浓度（即≥0.78mg/L）与卒中复发风险增加 2.48 倍相关（95%置信区间 [CI] 1.37-4.51；P=0.003），与血管事件风险增加 2.04 倍相关（95% CI 1.27-3.28；P=0.003）。血清 hsCRP 浓度显著改变了血清 CysC 与卒中复发（P=0.001）和血管事件（P=0.007）之间的关联。此外，CysC 可能改善卒中复发的重新分类（净重新分类改善 [NRI] 42.9%，P=0.001；综合判别改善 [IDI] 1.2%，P=0.001）和血管事件（NRI 35.8%，P=0.001；IDI 1.1%，P=0.004）。
在 hsCRP 浓度较高的缺血性脑卒中患者中，较高的 CysC 浓度增加了卒中复发和血管事件的风险。这表明 CysC 对卒中复发的预测价值可能取决于患者的炎症状态。
