Wu Min, Zhang Xiaohao, Chen Jingjing, Zha Mingming, Yuan Kang, Huang Kangmo, Xie Yi, Xue Jianzhong, Liu Xinfeng
Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, People's Republic of China.
Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, 210002, People's Republic of China.
J Inflamm Res. 2021 Sep 14;14:4605-4614. doi: 10.2147/JIR.S328383. eCollection 2021.
The impact of low-grade inflammation (LGI) on stroke recurrence has not been well studied yet. We aimed to evaluate the association between LGI and stroke recurrence in patients with ischemic stroke.
Patients with first-ever ischemic stroke diagnosed within 72 hours of symptoms onset were consecutively recruited from the Nanjing Stroke Registry Program. C-reactive protein (CRP) level, white blood cell (WBC) count, platelet (PLT) count, and neutrophil-to-lymphocyte ratio (NLR) were conceived as low-grade inflammation biomarkers and combined into a standardized LGI score. The association of LGI score with the risk of stroke recurrence was analyzed with multivariate Cox regression models. Analyses accounting for the competing risk of stroke recurrence and death were also performed.
Of the 1214 patients studied (median age, 61 years; male, 71.6%), 177 (14.6%) patients experienced a recurrent stroke with a median follow-up of 23.0 (interquartile ranges, 14.5-34.0) months. Patients with stroke recurrence had a higher LGI score (median, 3 versus -2; < 0.001) than those without recurrence. The univariate analysis indicated that patients with LGI scores in the fourth quartile were more likely to have a stroke recurrence (hazard ratios [HR], 4.312; 95% confidence interval [CI], 2.675-6.952; < 0.001). After adjusting for potential confounders, the association remained significant in the multivariate Cox regression model (HR, 4.080; 95% CI, 2.420-6.879; < 0.001). Competing risks model and sensitivity analysis further confirmed this conclusion.
This study showed that an elevated LGI score was associated with a higher risk of stroke recurrence, independent of other vascular risk factors.
低度炎症（LGI）对卒中复发的影响尚未得到充分研究。我们旨在评估缺血性卒中患者中LGI与卒中复发之间的关联。
从南京卒中登记项目中连续招募症状发作72小时内首次诊断为缺血性卒中的患者。将C反应蛋白（CRP）水平、白细胞（WBC）计数、血小板（PLT）计数和中性粒细胞与淋巴细胞比值（NLR）视为低度炎症生物标志物，并合并为标准化的LGI评分。采用多变量Cox回归模型分析LGI评分与卒中复发风险的关联。还进行了考虑卒中复发和死亡竞争风险的分析。
在1214例研究患者中（中位年龄61岁；男性占71.6%），177例（14.6%）患者发生卒中复发，中位随访时间为23.0（四分位间距14.5 - 34.0）个月。卒中复发患者的LGI评分（中位数为3，无复发患者为 - 2；P < 0.001）高于未复发患者。单因素分析表明，LGI评分处于第四四分位数的患者更易发生卒中复发（风险比[HR]为4.312；95%置信区间[CI]为2.675 - 6.952；P < 0.001）。在调整潜在混杂因素后，多变量Cox回归模型中的关联仍具有显著性（HR为4.080；95% CI为2.420 - 6.879；P < 0.001）。竞争风险模型和敏感性分析进一步证实了这一结论。
本研究表明，LGI评分升高与卒中复发风险较高相关，且独立于其他血管危险因素。
