Su Xiaofeng, Gao Yinghui, Xu Weihao, Li JianHua, Chen Kaibing, Gao Yan, Guo JingJing, Zhao LiBo, Wang Huanhuan, Qian Xiaoshun, Lin Junling, Han Jiming, Liu Lin
Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
Medical College, Yan'an University, Yan'an, China.
Front Neurosci. 2021 Dec 15;15:762552. doi: 10.3389/fnins.2021.762552. eCollection 2021.
Few prospective cohort studies have assessed the relationship between Cystatin C (Cys-C) and risk of stroke in elderly patients with obstructive sleep apnea (OSA). The study sought to examine the association between baseline serum Cys-C and long-term risk of stroke among elderly OSA patients. A total of 932 patients with OSA, no history of stroke, ≥60 years of age, and complete serum Cys-C records were included in this study. All patients had completed polysomnography (PSG). OSA was defined as an apnea-hypopnea index (AHI) of ≥5 events per hour. Participants were categorized into four groups according to baseline serum Cys-C concentration, split into quartiles. Multivariate Cox regression were used to evaluate the association between Cys-C and the incidence of new-onset stroke. Stroke occurred in 61 patients during the median 42-month follow-up period. The cumulative incidence rate of stroke was 6.5%, which included 54 patients with ischemic stroke and 7 patients with hemorrhagic stroke. The cumulative incidence of stroke was higher among patients with baseline serum Cys-C concentration of ≥1.15 mg/L when compared with other groups ( < 0.001). After adjusting for potential confounding factors in the Cox regression model, patients with a serum Cys-C concentration of ≥1.15 mg/L had a 2.16-fold higher risk of developing stroke compared with patients with serum Cys-C ≤ 0.81 mg/L (HR, 2.16, 95%CI, 1.09-6.60; = 0.017). Additionally, there was a higher risk in those of age ≥70 years (HR, 3.23, 95%CI, 1.05-9.24; = 0.010). The receiver-operating characteristic curves showed that the capability of Cys-C to identify elderly patients with OSA who had a long-time risk of stroke was moderate (AUC = 0.731, 95% CI: 0.683-0.779, = 0.001). Increased Cys-C concentration was identified as a risk factor in the incidence of stroke in elderly patients with OSA, independent of gender, BMI, hypertension and other risk factors. Additionally, it conferred a higher risk in patients of age ≥70 years.
很少有前瞻性队列研究评估老年阻塞性睡眠呼吸暂停（OSA）患者中胱抑素C（Cys-C）与中风风险之间的关系。该研究旨在探讨老年OSA患者基线血清Cys-C与中风长期风险之间的关联。本研究共纳入932例年龄≥60岁、无中风病史且有完整血清Cys-C记录的OSA患者。所有患者均完成了多导睡眠图（PSG）检查。OSA定义为呼吸暂停低通气指数（AHI）≥5次/小时。参与者根据基线血清Cys-C浓度分为四组，按四分位数划分。采用多因素Cox回归评估Cys-C与新发中风发生率之间的关联。在中位42个月的随访期内，有61例患者发生中风。中风的累积发生率为6.5%，其中包括54例缺血性中风患者和7例出血性中风患者。与其他组相比，基线血清Cys-C浓度≥1.15mg/L的患者中风累积发生率更高（<0.001）。在Cox回归模型中调整潜在混杂因素后，血清Cys-C浓度≥1.15mg/L的患者发生中风的风险比血清Cys-C≤0.81mg/L的患者高2.16倍（HR，2.16，95%CI，1.09-6.60；=0.017）。此外，年龄≥70岁的患者风险更高（HR，3.23，95%CI，1.05-9.24；=0.010）。受试者工作特征曲线显示，Cys-C识别有中风长期风险的老年OSA患者的能力中等（AUC=0.731，95%CI：0.683-0.779，=0.001）。Cys-C浓度升高被确定为老年OSA患者中风发生率的一个危险因素，独立于性别、BMI、高血压和其他危险因素。此外，年龄≥70岁的患者风险更高。
