不同病因缺血性脑卒中患者残留复发风险的非传统危险因素。
Nontraditional Risk Factors for Residual Recurrence Risk in Patients with Ischemic Stroke of Different Etiologies.
机构信息
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
出版信息
Cerebrovasc Dis. 2022;51(5):630-638. doi: 10.1159/000523919. Epub 2022 Apr 7.
BACKGROUND AND OBJECTIVE
With the popularization of guideline-based secondary prevention based on traditional risk factors, rates of stroke recurrence reduced greatly after ischemic stroke (IS) or transient ischemic attack (TIA), but the residual risk still exists. We aim to evaluate which IS subtype benefits the most from the current secondary prevention and to evaluate nontraditional risk factors for residual recurrence risk of different IS etiologies.
METHODS
The study included IS/TIA patients who participated in both biomarker substudy and imaging substudy of the Third China National Stroke Registry. We used 5 guideline-recommended interventions (antiplatelet, statins, anticoagulant, antihypertensive, and antidiabetic therapies) to document the performance of secondary prevention care. Residual risk was defined as the risk of stroke recurrence despite adherence to these 5 guideline-based secondary prevention strategies. Risk factors associated with stroke recurrence were analyzed by using Cox regression models.
RESULTS
In total, 9,733 patients were included in this study. At 3 months, 4,186 (43.0%) patients adhered to 5 secondary prevention strategies, and the residual risk of recurrence was 5.1%. According to Trial of Org 10172 in Acute Stroke Treatment subtypes, cardioembolism benefited the most from current secondary prevention (relative risk reduction: 65.2%), followed by large-artery atherosclerosis (LAA) (29.0%) and small-artery occlusion (SAO) (20.0%). Despite adhering to secondary prevention strategies, high sensitivity C-reactive protein, interleukin-6 (IL-6) levels, and impaired renal function were independent risk factors for the residual recurrence risk of LAA subtype, while IL-6 and trimethylamine N-oxide significantly contributed to the residual risk of SAO subtype.
CONCLUSIONS
LAA and SAO subtypes own the specific nontraditional risk factors while inflammation is a common risk factor for residual recurrence risk of both.
背景与目的
随着基于传统危险因素的指南指导下二级预防的普及，缺血性卒中（IS）或短暂性脑缺血发作（TIA）后的卒中复发率大大降低，但仍存在残余风险。我们旨在评估哪种 IS 亚型最能从当前二级预防中获益，并评估不同 IS 病因残留复发风险的非传统危险因素。
方法
本研究纳入了参加第三次中国国家卒中登记研究生物标志物亚研究和影像学亚研究的 IS/TIA 患者。我们使用 5 种指南推荐的干预措施（抗血小板、他汀类药物、抗凝、降压和降糖治疗）来记录二级预防护理的效果。残余风险定义为尽管采用了这 5 种基于指南的二级预防策略，但仍发生卒中复发的风险。采用 Cox 回归模型分析与卒中复发相关的危险因素。
结果
共纳入 9733 例患者。在 3 个月时，4186 例（43.0%）患者遵循了 5 种二级预防策略，复发的残余风险为 5.1%。根据组织型纤溶酶原激活物治疗急性卒中试验亚型，心源性栓塞从当前二级预防中获益最多（相对风险降低：65.2%），其次是大动脉粥样硬化（LAA）（29.0%）和小动脉闭塞（SAO）（20.0%）。尽管遵循了二级预防策略，但高敏 C 反应蛋白、白细胞介素-6（IL-6）水平和肾功能受损是 LAA 亚型残余复发风险的独立危险因素，而 IL-6 和三甲胺 N-氧化物显著增加了 SAO 亚型的残余风险。
结论
LAA 和 SAO 亚型有特定的非传统危险因素，而炎症是两者残余复发风险的共同危险因素。
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