From the Department of Neurology and Suzhou Clinical Research Center of Neurological Disease (S.Y., Y.C., C.-F.L.), The Second Affiliated Hospital of Soochow University; Department of Epidemiology (M.M., Z.L., A.B., J.D., B.C., T.X., C.Z., Y.Z.), School of Public Health, Medical College of Soochow University; Institutes of Neuroscience (Y.C., C.-F.L.), Soochow University, Suzhou, China; and Department of Epidemiology (J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.
Neurology. 2022 Aug 30;99(9):e925-e934. doi: 10.1212/WNL.0000000000200784. Epub 2022 Jun 2.
Recent studies have suggested that plasma soluble dipeptidyl peptidase-4 (sDPP4) have important physiologic effects, which may influence the prognosis of ischemic stroke. Our study aimed to examine the relationship between plasma sDDP4 levels and long-term clinical outcomes among patients with acute ischemic stroke.
Secondary analysis was conducted among 3,564 participants (2,270 men and 1,294 women) from the China Antihypertensive Trial in Acute Ischemic Stroke with baseline measurement of plasma sDPP4 levels. We evaluated the associations between plasma sDPP4 levels and 2-year clinical outcomes using logistic regression and Cox regression models. We further investigated the predictive utility of sDPP4 by calculating net reclassification index and integrated discrimination improvement.
The highest plasma sDPP4 quartile was associated with lower risk of cardiovascular events (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.45-0.87), recurrent stroke (HR 0.70, 95% CI 0.49-0.99), all-cause mortality (HR 0.62, 95% CI 0.44-0.87), stroke-specific mortality (HR 0.65, 95% CI 0.44-0.94), and poor functional outcomes (odds ratio 0.66, 95% CI 0.53-0.82) at 2 years compared with the lowest sDPP4 category in multivariable models. The addition of plasma sDPP4 to conventional risk factors model significantly improved risk prediction of all outcomes.
In this study, we found that higher plasma sDPP4 levels in patients with acute ischemic stroke were associated with decreased risks of cardiovascular events, recurrent stroke, all-cause mortality, and poor functional outcomes after ischemic stroke. These findings suggest that plasma sDPP4 may be a potential prognostic marker for initial risk stratification in patients with acute ischemic stroke.
最近的研究表明，血浆可溶性二肽基肽酶-4（sDPP4）具有重要的生理作用，可能影响缺血性脑卒中的预后。本研究旨在探讨急性缺血性脑卒中患者血浆 sDPP4 水平与长期临床结局的关系。
对基线测量血浆 sDPP4 水平的 3564 名参与者（2270 名男性和 1294 名女性）进行二次分析。我们使用逻辑回归和 Cox 回归模型评估血浆 sDPP4 水平与 2 年临床结局之间的关系。我们通过计算净重新分类指数和综合判别改善来进一步研究 sDPP4 的预测效用。
最高四分位数的血浆 sDPP4 与心血管事件风险降低相关（风险比 [HR] 0.62，95%置信区间 [CI] 0.45-0.87）、复发性卒中（HR 0.70，95% CI 0.49-0.99）、全因死亡率（HR 0.62，95% CI 0.44-0.87）、卒中特异性死亡率（HR 0.65，95% CI 0.44-0.94）和不良功能结局（OR 0.66，95% CI 0.53-0.82），与多变量模型中最低 sDPP4 类别相比，在 2 年内。将血浆 sDPP4 添加到常规风险因素模型中可显著提高所有结局的风险预测能力。
在这项研究中，我们发现急性缺血性脑卒中患者较高的血浆 sDPP4 水平与心血管事件、复发性卒中、全因死亡率和卒中后不良功能结局的风险降低相关。这些发现表明，血浆 sDPP4 可能是急性缺血性脑卒中患者初始风险分层的潜在预后标志物。
