远程缺血预处理在急性缺血性脑卒中中的年龄和疗效。
Age and efficacy of remote ischemic conditioning in acute ischemic stroke.
机构信息
Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China.
Yinchuan Dingxiang Internet Hospital, Yinchuan, China.
出版信息
CNS Neurosci Ther. 2024 Mar;30(3):e14451. doi: 10.1111/cns.14451. Epub 2023 Sep 4.
AIMS
A post hoc analysis of RICAMIS trial to evaluate functional outcomes in relation to patient age.
METHODS
Patients in RICAMIS were divided into six age groups. The primary outcome was excellent functional outcome at 90 days, defined as modified Rankin Scale (mRS) score of 0-1. Compared with patients receiving usual care alone, we investigated the association of remote ischemic conditioning (RIC) effect with functional outcomes in each group and the interaction between RIC effect and age.
RESULTS
Of 1776 patients, 498 were assigned to <60 years, 326 to 60 to <65 years, 325 to 65 to <70 years, 278 to 70 to <75 years, 206 to 75 to <80 years, and 143 to ≥80 years. Higher proportions of primary outcome were found associated with RIC in <60 years group (72.6% vs. 64.8%; adjusted risk difference [RD], 6.8%; 95% CI, -1.6% to 15.1%; p = 0.11), 60 to <65 years group (70.7% vs. 67.1%; adjusted RD, 3.1%; 95% CI, -7.2% to 13.3%; p = 0.56), 65 to <70 years group (70.5% vs. 63.6%; adjusted RD, 3.5%; 95% CI, -6.8% to 13.8%; p = 0.51), 70 to <75 years group (59.7% vs. 54.9%; adjusted RD, 4.7%; 95% CI, -7.1% to 16.4%; p = 0.61), 75 to <80 years group (61.5% vs. 55.9%; adjusted RD, 5.7%; 95% CI, -7.8% to 19.1%; p = 0.41), and ≥ 80 years group (59.2% vs. 59.7%; adjusted RD, -2.6%; 95% CI, -18.8% to 13.5%; p = 0.75). No significant interaction between RIC effect and age was found among groups.
CONCLUSIONS
This is the first report that RIC effect may be attenuated with increasing age in patients with acute moderate ischemic stroke with respect to functional outcome.
目的
对 RICAMIS 试验进行事后分析，以评估与患者年龄相关的功能结局。
方法
RICAMIS 中的患者被分为六个年龄组。主要结局为 90 天时的优秀功能结局，定义为改良 Rankin 量表（mRS）评分 0-1。与仅接受常规治疗的患者相比，我们研究了远程缺血预处理（RIC）效果与每个组的功能结局之间的关联，以及 RIC 效果与年龄之间的相互作用。
结果
在 1776 名患者中，498 名被分配到<60 岁，326 名到 60 至<65 岁，325 名到 65 至<70 岁，278 名到 70 至<75 岁，206 名到 75 至<80 岁，143 名到≥80 岁。发现具有更高比例的主要结局与<60 岁组的 RIC 相关（72.6%对 64.8%；调整后的风险差异[RD]，6.8%；95%置信区间，-1.6%至 15.1%；p=0.11），60 至<65 岁组（70.7%对 67.1%；调整后的 RD，3.1%；95%置信区间，-7.2%至 13.3%；p=0.56），65 至<70 岁组（70.5%对 63.6%；调整后的 RD，3.5%；95%置信区间，-6.8%至 13.8%；p=0.51），70 至<75 岁组（59.7%对 54.9%；调整后的 RD，4.7%；95%置信区间，-7.1%至 16.4%；p=0.61），75 至<80 岁组（61.5%对 55.9%；调整后的 RD，5.7%；95%置信区间，-7.8%至 19.1%；p=0.41），和≥80 岁组（59.2%对 59.7%；调整后的 RD，-2.6%；95%置信区间，-18.8%至 13.5%；p=0.75）。在各组之间未发现 RIC 效果与年龄之间存在显著的相互作用。
结论
这是第一项报告，表明在急性中度缺血性脑卒中患者中，RIC 效果可能随年龄的增加而减弱，与功能结局相关。
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