Weng Jiaxu, Qiu Xin, Jiang Yingyu, Gu Hong-Qiu, Meng Xia, Zhao Xingquan, Wang Yongjun, Li Zixiao
Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University.
J Atheroscler Thromb. 2025 Apr 1;32(4):525-534. doi: 10.5551/jat.65056. Epub 2024 Nov 23.
Clonal hematopoiesis of indeterminate potential (CHIP), which has recently been shown to be an age-related phenomenon, is associated with cardiovascular diseases, including atherosclerosis and stroke. This study focused on the association between CHIP and short- and long-term stroke recurrence in patients with acute ischemic stroke and intracranial atherosclerotic stenosis (ICAS).
This study included 4,699 patients with acute ischemic stroke based on data from the Third China National Stroke Registry (CNSR-III), a nationwide prospective hospital-based registry. The ICAS assessment followed the criteria established by the Warfarin-Aspirin Symptomatic Intracranial Disease Study and Brain Imaging. Atherosclerosis Scores (AS) were used to assess the atherosclerosis burden, as determined by the number and severity of steno-occlusions in the intracranial arteries. The primary outcome was stroke recurrence three months and one year after the event.
Among the 4,699 patients, 3,181 (67.7%) were female, and the median age was 63.0 (55.0-71.0) years. We found that CHIP significantly increased the risk of stroke recurrence at the 1-year follow-up in patients with ICAS (adjusted hazard ratio [HR] 2.71, 95% confidence interval [CI] (1.77-4.16), P for interaction, 0.008).
Our results revealed that CHIP might have a significant impact on the long-term risk of recurrent stroke, particularly in patients with a higher atherosclerotic burden.
不确定潜能的克隆性造血（CHIP）最近被证明是一种与年龄相关的现象，与心血管疾病相关，包括动脉粥样硬化和中风。本研究聚焦于急性缺血性中风和颅内动脉粥样硬化狭窄（ICAS）患者中CHIP与短期和长期中风复发之间的关联。
本研究纳入了4699例急性缺血性中风患者，数据来自全国性前瞻性医院登记系统——中国国家卒中登记（CNSR-III）。ICAS评估遵循华法林-阿司匹林有症状颅内疾病研究和脑成像制定的标准。动脉粥样硬化评分（AS）用于评估动脉粥样硬化负担，由颅内动脉狭窄闭塞的数量和严重程度决定。主要结局是事件发生后3个月和1年的中风复发。
在4699例患者中，3181例（67.7%）为女性，中位年龄为63.0（55.0 - 71.0）岁。我们发现，在ICAS患者中，CHIP在1年随访时显著增加中风复发风险（调整后风险比[HR] 2.71，95%置信区间[CI]（1.77 - 4.16），交互作用P值为0.008）。
我们的结果显示，CHIP可能对中风复发的长期风险有显著影响，尤其是在动脉粥样硬化负担较高的患者中。
