血管壁强化和高敏C反应蛋白作为颅内动脉粥样硬化性卒中的预后标志物：一项前瞻性队列研究。

Vessel wall enhancement and high-sensitivity CRP as prognostic markers in intracranial atherosclerotic stroke: A prospective cohort study.

作者信息

Na Seunghee, Kim Taewon, Koo Jaseong, Hong Yun Jeong, Kim Seong-Hoon

机构信息

Department of Neurology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Department of Neurology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

出版信息

Eur Stroke J. 2025 Feb 3:23969873251317341. doi: 10.1177/23969873251317341.

DOI:10.1177/23969873251317341

PMID:39901534

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11791967/

Abstract

INTRODUCTION

Eccentric vessel wall enhancement (EVWE) and high-sensitivity C-reactive protein (hs-CRP) are inflammatory biomarkers associated with atherosclerotic disease. We investigated their prognostic value in patients with acute ischemic stroke receiving guideline-adherent medical treatment.

PATIENTS AND METHODS

In this prospective observational cohort study, patients with acute ischemic stroke attributed to intracranial arterial disease (ICAD) underwent vessel wall MRI and hs-CRP testing. The study included intracranial cases of both large artery atherosclerosis (LAA) and small vessel occlusion (SVO). The primary outcome was subsequent ischemic stroke during the follow-up period. The median follow-up duration was 21 months. Kaplan-Meier survival and Cox regression analysis was used to determine the associations between EVWE, hs-CRP levels, and subsequent ischemic stroke.

RESULTS

Among 191 patients, 81 (42.4%) had EVWE. EVWE positivity showed a trend toward a lower risk of subsequent ischemic stroke compared to EVWE negativity (HR 0.32, 95% CI 0.12-0.87; = 0.061). Hs-CRP levels were not associated with recurrent stroke risk. The combination of EVWE positivity and low hs-CRP levels (<1.25 mg/l) was associated with a favorable outcome, while EVWE negativity and high hs-CRP levels (⩾1.25 mg/l) were associated with an unfavorable outcome (HR 0.143, 95% CI 0.04-0.50; = 0.031).

DISCUSSION

In this observational study of patients with intracranial atherosclerotic stroke receiving optimal medical therapy, EVWE positivity appeared to be associated with a trend toward lower risk of recurrent stroke, though this relationship requires further validation.

CONCLUSION

The combination of EVWE and hs-CRP status might potentially offer prognostic information, with preliminary data suggesting that EVWE positivity and low hs-CRP levels could be associated with more favorable outcomes in patients receiving guideline-adherent medical treatment. These preliminary findings suggest a possible role for combining imaging and serum inflammatory biomarkers in risk stratification, though larger prospective studies are needed to confirm these associations.

摘要

引言

血管壁偏心性强化（EVWE）和高敏C反应蛋白（hs-CRP）是与动脉粥样硬化疾病相关的炎症生物标志物。我们研究了它们在接受指南推荐药物治疗的急性缺血性卒中患者中的预后价值。

患者与方法

在这项前瞻性观察性队列研究中，因颅内动脉疾病（ICAD）导致急性缺血性卒中的患者接受了血管壁MRI和hs-CRP检测。该研究纳入了颅内大动脉粥样硬化（LAA）和小血管闭塞（SVO）的病例。主要结局是随访期间的后续缺血性卒中。中位随访时间为21个月。采用Kaplan-Meier生存分析和Cox回归分析来确定EVWE、hs-CRP水平与后续缺血性卒中之间的关联。

结果

在191例患者中，81例（42.4%）存在EVWE。与EVWE阴性相比，EVWE阳性显示出后续缺血性卒中风险较低的趋势（风险比0.32，95%置信区间0.12 - 0.87；P = 0.061）。hs-CRP水平与复发性卒中风险无关。EVWE阳性和低hs-CRP水平（<1.25mg/L）的组合与良好结局相关，而EVWE阴性和高hs-CRP水平（⩾1.25mg/L）与不良结局相关（风险比0.143，95%置信区间0.04 - 0.50；P = 0.031）。