C-reactive protein as a prognostic marker after lacunar stroke: levels of inflammatory markers in the treatment of stroke study.
C-reactive protein as a prognostic marker after lacunar stroke: levels of inflammatory markers in the treatment of stroke study.
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DOI：
10.1161/strokeaha.113.004562
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发表时间：
2014-03
期刊：
影响因子：
8.3
通讯作者：
LIMITS Investigators
中科院分区：
文献类型：
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作者：
Elkind MS;Luna JM;McClure LA;Zhang Y;Coffey CS;Roldan A;Del Brutto OH;Pretell EJ;Pettigrew LC;Meyer BC;Tapia J;White C;Benavente OR;LIMITS Investigators
炎症生物标志物可预测心脏事件的发生和复发，但其与卒中预后的关系尚不确定。我们假设高敏C-反应蛋白（hsCRP）可预测近期腔隙性卒中后缺血性卒中的复发。卒中治疗中的炎症标志物水平（LIMITS）是一项国际、多中心、前瞻性辅助生物标志物研究，嵌套在小皮质下卒中二级预防（SPS 3）中，这是一项在近期腔隙性卒中患者中进行的III期试验。采用析因设计将患者分为阿司匹林组和阿司匹林+氯吡格雷组，以及高血压组和低血压组。患者在入组时采集血液样本，并在中心实验室使用散射比浊法测量hsCRP。采用考克斯比例风险模型计算校正人口统计学、合并症和他汀类药物使用前后复发风险的风险比和95%置信区间（HR，95%CI）。1244例腔隙性脑卒中患者（平均年龄63.3 ± 10.8岁）中位hsCRP为2.16 mg/L。有83例复发性缺血性卒中（包括45例腔隙性），115例主要血管事件（卒中、心肌梗死、血管性死亡）。与最低四分位数相比，最高四分位数（hsCRP >4.86 mg/L）的患者缺血性卒中复发风险增加（未校正HR 2.54，95%CI 1.30-4.96），即使在校正人口统计学和风险因素后（校正HR 2.32，95%CI 1.15-4.68）。HsCRP预测主要血管事件风险增加（前四分位数校正HR 2.04，95%CI 1.14-3.67）。与随机化抗血小板治疗无相互作用。在近期腔隙性卒中患者中，hsCRP水平可预测复发性卒中和其他血管事件的风险。HsCRP不能预测对双重抗血小板药物的反应。
Inflammatory biomarkers predict incident and recurrent cardiac events, but their relationship to stroke prognosis is uncertain. We hypothesized that high-sensitivity C-reactive protein (hsCRP) predicts recurrent ischemic stroke after recent lacunar stroke. Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) was an international, multicenter, prospective ancillary biomarker study nested within Secondary Prevention of Small Subcortical Strokes (SPS3), a Phase III trial in patients with recent lacunar stroke. Patients were assigned in factorial design to aspirin versus aspirin plus clopidogrel, and higher versus lower blood pressure targets. Patients had blood samples collected at enrollment, and hsCRP measured using nephelometry at a central laboratory. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals (HR, 95%CI) for recurrence risks before and after adjusting for demographics, comorbidities, and statin use. Among 1244 lacunar stroke patients (mean 63.3 ± 10.8 years), median hsCRP was 2.16 mg/L. There were 83 recurrent ischemic strokes (including 45 lacunes), and 115 major vascular events (stroke, myocardial infarction, vascular death). Compared with the bottom quartile, those in the top quartile (hsCRP >4.86 mg/L) were at increased risk of recurrent ischemic stroke (unadjusted HR 2.54, 95%CI 1.30–4.96), even after adjusting for demographics and risk factors (adjusted HR 2.32, 95%CI 1.15–4.68). HsCRP predicted increased risk of major vascular events (top quartile adjusted HR 2.04, 95%CI 1.14–3.67). There was no interaction with randomized antiplatelet treatment. Among recent lacunar stroke patients, hsCRP levels predict risk of recurrent strokes and other vascular events. HsCRP did not predict response to dual antiplatelets.