Protein Z in ischemic stroke and its etiologic subtypes
Protein Z in ischemic stroke and its etiologic subtypes
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DOI：
10.1161/01.str.0000092124.52084.4b
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发表时间：
2003-10-01
期刊：
影响因子：
8.3
通讯作者：
Cole, V
中科院分区：
文献类型：
--
作者：
McQuillan, AM;Eikelboom, JW;Cole, V
背景和目的-蛋白Z是一种维生素K依赖性血浆蛋白，其在动脉血栓形成中的意义尚不清楚。本研究的目的是确定蛋白质Z，缺血性中风，缺血性stroks.Methods的病因亚型之间的关联-我们进行了一项病例对照研究的173例首次缺血性中风和186个随机选择的社区对照。使用已建立的标准，我们分类中风病例的病因亚型。蛋白Z浓度在前7天内，并在3至6个月后的急性stroke events.Results -血液中的蛋白Z水平在7天内测量急性中风的情况下，显着高于对照组（几何平均值，1.46与1.16 μ g/mL; P < 0.0001）。与最低三分位数相比，蛋白Z的上2个三分位数与缺血性卒中的校正比值比（OR）相关，第二个三分位数为1.75（95%CI，1.00至3.07），上三分位数为3.07（95%CI，1.73至5.45）。蛋白Z浓度在上三分位数的患者，大动脉粥样硬化血栓形成引起缺血性卒中的调整后几率是低三分位数患者的近8倍（OR，7.91; 95%CI，3.11 - 20.14）。与低三分位数相比，蛋白Z浓度在上三分位数的个体中，小动脉疾病（OR，1.79; 95%CI，0.83 - 3.87）和心源性栓塞（OR，1.80; 95%CI，0.58 - 5.64）引起的缺血性卒中的调整后几率也增加，但不显著。平均蛋白Z浓度之间没有显着差异的情况下，在恢复期（3个月）中风后，年龄和性别匹配的controls.Conclusions -有一个强大的，独立的关系升高的血液中蛋白Z水平和缺血性中风在急性期，特别是缺血性中风由于大动脉粥样硬化血栓栓塞，这是不再明显的恢复期。这些结果与蛋白Z是大动脉粥样硬化血栓栓塞或急性期反应物所致缺血性卒中发病机制中的重要因素的观点一致。需要进一步的研究来阐明蛋白Z是否在急性动脉血栓形成中具有致病或预后作用。
Background and Purpose - Protein Z is a vitamin K - dependent plasma protein whose significance in arterial thrombosis remains uncertain. The objectives of this study were to determine the association between protein Z, ischemic stroke, and etiologic subtypes of ischemic stroke.Methods - We conducted a case-control study of 173 hospital cases of first-ever ischemic stroke and 186 randomly selected community controls. Using established criteria, we classified cases of stroke by etiologic subtype. Protein Z concentrations were measured during the first 7 days and at 3 to 6 months after the acute stroke event.Results - Blood levels of protein Z measured within 7 days of acute stroke were significantly higher in cases than in controls ( geometric mean, 1.46 versus 1.16 mug/mL; P < 0.0001). Compared with the lowest tertile, the upper 2 tertiles of protein Z were associated with an adjusted odds ratio ( OR) of ischemic stroke of 1.75 (95% CI, 1.00 to 3.07) for the second tertile and 3.07 ( 95% CI, 1.73 to 5.45) for the upper tertile. The adjusted odds of ischemic stroke caused by large-artery atherothrombosis was nearly 8-fold greater for those with protein Z concentrations in the upper tertile compared with the lower tertile (OR, 7.91; 95% CI, 3.11 to 20.14). The adjusted odds of ischemic stroke due to small-artery disease ( OR, 1.79; 95% CI, 0.83 to 3.87) and cardioembolism ( OR, 1.80; 95% CI, 0.58 to 5.64) was also increased among individuals with protein Z concentrations in the upper tertile compared with the lower tertile, but not significantly so. There was no significant difference between mean protein Z concentrations among cases in the convalescent phase ( 3 months) after stroke and age- and sex-matched controls.Conclusions - There is a strong, independent relationship between elevated blood levels of protein Z and ischemic stroke during the acute phase, particularly ischemic stroke due to large-artery atherothromboembolism, which is no longer evident during the convalescent phase. These results are consistent with the notion that protein Z is either an important factor in the pathogenesis of ischemic stroke due to large-artery atherothromboembolism or an acute phase reactant. Further studies are required to elucidate whether protein Z has a causative or prognostic role in acute arterial thrombosis.