Glycated albumin predicts the effect of dual and single antiplatelet therapy on recurrent stroke
Glycated albumin predicts the effect of dual and single antiplatelet therapy on recurrent stroke
复制标题
糖化白蛋白预测双重和单一抗血小板治疗对复发性卒中的效果
DOI：
10.1212/wnl.0000000000001421
复制
发表时间：
2015-03-31
期刊：
影响因子：
9.9
通讯作者：
Wang, Yongjun
中科院分区：
文献类型：
--
作者：
Li, Jiejie;Wang, Yilong;Wang, Yongjun
目的：探讨糖化白蛋白（GA）与卒中复发率的关系。方法：氯吡格雷在高危急性非致残性脑血管事件患者中的临床试验，将轻度缺血性卒中或TIA患者随机分为氯吡格雷联合阿司匹林或阿司匹林单用抗血小板治疗两组。对来自73个（64%）预先指定的临床部位的连续3044例基线GA水平的患者进行亚组分析。根据GA水平15.5%（糖尿病发展的临界点）将患者分为两组。主要终点为90天随访期间卒中复发率。Cox比例风险模型用于评估GA与随机抗血小板治疗对卒中复发风险的相互作用。结果：在校正年龄、性别和其他常规混杂因素后，GA水平与2个抗血小板治疗组存在显著的相互作用（p = 0.009）。在进一步调整糖尿病史后，这种相互作用保持一致（p = 0.010）。在GA水平较低的患者中，氯吡格雷-阿司匹林组发生卒中的比例为5.5%，阿司匹林组为12.7%（校正风险比[HR] 0.40； 95%可信区间[CI] 0.26-0.61; p < 0.001）。此外，在GA水平升高的患者中，氯吡格雷-阿司匹林组有9.2%的患者发生卒中，阿司匹林组为11.4%（调整后HR 0.79; 95% CI 0.60-1.05; p = 0.103）。结论：GA可能是一种潜在的生物标志物，用于预测轻度卒中或TIA患者双抗和单抗血小板治疗的效果。
Objective: To determine the relationship of glycated albumin (GA) and the recurrence of stroke in patients on either dual or single antiplatelet therapy.Methods: The Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial randomized minor ischemic stroke or TIA patients to antiplatelet therapy of clopidogrel plus aspirin or aspirin alone. A subgroup of 3,044 consecutive patients with baseline GA levels from 73 (64%) prespecified clinical sites was analyzed. Patients were categorized into 2 groups based on GA level of 15.5%, the cut point for development of diabetes. The primary outcome was stroke recurrence during 90-day follow-up. Cox proportional hazards models were used to assess the interaction of GA with randomized antiplatelet therapy on their risk of recurrent stroke.Results: Significant interaction of GA levels with the 2 antiplatelet therapy groups was found after adjustment for age, sex, and other conventional confounding factors (p = 0.009). The interaction remained consistent after further adjustment for history of diabetes (p = 0.010). In patients with lower GA level, stroke occurred in 5.5% of patients in the clopidogrel-aspirin group, and 12.7% in the aspirin group (adjusted hazard ratio [HR] 0.40; 95% confidence interval [CI] 0.26-0.61; p < 0.001). Furthermore, in patients with elevated GA level, stroke occurred in 9.2% of patients in the clopidogrel-aspirin group, and 11.4% in the aspirin group (adjusted HR 0.79; 95% CI 0.60-1.05; p = 0.103).Conclusions: GA could be a potential biomarker to predict the effects of dual and single antiplatelet therapy in patients with minor stroke or TIA.