Inflammation and hemostasis biomarkers for predicting stroke in postmenopausal women: the Women's Health Initiative Observational Study.
Inflammation and hemostasis biomarkers for predicting stroke in postmenopausal women: the Women's Health Initiative Observational Study.
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DOI：
10.1016/j.jstrokecerebrovasdis.2008.04.006
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发表时间：
2008-11-01
期刊：
影响因子：
--
通讯作者：
Wassertheil-Smoller, Sylvia
中科院分区：
文献类型：
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作者：
Kaplan, Robert C;McGinn, Aileen P;Wassertheil-Smoller, Sylvia
背景技术背景：炎症和止血相关的生物标志物可能会识别妇女中风的风险。方法：激素和生物标志物预测中风是一项研究缺血性中风的绝经后妇女参与妇女健康倡议观察研究（n = 972病例对照对）。生物标志物风险评分（BRS）来源于7种炎症和止血相关生物标志物的水平，这些生物标志物单独出现可预测缺血性卒中的风险：C-反应蛋白（CRP）、白细胞介素-6、组织纤溶酶原激活物、D-二聚体、白色血细胞计数、新喋呤和同型半胱氨酸。c指数用于评估discrimination.Results：在所有检查的个体生物标志物中，在校正其他生物标志物和标准卒中风险因素后，CRP成为缺血性卒中的唯一独立单一预测因子（校正后的比值比比较四分位数（4）v四分位数（1）= 1.64，95%置信区间：1.15-2.32，P = 0.01）。BRS确定了卒中风险增加的梯度，炎症/止血生物标志物数量增加，与标准卒中风险因素相比，c指数显著改善（P = 0.02）。在符合当前CRP高风险水平（>3.0 mg/L）标准的个体亚组中，BRS定义的风险梯度约为2倍。我们没有发现中风和E-选择素，纤维蛋白原，肿瘤坏死因子-α，血管细胞粘附分子-1，凝血酶原片段1+2，因子VIIC，或纤溶酶原激活物抑制剂-1抗原（P > 0.15）的水平之间的关系的证据。讨论：研究结果支持进一步探索多个生物标志物面板开发的方法分层一个人的中风的风险。
BACKGROUND: Inflammatory and hemostasis-related biomarkers may identify women at risk of stroke.METHODS: Hormones and Biomarkers Predicting Stroke is a study of ischemic stroke among postmenopausal women participating in the Women's Health Initiative observational study (n = 972 case-control pairs). A Biomarker Risk Score (BRS) was derived from levels of 7 inflammatory and hemostasis-related biomarkers that appeared individually to predict risk of ischemic stroke: C-reactive protein (CRP), interleukin-6, tissue plasminogen activator, D-dimer, white blood cell count, neopterin, and homocysteine. The c index was used to evaluate discrimination.RESULTS: Of all the individual biomarkers examined, CRP emerged as the only independent single predictor of ischemic stroke (adjusted odds ratio comparing Quartile(4)v Quartile(1) = 1.64, 95% confidence interval: 1.15-2.32, P = .01) after adjustment for other biomarkers and standard stroke risk factors. The BRS identified a gradient of increasing stroke risk with a greater number of elevated inflammatory/hemostasis biomarkers, and improved the c index significantly compared with standard stroke risk factors (P = .02). Among the subset of individuals who met current criteria for high-risk levels of CRP (>3.0 mg/L), the BRS defined an approximately 2-fold gradient of risk. We found no evidence for a relationship between stroke and levels of E-selectin, fibrinogen, tumor necrosis factor-alpha, vascular cell adhesion molecule-1, prothrombin fragment 1+2, Factor VIIC, or plasminogen activator inhibitor-1 antigen (P > .15).DISCUSSION: The findings support the further exploration of multiple biomarker panels to develop approaches for stratifying an individual's risk of stroke.