High-sensitive C-reactive protein and dual antiplatelet in intracranial arterial stenosis
High-sensitive C-reactive protein and dual antiplatelet in intracranial arterial stenosis
复制标题
高敏 C 反应蛋白和双重抗血小板治疗颅内动脉狭窄
DOI：
10.1212/wnl.0000000000004928
复制
发表时间：
2018-02-06
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, Anxin;Wang, Yongjun
目的探讨高敏C反应蛋白（hsCRP）与氯吡格雷治疗急性非致残性脑血管事件高危患者（CHANCE）试验中颅内动脉狭窄（ICAS）患者和非颅内动脉狭窄患者双重抗血小板治疗的疗效和安全性的关系。考克斯比例风险模型被用来评估hsCRP水平与双重和单一抗血小板therapy.ResultsA的影响的相互作用，共有358（44.4%）患者有ICAS和449（55.6%）没有。ICAS组hsCRP水平升高的患者比例高于非ICAS组（40.2% vs 30.1%，p = 0.003）。在ICAS患者中，在调整混杂因素后，hsCRP和2个抗血小板治疗组对复发性卒中的影响存在显著的相互作用（p = 0.012），但在无ICAS的患者中无相互作用（p = 0.256）。与单独使用阿司匹林相比，氯吡格雷联合阿司匹林仅在ICAS和hsCRP水平未升高的患者中显著降低了复发性卒中的风险（校正风险比0.27; 95%置信区间0.11 - 0.69; p = 0.006）。对于复合血管事件，观察到类似的结果。出血无显着差异被发现。ConclusionsPresence的ICAS和nonelevated hsCRP水平可以预测更好的双重抗血小板治疗，减少新的中风和复合血管事件在轻微中风或高风险TIA患者。需要进一步的大规模随机对照临床试验来证实这一发现。
ObjectiveTo determine the relationship of high-sensitive C-reactive protein (hsCRP) and the efficacy and safety of dual antiplatelet therapy in patients with and without intracranial arterial stenosis (ICAS) in the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial.MethodsA subgroup of 807 patients with both magnetic resonance angiography images and hsCRP measurement was analyzed. Cox proportional hazards models were used to assess the interaction of hsCRP levels with the effects of dual and single antiplatelet therapy.ResultsA total of 358 (44.4%) patients had ICAS and 449 (55.6%) did not. The proportion of patients with elevated hsCRP levels was higher in the ICAS group than in the non-ICAS group (40.2% vs 30.1%, p = 0.003). There was significant interaction between hsCRP and the 2 antiplatelet therapy groups in their effects on recurrent stroke after adjustment for confounding factors in the patients with ICAS (p = 0.012), but not in those without (p = 0.256). Compared with aspirin alone, clopidogrel plus aspirin significantly reduced the risk of recurrent stroke only in the patients with ICAS and nonelevated hsCRP levels (adjusted hazard ratio 0.27; 95% confidence interval 0.11 to 0.69; p = 0.006). Similar results were observed for composite vascular events. No significant difference in bleeding was found.ConclusionsPresence of both ICAS and nonelevated hsCRP levels may predict better response to dual antiplatelet therapy in reducing new stroke and composite vascular events in minor stroke or high-risk TIA patients. Further large-scale randomized and controlled clinical trials are needed to confirm this finding.