根据中风亚型,C-反应蛋白,互白素-6和血管复发:一个个体参与者数据元分析
John J McCabe1, Cathal Walsh1, Sarah Gorey1
1From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom.
干白素-6 (IL-6) 和高灵敏性C反应蛋白 (hs-CRP) 与中风后的复发性血管事件有关. 这一发现有助于选择患者参加二次中风预防的抗炎疗法试验.
科学领域:
- 神经科学是一个神经科学.
- 心血管医学 心血管医学
- 免疫学 免疫学 免疫学
背景情况:
- 抗炎疗法对心血管事件是有效的,但它们在中风复发中的作用尚不清楚.
- 确定与中风复发相关的特定炎症标志物对于有针对性的二次预防策略至关重要.
- 需要特定亚型的关联来指导临床试验的患者选择.
研究的目的:
- 分析炎症标志物 (hs-CRP,IL-6) 与缺血性中风或过渡性缺血性攻击后血管复发之间的关联.
- 根据中风机制来确定这些关联是否有所不同.
- 为了告知患者选择用于二次中风预防的抗炎疗法随机对照试验 (RCT).
主要方法:
- 分析了来自10项研究 (8,420名患者) 的个人参与者数据 (IPD).
- 评估了hs-CRP,IL-6和复发性主要不良心血管事件 (MACE) 或复发性中风之间的关联.
- 分析按中风机制分层,并根据血管风险因素和疗法进行调整;还进行了研究水平的元分析.
主要成果:
- 干白素-6 (IL-6) 与在大动脉动脉样硬化 (LAA),未确定性 (UND) 和小血管封闭 (SVO) 中复发的MACE风险增加有关.
- IL-6还显示在LAA,SVO和UND中风亚型中与复发性中风有关.
- 高灵敏度C反应蛋白 (hs-CRP) 与仅在UND中风中复发的MACE有关.
结论:
- 炎症标志物,特别是IL-6,与特定缺血性中风亚型 (LAA,SVO,UND) 的复发性血管事件有关.
- 这些发现为未来的抗炎疗法的RCT中根据炎症概况选择患者提供了证据.
- 这项研究支持对二次中风预防的个性化方法.


