血浆高敏C反应蛋白水平与脑卒中预后

目的 探讨血浆高敏C反应蛋白(hsCRP)水平与脑卒中预后的关系.方法 在湖北省4个研究中心共收集290例初发脑卒中患者和与其性别、年龄相匹配的非脑血管疾病对照人群290例,检测其血浆hsCRP水平,并进行5年随访研究,分析血浆hsCRP水平与其预后的关系.结果 脑卒中患者血浆hsCRP水平显著高于对照组分别为(3.3±3.8)和(1.3±2.2)mg/L,t=8.048,P<0.01];脑卒中组在5年随访中发生再发脑卒中、心肌梗死和死亡事件者血浆hsCRP水平与未发生事件者差异有统计学意义分别为(4.4±4.3)和(2.7±3.3)mg/L,t=3.496,P<0.01];脑卒中患者血浆hsCRP水平超过3 mg/L者较hsCRP水平低于1 mg/L者发生死亡或心脑血管事件的相对危险为2.807(95%Cl1.544～5.495,P<0.01).即使在排除年龄、性别、体重指数、血脂水平以及高血压、糖尿病、吸烟等病史的影响,脑卒中患者血浆hsCRP水平>3 mg/L时,其发生再发脑卒中、心肌梗死和死亡的危险显著高于hsCRP水平<1 mg/L者(OR 2.661,95%Cl 1.323～5.352,P=0.006).结论 血浆hsCRP水平与脑卒中患者的预后密切相关,提示炎症反应在脑卒中起着重要作用,因此可能作为脑卒中患者预后评估的有效标志物.

Relationship between plasma high sensitivity C-reactive protein level and prognosis of Chinese patients with first-onset stroke

Objective To investigate the association between elevated levels of hsCRP and prognosis after stroke in Chinese patients.Methods Two hundred and ninety consecutive patients with firstonset stroke(197 ischemic and 93 hemorrhagic)and 290 age-and sex-matched control subjects without any cerebrovascular disease were studied.Plasma hsCRP level was measured and subsequent vascular events and death were determined in both groups over a 5-year period.Results Compared to control group,patients with stroke had higher plasma hsCRP level((3.3 ±3.8)vs(1.3±2.2)mg/L,t=8.048,P<0.01).Furthermore.within the group of patients with stroke,the mean plasma hsCRP level was higher in patients who experienced subsequent vascular events or death compared to patients without further complications ((4.4±4.3)vs(2.7±3.3)mg/L,t=3.496,P=0.001).Compared to the patients with lower hsCRP level(<1 mg/L),the relative risk for vascular events and death in stroke patients was 2.807(95%CI 1.544-5.495,P=0.001)in the hish hsCRP(>3 mg/L)patients.This increase of relative risk for vascular events and death in stroke patients persisted after the adjustment for age,sex and other cardiovascular risk factors such as hypertension and diabetes(OR 2.661,95%CI 1.323-5.352.P=0.006).Conclusions Patients presenting with stroke have higher levels of hsCRP compared to agematched controls.The degree of hsCRP elevation is correlated with the likelihood of subsequent VasCular events and death.These findings indicate that inerease of hsCRP level is associated with worsening prognosis after stroke in Chinese patients.