中文摘要：

目的：探讨血管内皮细胞生长因子受体（VEGFR-2）基因启动子区多态与颈动脉粥样硬化以及脑卒中复发风险的关系。 方法：对1849例脑卒中患者进行前瞻性随访4．5年（中位数，范围0．1～6．0年），Cox生存回归模型分析基因多态与脑卒中复发风险的关联性。并在一个横断面队列研究中随机入选1123名无心脑血管病史的参加者，检测颈动脉内膜一中膜厚度，观察越囚多态与动脉粥样硬化的关系。 结果：长期随访过程中，355例患者发生脑卒中复发事件。携带-604TC和CC基因型的脑卒中患者4．5年累积复发率为17．1％（159／929，复发／总例数），而-604TT基因型携带者的累积复发率为21．3％（196／920，复发／总例数）。Cox生存回归模型校正了年龄、性别和其他心血管危险因素后，604TC和CC基因型与降低的脑卒中复发风险相关，风险比0．71（95％可信区间，0．58—0．89；Jp=0．002）；这种保护作用对动脉粥样硬化性血栓性脑梗塞患者更为显著，降低复发风险达35％。多元线性回归分析表明～604C等位基因与颈动脉内膜-中膜厚度呈显著负相关（标化回归系数B=0．125；P〈0．001）。 结论：VEGFR-2基因启动了多态-604TC和CC基因型携带者与-604TT基因型相比，脑卒中复发风险相对较低，尤其在动脉粥样硬化性血栓性腑梗塞患者中作用更显著。其机制可能与影响动脉粥样硬化的进展有关。

英文摘要：

Objective ： To assess the relationship of the variants in promoter region of vascular endothelial growth factor receptor 2 （ VEG- FR-2） gene in susceptibility to the risk of stroke recurrence. Methods ： A total of 1849 stroke patients were prospectively followed up from （ 0. 1 - 6. 0） years for a median of 4. 5 years, Cox proportional-hazards models were used to examine the association between genotypes and stroke recurrence after adjustment of age,sex,and other cardiovascular risk factors. The correlation of variants with carotid artery intima-media thickness （IMT） was examined in 1123 healthy participants as the control study. Results：There were 355 recurrent stroke patients were documented. The recurrence occurred in 17. 1% of carriers with CC and TC genotypes （ 159/929 ）, and in 21.3 % of carriers with-604 TT genotype （ 196/920 ）. The variant-604 C allele was associated with the reduced risk for stroke recurrence（ RR 0. 71,95% CI 0. 58 to 0. 89 ;P =0. 002） compared with the TT genotype,and the protective effect was stronger in patients with atherosclerotic stroke. In addition, the presence of-604 C allele was correlated w{th the lower carotid artery IMT（P 〈0. 001 ）. Conclusion：Promoter variant-604T/C in VEGFR-2 gene contributed to a redueed risk for stroke reeurrence, especially for atherosclerotie stroke. This might be through a down-regulated angiogenesis of VEGF signaling in the progress of atherosclerosis.