On the morning of January 9, 2017, the National Science and Technology Awards Conference was held in Beijing. The key technology and application of high-risk non-disabling cerebrovascular disease and its prevention and control led by Professor Wang Yongjun, vice president of Beijing Tiantan Hospital affiliated to Capital Medical University, won the 2016. The second prize of the National Science and Technology Progress Award.

The research results of this topic have been published in many well-known foreign academic journals, which not only make the prevention and treatment level of cerebrovascular diseases in China at the forefront of the world, but also lead the international peers to follow the research boom.

If the results of this topic can be promoted nationwide, about 740,000 Chinese people can be prevented from causing disability due to cerebrovascular disease every year, and the country can save about 15 billion yuan a year.

How can such a powerful study bring about changes in the treatment of cerebrovascular disease?

With doubts, Health Beijing interviewed Wang Yongjun, deputy dean of Beijing Tiantan Hospital affiliated to Capital Medical University, and asked him to explain in depth the work he devoted to more than ten years of hard work.

National Science and Technology Awards Conference Photo: Xinhua Net

Cerebrovascular disease is the first killer of the death and disability of our residents!

60% of patients with high-risk non-disabling cerebrovascular disease!

Health Beijing: The concept of “high-risk non-disabling cerebrovascular disease” was first proposed by the project team at the international level. Why did you think about studying such cerebrovascular diseases?

Wang Yongjun: Because cerebrovascular disease is the first cause of death and adult disability in China, the state has a major need to reduce the burden of cerebrovascular disease.

Although in the prevention and control strategy, we have been saying that “the center of gravity sinks and the gate moves forward”, but in actual operation, when will the gate move forward? If prevention is started from birth, first, the state cannot afford such a large cost, and second, the population compliance to be prevented is very poor, and no one will take this seriously.

Therefore, if we want to "sink down the center of gravity and move forward", we must find a suitable prevention group.

Previous studies have focused on patients with disabling cerebrovascular disease, but there is currently no effective means to reduce recurrence or disability in the acute phase. Non-disabling cerebrovascular disease with relatively mild symptoms and clinical recurrence or progression has been largely ignored. In fact, this group of people may be completely healthy through effective intervention.

Health Beijing: Since this is a long-time neglected group, how do you determine that these people are the right prevention people you are looking for?

Wang Yongjun: We must first understand the basic situation of these people. We have found through two epidemiological surveys that this group of people has three characteristics. One is more than the actual stroke patients, and there are 23.9 million people in China, accounting for the Chinese brain. More than 60% of the vascular patient population. Second, the treatment opportunities for such patients are very low, probably only one-twentieth of the treatment opportunities for stroke patients. Why is the treatment opportunity low? Because these people are not conscious of going to see a doctor, or these people go to the hospital to see that there is no big problem. Third, the condition of this type of person is very unstable. The recurrence rate in the early stage, especially in the first year, is more than four times that of the stroke.

How to find patients with high-risk non-disabling cerebrovascular disease?

This high-risk early warning system is already in use in major public hospitals across the country!

Health Beijing: After understanding the characteristics of high-risk non-disabling cerebrovascular patients, how can the project team further find this population from many patients?

Wang Yongjun: Statistics show that 80% of patients have had a slight stroke, but they will not leave sequelae and will not relapse. We are looking for the remaining 20%, because once these patients relapse, they will Disabling or dying.

Therefore, we have established a high-risk early warning system, including clinical, imaging and biochemical indicators.

At present, the use of clinical indicators has covered national public medical institutions. A patient with cerebrovascular disease has entered any of these hospitals. Doctors can judge whether they are disabling or non-disabled according to clinical indicators, whether they are high-risk or low-risk.

How to treat patients with high-risk non-disabling cerebrovascular disease?

The chance program reduces the patient's three-month recurrence rate by 30%

Health Beijing: Since patients can be found through the high-risk early warning system, how to treat it becomes the next problem?

Wang Yongjun: Yes. Aspirin was the only effective early antiplatelet drug recommended by the evidence-based guidelines at the time, but the efficacy alone was limited. Even in early applications, the recurrence rate of cerebrovascular disease was as high as 10-20%. The international series of dual antiplatelet “double-antibody” clinical trials have failed because the bleeding risk is greater than the benefit. The “double-antibody” treatment is considered by the international guidelines to be the “forbidden zone” in the field of recurrence and prevention of cerebrovascular disease.

However, we did not abandon the research in this direction. Through analysis of more than 90,000 cases worldwide, we found that early stage (within 24 hours), short-term (3 weeks), and patients with TIA who met one indicator received a double-antibiotic treatment for bleeding risk. Lower. The reason why the original "double resistance" is so risky is because the timing is not right, the people who use it are wrong, and the length of use is not correct.

So we started the famous CHANCE study. At present, the treatment of more than 5,100 patients has proved that this method is reliable. It can reduce the patient's probability of recurrence by 32% for three months without increasing any bleeding risk.

Health Beijing: As far as I know, after verifying the validity of the CHANCE study, you have not stopped, but further research on how to make treatment more precise?

Wang Yongjun: Yes. Although 32% of relapses can be reduced by "double-antibody" treatment, how to accurately find the 32% of patients who respond to the CHANCE study is the next challenge.

We found the pharmacogenomic and drug proteome of the treatment regimen. Gene and protein markers sensitive to drugs were discovered, providing evidence for the precise benefit of finding a “double-antibody” treatment. In the future, patients can know whether they are suitable for "double antibody" treatment by blood test and gene search.

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