Correlation Between Thrombotic Inflammation And Cerebral Hemorrhage And Early Recovery Of Neurological Function After Intravenous Thrombolysis In Acute Ischemic Stroke

Acute ischemic stroke(AIS)is one of the leading causes of death and disability in countries around the world.In the early stage of cerebral apoplexy,timely Intravenous thrombolysis(IVT)can promote the recanalization of blocked cerebral arteries,thus achieving good clinical efficacy.IVT treatment in AIS patients has a significant time dependence,and the functional prognosis of patients after stroke is closely related to the recanalization time of occlusive vessels.The earlier IVT treatment is started,the greater the patient’s benefit.Intravenous thrombolysis with alteplase is beneficial for AIS,but complications of Intracerebral hemorrhage(ICH)may occur early after treatment in some patients.It is usually associated with an increased risk of poor prognosis or even death in AIS patients after IVT treatment,thus affecting the benefit of PATIENTS treated with IVT.At present,sufficient research evidence shows that in the complex pathophysiological process of AIS,thrombosis and inflammatory response are highly intertwined,and the common pathway of thrombosis and inflammatory response is an important pathogenesis of AIS brain injury.In ischemic cerebrovascular disease,platelets adhere to and activate,thereby increasing the risk of secondary thrombotic events.At the same time,cerebral ischemia induces a strong inflammatory response,including upregulation of cell adhesion molecules and cytokines,and adhesion,activation,and migration of several white blood cell subpopulations.The Neutrophil/Lymphocyte Ratio(NLR),which can be easily measured by a patient’s white blood cell count at admission,is a marker of inflammation in the body,and a higher NLR means a higher level of inflammation.Lipoprotein-associated Phospholipase A2(Lp-PLA2)sits at the intersection of lipid metabolism and inflammation.It is produced by inflammatory cells and binds to Low Density Lipoprotein(LDL)and other lipoproteins,And participate in the metabolic response in which LDL is converted into pro-inflammatory mediators.Lp-PLA2 is a vascular-specific inflammatory enzyme associated with vascular inflammation,producing two pro-inflammatory mediators,lysophosphatidylcholine and oxidized non-esterified fatty acids,which play an important role in the development of atherosclerotic lesions and the formation of necrotic core,leading to the formation of more vulnerable plaques.These inflammatory responses can promote the formation and release of atherosclerotic plaques and thrombosis,thus contributing to the occurrence of ischemic stroke.In conclusion,thrombotic inflammation is involved in the pathogenesis of AIS,and early IVT treatment can significantly improve the prognosis of patients.The purpose of this study was to evaluate the correlation between the level of thrombotic inflammation in AIS patients and the early occurrence of ICH complications and early recovery of neurological function after IVT treatment,so as to provide a clinical research basis for selecting more appropriate patients for IVT treatment.To provide theoretical support for reducing the occurrence of ICH complications after IVT treatment in AIS patients and improving the proportion of benefit and risk of IVT treatment.Part One Association of Neutrophil/Lymphocyte Ratio(NLR)at admission with intracerebral hemorrhage after intravenous thrombolysis in acute ischemic strokeObjective:AIS is one of the leading causes of death and disability in countries around the world.In the early stage of stroke,timely administration of alteplase IVT drug therapy can promote the recanalization of blocked cerebral arteries,so as to obtain better clinical efficacy.Intravenous thrombolysis with alteplase is beneficial for AIS,but complications of post-thrombolysis ICH may occur in some patients early after treatment,and the prognosis is poor.Thrombotic inflammation is involved in the pathogenesis of AIS.NLR is a marker of human inflammatory response,and a higher NLR means a higher level of inflammatory response.The purpose of this study was to evaluate the correlation between NLR level at admission and ICH complications early after IVT treatment in AIS patients,so as to provide a clinical research basis for selecting more suitable patients for IVT treatment.To provide theoretical support for reducing the occurrence of ICH complications after IVT treatment in AIS patients and improving the proportion of benefit and risk of IVT treatment.Methods:1.In this study,AIS patients receiving IVT treatment in The Affiliated Hospital of North China University of Science and Technology from January2020 to December 2020 were continuously collected.All patients underwent craniocerebral CT examination on admission to exclude hemorrhagic stroke.All patients were hospitalized and treated with alteplase IVT within 4.5 hours of onset of stroke symptoms;2.Blood samples were collected from all patients eligible for inclusion before receiving alteplase IVT for blood routine examination,and brain CT examination was performed again within 24 hours after receiving alteplase IVT treatment;3.According to whether early cerebral hemorrhage occurred after IVT drug treatment,the patients were divided into two groups for statistical description;4.SPSS 17.0 software was used for statistical analysis of all research data.Results:A total of 102 patients were enrolled,and 12 patients developed ICH complications after IVT treatment,accounting for 11.76%of the total number of patients.Using the occurrence of ICH after IVT treatment as the dichotomous dependent variable,univariate logistic regression analysis was performed on the above independent variables.National Institute of Health Stroke Scale(NIHSS)score at admission(P=0.006),diastolic blood pressure at admission(P=0.015),peripheral blood glucose at admission(P=0.042),history of atrial fibrillation(P=0.036),lymphocyte(P=0.001),monocyte(P=0.043)and NLR(P=0.041)were statistically significant(P<0.05).Multivariate logistic regression analysis was carried out by stepwise forward regression analysis.The results showed that for each increase of lymphocyte1×10~9/L,the risk of ICH complications after IVT treatment in AIS patients increased by 8.216 times(OR=9.216,95%CI:2.338-36.333).Multivariate Logistic regression analysis and statistical method was adopted.Results suggest that NLR may be an independent predictor of ICH complications after IVT in AIS patients.Each 1 increase in NLR was associated with an 88.2%increase in the risk of ICH complications after IVT in AIS patients(OR=1.882,95%CI:1.203-2.947).For each increase of monocytes of 1×10~9/L,the risk of ICH complications after IVT in AIS patients increased 52.514 times(OR=53.514,95%CI:1.641-1744.852).Conclusions:The results of this study suggest that high levels of NLR,lymphocytes and monocytes in peripheral blood at admission may be a risk factor for ICH complications after IVT treatment in AIS patients.Thrombotic inflammation is involved in the pathological process of the acute phase of AIS,and a variety of inflammatory cells and inflammatory cytokines are activated.By measuring the levels of NLR,lymphocytes and monocytes in peripheral blood at admission to identify the status of early thrombotic inflammatory response in patients with ACUTE AIS,it can help determine the risk-benefit ratio of AIS patients after IVT treatment,reduce the occurrence of ICH complications and improve the safety of IVT treatment in AIS patients.Part Two Association of Lipoprotein-associated Phospholipase A2(Lp-PLA2)with early recovery of neurological function after intravenous thrombolysis in acute ischemic strokeObjective:Lipoprotein-associated Phospholipase A2(Lp-PLA2)is considered as a biomarker of systemic inflammation and risk factors for myocardial infarction and stroke.However,little is known about the effect of this marker in AIS.The purpose of this study was to evaluate the potential association between early recovery of neurological function after IVT and peripheral blood Lp-PLA2 levels in AIS patients.Methods:1.This study included a series of first-episode AIS patients treated with IVT at the Affiliated Hospital of North China University of Science and Technology from January 2020 to December 2020.All patients underwent craniocerebral CT examination on admission to exclude hemorrhagic stroke.All patients were hospitalized within 5.0 hours of onset of stroke symptoms and voluntarily chose to receive alteplase or urokinase IVT;2.All patients eligible for inclusion were assessed by NIHSS scores twice at admission and 1 hour after IVT treatment.Blood samples were collected within 24 hours after IVT treatment for Lp-PLA2 level determination.3.According to the level of Lp-PLA2 in peripheral blood of patients,patients were divided into three groups for statistical description;4.SPSS 17.0 software was used for statistical analysis of all research data.Results:The early recovery of neurological function in AIS patients after IVT was correlated with the level of Lp-PLA2 in peripheral blood,and the level of Lp-PLA2 decreased with the increase of the probability of early recovery of neurological function.Conclusions:The early recovery of neurological function after IVT treatment in AIS patients is negatively correlated with the level of Lp-PLA2 in peripheral blood.