The Significance Of Clusterin In Acute Cerebral Infarction

Objective:To detect the changing of serum clusterin(CLU, also known as apoliprotein J,ApoJ) in the cases of acute cerebral infarction(ACI), making an assay of its possiblemechanisms in the pathological processes, and relationship with different typescerebral infarction and different prognostic groups. So as to explore what role do theserum clusterin in the progression of ACI, and make an assess whether it can be anclinical biochemical predictor of the disease severity and prognosis inACI patients.Methods:1.154cases of the first acute infarction within the first48hours of the affiliatedhospital of nanchang university from Aprial2013to February2013hospitalized withacute infarction were enrolled in ACI group. Collect the clinical data, make aneurological deficit(NIHSS) score, activities of daily living(ADL) score, ADL is usedwith Barthel index,4ml elbow venous blood to measure serum clusterin wasexsanguinated to centrifugal extraction and stored at-80℃refrigerator, thenanother blood was exsanguinated to send our hospital clinical laboratory to detectcomplement C3levels, complete brain MRI, MRA, carotid ultrasound. The infarctionpatients were divided into4groups according to infarct size, severity of neurologicaldeficit, with or without plaque and plaque nature, area of infarct, then the fasting liverand kidney function, blood glucose, blood lipids, coagulation tests, homocysteine,superoxide dismutase enzymes were measured in the second day. And made anoutpatient referral or telephone follow-up conducted Barthel index score at90daysafter acute infarction.45cases of age and sex-matched healthy subjects and inpatientsin neurology because of dizziness and headache but neurological examination nopositive signs were enrolled to control group, the control group was also for generalclinical data collection, clusterin, complement C3and other labortatory parameters todetect, and also for brain MRI, MRA, carotid ultrasound to be completed.2. All of the data was to create an Excel spreadsheet for statistical analysis, making a comparison of general data, relavant laboratory parameters, the incidence ofcarotid artery plaque, clusterin, complement C3in ACI group and control group, andcorrelation of clusterin with other parameters, a statistical analysis of the serumclusterin levels among different types cerebral infarction groups and differentprognosis cerebral infarction groups after90days, and making an analysis of therelevance of serum clusterin with acute cerebral infarction and its prognosis.Result:1. The total cholesterol(TC), triglyceride(TG), low density lipoproteincholesterol(LDL-C), apolipoprotein B(ApoB), apolipoprotein B/apolipoproteinA1(ApoB/ApoA1), fasting plasma glucose(FPG), fibrinogen(Fib), homocysteine(HCY) in ACI group are significantly higher than those in control group, thedifferences are statistically significant(P<0.01or P<0.05), the superoxide dismutase(SOD) level in ACI group is lower than that in control group, the difference isstatistically significant(P<0.01), the high density lipoprotein cholesterol(HDL-C),apolipoprotein A1levels in ACI group are lower than those in control group, but thedifferences are not statistically significant(P＞0.05).2. The serum clusterin and complement C3levels in ACI group are significantlyhigher than that in control group, the differences are statistically significant(P<0.01).The incidence of carotid artery plaque is significantly higher in ACI group than thatin control group, the differences is statistically significant(P<0.01).3. The serum clusterin level in ACI group is significantly positively correlatedwith TC、 FPG、Lp(a)、 C3，correlation coefficients are0.314、0.263、0.259、0.430,the serum clusterin level in ACI group is significantly negatively correlated withSOD, correlation coefficients is-0.243. There are no correlation among serumclusterin levels with age、gender、TG、HDL-C、LDL-C、ApoA1、ApoB、Fib、HCY.4. The serum clusterin level in large size cerebral infarction group is significantlyhigher than those of small size cerebral infarction group and lacunar infarction group,the serum clusterin level in small size cerebral infarction group is significantly higherthan those of lacunar infarction group, the differences are statistically significant(P<0.01). The serum clusterin level in heavy neurological deficits group issignificantly higher than those of moderate and light neurological deficits group, theserum clusterin level in moderate neurological deficits group is significantly higherthan that of light neurological deficits group, the differences are statisticallysignificant(P<0.01or P<0.05). The serum clusterin levels in hard carotid arteryplaque group and soft carotid artery plaque group are significantly higher than thoseof without plaque group, the differences are statistically significant(P<0.01orP<0.05), The serum clusterin levels in soft carotid artery plaque group is higher thanthat of hard carotid artery plaque group, but the difference is not statisticallysignificant(P＞0.05). The serum clusterin levels in different cerebral infarction areaare not statistically significant(P＞0.05).5. The serum clusterin level in recovery group、effective group、progressivegroup、ineffective group is guadually increased, but the the difference in recoverygroup and effective group is not statistically significant(P＞0.05), the differencesbetween the other groups are statistically significant(P<0.01or P<0.05).Conclusions:1. The serum clusterin level is significantly higher than that in control group,serum clusterin level is correlated with infarction size, carotid artery plaque, thelarger the infarction size is, the more severe the neurological deficit is, and withcarotid artery plaque, the higher the serum clusterin level is, but the serum clusterinlevel has no significant correlation with the infarction area.2. The C3level in ACI group is significantly higher, the serum clusterin level issignificantly positively correlated with C3in ACI group, suggesting there is anactivation of complement system after cerebral infarction, clusterin is related tocomplement regulation. And the serum clusterin level in ACI group is significantlypositively correlated with TC、 FPG、Lp(a), significantly negatively correlated withSOD, suggesting clusterin is related to blood sugar and lipid metabolism regulation.3. The serum clusterin level in ACI group maybe correlated with rehabilitationeffect, the patient has lower serum clusterin level, his future recovery of activities ofdaily living may be better, serum clusterin level can be an biochenmical indicator to the severity, prognosis of acute cerebral infarction.