The Clinical Research Between Plasma Hs-CRP, HCY And FIB Level Of Acute Ischemic Stroke In The Middle Cerebral Artery Region And Transcranial Doppler Hemodynamic Types

Objective:Inflammation is not only a result of stroke,but also participating in the injury of nervous tissue in acute ischemic stroke, there is few study about the relationship between the classification of acute ischemic stroke beyond thrombolytic time window(using transcranial Doppler hemodynamics to test the ipsilateral MCA) and the level of plasma hs-CRP, HCY and FIB. Therefore, the purpose of this study is to explore the impact of the biomarker to the classification of hemodynamic MCA, and compare the degree of neurological deficit and the improvement rate of early symptoms of neurological defects between difference hemodynamic classification.Methods:We prospectively included 67 patients with acute ischemic stroke. Plasma hs-CRP, HCY were obtained from patients using automatic biochemical analyzer(AU-5800), it is defined as Hhs-CRP and HHCY when the plasma concentrations exceeded 3.0mg/L and 15umol/L, while using coagulation method for the determination of plasma fibrinogen, it is defined as HFIB when the plasma concentrations exceeded 3.5g/L. Using transcranial Doppler with 2 MHz and the Philips iU Elite ultrasound instrument with 10MHz to perform TCD and carotid ultrasound examination 24h after admission. According to TIBI (Thrombolysis in Brain Ischemia) standard and spectrum characteristics, the hemodynamics types of ipsilateral middle cerebral artery is divided as the occlusion group and the non-occlusive group. Stroke severity was analyzed by the National Institutes of Health Stroke Scale (NIHSS).The improvement of early symptoms of neurological defects is defined as NIHSS score decreasing 6 points comparing with admission or scored 0～4 points.Results:In this paper, the occlusion group had 26 cases, non-occlusion group had 41 cases, the peak systolic velocity, end-diastolic flow velocity and mean flow velocity of ipsilateral middle cerebral artery between the two groups had a significant difference(P<0.001):48.31±26.42 vs.102.78±36.90、14.50±12.20 vs.41.02±20.40 and 29.08±15.58 vs.63.78±25.13.Between the occlusion group and non-occlusive group, there was a significant difference in the degree of NIHSS score on admission date and 7 days after the onset(P<0.05,7.38 ± 4.85 vs.5.41 ± 2.78 and 5.42 ± 3.79 vs. 3.32 ± 2.30). There was a significant difference in the level of FIB in the acute phase (P<0.05,3.16 ± 0.68 vs.2.80 ± 0.52). Between occlusion group and non-occlusion group, patients with improvement of early symptoms of neurological defects were respectively 12 cases and 32 cases, the difference was statistically significant (x2= 7.18, P<0.05).There are 10 Hhs-CRP patients and 57 cases Lhs-CRP in this article, comparing of hemodynamic classification between the two groups, the difference was statistically significant (x2= 6.484, P<0.05), the occlusion type of ipsilateral middle cerebral artery were respectively 8 cases and 18 cases. Similarly, HHCY 46 cases, NHCY 21 cases, there were still significant differences between the two groups (x2= 5.028, P<0.05), the occlusion type of ipsilateral middle cerebral artery were respectively 22 cases and 4 cases. HFIB had13 cases, LFIB 54 cases, the difference was statistically significant (x2= 14.25, P<0.05),the occlusion type of ipsilateral middle cerebral artery were respectively 11 cases and 15 cases. Logistic analysis of the ipsilateral MCA occlusion showed that gender, diabetes, NIHSS score, and FIB acted as predictors of occlusion cases using TCD monitoring, respectively (P= 0.044, 95% C.I.= 1.059～79.583), (P= 0.01,95%C.I.= 1.762～64.788), (P= 0.027,95% C.I.= 1.033～1.729) and (P= 0.02,95% C.I.= 1.305～22.059).Conclusion:According to MCA residual hemodynamic classification, it is predicted that the occlusion group has a lower rate of improvement of early symptoms of neurological defects and much more serious neurological deficit than the non-occlusion group. In the artery atherosclerosis subtypes of ischemic stroke, high levels of plasma hs-CRP, HCY and FIB of acute phase had an impact in the classification of hemodynamic, plus, gender, diabetes, NIHSS score and FIB is predictors of the occlusion type.