Correlation Between Serum IMA,NGAL And Carotid Intima-media Thickness In Patients With LAA Cerebral Infarction

Background:Cerebral infarction,also known as ischemic stroke,refers to brain blood supply disorders,ischemia and hypoxia resulting in ischemic necrosis or softening of localized brain tissue.The number of new stroke in my country has been on the rise every year.If it is not treated effectively in time,the mortality rate is extremely high.According to the etiological classification,Large artery atherosclerosis cerebral infarction is the most common.As a manifestation of systemic atherosclerosis,carotid atherosclerosis has become an important window to reflect systemic AS.It is generally believed that the increase of carotid artery intima-media thickness（CIMT）is the early clinical manifestation of AS.Currently CIMT basic ultrasound technology,detection means in the process of the arteriosclerosis diagnosis is still lack of reliable laboratory data detection CIMT reference for clinicians to guide clinical work,and lack of relevant research at home and abroad,therefore,to further explore new predictor,early projections for the cause of cerebral infarction patients,It is of great significance to guide clinicians to adopt real time and effective treatment plan to improve the diagnosis,treatment and prevention of cerebral infarction patients.Studies have shown that the risk factors of different superficial parts of carotid artery wall are not completely consistent.Most studies do not separate the associations between carotid segments,but instead measure CIMT in a comprehensive way.Few studies at home and abroad have distinguished the risk factors for IMT in different parts of carotid artery,and the results are inconsistent.There are many factors related to the thickening process of CIMT in patients with LAA cerebral infarction.The purpose of this study is to explore the related risk factors of IMT of carotid artery bulband Common carotid artery in patients with LAA cerebral infarction.The relationship between Ischemia modified albumin,neutrophil’s gelatase-associated lipid transport protein,IMT of carotid bulb and IMT of common carotid artery in patients with LAA cerebral infarction was evaluated,which provided reliable basis for risk prediction and treatment of cerebral infarction.Objective:The aim of this study was to investigate the carotid bulb IMT,common carotid artery IMT,IMA and NGAL in patients with LAA cerebral infarction,and to analyze the correlation between serum IMA and NGAL and IMT in carotid bulb and IMT in patients with LAA cerebral infarction,so as to provide theoretical basis for clinical practice.Methods:A retrospectively studied of the clinical data of LAA cerebral infarction patients admitted to a third-class hospital in a city from January 2018 to January 2021.A total of370 cases were retrospectively included.LAA cerebral infarction patients were divided into CAB observation group（n=202）,normal group（T₁:36 cases of normal intima）,abnormal group（T₂:29 cases of intima thickening,T₃:137 cases of plaque formation）and CCA observation group（n=168）,normal intima（T₁:61 cases of normal intima）,abnormal group（T₂:42 cases of intima thickening,T₃:65 cases of plaque formation）,The levels of serum IMA and NGAL parameters in T₁,T₂and T₃groups were compared,and the correlation between serum IMA and NGAL and IMT parameters of carotid bulb and common carotid artery was tested by bivariate Spearman correlation.Univariate Logistic regression and multivariate Logistic regression were used to analyze whether the levels of IMA and NGAL parameters in serum will affect IMT of carotid bulb and common carotid artery in patients with LAA cerebral infarction.The area under the curve（AUC）was obtained by drawing the receiver operating characteristic curve（ROC）,and the predictive value of serum IMA and NGAL parameters on IMT of carotid bulb and IMT of common carotid artery in patients with LAA cerebral infarction was analyzed.Results:（1）370 patients with LAA cerebral infarction were retrospectively collected,and divided into CAB group（n=202）and CCA group（n=168）according to different superficial site of ultrasound measurement.There were no significant differences in age,smoking,alcohol consumption,hypertension,diabetes,family history of stroke,BMI,NGAL,Hcy,UA,TC,TSH and FT3 groups（P>0.05）.There were statistically significant differences in gender,NIHSS score,Hb A1c,IMA,hs-CRP,TG,HDL-C,LDL-C and FT4 between the two groups before admission（P<0.05）.（2）With the increase of IMT in carotid bulb,there were no significant differences in age,gender,alcohol consumption,diabetes,Hb A1c,family history of stroke,TC and FT4among the three groups of LAA cerebral infarction patients（P>0.05）.Smoking,hypertension,NIHSS score,Hcy,hs-CRP,UA,TG,LDL-C,TSH,NGAL and IMA showed an upward trend,while BMI,HDL-C and FT3 showed a decreasing trend,with statistical significance among the three groups（P<0.05）.With the increase of IMT of common carotid artery,there were no significant differences in alcohol consumption,family history of stroke,BMI,TC,TSH and FT3 among the three groups of LAA cerebral infarction patients（P>0.05）.Age,male proportion,smoking,hypertension,diabetes,NIHSS score,Hb A1c,NGAL,IMA,Hcy,hs-CRP,UA,TG,LDL-C,FT4 showed an increasing trend,while HDL-C showed a decreasing trend,with statistical significance among the three groups（P<0.05）.（3）Taking IMA and NGAL as independent variables,Spearman correlation analysis showed that IMA and NGAL were positively correlated with IMT of carotid artery bulb（r=0.616,P<0.001;r=0.464,P<0.001）;IMA had a low positive correlation with common carotid IMT（r=0.356,P<0.001）,and NGAL had a moderate positive correlation with common carotid IMT（r=0.572,P<0.001）.（4）Clinical and laboratory parameters with statistical significance were selected as independent variables by univariate Logistic regression analysis,and further multivariate Logistic regression analysis showed that LDL-C（OR=7.234;95%CI:1.392-37.579;P=0.019）,IMA（OR=1.06;95%CI:1-1.11;P=0.048）,the hs-CRP（OR=3.993;95%CI:1.372-11.619;P=0.011）,NGAL（OR=1.049;95%CI:1.006-1.095;P=0.024）and TSH（OR=4.64;95%CI:1.779-12.102;P=0.002）was an independent risk factor for increased IMT in carotid bulb of LAA cerebral infarction patients.Hcy（OR=1.078;95%CI:1.003-1.158;P=0.042）,the NGAL（OR=1.017;95%CI:1.005-1.029;P=0.004）,IMA（OR=1.028;95%CI:1.003-1.052;P=0.025）was an independent risk factor for increased common carotid artery IMT in LAA cerebral infarction patients.（5）ROC curve analysis:The AUC of IMA and NGAL in predicting IMT of carotid bulb in patients with LAA cerebral infarction were 0.896 and 0.84,respectively.The predictive value of IMA（P<0.001）was better than that of NGAL.When the cut off value of IMA was 89.48,The sensitivity and specificity were 80.7%and 88.9%,respectively.The AUC of IMA and NGAL in predicting IMT of common carotid artery in patients with LAA type cerebral infarction were 0.683 and 0.793,respectively.The predictive value of NGAL（P<0.001）was better than that of IMA.When NGAL cutoff was 99.185,The sensitivity and specificity were 68.2%and 82%,respectively.Conclusion:（1）Serum IMA and NGAL may be risk factors for CIMT in patients with LAA cerebral infarction,and can be used as predictors of CIMT in patients with LAA cerebral infarction.（2）Serum IMA and NGAL have different predictive values for IMT in different superficial parts of carotid artery wall.IMA has better predictive value for IMT in carotid bulb than NGAL,and NGAL has better predictive value for IMT in common carotid artery than IMA.