Correlation Between ICAM-1、VEGF、ox-LDL And Intracranial And Extracranial Large-artery Atherosclerotic Stenosis

Objective: To investigate the correlation between the levels of serum intercellular adhesion molecule-1(ICAM-1),vascular endothelial growth factor(VEGF)and oxidized low density lipoprotein(ox-LDL)and intracranial and extracranial large-artery atherosclerotic stenosis in patients with ischemic cerebrovascular disease(ICVD)and its clinical application value.Methods: 155 patients with ICVD who underwent digital subtraction angiography(DSA)were selected as the research objects.The patients were divided into control group and stenosis group according to whether there was atherosclerotic stenosis of intracranial/extracranial arteries,and the stenosis group were further categorized into mild stenosis group,moderate stenosis group and severe stenosis group according to the stenosis degree of intracranial/extracranial arteries,and then the severe stenosis group was divided into the group with collateral circulation and the group without collateral circulation.According to the discharge m RS score,patients were divided into good prognostic group(m RS score 0-2)and poor prognostic group(m RS score ≥ 3).Clinical baseline data of all patients were collected,including gender,age,admission NIHSS score,discharge m RS score,duration of hospitalization,underlying diseases(hypertension,diabetes,coronary heart disease,hyperuricemia,hyperlipidemia,TIA or stroke history),total cholesterol,triglycerides,high density lipoprotein cholesterol,low density lipoprotein cholesterol,fasting plasma glucose,homocysteine,fibrinogen,cystatin C,high-sensitivity c-reactive protein,white blood cell count,lymphocyte count,neutrophil count,platelet count,and the location of arterial stenosis,the number of diseased arteries,and the collateral circulation grade in the stenosis group.The serum levels of ICAM-1,VEGF and ox-LDL in all patients were determined by enzyme-linked immunosorbent assay(ELISA).Compare the differences of clinical data between different groups,and analyze the correlation between serum ICAM-1,VEGF and ox LDL and the degree of cerebral artery stenosis,the number of diseased arteries,the degree of neurological deficit and related clinical risk factors.Multivariate Logistic regression analysis was used to explore the influencing factors of intracranial/extracranial large-artery atherosclerotic stenosis and its severity.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of ICAM-1,VEGF and ox-LDL in intracranial/extracranial atherosclerotic stenosis and its severity,collateral circulation formation.Results: 1.Compared with the control group,the serum levels of ICAM-1,VEGF and ox-LDL in the stenosis group were significantly higher(P<0.05).2.There were significant differences in serum levels of ICAM-1,VEGF and ox-LDL among mild stenosis group,moderate stenosis group and severe stenosis group(P<0.05);Further pairwise comparison showed that serum ICAM-1 level in moderate stenosis group and severe stenosis group was significantly higher than that in mild stenosis group(all P<0.001),serum VEGF level in severe stenosis group was significantly higher than that in moderate stenosis group(P=0.006),and serum ox-LDL level in severe stenosis group was significantly higher than that in mild stenosis group and moderate stenosis group(P<0.001,P=0.003,respectively).3.There was no significant difference in serum ICAM-1,VEGF and ox-LDL levels between the group with collateral circulation and the group without collateral circulation(P>0.05).4.The serum levels of ICAM-1 and ox-LDL in poor prognostic group were significantly higher than those in good prognostic group(P=0.011,P=0.016,respectively).There was no significant difference in serum VEGF level between the two groups(P>0.05).5.The levels of serum ICAM-1,VEGF and ox-LDL in patients with intracranial and extracranial atherosclerotic stenosis were positively correlated with the degree of arterial stenosis(P<0.05),and the levels of serum ICAM-1 and ox-LDL were positively correlated with the degree of neurological deficits(P<0.05).Serum ICAM-1 levels were positively correlated with VEGF and ox-LDL levels respectively,and serum VEGF and ox-LDL levels were also positively correlated(all P<0.05).6.The regression analysis results showed that VEGF was a risk factor for intracranial/extracranial atherosclerotic stenosis in patients with ICVD(P<0.05).ICAM-1 and ox-LDL were the factors influencing the severity of atherosclerotic stenosis(P<0.05).7.ROC curve showed that the models established by ICAM-1,VEGF,ox-LDL and the three combined with clinical indicators both had certain predictive value for intracranial/extracranial large-artery atherosclerotic stenosis in patients with ICVD,and the latter had better predictive value.Detection of ICAM-1,ox-LDL alone and combination of ICAM-1,VEGF and ox-LDL both have certain predictive value for moderate and severe stenosis of intracranial/ extracranial arteries in ICVD patients.The combined detection of ICAM-1,VEGF and ox-LDL can also predict the formation of collateral circulation in ICVD patients with severe stenosis or occlusion of intracranial/ extracranial arteries.Conclusion: With the aggravation of the severity of intracranial and extracranial large-artery atherosclerotic stenosis in patients with ICVD,the serum levels of ICAM-1,VEGF and ox-LDL showed an upward trend,and their levels may have different degrees of influence on the formation of collateral circulation,clinical prognosis,neurological deficits,etc.,suggesting that ICAM-1,VEGF and ox LDL are related to intracranial and extracranial large-artery atherosclerotic stenosis in patients with ICVD,and may be effective predictors and clinical therapeutic targets.The specific mechanism remains to be further clarified.