| Objective:To study the influencing factors of increased cTnT in patients with large artery atherosclerotic cerebral infarction.Method:In this study,167 patients admitted to our department(Department of Neurology,The First Hospital of Jilin University)from August 2020 to May 2021 who were diagnosed with large artery atherosclerotic cerebral infarction by TOAST classification were selected as the research subjects.They were divided into two groups according to whether their serum cTnT increased,namely,the cerebral infarction group with increased cTnT(group A)and the cerebral infarction group with normal cTnT(group B).Clinical data related to the study were collected and sorted out:(1)General data:gender and age;(2)Personal history and medical history: addiction to tobacco,alcohol,hypertension,diabetes;(3)NIHSS score;(4)Laboratory related indicators: serum cTnT,Hb A1 c,total cholesterol,low density lipoprotein C,triglyceride;(5)Imaging data:lesion site of cerebral infarction.The differences and significance of the above indicators between the two groups were compared and analyzed,the correlation between NIHSS score and cTnT level was analyzed by Pearson linear correlation analysis,and the cause of serum cTnT increase was analyzed by binary Logistic regression analysis.Results:In this study,there were 56 patients in group A and 111 patients in group B.There were statistically significant differences in age and cTnT between the two groups(P<0.05),there were no significant differences in gender,hypertension,diabetes,smoking,alcohol addiction,normal/abnormal ecg,h BA1 c,total cholesterol,low density lipoprotein C,triglyceride and NIHSS score(P>0.05).In the study,the incidence of increased serum cTnT in patients with cerebral infarction at different ages was analyzed,which showed that the incidence of increased serum cTnT was 11.11%at 46-50 years old,12.50% at 51-55 years old,16.00% at 56-60 years old,33.33% at61-65 years old,34.78% at 66-70 years old,and 50.00% at 71-75 years old.53.33% in76-80 years old and 80.00% in those over 80 years old.It was found that with the increase of age of cerebral infarction,the percentage of cerebral infarction patients with increased serum cTnT also showed a trend of gradual increase.This study also analyzed the correlation between cTnT level and NIHSS score,and the results showed that there was no linear correlation between cTnT level and NIHSS score in both group A and all patients(P>0.05).The possible influencing factors of serum cTnT increase and normal were analyzed by binary logistic regression analysis(Hosmer-Lemshaw test P=0.234);The results showed that the risk of increased serum cTnT in patients over 60 years of age was significantly higher than that in patients under 60 years of age(P=0.001),the risk of the former was 5.851 times higher than that of the latter,and the 95% Confidence interval(CI)was 2.117-16.172;Meanwhile,the risk of increased serum cTnT in patients with supratentorial cerebral infarction was significantly higher than that in patients with supratentorial cerebral infarction(P=0.011),the increased risk of the former was 4.045 times higher than that of the latter,with a 95% confidence interval of1.382-11.845;These results suggest that age ≥60 years and brainstem infarction are independent risk factors for increased serum cTnT.However,gender,hypertension,diabetes,smoking,alcohol addiction,ecg,Hb A1 c,total cholesterol,LDL-C,triglyceride and NIHSS were not independent factors for the increase of serum cTnT(P>0.05).The difference of cerebral infarction site between the two groups was also studied in this study.A group of 56 patients with cerebral infarction in areas involving the frontal and parietal(10 cases),the insula(8 cases),corona radiata in basal ganglia area(12 cases),temporal lobe(2 cases),thalamus(8 cases),brain stem(16 cases),including the autonomic nervous system central related brain regions(insula,the amygdala,cingulate gyrus,frontal lobe,the pineal gland and the hypothalamus,29 patients with cerebral infarction(collectively referred to as autonomic nerve center)and 27 patients with cerebral infarction in other brain regions related to autonomic nervous system(including brain stem,collectively referred to as autonomic nerve center).In group B,111 cases of patients with cerebral infarction areas involving the frontal and parietal(17cases),the insula(29 cases),corona radiata in basal ganglia area(31 cases),temporal lobe(13 cases),thalamus(11 cases),brain stem(10 cases),including the autonomic nervous system central related brain regions,72 cases of patients with cerebral infarction,other than the autonomic nervous system central related brain regions of 39 patients with cerebral infarction.There was no statistically significant difference between the two groups in the cerebral infarction sites of autonomic and non-autonomic CNS related brain regions(P=0.131).The comparison of cerebral infarction in supratentorial and supratentorial(brain stem)regions between the two groups showed that supratentorial cerebral infarction was more common in group A,and the difference between the two groups was statistically significant(P=0.003).Cardiac injury is often accompanied by ECG changes.In this study,the characteristics of ECG changes in the two groups of patients were analyzed.Among the56 patients in group A,26 patients had abnormal ECG changes,including 17 patients with sinus bradycardia and ST segment descent,accounting for 65.38% of abnormal ECG.Other abnormalities(including sinus tachycardia,transient ST segment elevation,T wave flatness or inversion)were observed in 9 patients,accounting for 34.62% of abnormal ECG.Among 111 patients in group B,44 patients had abnormal ECG changes,including 36 patients with sinus bradycardia and ST segment descent,accounting for81.82% of abnormal ECG.Other abnormalities(including sinus tachycardia,transient ST segment elevation,T wave flatness or inversion)were observed in 8 patients,accounting for 18.18% of abnormal ECG.Sinus bradycardia and ST segment descent were the main manifestations in both groups,and there was no significant difference in ECG changes(P>0.05).Conclusion:Age and brainstem infarction were the main factors affecting the increase of serum cTnT in patients with large artery atherosclerotic cerebral infarction.The risk of increased serum cTnT in patients with large artery atherosclerotic cerebral infarction increased with the age of onset,and age ≥60 years was an independent risk factor for increased serum cTnT.Cerebral stem infarction is also one of the independent risk factors for the increase of serum cTnT.Compared with supratentorial infarction,cerebral stem infarction is more likely to cause myocardial injury and lead to the increase of serum cTnT,while cerebral infarction in autonomic nerve center related brain region has less influence on the level of serum cTnT.At the same time,whether the serum cTnT level is increased and the degree of increase is not related to the severity of the disease in patients with large artery atherosclerotic cerebral infarction. |
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