| ObjectiveSerum indole-3-propionic acid(IPA),a metabolite of intestinal flora,was measured in patients with acute cerebral infarction within 3 days of onset,and to explore the correlation between indole-3-propionic acid and the progression and prognosis of acute cerebral infarction.Methods(1)In this study,197 patients with acute cerebral infarction diagnosed and treated in the neurology ward of Northern Jiangsu People’s Hospital within 3 days of onset from April 2022 to October 2022 were included,and 53 patients who underwent community stroke screening during the same period were included as the control group.Basic clinical data of enrolled patients were collected,including general information:age,sex;Previous history:history of hypertension,diabetes,cerebral infarction,atrial fibrillation,coronary heart disease,smoking,drinking;NIHSS score,TOAST,infarct volume.All enrolled patients completed the laboratory examination on an empty stomach the next morning,These include blood routine(red blood cell count,white blood cell count,neutrophil count,lymphocyte count,monocyte count,platelet count,hemoglobin,etc.),liver function(alanine aminotransferase,aspartate aminotransferase),kidney function(creatinine,urea nitrogen,uric acid),D-dimer,blood lipids(total cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein egg,and lipoprotein a)Homocysteine,fasting blood glucose,glycosylated hemoglobin.(2)Fasting venous blood samples were taken from all enrolled patients in the early morning of the second day,centrifuged at 3000 RPM for 10 min,and serum was taken and stored in the refrigerator at-80℃ for testing.ELISA was used to detect serum IPA levels.(3)All enrolled patients with acute cerebral infarction were assessed daily NIHSS score to determine the degree of neurological impairment.If the neurological impairment symptoms were aggravated within 7 days of onset and the NIHSS score increased by more than 2 points,the patients were classified as the progressive group of cerebral infarction;otherwise,the patients were classified as the non-progressive group.After 90 days of discharge,patients were followed up by telephone or face to face.Clinical prognosis was determined according to the modified Rankin Scale(mRS).mRS 0-2 was defined as a good prognosis group and 3-6 as a poor prognosis group.(4)SPSS26.0 statistical software was used to analyze the data.To explore whether there was statistical difference in serum IPA level between the acute cerebral infarction group and the control group.Univariate analysis of baseline data and serum IPA levels in progressive and non-progressive groups,good and poor prognosis groups;Multivariate regression analysis of independent risk factors affecting the progression and poor prognosis of cerebral infarction;ROC curve evaluated the predictive value of serum IPA level for the progression and prognosis of acute cerebral infarction.Results1.Correlation analysis between acute cerebral infarction and serum IPA levelA total of 250 subjects were included in this study,including 197 patients with acute cerebral infarction and 53 controls.The baseline systolic blood pressure,baseline diastolic blood pressure,white blood cell count,neutrophil count,homocysteine,smoking history and drinking history of acute cerebral infarction group were higher than those of control group,the differences were statistically significant(P<0.05).There were no significant differences between the two groups in gender,age,history of hypertension,diabetes,coronary heart disease,atrial fibrillation,fasting blood glucose,glycosylated hemoglobin,red blood cell count and other laboratory tests(P>0.05).The serum IPA level of the acute cerebral infarction group was 198.90±53.16pg/mL,and that of the control group was 225.22±45.92pg/mL.The serum IPA level of the acute cerebral infarction group was significantly lower than that of the healthy control group(P<0.05).Multivariate regression analysis indicated that the serum IPA level and baseline systolic blood pressure level in the acute cerebral infarction group were statistically significant compared with the control group(OR=0.992,95%CI:0.984-0.999,P=0.035;OR=1.029,95%CI:1.007-1.053,P=0.011).2.Comparison of baseline data of patients with serum IPA level after quartile stratificationAccording to the level of serum IPA,patients in the acute cerebral infarction group were divided into quartile stratification groups(≤163.91pg/mL,n=50;163.91-199.20pg/mL,n=49;199.20-230.60pg/mL,n=49;>230.60pg/mL,n=49).There were no statistically significant differences in gender,age,baseline systolic blood pressure,history of hypertension,coronary heart disease,atrial fibrillation,smoking,drinking,fasting blood glucose,glycosylated hemoglobin,red blood cell count and other laboratory tests among the four groups(P>0.05).There were statistically significant differences in baseline diastolic blood pressure,diabetes history,fasting blood glucose,progression and prognosis of cerebral infarction(P<0.05).3.Correlation analysis between stroke progression and serum IPA level in patients with acute cerebral infarctionAmong the 197 patients with acute cerebral infarction included,43 cases(21.83%)were in the progressive group and 154 cases(78.17%)were in the non-progressive group.There were no statistical differences between the two groups in age,gender,history of hypertension,diabetes,coronary heart disease,atrial fibrillation,smoking,drinking,TOAST classification,cerebral infarction volume,NIHSS score on admission,fasting blood glucose,white blood cell count,neutrophil count and other laboratory tests(P>0.05).Compared with the non-progressive group,the baseline systolic blood pressure and baseline diastolic blood pressure in the progressive group were higher than those in the non-progressive group(P<0.05).The creatinine was lower than that in non-progressive group(P<0.05).The serum IPA concentration in the advanced group was 159.92±55.45pg/mL,and that in the non-advanced group was 209.7±47.53pg/mL.The serum IPA concentration in the advanced group was significantly lower than that in the non-advanced group(P=0.000),and the difference was statistically significant.Multivariate regression analysis suggested that patients with acute cerebral infarction were more likely to progress when the level of serum IPA was low.ROC curve was used to analyze the predictive value of IPA level on the progression of acute cerebral infarction.The area under the curve(AUC)was 0.766(95%CI:0.6855-0.847,P<0.05),the optimal cut-off value was 193.62pg/mL,the sensitivity was 67.5%,and the specificity was less than 83.7%.4.Correlation analysis between prognosis and serum IPA level in patients with acute cerebral infarctionAmong the 197 patients with acute cerebral infarction included,128(64.97%)had a good prognosis and 69(35.03%)had a bad prognosis.There were no significant differences in age,gender,history of hypertension,diabetes,coronary heart disease,atrial fibrillation,smoking,drinking,fasting blood glucose,red blood cell count,white blood cell count and other laboratory tests between the two groups(P>0.05).Compared with the non-progressive group,baseline systolic blood pressure,admission NIHSS score,proportion of large atherosclerosis type,infarct volume and neutrophil count in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Creatinine,homocysteine and high density lipoprotein were lower than those in good prognosis group(P>0.05).The serum IPA concentration in the poor prognosis group was 168.91±50.61pg/mL,and that in the good prognosis group was 215.11±47.69pg/mL.The serum IPA concentration in the poor prognosis group was significantly lower than that in the good prognosis group(P=0.000),and the difference was statistically significant.Multivariate regression analysis suggested that admission NIHSS score was an independent risk factor for poor prognosis in patients with acute cerebral infarction,and patients with acute cerebral infarction were prone to poor prognosis when serum IPA level was low.ROC curve was used to analyze the predictive value of IPA level for poor prognosis of acute cerebral infarction.The area under the curve(AUC)was 0.749(95%CI:0.6766-0.823,P<0.05),the optimal cut-off value was 193.77pg/mL,the sensitivity was 71.1%,and the specificity was 72.5%.Conclusions1.There is a certain correlation between acute cerebral infarction and serum IPA level of patients.2.Patients with acute cerebral infarction are prone to disease progression and poor prognosis when the serum IPA level is low.3.Serum IPA level has certain predictive value for the progression and prognosis of patients with acute cerebral infarction. |
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