| Part I Study On The Distribution Of Cerebral Artery Stenosis And Relative Factors In Zhuang Patients With Ischemic Stroke In GuangxiObjective To investigate the distribution characteristics and relative factors of cerebral artery stenosis in patients with ischemic stroke in Zhuang groups in Gaungxi.Methods A total of 1,101 patients with first-ever ischemic stroke were divided into two groups according to their ethnicity: Zhuang group(n=352)and Han group(n=749).All patients underwent 64-slice spiral computed tomographic angiography(CTA)scanning to document the presence of intracranial or extracranial stenosis: Intracranial Atherosclerosis Stenosis group(ICAS)(n=257),Extracranial Artery Stenosis group(ECAS)(n=185)and Intracranial and Extracranial Artery Atherosclerosis Stenosis group(I – ECAS)(n=443).The Chinese Ischemic Stroke Subclassification(CISS)standard was referred to for etiological classification of cases,LAA(n=583)and non-LAA(n=513).Clinical data of the patients were collected and analyzed.Result(1)The distribution of cerebral artery stenosis showed differences in Zhuang and Han groups : the proportion of RCAS in Zhuang patients was significantly higher than that in Han patients(20.2% vs.15.2%,P=0.047),while the proportion of ICAS was significantly lower than that in Han patients(35.8%vs.40.2%,P=0.041).The proportion of anterior circulation atherosclerosis stenosis in Zhuang patients was significantly lower than that in Han(29.3% vs41.5%,P<0.001),while the proportion of posterior circulation stenosis was significantly higher than that in Han(23.0% vs 13.1%,P<0.001).The proportion of I-ICA,MCA and E-ICA stenosis in Zhuang patients was significantly lower than that in Han patients(23.4% vs.28.9%,P=0.025;28.3% vs 35.9%,P=0.003;31.6% vs 38.5%,P=0.009;respectively),and the proportion of PCA,I-VA and E-VA stenosis was significantly higher than that of Han patients(18.4% vs10.1%,P<0.001).16.2% vs 12.1%,P=0.026;33.4% vs 22.4%,P=0.020;respectively).(2)Drinking was an independent risk factor for three types of cerebral atherosclerotic stenosis.Male and age are closely related to ECAS and I-ECAS.Smoking is only related to ICAS,while hypertension is only related to I-ECAS.(3)Advanced age,hypertension,diabetes,hyperlipidemia,smoking and alcohol consumption were independent risk factors for LAA stroke,respectively.(4)There was positive correlation between the degree of cerebral artery stenosis and the number of risk factors in ischemic stroke patients(Kendall’s tau-b=0.376,P<0.001).Conclusion(1)The distribution of cerebral artery stenosis showed ethnic differences in Zhuang and Han groups.The proportion of ECAS and posterior circulation stenosis in Zhuang patients was significantly higher than that in Han patients,which may be related to the difference exposure of risk factors.(2)The degree of cerebral arterial stenosis is positively correlated with the number of risk factors.Part II Plaque Characteristic In Middle Cerebral Artery Stenosis In Zhuang Patients With Ischemic Stroke In Guangxi:A High-Resolution Mr StudyObjective High-resolution magnetic resonance imaging(HR-MRI)was used to investigate the plaque distribution and characteristics in middle cerebral artery in Zhuang and Han patients with ischemic stroke in Guangxi.Methods A total of 47 patients were selected from the part I,each patient had M1 segment stenosis in the middle cerebral artery,confirmed by CTA/DSA.HR-MRI was performed using PDWI,T1 WI,T2WI,3D-TOF and enhanced scan to analyze the atherosclerosis plaques in the most severe site of M1 segment of the middle cerebral artery.The distribution location,the characteristics and the components of the plaques were compared between the two ethnic groups.Results Among the 47 patients,22 were of Zhuang group and 25 were Han group,there was no significant difference in age,gender and the proportion of bilateral MCA stenosis between the two groups(P > 0.05,respectively).Sixty-six plaques(42 in culprit vessels and 24 in non-culprit vessels)were included.There was no significant difference in the proportion of unstable plaque in culprit vessels or in non-culprit vessels between the two groups(P >0.05,respectively),however,the proportion of unstable plaque in culprit vessels was significant higher than in non-culprit vessels(73.8% vs 29.2%,P<0.001).MCA atherosclerotic plaques occurred more frequently on eccentric location(49/66),mainly in the anterior wall(23/66),followed by superior(12/66)and inferior wall(10/66).There was no significant difference in the distribution of plaques between the two groups(P > 0.05,respectively).Most of unstable plaques show enhancement on HR-MRI.The proportion of components of the unstable plaques between the two groups,the rate of intraplaque hemorrhage in Zhuang group was significantly higher than that of in Han group(41.2% vs4.8%,P<0.05).Conclusions(1)The distribution of unstable plaques in culprit vessels and non-culprit vessels was statistically different,while there was no statistical difference between Zhuang and Han groups.(2)In both Zhuang and Han LAA stroke patients,the distribution of MCA atherosclerotic plaques occurred more frequently on eccentric location,mainly in the anterior wall,followed by superior and inferior wall.(3)Most of unstable plaques show enhancement on HR-MRI in both Zhuang and Han LAA stroke patients,whereas the proportion of intraplaque hemorrhage in Zhuang patients was significantly higherPart III Association Study Of Gene Polymorphism In Zhuang Populations In Guangxi With Large Artery Atherosclerotic StrokeObjective To explore the polymorphism of Klotho and PPARγ polymorphism in Zhuang and Han populations in Guangxi with Large Artery Atherosclerotic Stroke(LAA).Methods A total of 235 patients with LAA were selected from part I as the case group,and 240 participants who underwent physical examination were selected as the control group.All the participants were divided into four groups according to their ethnicity: Zhuang control group(C1,n=120),Han control group(C2,n=120),Zhuang case group(D1,n=113)and Han case group(D2,n=122).Collected the clinical data.Selected the SNPs ac cording the db SNP database(http://www.ncbi.nlm.nih.gov/snp/),Klotho SN Ps were rs9527025,rs1207568,rs564881;PPARγ SNPs were rs3856386,r s1801282.Detected the genotypes and allele frequencies by SNa Pshot met hod.Results(1)In Zhuang population,there was no statistically significant difference between the control group and the case group in average age,the proportion of gender,smoking and drinking(P > 0.05).The proportion of hypertension,diabetes and hyperlipidemia in the case group was significantly higher than that in the control group(P < 0.05).(2)In Han population,there was no statistically significant difference between the control group and the case group in average age,the proportion of gender,smoking and drinking(P >0.05).The proportion of hypertension,diabetes and hyperlipidemia in the case group was significantly higher than that in the control group(P < 0.05).(3)The gene mutations of rs9527025,rs1207568,rs564881 were consistent with the Hardy-Weinberg equilibrium(HWE,P > 0.05).(4)The gene mutations of rs3856386,rs1801282 were consistent with the Hardy-Weinberg equilibrium(HWE,P > 0.05).(5)There was no statistically significant difference in genotype distribution and allele frequency of rs9527025 between Zhuang and Han populations(P >0.05).(6)The genotype distribution and allele frequency of rs1207568 was difference between C1 and D1(P < 0.05).the allele frequency of rs1207568 was difference between C2 and D2(P < 0.05),while the genotype distribution was not difference(P > 0.05).In case groups,the allele frequency of rs1207568 was statistically significant between D1 and D2(P< 0.05),while the distribution of genotype was not difference(P >0.05).In control groups,there was no difference in the genotype distribution and allele frequency of rs1207568 between C1 and C2(P > 0.05).(7)The genotype distribution and allele frequency of rs564481 was difference between C1 and D1(P < 0.05).There was no significant difference in the genotype distribution and allele frequency of rs564481 between C2 and D2,C1 and D1,D1 and D2(P>0.05,respectively).(8)The genotype distribution of rs3856386 was difference between C1 and C2(P < 0.05),while the allele frequency was no significant difference(P > 0.05).The genotype distribution and allele frequency of rs3856386 was difference between C2 and D2(P < 0.05),while there was no difference between C1 and D1(P > 0.05).(9)There was no significant difference in the genotype distribution and allele frequency of rs1801282 between Zhuang and Han populations(P >0.05).(10)There was gene-gene and gene-environment interaction between rs9527025,rs1207568,rs564881,rs3856386,rs1801282,hypertension,diabetes and hyperlipidemia,which significantly affect on the LAA stroke in Zhuang and Han population in Guangxi.Conclusion(1)The distribution of PPARγ polymorphism in LAA patients was ethnically different,and the T allele of rs3856836 in Zhuang patients may be more correlated with the occurrence of LAA stroke.(2)The interaction between rs9527025,rs1207568,rs564881,rs3856386,rs1801282 and risk factors may be related to the incidence of LAA stroke in Zhuang and Han population in Guangxi,and its mechanism needs further study. |
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