The Study Of Relationship Between Serum High Sensitivity C-Reponse Protein And Carotid Atherosclerosis In Patients Cerebral Infarction

PURPOSE1) To investigate the relationship between serum high sensitivity C-Reponse Protein (hs-CRP) and carotid intima-media thickness in the patient of diabetes mellitus complicated with cerebral infarction.2) To analyses risk factors of diabetes mellitus complicated with cerebral infarction and value of combined detection of hs-CRP and TC/HDL in prognosticating Cerebral infarction complication in the patient of diabetes mellitusMETHODSThirty one patients of T₂DM with cerebral infarction(DCI) and twenty seven patients of T₂DM and forty two case of control subject were collected.The serum level of hs-CRP was determined by a high sensitive ELISA,we also evaluated the serum levels of fasting bleed glucose(FBG),postcibal blood glucose(PBG), triglyceride(TG),total cholesterol(TC),high density lipoprotein(HDL-C),low density lipoprotein(LDL-C),CT image standardization and MRI were performed in all patients,and the average carotid IMT were measured by a high resolution B-mode ultrasonography,observed the level of IMT in the average of common carotid artery. All patients were divided into two groups according to the average carotid IMT measurement:IMT＜1.2mm and IMT≥1.2mm.hs-CRP and TC/HDL-C were compared among the three groups,and discuss the multiple factors affecting carotid arteriosclerosis.To investigate the relationship between serum high sensitivity C-Reponse Protein(hs-CRP) and total cholesterol/high-density lipoprotein cholesterol ratio(TC/HDL-C) with carotid intima-media thickness in the patient of diabetesmellitus complicated with cerebral infarction.To analyses Risk factors of diabetesmellitus complicated with cerebral infarction and decompose the contribution of combined detection in hs-CRP with TC/HDL in the patient of diabetesmellitus complicated with cerebral infarction.All the sample was calculated by SPSS11.5.sample groups compared byx²-test, average of each two groups was compared by T-test,average of each three groups was compared by one-way ANOVA analysis,and was also analyzed by multi stepwise regression with the average carotid IMT as variable.P≤0.05 difference has statistics sense.RESULTS1.The level of IMT in the average of common carotid artery were(1.02±0.13) mm,(1.12±0.21) mm and(1.26±0.17) mm in the normal controls group,DM group and DCI group,DCI group was significantly greater than the other two groups(P＜0.001).There were 25 samples in DCI group with IMT≥1.2mm among 32 patients,also has significant differences with the other 2 groups:normal group and DM group(P＜0.001,P=0.03)。2.Pearson's analysis showed:there was a positive correlation between the average of common carotid artery IMT and hs-CRP(r=0.627,P＜0.001),as well as common carotid artery IMT and TC/HDL-C(r=0.059,P=0.000).In addition,there was negative correlation between HDL-C and common carotid artery IMT(r= -0.281,P＜0.001);The level of hs-CRP and TC/HDL-C in IMT＜1.2mm and IMT≥1.2mm were(4.33±16.32,3.88±1.56),(10.83±12.67,4.91±2.39) respectively.So we can see that hs-CRP and TC/HDL-C will increase accordingly by the severity of carotid atherosclerosis.The difference has statistics sense(P= 0.023,0.004)。 3.Multiple regression analysis confirmed that average carotid IMT were correlated with age and hs-CRP.Multi-coefficient of the model is R=0.687,decisive coefficient is R²=0.472。Regression equation:IMT=0.707+0.007 hs-CRP+ 0.005age。4.The expression levels of hs-CRP was significantly higher in DCI than those in DM and normal controls.The level of hs-CRP were(16.1±0.19) mg/L,(1.50±1.68) mg/L and(8.25±1.7) mg/L in the DCI group,normal controls group and DM group,there were significant differences in the levels of hs-CRP among these three groups(P＜0.001),between the DCI group and normal controls group (P＜0.001).The DCI group and DM group(P=0.042).5.FBG,PBG,TG,TC,LDL-C and HDL-C,there were no significant difference among three groups.TC/HDL-C were(5.4±2.95),(3.61±1.01) and(4.45±1.6) in the DCI group,normal controls group and DM group,there were significant differences in TC/HDL-C among these three groups(P=0.000),between the DCI group and normal controls group(P＜0.001).The DCI group and DM group (P=0.047).6.If take the hs—CRP and TC/HDL-C as the index with forecast probability of T₂DM patients,from the result we can see:with the increase of hs-CRP,the sensiticity,specificity,positive predictive value(PPV) and negative predictive value(NPV) of cerebral infarction occurrence in T₂DM patients were 59.4%,76 %,46.3%and 84.7%respectively;With the increase of TC/HDL-C,the sensiticity,specificity,PPV and NPV of cerebral infarction occurrence of T₂DM patients were 62.5%,66%,35.5%and 83.8%respectively.With the synchronous increase of hs-CRP and TC/HDL-C,the sensiticity,specificity,PPV and NPV of cerebral infarction occurrence of T₂DM patients were 43.8%,84.5%,60.9%and 73.1%respectively.From prior data we can get:with the synchronous increase of hs-CRP and TC/HDL-C,the PPV of cerebral infarction in T₂DM patients should increase accordingly。 CONCLUSIONS1.hs-CRP is the independence risk factor of carotid atherosclerosis in patients with type 2 diabetes,Indicating it may play important role in the Pathogenesis and development of carotid atherosclerosis in type 2 diabetes.2.In the DCI group,IMT,hs-CRP,TC/HDL-C were signifieantly higher than those in other two groups,indicating IMT,hs-CRP,TC/HDL-C were related with the complication of cerebral infarction in type 2 diabetes,the proportion of patiens with high IMT in DCI group was significantly greater than that in other two groups(P＜0.001),considering hs-CRP may affect the pathogenesis and development of cerebral infarction in type 2 diabetes by participate in formation of carotid atherosclerosis.3.Combination detection of hs—CRP and TC/HDL-C can increase significantly the diagnostic specificity and PPV of cerebral infarction complication in T₂DM patients,hs—CRP and TC/HDL-C are associated with type 2 diabetes complicated with cerebral infarction.