The Relationship Between Acute Cerebral Infarction And Carotid Atherosclerosis And High-sensitive C-reactive Protein

IntroductionCerebral infarction is one of the major diseases that damage severely human health and cause dealth. Atherosclerosis(AS) is the most leading cause of it. Carotid Artery is the first layer of sole arteries. It reflects atherosclerosis from head to foot. It has been evidented the associations between carotid artery atherosclerosis and coronary artery stenosis by a great deal clinical epidemiology research at home and abroad . Research detects that high-sensitive C-reactive protein(hs-CRP) is concerned to the whole pathology process of atherosclerosis which include the information and rupture of the atheromatous plagues and the occurrence and development of cerebrovascular and cardiovascular diseases. This research study the pertinence of the acute former circulation cerebral infarction with hs-CRP and carotid atherosclerosis.Experiment datas and means一,One: case choiceThe patients with acute former circulation cerebral infarction from the second hospital of Fuxin from december 2006 to december 2007 ( within 72 hours after the onset, except cardiogenic crebral embolism). Experiment standards: All patients accorded with the diagnostic standard by the fourth Cerebravascular Disease Conference in 1995, confirmed by brain CT and/or MRI were chosen, age between 45-75, mean 67±15 years. Elimination criteria: heart, liver, kidney failure and tumour history; serious infection or the main symptoms and signs of infection 4 weeks before the onset; surgical operation, trauma, rheumatic heart disease; polycythemia vera; with heredity of cerebral infarction.二,Two: case grouping Two groups: case group, 107 cases,75 males, 32 females. age between 45-75, mean 67±15 years. Comparison group, 95 healthy people were found in physical examination outpatients, No cerebral infarction previous medical history, 57 males, 38 females. age between 47-69, mean 61±12 years.We record the age, sex and whether diabetes mellitus and hypertension of each case, blood pressure, blood lipid.三,Three: Color Doppler sonograms of Carotid ArteryWe use two dimensional Philips 5500 ultrasonic diagnosis devices with the10 MHz transducer. Two groups were treated. 1.The carotid arteries intima-media thickness(IMT): . IMT is the perpendicular distance from the interface of intima-media to media-adventitia, IMT< 1.0mm is normal, 1.0mm≤IMT≤1.2mm is intima thicking, IMT > 1.2mm is plaque shaping. 2. The site , morphogenesis and echo of plaques were classified:①low echo plaque which mainly composed of lipid deposit;②High intensity echo which mainly composed of calcium deposit;③The ulcers plaque with the internal echo is no homogenous ulcers.( High intensity echo plaque has higher acoustic densitometry than lumen acoustic densitometry, hyperechoic echo plaque has hyperechoic acoustic densitometry with lumen acoustic densitometry, weak echo plaque has weaker acoustic densitometry than lumen acoustic densitometry or hyperechoic blood). Some enlarged over two echos plaques were mixed plaques. Fibro and calcification plaques were stable plaques, soft and mixed plaques were unstable plaques四,Four: Blood serum high-sensitive C-reactive protein(hs-CRP)The fasting venous blood samples were taken on the morning inside 24 hours for case group. The fasting venous blood samples were taken for comparison group, and separate the serum, Detection on IMMAGE immune System(BECKMAN COULTER AMERICAN), The serum hs-CRP was detected by Dade Behring prospect. hs-CRP < 3mg/L is normal.Experiment results一,One :The relatively between the groups in IMT of common carotid arteries of both sides There were significant difference between the case group and control group.二,Two: The relation between concentrations of hs-CRP anddifferent IMT in cerebral infarction casesThere were significant difference in concentrations of hs-CRP in intima thicking group and in the normal IMT group(t=4.129, p<0.05), and There were significant difference in concentrations of hs-CRP between patients with cerebral infarction in the plaque shaping group and those of the normal IMT groupand patients with stable angina pectoris(t=5.989, p<0.05), There were significant difference of hs-CRP between patients with cerebral infarction in the plaque shaping group and those in intima thicking group(t= 4.200, p<0.05),Three: The relatively of concentrations of hs-CRP in cases with different quality carotid plaqueThere were significant difference in concentrations of hs-CRP between instabitity cases and stabitity carotid artery atherosclerosis.DiscussionResearch considered that atherosclerosis is the major pathogeny ischemic cerebral vascular diseases. IMT is the forepart sign of atherosclerosis. Aggravate damage in inner membrane cause atherosclerosis plaque shaping. IMT is associated with the dangerous complication of atherosclerosis and cerebral infarction. There were 120 cases with cerebral infarction at carotid artery systerm because atherosclerosis color doppler sonograms of carotid artery shows that 72.5 %(87cases) and the incedence of severe Carotid stenosis is 4.17 %. This shows that Carotid ultrasound check of Carotid MIT is rather significant for the prevention of Carotid Atheromatou Sclerosis cerebral infarction.This research indicated the blood serum hs-CRP concentrations of the atherosclerosis patient presents positive correlation with the degree of carotid sclerosis, which means the blood serum hs-CRP concentrations of a person with normal IMT, a person of thickening IMT, a person with the plaque formation respectively increases in turn. It shows hs-CRP involves in the whole process of the formation and the development of atherosclerosis of patients. The research also shows that inflammation plays a very important role in the occurrence, evolution and the rupture process of atherosclerosis plaque, which is in low chronic inflammation state.CRP is one kind of response proteins synthesized by the liver cell in acute state. It's number is quite few in the normal human body but will increases to its dozens of times in the state of serious infection, damage, the pathological change of serum, ischemia and necrosis and so on. It is often examined as the usual tracer of inflammation .CRP is a possible dangerous factor leading to cerebral infarction . Recently studying transgenic mouse has shown that human CRP increases the risk of thrombus and arteriosclerosis formation and the rupture of plague. The possible working mechanism of CRP in the happening of cerebral infarction is: it involves in the formation and the development of arteriosclerosis. The internal environment disorder such as the infection, the inflammation, the tissue damage so on brings about the acute stage response. The activation of interleukin - 6of the acute stage response results in CRP which causes the inflammation response. The partial endarteritis gives rise to the thickness raise of IMT and the rupture of atherosclerosis which causes the cerebrovascular and cardiovascular disease.CRP can contributes to the release of adherent molecule which is the key point leading to arteriosclerosis. It makes white cell adhere and go through endodermis to accelerate the formation of atherosclerosis. CRP can recuperate natural LDL and have it absorbed by the foam cell, thus promoting the development of arteriosclerosis. It can activate the complement system. In the arteriosclerosis plague, the content of mRNA of CRP is 10 times as much as that in normal arteria. CRP combined with ligand activates the classical complement activation pathway. The activated complement component can activate the static endothelial cell of blood vessel directly, thus leading the white blood cell to trundle, adheres and seeps out in the endothelial cell. The endothelial cell in the blood vessel activated by complement has many kinds of biological functions such as participating in inflammation response, causing coagulation in the blood vessel, adjusting the vasotonia, the permeability as well as the expression of blood vessel adhesion molecule and so on. CRP takes part in the inflammation response and tissue damages by activating complement pathway, thus giving rise to the formation of thrombus. The level raise of CRP can affect coagulation fibrinolysis mechanism by the expression of tissue factor. As for the patients of ischemic stroke in acute stage, their coagulation fibrinolytic system activity and aggregation function of the blood plate are much higher than those with normal CRP level patient and the control group , indicating the coagulation fibrinolytic system and the activation of blood plate fuction presents correlation .Guo with others determines the CRP level of 121 examples among the patients with ischemic cerebrovascular disease within 72 h discovering that the CRP level of the patients rose obviously and present positive correlation with the area of cerebral infarction and the thickness of arteriosclerosis plague. It indicates that CRP is closely related with the formation and the development of ischemic cerebrovascular disease. The study of over twenty prospective epidemiology shows that for healthy individuals, the hs-CRP level raise can forcast the occurrence of stroke, ACS, the cardiac infarction and sudden death as an independent dangerous factor.On the one hand, contacting with the endothelial cell and with the existence of ADP, CRP induces enzymatic activity, activates XII factor, initiates endogenous blood coagulation system organism and destroys the balance of coagulation fibrinolysis of the organism. It causes the hypercoagulability and contributes to the formation of thrombus. On the other hand the embolus produced by the rupture of plague blocks the cerebrovascular lumen directly and result in embolism. The early research shows that the heavier the degree of the arteriosclerosis is, the more obvious the narrowness of the lumen is, which leads to cerebral infarction more easily. However the recent years studies indicated the cerebral infarction was mainly connected with the structure of plague. As phlogotic marker closely connected with the unstable plague, the level of hs-CRP can reflect the seriousness of atherosclerosis, the danger of apoplexy and prognosis. By anti-inflammatory therapy people can control the progress of atherosclerosis and stabilize the plaque to reduce the occurrence of atherosclerosis.This research indicates the acute cerebral infarction has the close relationship with the atherosclerosis plague. CRP may reflect the stability of the atherosclerosis plague. The union of plasma CRP examination and the carotid artery supersonic inspection may forecast the danger of the atherosclerosis cerebral infarction. Therefore it is very significant to strengthen the clinical monitoring and the positive intervention to the hs-CRP level raise patients .ConclusionI. That more severity of Carotid Atheromatou Sclerosis among the case group than that of the control group proves that Carotid Atheromatou Sclerosis is the dangerous factor of cerebral infarction.II. Among acute cerebral infarction patients, the blood serum hs-CRP of those of Carotid Atheromatou Sclerosis, of Carotid plagues, and in particular of unstable plagues is obviously higher than those patients without Carotid pathology or with stable plagues. This shows that the concentrations of blood serum hs-CRP is significantly related to the occurrence of Carotid Atheromatou Sclerosis and acute cerebral infarction. Inflammation reaction is possibly involved in the formation of Carotid Atheromatou Sclerosis, rupture of plagues and leads to the formation of cerebral Infarction.