The Relationship Between Fractalkine And Abnormal Metabolism Of Blood Glucosein In Patients With Acute Cerebral Infarction

Objective:In recent years,diabetes is higher year by year along with lifestyle changes,becoming the common risk factors in cerebrovascular disease. Clinical studies have shown that the stroke mortality,morbidity,and recurrence rates are relatively high,the condition of recovery is weak compared with non-diabetic population with diabetes.Impaired glucose tolerance (IGT) and impaired fasting glucose regulation (IFG)are behalf of the intermediate state between a normal glucose homeostasis and diabetes/high blood sugar metabolism,is high-risk predisposing factor of type 2 diabetes.Research suggests that patients with IGT have been the risk of cerebral vascular accident.In the IGT stage,the complex relations have been fully exposed abnormal glucose metabolism, insulin resistance,hyperinsulinemia, endothelial cell dysfunction,oxidative stress, lipid abnormalities,high blood pressure,and then woven together,leading to the target organ damage. Glucose metabolism in patients with cerebrovascular disease state is an important prognostic and prediction factor.Fractalkine(FKN)is a chemotactic factor which is released by inflammation endothelial cells,combining with the receptor CX3CR1,could enhance the effect of Natural killer cells(NK cells), damage the vascular endothelial cells,then promote the formation of atherosclerosis(AS).Therefore,the study of hyperglycemia especially impaired glucose regulation and the expression of FKN in acute cerebral infarction is beneficial to the prevention and treatment of cerebral ischemic with hyperglycemia.Methods:Choose 90 patients with acute cerebral infarction from March 2009 to November 2009 in the Second Hospital of Hebei Medical University, department of Neurology,aged 45-85 year-old. In all cases in line with①1995 for the fourth National Conference on Cerebrovascular Diseases to develop a "brain disease diagnostic criteria",characterized by cranial CT or MRI confirmed cerebral infarction, the incidence were within 72h.②Coincide with the 2006 WHO Expert Committee Sugar metabolism disorders diagnostic criteria: fasting plasma glucose (FPG)≥7.0mmol/L and(or)OGTT 2-hour plasma glucose(2hPG)≥11.1mmol/L diagnosis diabetes mellitus(DM); FPG< 6.1mmol/L and 2hPG<7.8mmol/L diagnosis normal glucose tolerence(NGT); impaired glucose regulation(IGR) including isolated impaired fasting glucose (IFG)6.1mmol/L≤FPG<7.0mmol/L and 2hPG<7.8mmol/L,isolated impaired glucose tolerence(IGT)FPG<6.1mmol/L and 7.8mmol/L≤2hPG< 11.1 mmol/L,and combined hyperglycemia(IFG+IGT)6.1mmol/L≤FPG <7.0 mmol/L and7.8mmol/L≤2hPG<11.1mmol/L. Normal control group is the patients to hospital out-patient clinics for the same period of the 30 cases of healthy persons, aged 45- 85 year-old.The undiagnosed diabetic patients were treated with oral glucose tolerance test (OGTT).In patients with acute ischemic cerebrovascular disease are required after admission (14±2) days to OGTT test.Only FPG and the OGTT test blood glucose 2h after glucose load (2hPG) two points. OGTT using 75g anhydrous glucose load.Divided into four groups: diabetes-acute cerebral infarction group (DACI group),30caces;impaired glucose regulation-acute cerebral infarction group (IGACI group), 30caces;normal blood glucose-acute cerebral infarction group (NGACI group), 30caces; normal control group(NC group), 30caces.Detect the peripheral blood levels of FKN in each acute cerebral infarction group and the normal control group with the method of Enzyme-linked immunosorbent assay, and compare the differences expression of serum FKN in DACI group, IGACI group, NGACI group and NC group. Detect the peripheral blood levels of fasting plasma glucose and blood lipids in each acute cerebral infarction group and the normal control group by biochemics method, in order to compare the differences of fasting plasma glucose and blood lipids in DACI group, IGACI group, NGACI group and NC group.Results:1 The serum FKN concentration of is normal distribution.In DACI group, IGACI group, NGACI group, the mean and standard deviation of FKN levels in serum is (291.50±100.12;206.97±84.15;154.76±41.46)pg/ml,which is higher than the mean and standard deviation of FKN levels in the NC group (93.35±30.66)pg/ml,the difference is statistically significant(P<0.05).In DACI group and IGACI group, the mean and standard deviation of FKN levels in serum is higher than the mean and standard deviation of FKN levels in the NGACI group,the difference is statistically significant(P<0.05). In DACI group, the mean and standard deviation of FKN levels in serum is higher than the mean and standard deviation of FKN levels in the IGACI group,the difference is statistically significant(P<0.05).2 In DACI group, IGACI group, the mean and standard deviation of fasting plasma glucose level in serum is (8.659±1.321;6.069±0.818)mmol/l, which is higher than the mean and standard deviation of fasting plasma glucose level in IGACI group and NC group(4.741±0.497,4.970±0.507) mmol/l,the difference is statistically significant(P<0.05).In DACI group, the mean and standard deviation of fasting plasma glucose level in serum is higher than the mean and standard deviation of fasting plasma glucose level in IGACI group, the difference is statistically significant(P<0.05).In NGACI group,the mean and standard deviation of fasting plasma glucose level in serum is higher than the mean and standard deviation of fasting plasma glucose level in IGACI group,the difference is statistically significant (P<0.05).The mean and standard deviation of fasting plasma glucose level in serum between NGACI group and NC group is different,but the difference is no statistically significant (P>0.05).3 In DACI group,IGACI group,NGACI group,the mean and standard deviation of CHOL level is(5.856±0.950;5.308±0.932;5.351±0.818)mmol/l, which is higher than the mean and standard deviation of CHOL level in NC group(3.853±0.457)mmol/l,the difference is statistically significant(P<0.05). In DACI group,IGACI group, NGACI group, the mean and standard deviation of TG level is(3.042±0.922;3.085±1.160;3.111±1.263)mmol/l, which is higher than the mean and standard deviation of TG level in NC group(1.128±0.416) mmol/l,the difference is statistically significant (P<0.05).In DACI group, IGACI group, NGACI group,the mean and standard deviation of LDL level is (3.394±1.015;3.193±1.255;3.271±1.067)mmol/l,which is higher than the mean and standard deviation of LDL level in NC group(2.563±0.945)mmol/l, the difference is statistically significant(P<0.05).In DACI group, IGACI group, NGACI group, the mean and standard deviation of HDL level is (1.394±0.331; 1.415±0.487;1.478±0.373)mmol/l,which is lower than the mean and standard deviation of HDL level in NC group(1.718±0.341)mmol/l,the difference is statistically significant(P<0.05).The mean and standard deviation of CHOL, TG,LDL,HDL levels in DACI group,IGACI group and NGACI group is different,but the difference is no statistically significant(P>0.05).4 In DACI group,IGACI group,NGACI group and NC group,age and gender are no significantly different(P>0.05).5 In DACI group,IGACI group,NGACI group and NC group,the FKN level in serum is not associated with age and there is not a statistically significant correlation(P>0.05).Conclusions:1 DACI group,IGACI group,NGACI group are significantly higher than NC group by levels of serum FKN,indicating in the cerebral infarction.FKN increased expression may be involved in nerve tissue after infarction in the inflammatory process.2 DACI group blood glucose is significantly higher than IGACI group and NGACI group.The DACI group serum FKN levels comparison with IGACI group and NGACI group is significantly difference,indicating cerebral glucose metabolic abnormalities increase the expression of pro-inflammatory cytokines and increased the extent of cerebral infarction.3 IGACI group blood glucose is significantly higher than NGACI group,and the IGACI group serum FKN levels comparison with NGACI group is significantly difference,indicating even the stage of abnormal glucose regulation in brain tissue has been a significant injury,its harmful effects,and is similar to diabetes.Therefore,attention should be given abnormal glucose regulation stage,to strengthen the control of blood sugar, prevent the occurrence of cerebral ischemia.4 CHOL,TG,LDL level of DACI group,IGACI group,NGACI group is significantly higher than the NC group,HDL level is significantly lower than the NC group,indicating increased cerebral blood lipid abnormalities.High blood sugar and high blood lipids are increased the brain damage.5 In DACI group,IGACI group,NGACI group and NC group,is not found in serum FKN levels and age, there is not a significant correlation.