The Relationship Between The Soluble CD40L And Deferent Type Of Cerebral Infarction And The Effect Of The Prognosis

Objective:Cerebral infarction brought a heavy burden to the society and the family because of the high incidence, high morbidity and mortality, this study was to investigate the relationship between the serum level of soluble CD40L, the volume size of infarction, degree of neurologic functional deficits as well as prognosis in patients with acute cerebral infarction. New way of think was expected for clinical prevention and treatment of cerebral infarction.Methods:All cases were persons with health check and patients with acute ischemic stroke admitted to the medical department of Neurology of Heze Municipal Hospital since October 1,2009 to August 31,2010.All cases were divided into A. cerebral infarction group:48 patients with acute ischemic stroke treated in our hospital,aged from 36 to 75 years, average 59.40±8.71.All were in line with the Fourth National Conference revised diagnostic criteria of cerebral infarction, and confirmed by brain CT or MRI. According to the head CT or MRI of lesion size, by Pullicino formula (infarct volume=length×width×number of layers xthickness of layer÷2), calculate the infarct volume, the cerebral infarction patients were divided into large groups (LI) 18 cases, lesion volume> 10cm3;middle group (MI) 20 patients, lesion size (5-10cm3); small group (SI) 10 cases, lesion size <5cm3. According to the clinical neurological deficit scoring (CNFDS), developed based on the 1995 Fourth National Conference on cerebrovascular disease, all patients were divided into severe type group (31-45 points),13 cases, medium type group (16-30 points),20 cases, light type group (0-15 points),15 cases. All patients were given Doppler ultrasound to observe the carotid artery intima. According to the carotid artery atherosclerosis plaque index, the cerebral infarction group were divided into:the no plaque group,8 cases; grate one group,8 cases, one small plaque(<30% vascular cross-section); grate two group,9 cases, one middle size plaque (30%-50% vascular cross-section)or many small plaques; grate three group,13 cases, one big plaque(>50% vascular cross-section)or many plaque at least one middle plaque. B. control group: Select the normal healthy subjects, at the same period, as control group,30 cases, aged 40-72years, mean 58.56±7.23 years. Fasting venous blood were taken 4ml,for two samples, cerebral infarction group were taken after the onset of 24h and 7d,contral group were taken at the first day and the 7d.The serum were collected after one blood sample at room temperature to be solidified, and centrifuged for 10 minutes at 2000 r/ min, then detected the sCD40L concentration, the other sample was send to our biochemistry laboratory to tested the indicators of blood glucose, cholesterol, triglycerides, low density lipoprotein and lipoprotein a. Experimental data analyzed by statistical software SPSS 11.5. Comparison between two groups were the number of samples t test, single-factor analysis of variance was sued to compare multiple samples mean.Results:1. Compared with the control group, the systolic pressure, diastolic pressure, blood glucose, cholesterol, and lipoproteins of infarction group(onset 24-48h)were significantly different (P<0.01); Other indicators, including age, gender, coronary heart disease, cerebrovascular disease, family history, smoking, alcohol consumption, triglycerides were not significantly different between the two groups.2. Compare with the control group, cerebral infarction serum levels of sCD40L in the course of 24h, at 7d were significantly higher(P<0.01); it was higher at 7d than that of 24h (p<0.01).3. Of patients with cerebral infarction, the sCD40L level was positively correlated with the size of the infarction volume (P<0.05),the larger the infarction volume, the higher the serum level of sCD40L.4. Of patients with cerebral infarction, the sCD40L level was positively correlated with neurologic deficit extent (P<0.01); i.e., the more severe the neurologic deficit, the higher the serum levels of sCD40L5. The sCD40L levels in patients with cerebral infarction correlated with artery atherosclerosis plaque index (p<0.01), i.e., the more severe the atherosclerosis extent, the higher the serum sCD40L, the worse the prognosis of patients with cerebral infarction.Conclusion:The results showed that, the increased levels of sCD40L in patients with cerebral infarction positively correlated with the lesion size and severity, which also closely correlated with prognosis. Suggesting that sCD40L play an important role in the pathogenesis and development of acute ischemic cerebrovascular disease. So, early detection of serum levels of sCD40L could be a reliable indicator to determine the infarction size, severity and prognosis of patients. To reduce the level of sCD40L may be effective for the treatment of cerebral infarction.