Study On The Inflammatory Mechanisms Of Ischemic Stroke Associated With Obstructive Sleep Apnea Syndrome

Objective:To detect the inflammatory cytokines soluble endothelial protein c receptor,(SEPCR), acute phase serum amyloid A (acute serum amyloid a, SAA), soluble CD40ligand (, SCD40L) level in plasma, and to analyze the correlation with all related risk factors and the severity of obstructive sleep apnea syndrome(OSAS) and ischemic stroke, so as to investigate the possible mechanisms of pathogenesis in ischemic stroke with OSAS.Methods:120patients admitted for in-hospital treatment in the department of neurology of the second affiliated hospital of Kunming Medical University were collected, from November2011to November2012.There were three observation groups, and each group admitted30cases. OSAS without ischemic storke group(group A), ischemic stroke without OSAS group(group B), ischemic stroke with OSAS group(group C);30cases in-hospital treatment patients without OSAS and ischemic stroke were selected as a control group(group D). Affter admission, all information of age, sex, weight, height, smoking, previous medical history include hypertension, diabetes, was recorded, as well as the score of National Institutes of Health Stroke Scale (NIHSS) with the patients who suffered ischemic stroke. All selected cases were exsanguinated venous blood3ml, to detect plasma SEPCR, SAA, SCD40L level, As well as the level of high sensitivity Creactive protein (HS-CRP), homocysteine (HCY), Fibrinogen (Fg). All selected cases accepted carotid Doppler ultrasonographic, polysomnography detection, and carotid artery intima-media thickness (IMT) characters of carotid plaquesand apnea hypopnea index (AHI) were recorded. SPSS17.0statistical analysis software was applied to demonstrate the correlations of all related factors.Results:Significant differences of gender, AHI, SaO2min, BMI, IMT, Fg, HCY, SEPCR,SAA, SCD40L, NIHSS score were found between A,B,C,D groupsPairwise comparisons displayed that significant differences of gender, AHI, SaO2min, BMI, IMT, HCY, Fg, SEPCR, SAA, SCD40L NIHSS score were found between groups A-C、B-C、 A-D、 C-D, but no significant differences were found in AHI between B-D and NIHSS score between A-D. AHI was linear correlated positively with NIHSS score. SEPCR, SAA、 SCD40L was correlated positively with AHI, NIHSS score, IMT, HCY, Fg, but correlated negatively with SaO2min.Conclusion:OSAS was an independent risk factor of ischemic stroke.There was systemic inflammation in patients with OSAS and the blood SEPCR、 SAA、 SCD40L level were elevated directly or indirectly. Inflammatory response was strengthened, and further promoted arterial intimal thickening, and participated the atherosclerosis process, revealed that ischemic stroke could be caused by OSAS independently through inflammatory response mechanisms.