Relationship Between The Signal Pathway Of Pregnancy Associated Plasma Protein-A And Vulnerable Atherosclerotic Plaques Of Middle Cerebral Artery Stenosis

ObjectiveWe sought to study the relationship between pregnancy associated plasmaprotein-A (PAPP-A), insulin-Like growth factor-1(IGF-1), inducible NOS(iNOS) and the vulnerable atherosclerotic plaques of middle cerebral artery(MCA).MethodsWe recruited24patients with middle cerebral artery (MCA)-typy strokewith stenosis, in that microembolic signals (MES)positive(MwS MES+),19patients with MCA-typy stroke with stenosis, in that microembolic signalsnegative (MwS MES-),19patients with MCA-typy stroke without stenosis（MwOS MES-）. We also recruited19healthy individuals as controls(Con).Pregnancy associated plasma protein-A, insulin-Like growth factor-1,inducible NOS was measured by ELISA.ResultsThe mean age of MwS MES+, MwS MES-, MwOS MES-and healthycontrols is56.62±11.83years,55.05±10.91years,55.16±11.53years，56.62±11.83years；There are20male and4female in MwS MES+group.There are16male and3female in MwS MES-group.There are16male and3female in MwOS MES-group. There are16male and3female in healthy controls. By comparing the patients with acute cerebral infarction MwSMES+, MwS MES-, MwOS MES-and healthy controls,there is no differenceof age and sex (P＞0.05).There is no influence each other in hypertension,diabetes, cardiac disease and smoking. The concentrations of pregnancyassociated plasma protein-A in patients with MwS MES+, MwS MES-, MwOSMES-and healthy controls are115.7±36.31pg/ml,121.9±26.84pg/ml,156.6±43.91pg/ml，130.1±39.99pg/ml. There is different in each other(MwOSMES-v.s MwS MES-,P=0.006; MwOS MES-v.s MwS MES+,P=0,004).Theconcentration of IGF-1in four groups are460.88±269.90ug/ml,361.27±236.22ug/ml,372.10±215.34ug/ml,433.79±243.56ug/ml. There is nodifference each other. The concentration of iNOS in four groups are550.97±503.71pg/ml,443.44±414.95pg/ml,562.92±510.56pg/ml,521.68±475.57pg/ml.There is no different in four groups (P＞0.05).Bycomparing the volume of cerebral infarction and the concentration ofpregnancy associated plasma protein-A, IGF-1and iNOS,there is nodifference (P＞0.05).By comparing the influence including cerebralinfarction,artery steins,hypertension, diabetes, cardiac disease,smoke,PAPP-A, IGF-1and iNOS than whether microembolic signals ispositive,there is PAPP-A affected by whether microemblic signals positive(P=0.001) through multivariate logistic regression analysis.Conclusions1. Multivariate logistic regression analysis showed PAPP-A is independentpredictor for vulnerable atherosclerotic plaques of cerebral middle artery. When the vulnerable atherosclerotic plaques of cerebral middle artery is moreamphibolic, the concentration of pregnancy associated plasma protein-A isreduced.We conclude that pregnancy associated plasma protein-A is could beused as a clinical biomarker for assessing atherosclerotic instability.2. The volume of cerebral infarction is not the influence which affects theconcentration of pregnancy associated plasma protein-A, IGF-1and iNOS.