Correlation Study Between Acute Phase Syndrome Of Ischemic Stroke, Biological Indicators PARK7, NDKA And NIHSS

OBJECTIVE:With clinical characteristics of high morbidity, high disability rate and high mortality,stroke have received much attention in clinical and scientific research,and relevant studies go deep into all levels.In recent years, biomarks related to acute cerebral vascular disease become a research hotspot. Similarly to the microscopic biomarks,TCM (Traditional Chinese Medicine) syndrome also reflect the microscopic characteristics of stroke from the perspective of Traditional Chinese Medicine,as it represent the disease location,etiological factor, pathogenesis and disease tendency of a certain stage in the process of stroke in TCM.This study intends to explore the correlation between TCM syndromes and the biomarker,the role of biomarkers in diagnosis and evaluation to TCM syndrome of Ischemic stroke from the perspective qi deficiency syndrome, phlegm-heat syndrome of TCM syndromes in ischemic stroke and serums PARK7, NDKA levels in relevant biomarkers.lt tried to promote the objective and quantifiable process of TCM syndrome Evaluation and diagnosis.Meanwhile,our research adopted the US National Institutes,, of Health Stroke Scale(NIHSS)to assess the neurological impairment, analysed the correlation of TCM syndrome, biomarker and neurological impairment,explored the diagnostic value and the evaluable value of biomarker in ischemic stroke and TCM syndrome.METHOD:This study recruited 105 healthy human serum samples as controls,33 cases of Qi deficiency syndrome and 87 cases of phlegm-heat syndrome in acute phase of ischemic stroke.The serum samples of patients were collected within 3 days of onset and 7 and 14 days after onset to measure the serum NDKA and PARK7 levels.Syndrome evaluation used the "Ischemic Stroke TCM Syndrome Factor Evaluation Scale (ISTSFES)" to assess the syndrome severity(phlegm-heat syndrome scores= phlegm-dampness syndrome scores+ internal-fire syndrome scores). Disease evaluation used the NIHSS (National Institutes of Health Stroke Scale) to assess the neurological impairment. Evaluation point is within 3 days of onset and at day 7 and day 14 after onset.RESULTS:?Characteristics of serum NDKA and PARK7 levels in acute ischemic stroke:the serum level of PARK7 in the total Qi deficiency group was lower than that of the normal controls(25.80(16.44)vs36.00(17.85),P<0.01). The serum level of PARK7 in the total phlegm-heat group was higher than that in the normal controls(46.44(92.23)vs36.00(17.85), P<0.01).The serum level of NDKA in the total Qi deficiency group was higher than that of the normal controls(43.01(22.84)vs 29.50(17.65),P<0.01).There was no significant difiference in the serum levels of NDKA between the total phlegm-heat group and normal controls(P>0.05).The PARK7 and NDKA of Qi deficiency group showed a trend from slight rising to declining, and the two biomarkers of phlegm-heat group showed a continuous downward trend.The serum levels of PARK7 in phlegm-heat group were higher than those in Qi deficiency group(P<0.01).The serum levels of NDKA in Qi deficiency group were higher than those in phlegm-heat group(P<0.01). ?The correlation of NDKA and PARK7 in acute ischemic stroke:The serum levels of PARK7 and NDKA in total and three time points of acute ischemic stroke were positively correlated and possessed a linear relationship(P<0.05).When analysed in the group of Qi deficiency syndrome or phlegm-heat syndrome,there were a positive correlation and a linear relationship between PARK7 and NDKA(P<0.05).? The correlation of serum levels of NDKA,PARK7 and neurological impairment in acute ischemic stroke:There were no correlation between serum PARK7,NDKA levels and NIHSS scores no matter analysed in total or in different TCM syndrome(P>0.05).(4)The correlation of serum levels of NDKA,PARK7 and TCM syndrome:There was a negative correlation between the content of PARK7 and the Qi deficiency syndrome scores in total Qi deficiency group (P<0.05).However, there was a positive correlation between the phlegm-heat syndrome scores of first time point and the content of PARK7 in phlegm-heat group (P<0.05).?The correlation of neurological impairment and TCM syndrome in acute ischemic stroke:The scores of Qi deficiency syndrome in the third time point and phlegm-heat syndrome in total and different time points had positive correlation with NIHSS score (P<0.05). Furthermore,the phlegm-heat group had a linear relationship with the NIHSS score in total and different time points(P<0.05).?The diagnostic value of NDKA and PARK7 serum levels in acute ischemic stroke and TCM syndrome:Results showed that serum level of PARK7 in 14 days after onset exhibited certain diagnostic value with an AUC of 0.598, sensitivity of 39.2% and specificity of 100%. The cut-off values of serum PARK7 levels for the diagnosis of ischemic stroke were 78.15ng/mL.Serum PARK7 levels showed no diagnostic value in Qi deficiency syndrome(AUC:0.261).Serum PARK7 levels exhibited certain diagnostic value in phlegm-heat syndrome with an AUC of 0.615, sensitivity of 39.5% and specificity of 98.6%.The cut-off values of serum PARK7 levels for the diagnosis of phlegm-heat syndrome were 69.76ng/mL.Serum NDKA levels showed no diagnostic value in phlegm-heat syndrome(P>0.05). Serum NDKA levels exhibited certain diagnostic value in Qi deficiency syndrome with an AUC of 0.749, sensitivity of 71.4% and specificity of 76.4%.The cut-off values of serum NDKA levels for the diagnosis of Qi deficiency syndrome were 39.40ng/mLCONCLUSION:PARK7 has certain value in diagnosis of phlegm-heat syndrome in the acute stage of ischemic stroke, and NDKA has certain value in the diagnosis of Qi deficiency syndrome in the acute stage of ischemic stroke, which implicate that PARK7 and NDKA may act as potential diagnostic biomarker of TCM syndrome in acute ischemic stroke.In view of the founding of positive correlation and linear relationship between PARK7 and NDKA,it suggests that NDKA and PARK7 may exist some relations in the process of ischemic injury in the acute ischemic stroke and deserve further molecular level research.PAKR7 and NDKA have different expression characteristics and dynamic distribution characteristics in the acute phase of ischemic cerebral infarction, which suggests that PARK7 and NDKA have potential value in the diagnosis and evaluation of ischemic stroke.This study didn find the correlation between the serum levels of PARK7,NDKA and NIHSS scores. Therefore,the correlation between biomarker and the neurological impairment needs further relevant study.However, this study finds that there is a positive correlation between TCM syndrome scores and NIHSS scores,it implicates that TCM symptom severity is related to the degree neurological impairment and timely intervention to TCM syndrome may contribute to the recovery of neurological impairment.We need further and deeper research with more observation time, larger sample size, and wider TCM syndrome group to exploring more valuable information.