Clinical Application Of Serological Markers In Risk Assessment Of The Acute Ischemic Stroke

Background and purposeCerebrovascular disease is one of the most common morbidity and mortality problems in the world.There are millions of new patients each year in the world,which brings serious burden to the society and the family.Ischemic stroke,IS)as an important type of cerebrovascular disease,accounting for 60-80%of all stroke.It is caused by various causes of brain blood supply disorders,leading to brain tissue ischemia,hypoxia necrosis,resulting in irreversible consequences,causing the corresponding symptoms and signs.Nearly 10%of patients can die in the acute phase of the disease,its early diagnosis is the key to timely and effective treatment.To clarify the correlation between acute ischemic stroke and serum markers,and to provide reference for early prevention and treatment of acute ischemic stroke.This study was to investigate the effects of total cholesterol(TC),total triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),and superoxide dismutase in patients with acute ischemic stroke(Hs-CRP),homocysteine(HCY),lipoprotein-associated phospholipase A2(Lp-PLA2),ischemic modified albumin(IMA),complement C1q,(Clq),lipoprotein a[Lp(a)]were analyzed and compared,which provided the basis for clinical selection and optimization of more reasonable and economical combination of serological markers.And the levels of serum lipoprotein aLp(a)in patients with acute ischemic stroke were analyzed and compared by particle unit test and mass method.The diagnosis of nuclear magnetic resonance was used as the gold index of diagnosis.Comparison of the sensitivity,specificity and accuracy of the two methods to elucidate the clinical value for acute ischemic stroke.The levels of complement Clq in the serum of patients with acute ischemic stroke were compared with those of 42 healthy controls.The relationship between the level of serum complement C1q and the risk of acute ischemic stroke and its severity was analyzed to provide experimental basis for clinical diagnosis.Objects and methods1.154 patients with acute ischemic stroke who were hospitalized in Liaocheng People’s Hospital from January 2015 to June 2015 were enrolled within 72 hours of onset.All cases were confirmed by brain CT or MRI.All of these cases are in line with the guidelines for the diagnosis and treatment of acute ischemic stroke in China 2010,exclusion criteria:(1)lacunar infarction,recurrent cerebral infarction;(2)cardiogenic pulmonary embolism;(3)severe infection and Heart,liver and kidney disease;(4)tumor and autoimmune diseases;(5)cerebral hemorrhage after infarction(6)taking hypolipidemic drugs.At the same time randomly selected 42 healthy subjects of Liaocheng City People’s Hospital physical examination center as a normal control group.The trial study was approved by Liaocheng City People’s Hospital Ethics Committee and all patients or their families agreed to obtain informed consent.2.All specimens were collected after the first day of admission in the morning fasting,placed in the coagulation tube 3ml,in 1200g centrifugation 6min separation supernatant to the EP tube,unified number after the rear-80 ℃ refrigerator.Finally unified through the Beckman DXC800 measurement data.All data were analyzed by SPSS 17.0 software.Result1.The levels of TC,TG,LDL-C,hs-CRP,HCY,Lp-PLA2,IMA,Clq and Lp(a)in acute ischemic stroke group were higher than those in normal control group(P 小于0.01)With the increase of the maximal diameter of the infarct,the level of each item was also increased(P 小于 0.05)2.The positive rates of TC,TG,LDL-C,hs-CRP,HCY,Lp-PLA2,IMA,C1q,Lp(a)in acute ischemic stroke group were higher than those in control group(P 小于 0.01)HCY single diagnosis of the positive rate of up to 89.9%.3.The other nine indicators except HDL-C were combined to obtain the maximum working area under the subject’s characteristic curve(ROC curve)4.The positive rate for acute ischemic stroke of particle unit test and mass method was significantly higher than the control group,And the positive rate of particle units was higher than that of mass method(p小于 0.01).The sensitivity and specificity of particle units test method for Lp(a)were significantly higher than those of mass method.The particle unit test method has a better correlation with the degree of neurological deficit in patients with acute ischemic stroke than mass method。5.The level of serum complement Clq in acute ischemic stroke group was higher than that in control group.The conditional logistic regression model showed that complement Clq in serum was an independent risk factor for acute ischemic stroke.6.The level of complement Clq in the acute ischemic stroke group decreased with the prolongation of the onset time.With the increase of the maximal diameter of the infarct,the level of complement C1q in the serum was increasing,P小于 0.05.Conclusion1.TC,TG,LDL-C,hs-CRP,HCY,Lp-PLA2,IMA,C1q,Lp(a)are risk factors for acute ischemic stroke and can be used to assess ischemic brain The risk of stroke.2.Through the multivariate Losistic regression analysis and ROC curve found that HDL-C for acute ischemic stroke is the smallest of the ten serological markers in the variable.3.The ROC curves of the remaining 9 markers except HDL-C showed that the nine kinds of markers together were the largest area under the ROC curve,the ROC curve area among which the serum lipids three,CRP,HCY,Lp-PLA2 and IMA,C1q,Lp(a),respectively combined was no significant difference with nine kinds of markers together,can be seen as having the same diagnostic value.4.The positive rate and sensitivity and pecificity of particle unit test in the diagnosis of acute ischemic stroke were higher than those of mass method,There is a better correlation between the assessment of neurological deficits in patients with ischemic stroke..5.By conditioned logistic regression model test found that serum complement C1q for acute ischemic stroke independent pathogenic factors.And its content in the serum and acute ischemic stroke patients were negatively correlated with the incidence of infarct size in patients with a positive correlation.And was moderately correlated with the neurological deficit score(NIHSS score).