Study On Serum Levels Of Del-1 And IL-17 And Their Clinical Relevance In Patients With Acute Cerebral Infarction

Stroke is a significant global health concern.Acute cerebral infarction(ACI)accounts for more than 85% of all strokes and seriously harms human health.It has been the focus of researches for it?s high incidence and high mortality rate.Therapeutic angiogenesis and modulation of adaptive immunity after ACI is correlated to longer survival in patients with ischemic stroke.Developmental endothelial locus-1(Del-1)is a recently characterized extracellular matrix protein that may play an important role in vascular remodeling and anti-inflammatory,and there is evidence that Del-1 expression is inversed to Interleukin-17(IL-17).Our study have detected the dynamic changes of serum levels of Del-1and IL-17 in the acute phase of cerebral infarction,and analyzed the correlation between Del-1 and IL-17 with the clinical features and outcomes of ACI,and then provides new ideas for the treatment and prognosis of ACI.Method62 patients diagnosed ACI were invesgated at the depatment of Neurology in Affiliated Hospital of Xi'an Medical University from April,2017 to January,2018.32 healthy volunteers matched in age and gender are recruited as control group,which are from our Health Examination Center during the same period.All patients were admitted within 24 hours of onset.They accepted the same medication after admission,thrombolytic therapy were excepted.Observe the serum Del-1,IL-17 levels of patients on admission(day 1),day 3,day 7 anddays 14 after onset,and check the control group for comparison.All subjects were obtained clinical information,especially the NIHSS scores on admission,infarction volume at day 3,NIHSS scores at week 2,mRS scores at 3 months follow-up of patients were collected.serum Del-1 and IL-17 levels were measured by enzyme-linked immunosorbent assay method.Statistical analysis included Single Sample Kolmogorov-Smirnov test,t-test,Mann-Whitney U test,Chi-square test,Analysis of variance(ANOVA),Person correlation analysis,Spearman correlation analysis,ROC curve,and Binary logistic regression analysis.Results1.Dynamical expression of Del-1 was significantly decreased in patients at each time point compared with controls.The levels of Del-1 began to decresed in the first 24 hours after ACI.Lowest expression occurred at day 7,and it remained low at day 14 after ACI(P<0.05).2.Dynamical expression of IL-17 was significantly increased in patients at each time point compared with controls.The levels of IL-17 began to incresed in the first 24 hours after ACI.Highest expression occurred at day 7,and it remained elevated at day 14 after ACI(P<0.01).3.Patients were devided into two groups acorrding to different clinical information.There were no significant differences in serum Del-1 levels between two groups of different clinical information(P>0.05).But there were significant differences of serum IL-17 levels in gender group,age group,FBG group and HbA1 c group(P <0.05),there were no significant differences in the other groups(P>0.05).4.There is negative linear correlation between serum Del-1 levels with age,white bloodcell count,HbA1 c,IL-17 levels,infarct volume,NIHSS score on admission,and NIHSS score at week 2(P<0.05).There is positive linear correlation between serum IL-17 levels with gender,age,white blood cell count,Del-1 level,infarct volume,NIHSS score on admission,and NIHSS score at week 2(P<0.05).5.Patients were devided into two groups acorrding to cutpoint of mRS of 2.The serum levels of Del-1 in patients with mRS?2 was higher than that in patients with mRS>2,but there was a statistically significant difference only at day 7(P<0.05),not at day 1,day 3 and days 14;The serum levels of IL-17 in patients with mRS?2 were significantly lower than those with mRS scores >2,and there was a statistically significant difference at each time points.6.Patients were devided into two groups acorrding to cutpoint of mRS of 2.There were significant differences in low-density lipoprotein levels,homocysteine levels,IL-17 levels,Del-1 levels,NIHSS scores on admission,NIHSS scores at week 2,cerebral infarct volume,and prevalence of hypertension between two groups.7.There is positive linear correlation between mRS scores with low-density protein levels,homocysteine levels,IL-17 levels,NIHSS scores on admission,NIHSS score at week 2,cerebral infarction volume,prevalence of hypertension,and prevalence of diabetes in patients.There is negative linear correlation between mRS scores with Del-1 levels.8.A ROC curve detected the IL-17 level of 36.71pg/ml at day 7 as the opitmum cutoff point according to result of follow-up(area under ROC curve 0.702±0.067,P = 0.0024,thesensitivity corresponding to this cutoff point is 95.65%,1-specificity is 41.0%)9.Binary logistic regression analysis showed that both complicating Diabetes and elevated NIHSS score at week 2 were independent risk factors for poor prognosis.Conclusion1.Del-1 may play an anti-inflammatory role in the pathological process of ACI,and IL-17 may play a proinflammatory role.Therefore,promoting the expression of Del-1 or inhibiting the expression of IL-17 may become new targets for the treatment of ACI.2.Del-1 and IL-17 are both related to the severity and prognosis of the disease.Either Del-1 or IL-17 might be the reference marker for judging the state and important agent for estimating prognosis of ACI3.Complicating Diabetes and elevated NIHSS score at week 2 were independent risk factors for poor prognosis.