| Objective The purpose of this research was to explore the relationship between plasma NGAL level and stroke risk and prognosis in patients with acute cerebral infarction,to study the role and clinical significance of NGAL in the occurrence of acute cerebral infarction,and to explore the value of this index in evaluating the prognosis of cerebral infarction.Methods This research included patients with acute cerebral infarction hospitalized in Department of Neurology,Jiangsu Shengze Hospital,from October 9,2017 to August 17,2018.The patients' gender,age,past history(hypertension,diabetes,hyperlipidemia,coronary disease),family history of stroke,personal history(smoking history,drinking history),onset time,total cholesterol,fasting blood-glucose,C-reactive protein,plasma NGAL level,blood pressure and NIHSS score at admission were recorded.In addition,asymptomatic lacunar infarction patients or healthy people who were hospitalized in Shengze Hospital of Jiangsu Province during the same period were included as control group.Gender,age and serum NGAL levels were recorded respectively.The prognosis of patients with acute cerebral infarction 3 months after onset was followed up and scored with Modifield Rankin Scale scale.The correlation between plasma NGAL level and the incidence of acute stroke was determined by variance analysis.Univariate analysis and multivariate analysis were used to determine the correlation between NGAL levels in patients with acute stroke and prognostic evaluation in 90-days acute stroke patients.Results 1)A total of 86 patients with acute cerebral infarction in the research group and 112 patients in the control group were included.The proportion of male and family history of stroke in the research group was slightly higher than that in the control group(P=0.041;0.047).The proportion of smoking history,hypertension history,diabetes history and the level of systolic and diastolic blood pressure in the research group were significantly higher than those in the control group(all P<0.001).There was no difference in plasma NGAL level between the two groups(P=0.674).2)Eighty-six patients with acute cerebral infarction in the research group were divided into two sub-groups according to the median level of plasma NGAL(1 17.7ng/mL).42 patients in the low NGAL group(NGAL<117.7ng/mL)and 44 patients in the high NGAL group(NGAL>117.7ng/mL).It was found that younger age((P=0.018)and higher fasting blood-glucose levels((P=0.007))in the low NGAL group.The subjects were divided into three sub-groups according to the level of plasma NGAL three-position(<105.8 ng/mL group,105.8-140.69 ng/mL group and>140.9 ng/mL group).The results showed that:(1)the patients of the medium NGAL group was the youngest,and the patients of the high NGAL group was the oldest(P=0.001).(2)High NGAL group had the lowest level of fasting blood-glucose on the next day of admission,while low NGAL group had the highest level of fasting blood-glucose(P=0.004).(3)The acute stroke patients with high NGAL had the lowest proportion of diabetes mellitus,while the patients with low NGAL had the highest proportion of diabetes mellitus(P=0.007).There was a significant positive correlation between plasma NGAL level and age(P=0.005),and a significant negative correlation with fasting blood-glucose level(P=0.033).3)Acute cerebral infarction patients was divided into good prognosis sub-group(mRS score 0-1)63 cases and poor prognosis sub-group(mRS score 2-6)23 cases according to clinical outcomes.The results showed that the average age of the good prognosis group was younger(P=0.029),the NIHSS score was lower(P<0.001),and the levels of C-reactive protein and NGAL in plasma were significantly lower than those in poor prognosis group(P=0.018;P=0.034).4)Univariate analysis of 90-day good prognosis in patients with acute cerebral infarction showed that plasma NGAL level,age and NIHSS score at admission were related to 90-day good prognosis.Compared with the high NGAL group(>117.7 ng/mL),the low NGAL group(NGAL<117.7 ng/mL)had a significantly higher probability of good prognosis(P=0.023).The probability of good prognosis decreased by 5%(P=0.034)for every one year increase in age,and 53%(P=0.001)for every one point increase in NIHSS score.Multivariate adjusted analysis showed that plasma NGAL level and NIHSS score at admission were still associated with a good prognosis after 90 days.Patients in low NGAL group(<117.7 ng/mL)had a 5.43 times higher probability of good prognosis than those in high NGAL group(>117.7 ng/mL)(P=0.039).The probability of good prognosis was reduced by 63%(P=0.003)for each increase in NIHSS score.5)The incidence of 90-day good prognosis in patients with cerebral infarction was analyzed according to the median and tri-level of NGAL.The results showed that the incidence of 90-day good prognosis in low NGAL group(<117.7 ng/mL)was significantly higher than that in high NGAL group(>117.7 ng/mL)(P=0.028).After dividing the subjects into three groups,the lowest three group had the highest incidence of good prognosis,while the highest three group had the lowest incidence of good prognosis(P=0.020)?After multi-factor adjustment,the probability of good prognosis in the lowest three group was 16.68 times higher than that in the highest three group.6)The ROC curve was used to evaluate the predictive ability of NGAL for 90 days of good prognosis in patients with acute cerebral infarction.It was found that the optimal threshold value was 130ng/mL,and the probability of good prognosis was significantly increased in patients with plasma NGAL level lower than 130ng/ml(OR:10.92;95%CI:1.85-64.34;P=0.008)?Conclusion 1)The plasma NGAL level in patients with acute cerebral infarction was correlated with age and fasting blood-glucose level on the second day of admission.2)The 90-day prognosis of patients with acute cerebral infarction was significantly correlated with plasma NGAL level,which was lower and had better prognosis. |
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