Correlation Between Acute Hypertensive Reaction After Ischemic Stroke And Serum CTRP9 And Post-stroke Cognitive Impairment

Objective:As an important strategy for prevention and treatment of PSCI,early identification and intervention of post-stroke cognitive impairment(PSCI)are still in the exploratory stage.Hypertension and blood pressure variability are known risk factors of PSCI.Acute hypertensive response(AHR)is an important manifestation of stress.It means that the blood pressure measured twice within 5 minutes after the onset of ischemic stroke within 24 hours shows systolic blood pressure 3 140 mmHg or diastolic blood pressure 390mmHg.AHR is closely related to the recovery of limb function after stroke,but there are few studies on the correlation between AHR and PSCI.In addition,C1 q tumor necrosis factor-related protein 9(CTRP9)as a newly discovered adipose factor which is closely related to PSCI risk factors,so there may be a correlation between it and PSCI.Meanwhile,CTRP9 also plays a role in regulating inflammation and vasomotion,which may be correlated with AHR.In this study,a prospective cohort study was conducted to preliminarily explore the correlation between AHR,CTRP9 and cognitive impairment in acute ischemic stroke at 3 months.The occurrence mechanism of PSCI is complex,and a single indicator may be difficult to accurately reflect the body state.On the basis of the above research,it is further discussed whether AHR in combination with CTRP9 can give a better warning of PSCI,for providing laboratorial basis for the discussion of early warning indicators of PSCI.Methods:Acute ischemic stroke patients were consecutively recruited within the first 24 h after admission of the department of neurology of the west theater general hospital of the Chinese people's liberation army from 2017.01 to 2018.11.General cognitive function was assessed at 3 months after stroke using the Montreal Cognitive Assessment,and patients were divided into the non-PSCI group and the PSCI group according to the score.At the same time,the patient's executive function was assessed by a digital-character coding test.According to the definition of AHR,patients were divided into non-AHR group and AHR group.Blood samples were collected at 6:00-7:00 on the second day after admission,and human serum CTRP9 was detected by ELISA.Patientswere divided into low level group and high level group according to the number of the first quartile spacing of CTRP9 level,and on this basis,according to the presence or absence of AHR,patients were divided into non-AHR low level group,non-AHR high level group,AHR low level group and AHR high level group.In order to study the correlation between AHR,CTRP9 and PSCI,binary classification logistic regression analysis was used.Result:1.According to the inclusion criteria,a total of 268 patients were included.A total of107 cases were excluded according to the exclusion criteria,as well as loss follow-up and death.Finally,161 cases were included for statistical analysis.There were 102 cases of AHR(63.35%)and 59 cases of non-AHR(36.65%),and 54 cases(33.54%)without PSCI and 107 cases(66.46%)with PSCI in ischemic stroke patients at 3 months.The first quartile of the serum CTRP9 level was 131mmol/L.2.Correlation between AHR and PSCI: scores of Digital-character coding test and MoCA of AHR group were lower than that of non-AHR group(P(27)0.05);Logistic regression analysis showed that AHR was correlated with PSCI(OR=3.728,95% CI:1.719-8.085,P=0.001).3.Correlation between CTRP9 and PSCI: The level of serum CTRP9 in the PSCI group was significantly higher than that in the non-PSCI group;Logistic regression analysis showed that CTRP9 was correlated with the PSCI(OR(28)1.027,95% CI:1.012-1.041,P(27)0.001).4.Correlation between AHR and CTRP9: The level of serum CTRP9 in the AHR group was significantly higher than that in the non-AHR group;Logistic regression analysis showed that AHR was correlated with CTRP9(OR=1.022,95% CI:1.005-1.040,P=0.011).5.Correlation between AHR in combination with CTRP9 and PSCI: Logistic regression analysis showed that,AHR in combination with CTRP9 was correlated with PSCI(OR=5.892,95% CI: 1.763-19.692,P=0.004).Conclusion:1.AHR may be an early warning indicator of PSCI in ischemic stroke at 3 months.2.The level of serum CTRP9 in the PSCI group was also significantly higher thanthat in the non-PSCI group,indicating that CTRP9 might be an early-warning indicator of PSCI in 3 months after ischemic stroke.3.The occurrence mechanism of PSCI is complex,and neither single clinical index nor laboratory index can fully warn PSCI,and the clinical index combined with laboratory index may better warn PSCI.In this study,PSCI is more likely to occur in patients with ischemic stroke who have AHR and high level of serum CTRP9.