Analysis And Clinical Evaluation Of Serum CTRP9 And APN Levels In Patients With Cerebral Infarction

ObjectiveTo explore the changes of C1q/TNF-related protein-9(CTRP9)and adiponectin(APN)with different molecular weight in the occurrence and development of cerebral infarction,and to analyze the relationship between CTRP9,APN and cerebral infarction,so as to provide a new clinical direction and experimental basis for comprehensive prevention and treatment of cerebral infarction.MethodsAccording to the criteria of case inclusion,exclusion and grouping,269 patients with cerebral infarction in our hospital were selected as cerebral infarction group from October2016 to November 2017,while another 182 non-cerebral infarction patients as control group from March to May 2017.According to the results of blood lipid test,all cases were divided into non-dyslipidemia group(n=297)and dyslipidemia group(n=154).Then subgroups are further distinguished.The serum levels of CTRP9 and APN with different molecular weight were compared between cerebral infarction group and control group,and among subgroups.The differences were analyzed by rank correlation analysis and binary logistic regression analysis.The changes of CTRP9 and APN levels in different TOAST subtypes and different stages of the disease were observed.Results1.CTRP9 was closely related to total adiponectin(tAPN)and high molecular weight adiponectin(HMW)(r_s=0.992,0.991,P<0.001,respectively).Meanwhile,high concentration of serum CTRP9 is an independent protective factor for cerebral infarction(OR=0.400,95%CI 0.197-0.810,P<0.05).2.No significant difference in serum CTRP9 and APN levels was found when compared between cerebral infarction group and control group(P>0.05).According to the results of blood lipid test,all cases were divided into non-dyslipidemia group(n=297)and dyslipidemia group(n=154).Then all cases in cerebral infarction group and control group were further divided into subgroups according to whether the patients had dyslipidemia or not.Patients in cerebral infarction group were divided into non-dyslipidemia cerebral infarction subgroup(n=182)and dyslipidemia cerebral infarction subgroup(n=87),while patients in control group were divided into non-dyslipidemia control subgroup(n=115)and dyslipidemia subgroup(n=67).Compared between the non-dyslipidemia subgroups,the serum CTRP9[0.44(0.83)ng/ml],tAPN[12.21(11.66)?g/ml]and HMW[11.38(11.76)?g/ml]levels in cerebral infarction subgroup,especially in the patients with large artery atherosclerotic cerebral infarction subtype(LAA)[CTRP9 0.43(0.78)ng/ml?tAPN12.05(10.76)?g/ml?HMW 11.23(10.89)?g/ml],were lower than those in control subgroup[CTRP9 0.66(0.76)ng/ml?tAPN 15.07(12.05)?g/ml?HMW 14.16(11.93)?g/ml](P<0.05).3.Compared with other stages,the plasma level of middle molecular weight adiponectin(MMW)increased significantly within 72 hours in patients with LAA[26.52(32.24)ng/ml](P<0.05),while the plasma levels of CTRP9,tAPN and HMW decreased first and then increased in patients with small artery occlusion cerebral infarction subtype(SAO)between the 4th and 10th days of the course[CTRP9 0.18(0.33)ng/ml?tAPN 7.89(6.68)?g/ml?HMW 7.46(6.06)?g/ml](P<0.05),which is similar to those in the cerebral infarction group.The serum low molecular weight adiponectin(LMW)concentration in SAO with the stage of more than a month[0.81(0.32)?g/ml]was higher than that in control group[0.71(0.33)?g/ml]and other stages(P<0.05).4.The concentration of serum MMW in patients with cardiogenic cerebral embolism subtype(CCE)was higher than that in control group(P<0.05).The serum levels of CTRP9,tAPN and HMW in Stroke of other determined and undetermined causes were lower than those in control group(P<0.05).Conclusion1.CTRP9 is highly positively correlated with tAPN and HMW.High concentration of CTRP9 is an independent protective factor of cerebral infarction and may have protective effect on reducing the risk of cerebral infarction.It may have protective effect on brain tissue and reducing brain injury in the course of cerebral infarction.2.In the non-dyslipidemia group,the serum levels of CTRP9,tAPN and HMW in cerebral infarction subgroup were lower than those in control subgroup,especially in LAA subgroup.3.The serum levels of CTRP9,tAPN and HMW in cerebral infarction group decreased first and then recovered,especially in SAO group.4.The concentration of CTRP9 and APN in serum is closely related to cerebral infarction.There are significant differences in the concentration of CTRP9 and APN isoforms in different TOAST subtypes and stages of cerebral infarction,which suggest that CTRP9 and APN isoforms may be used as reference indicators for clinical diagnosis of cerebral infarction and effective clinical intervention for cerebral infarction patients and providing reference basis for follow-up research.