Detection Of Serum IL-17 And IL-23 In Patients With Acute Cerebral Infarction And Its Clinical Significance

Background and Objective:Cerebral infarction,also known as ischemic stroke,refers to the ischemic necrosis or softening of local brain tissue caused by cerebral blood circulation disorder,ischemia and hypoxia[1].Brain cells are sensitive to ischemia and hypoxia.The interruption of cerebral blood flow for 5 minutes will lead to irreversible damage of nerve cells and damage of neurological function.Because of the high incidence rate of cerebral infarction and the limitation for the therapy of time window,the morbidity and mortality of cerebral infarction are high,which brings heavy burden to family and society[2-3].How to prevent and control cerebral infarction and reduce the harm caused by cerebral infarction has become the focus of current research.In recent years,it has been found that inflammatory response plays an important role in the pathophysiological process of cerebral infarction,but there are few studies on the relationship between the levels of serum IL-17 and IL-23 and the severity and prognosis of cerebral infarction.In this study,the changes of serum levels of IL-17 and IL-23 in patients with acute cerebral infarction at different time points were detected,and the relationship between serum IL-17 and IL-23 and infarction volume,NIHSS score and mRS score in patients with acute cerebral infarction was evaluated,in order to find effective biomarkers for the prediction of the severity and prognosis of patients with acute cerebral infarction.MethodsNinety patients with acute cerebral infarction diagnosed by cranial CT or MRI within 24 hours of onset were selected.The ratio of male to female was 52:38.Another 50 healthy persons were selected as healthy control group.On day 1,3,7 and 14 after the onset of the disease,blood samples were collected in the infarct group,and blood samples were also collected in the control group at the time of physical examination.The serum levels of IL-17 and IL-23 in patients with acute cerebral infarction were measured by enzyme-linked immunosorbent assay(ELISA),and compared with those in the control group.According to NIHSS score(stroke scale of National Institutes of Health),they were divided into three groups:group a with NIHSS?5,group b with 5<NIHSS?12,and group c with NIHSS>12.We used the modified mRS,a 7-point scaleranging frorn 0(no symptoms)to 6(death),to assessneurologic outcomes on day 90 after symptom onset.Tosatisfy the proportional odds assumption,we reclassifiedthe mRS as follows:mRS 0-3(good outcome),mRS 4-6(poor outcome).The serum levels of IL-17 and IL-23 were measured at different time points in patients with acute cerebral infarction.The relationship between the levels of IL-17 and IL-23 and clinical neurological deficit score on admission,mRS score at 90 days after the onset of the disease,and the effect of IL-17 and IL-23 on the prognosis of neurological function in patients with acute cerebral infarction were analyzed.Results1.The serum levels of IL-17 and IL-23 in the patients with acute cerebral infarction were significantly higher than those in the healthy control group(p<0.01),and the content of both reached the peak on the third day after the onset of the disease,and gradually decreased with the extension of time.However,they were still significantly higher than the control group until the day 14 after the onset of the disease(p<0.01).2.The levels of serum IL-17 and IL-23 in patients with acute cerebral infarction with different NIHSS scores were different(p<0.001).NIHSS score was positively correlated with serum level of IL-17 in patients with acute cerebral infarction(r>0.641,P<0.01).3.The clinical data of patients with good and poor prognosis were analyzed in patients with acute cerebral infarction.The results showed that the serum level of IL-17(84.65 � 17.74 VS 94.43�19.17,t=2.21,p=0.029),IL-23(23.07�2.66 VS 24.02�1.62,t=2.11,p=0.038),diabetes(8 VS 22,?2=4.46,p=0.035),atrial fibrillation(2 VS 12,?2=5.304,p=0.021),cardiogenic cerebral infarction(2 VS 12,?2=5.304,p=0.021),cerebral infarct volume(5.16�4.95 VS 8.92�10.30,t=-2.078,p=0.041),and NIHSS score(6.18�2.20VS 6.63�5.10,t=3.091,p=0.003)on admission were significant different between patients with good and poor prognosis(p<0.05).The results of logistic regression analysis showed that the size of cerebral infarction(OR=21.350,p=0.00.1)was an independent risk factor for the prognosis of neurological function within 90 days.The results of logistic regression analysis showed that high IL-17 content(OR=2.320,p=0.004),high NIHSS score(OR=1.672,p=0.044)and history of type 2 diabetes(OR=1.902,p=0.031)were independent risk factors for predicting the poor prognosis of patients with acute cerebral infarction at 90 days after stroke onset.Conclusion1.The content of IL-17 and IL-23 in the serum of patients with acute cerebral infarction increased significantly when compared with healthy control group.The content of IL-17 was positively correlated with the clinical NIHSS score of patients,which may be used as a laboratory index to evaluate the severity of the disease of patients with acute cerebral infarction.2.This study also found that higher IL-17 level on the third day of the disease,higher NIHSS score on admission and history of typ e 2 diabetes mellitus were independent risk factors for poor prognosis.of patients with acute cerebral infarction on day 90 after stroke onset.