Study On The Correlation Between Lipoprotein-associated Phospholipase A2 And Hyaluronic Acid With The Formation Of Cerebral Collateral Circulation In Ischemic Stroke

Objective: Cerebrovascular angiography was used to determine the condition of cerebral collateral circulation in patients with ischemic stroke,and the association of lipoprotein-associated phospholipase A2(Lp-PLA2)and hyaluronic acid(HA)with the formation of cerebral collateral circulation was evaluated.The value of Lp-PLA2 and HA levels in judging the formation of cerebral collateral circulation was analyzed,and the factors affecting the formation of cerebral collateral circulation were analyzed.Methods: Based on the inclusion and exclusion criteria,42 patients who were admitted to the Department of Neurology in the Third People’s Hospital of Hubei Province from February 2017 to July 2017 were selected as research subjects.Detailed clinical data collected on admission,including hospital number,name,age,gender,previous medical history(including hypertension,diabetes,atrial fibrillation,hyperlipidemia,etc.)and smoking history,and patients National Institutes of Health Stroke Scale(NIHSS)score.Completed auxiliary examinations,such as admission to blood pressure,blood routine,liver and kidney function,homocysteine,blood lipids,blood sugar,glycated hemoglobin,head CT,or MRI.Serum from patients before cerebral angiography was collected for uniform detection of Lp-PLA2 and HA levels.The results of cerebral angiography were evaluated and graded according to the American Society of Interventional and Therapeutic Neuroradiology/Interventional Radiology(ASITN/SIR)criteria.Among them,patients with grades 0 to 2 were divided into poor collateral circulation group,and patients with grades 3 to 4 were divided into good collateral circulation group.The differences of Lp-PLA2,HA levels and clinical data between the two groups were investigated and statistical analysis was performed.The receiver operating characteristic(ROC)curve was used to evaluate the value of serum Lp-PLA2 and HA levels in determining cerebral collateral circulation in patients with ischemic stroke.Logistic regression analysis was used to analyze the factors affecting the formation of cerebral collateral circulation.Results: 1.A total of 42 patients were included in this study,including 12 with good collateral circulation and 30 with poor collateral circulation.The difference in admission systolic blood pressure(SBP)between the patients with good collateral circulation and those with poor collateral circulation was statistically significant(t=-2.241,P=0.031).There was no significant difference in gender,age,history of smoking,history of hypertension,diabetes,atrial fibrillation,hyperlipidemia,admission diastolic blood pressure(DBP),admission NIHSS score,the levels of gamma-glutamyl transferase(GGT),total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),uric acid(UA),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),triglyceride(TG),total cholesterol(CHOL),HbA1 c,blood glucose(GLU)and homocysteine(HCY)between the two groups(P>0.05).2.The serum Lp-PLA2 levels in the good collateral circulation group were higher than those in the poor collateral circulation group(t=-2.876,P=0.006).There was no significant difference in serum HA levels between the two groups(P>0.05).According to the patient’s serum Lp-PLA2 and HA detection results,the ROC curve was drawn.The serum Lp-PLA2 level had a certain value,the area under the curve was 0.767,and the progressive 95% confidence interval was(0.622-0.911),P=0.008.The sensitivity was 83.3%,the specificity was 66.7%,the Youden index was 0.500,and the corresponding critical serum Lp-PLA2 level was 11.77 ng/mL;however,the ROC curve drawn according to the serum HA level was not statistically significant(P>0.05).3.Pearson correlation analysis between serum Lp-PLA2 levels and admission SBP showed that there was no significant correlation between the two indicators of all patients(r=0.293,P>0.05),patients with good collateral circulation(r=0.147,P>0.05)and patients with poor collateral circulation(r=0.190,P>0.05).4.Logistic regression analysis of factors affecting the formation of cerebral collateral circulation showed admission SBP(OR=1.032,P=0.041)and serum Lp-PLA2 levels(OR=1.562,P=0.013)were significantly correlated with the formation of cerebral collateral circulation.However,there was no significant correlation between the gender,age,history of smoking,history of hypertension,diabetes,atrial fibrillation,hyperlipidemia,admission DBP,admission NIHSS,the levels of GGT,TBIL,DBIL,IBIL,UA,LDL-C,HDL-C,TG,CHOL,HbA1 c,GLU,HCY and HA(P>0.05).Multivariate logistic regression analysis of the factors associated with the formation of cerebral collateral circulation indicated that serum Lp-PLA2 level was an influencing factor for the formation of cerebral collateral circulation(OR=1.459,P=0.041).Conclusion: 1.Serum Lp-PLA2 level is an influencing factor for the formation of cerebral collateral circulation in ischemic stroke.It has a certain value for judging the formation of collateral circulation in ischemic stroke with a sensitivity of 83.3% and a specificity of 66.7%.The critical value of serum Lp-PLA2 level was 11.77 ng/mL.The formation of collateral circulation was better in ischemic stroke patients with higher serum Lp-PLA2 levels.2.Serum HA level is not an influencing factor for the formation of collateral circulation in ischemic stroke,and it has no obvious value in the formation of cerebral collateral circulation in ischemic stroke.There is no statistical difference in serum HA level between good and poor cerebral collateral circulation.significance.3.The admission systolic systolic blood pressure was higher in patients with good collateral circulation,but there was no significant correlation between elevated serum Lp-PLA2 levels and increased admission systolic blood pressure.4.There was no significant difference in NIHSS scores between patients with good lateral collateral circulation and those with poor collateral circulation.