| Objective Stroke is still one of the leading causes of death worldwide,which is characterized by high incidence,high disability rate and high mortality.Atherosclerosis is one of the most common causes of acute cerebral infarction.Although intravenous injection of recombinant tissue plasminogen activator or intravascular thrombectomy is the main method for the treatment of acute ischemic stroke,there are still only a few benefits in the treatment time window and technical requirements of its stenosis.It has become a common concern of clinicians to actively evaluate the severity and prognosis of patients with acute ischemic stroke.CCL21 is a steady-state chemokine that transduces signals through CCR7 or CXCR3,which plays an important role in adaptive immune response and inflammatory response.CCL21 may be a candidate marker of ischemic stroke.Here,we aim to study the prognostic significance of CCL21 in patients with acute ischemic stroke(ACI).Methods A total of 129 patients with atherosclerotic acute cerebral infarction who were hospitalized in the Department of Neurology of Subei people’s Hospital from March 2020 to December 2020 were collected.Age-and sex-matched community stroke screening population: a healthy control group of 71 cases.All patients with cerebral infarction were confirmed by cranial MRI/CT examination.According to the results of etiological screening of polyvascular bed,the patients were classified by TOAST,and the volume of cerebral infarction was calculated according to Pullicino formula.The general clinical information of the patients was collected in detail,including age,sex,body mass index(BMI),history of hypertension,history of coronary heart disease,history of smoking,history of peripheral vascular disease,history of diabetes.Laboratory indexes on admission,such as cholesterol,triglyceride,low density lipoprotein,high density lipoprotein,creatinine,glutamic pyruvic transaminase,glutamic oxaloacetic transaminase,homocysteine,uric acid,urea nitrogen,glycosylated hemoglobin,neutrophils,D-dimer,etc.The neurological deficit was evaluated by NIHSS score on admission,and the functional prognosis of 90 days was evaluated by modified Rankin scale score(m RS).Fasting blood samples were taken from all patients the next morning,and the level of serum CCL21 was detected by ELISA method.The functional prognosis of patients at90 days was evaluated by modified Rankin score.m RS0～2 score was defined as good prognosis and 3-6 as poor prognosis.According to m RS score,patients were divided into two groups: good prognosis group and poor prognosis group.The increase of NIHSS score by more than 2 points or the occurrence of any new neurological impairment at any time point within 7 days after onset is defined as stroke progression.To compare the difference of CCL21 expression between large atherosclerotic cerebral infarction group and healthy control group,and to explore the correlation between serum CCL21 content and NHISS score and infarction volume in patients with large atherosclerotic cerebral infarction.Comparative analysis of the difference of general baseline data and serum CCL21 levels between patients with good prognosis and poor prognosis in patients with large atherosclerotic cerebral infarction.Binary logistic regression model was used to analyze the effects of cerebral infarction volume,NHISS score and serum CCL21 level on functional prognosis of patients.The prognostic value of serum CCL21 detected by receiver operating characteristic curve(ROC curve).Results 1.The level of serum CCL21 in the healthy control group was 931.44 ±359.31 ng / ml,and that in the atherosclerotic cerebral infarction group was 1079.96 ±562.59 ng / ml.Compared with the healthy control group,the serum CCL21 level in the atherosclerotic cerebral infarction group was significantly higher than that in the control group(P < 0.05).2.The level of serum CCL21 in patients with large atherosclerotic cerebral infarction was positively correlated with the severity of the patients(NHISS score,r = 0.241)and the volume of cerebral infarction(r = 0.292,P = 0.006).3.The level of serum CCL21 in patients with atherosclerotic cerebral infarction in poor functional prognosis group was significantly higher than that in poor prognosis group(1240.21 ±595.96 vs 964.58 ±510.76).4.129 patients with atherosclerotic acute cerebral infarction were included,including 54 patients with poor prognosis and 75 patients with good prognosis.There were significant differences in age,history of hypertension,NIHSS score,cerebral infarction volume,aspartate aminotransferase and blood homocysteine between the two groups(P< 0.05).In addition,we compared the number of stroke progression between the two groups,7 cases in the good prognosis group(9.3%)and 21 cases in the poor prognosis group(38.9%).The number of stroke progression in the poor prognosis group was significantly higher than that in the poor prognosis group(P < 0.05).5.Binary logistic regression showed that the functional prognostic risk factors of 90 days included NIHSS score at admission(OR 1.139,95% CI 1.006-1.218,P<.001).The level of serum CCL21 on admission(OR 1.001,95% CI 1.000-1.013,P= 0.047).6.Receiver operating characteristic curve of serum CCL21 level predicts the prognosis of stroke.The area under the curve was 0.654(P=0.03;95% CI 0.56 ～ 0.75).The best cut-off value of serum CCL21 for predicting stroke prognosis is 1099.38 ng/m L,the specificity is 75.5%,and the sensitivity is 59.3%.Conclusion The level of serum CCL21 in patients with atherosclerotic acute cerebral infarction was significantly higher than that in healthy controls at admission,and it was positively correlated with cerebral infarction volume and NHISS score.The increase of serum CCL21 level on admission(> 1099.38ng/ml)was positively correlated with poor functional prognosis of patients with atherosclerotic acute cerebral infarction for 90 days.The pathophysiological mechanism of CCL21 affecting the pathogenesis and prognosis of ACI and the value of serum CCL21 level as a potential biomarker need to be further studied. |
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