| Objective:In this study,acute ischemic stroke patients were observed to clarify the following questions:(1)To detect the expression and changes of specialized pro-resolving mediator resolvin D1(Rv D1)and proinflammatory factor leukotriene B4(LTB4)in the peripheral blood of acute ischemic stroke patients with time and treatment changes.(2)To explore the correlation between remote ischemic postconditioning(RIPost C)and specialized pro-resolving mediators(SPMs)in playing a protective role in patients with acute ischemic stroke.(3)Whether multiple stroke risk factors affect the expression of Rv D1,LTB4 and Rv D1/LTB4 ratios in the peripheral blood of patients with acute ischemic stroke.Methods:(1)According to the inclusion criteria and exclusion criteria,patients with acute cerebral infarction hospitalized in the department of neurology of the first hospital of Jilin university within 72 hours of the onset of the disease were selected.They were divided into the conventional treatment group and RIPost C treatment group based on patients’ own will.Volunteers with matching age,sex and no history of cerebral infarction or other inflammation-related diseases were recruited and included in the control group at the same time.By November 2020,there were 68 patients in the conventional treatment group,38 in the RIPost C group,and 20 in the control group.The patients in conventional treatment group and RIPost C group were both treated with regular treatment(aspirin,statins,neuro nutrition drugs and circulation improvement drugs),but the RIPost C group were also treated with RIPost C that cause intermittent arm ischaemia through five cycles of 5-min inflation and 5-min deflation of a blood-pressure cuff,twice a day,for 7 days.General information,neutrophil count(NE#),lymphocyte count(LY#)and neutrophil to lymphocyte ratio(NLR)were recorded before treatment,1d and 7d after treatment after treatment.NIHSS score and ADL score were assessed before and 7 days after treatment to evaluate the neurological deficits for patients in the RIPost C group and the conventional treatment group.(2)Fasting peripheral blood samples of the RIPost C group were collected in the morning before treatment,1d and 7d after treatment,blood samples of the conventional treatment group were collected at the same time,and fasting blood samples of the control group were also collected.Serum was isolated within 2 hours.Elisa was used to detect expression of Rv D1 and LTB4 in peripheral blood serum,and Rv D1/LTB4 was calculated.The effect of the NIHSS score before and after treatment,Δ NIHSS,onset time,blood glucose abnormalities,dyslipidemia and other factors on the above indicators were analyzed.(3)SPSS 22.0 and Graph Pad Prism7 are used for data analysis and chart making.Results:(1)The NIHSS changes in patients undergoing RIPost C treatment were more significant than those in the conventional treatment group(P<0.05).(2)Compared with the control group,Rv D1 concentration in acute ischemic stroke patients was higher while LTB4 was remarkably lower,there were significant differences(P<0.05).The Rv D1 and LTB4 concentration of RIPost C group patients was significantly higher than that in the conventional treatment group,significant differences are observed in LTB4 concentration(P<0.05).(3)Rv D1 and LTB4 changed with the onset time of acute ischemic cerebral infarction,RVD1 and LTB4 concentration of patients on the 8th day of onset was higher than that on the 2nd or 3rd day of onset,but there was no significant difference(P>0.05).The difference of LTB4 concentration measured on the 2nd,3rd and 8th day was statistically significant(P <0.05).(4)For conventional treatment group: Patients were divided into different subgroups according to NIHSS scores before and after treatment.According to the NIHSS score before treatment,Rv D1/LTB4 ratios of patients with mild ischemic stroke were higher 7 days after treatment than before and 1 day after treatment(P<0.05).Patients with mild ischemic stroke before treatment had higher Rv D1 concentrations and Rv D1/LTB4 ratios and lower LTB4 concentrations at all time points compared with those with moderate ischemic stroke(P<0.05).According to the NIHSS score after treatment,patients with mild ischemic stroke after treatment had lower LTB4 concentrations but higher RVD1 /LTB4 ratios compared with those with moderate ischemic stroke(P<0.05).The blood glucose level of patients was positively correlated with Rv D1 concentration before and after treatment.WBC,NE%,NE#,and NLR were positively correlated with LTB4 concentration before treatment.NE%,NE# and NLR was negatively correlated with Rv D1/LTB4 before treatment.The above results were statistically significant(P<0.05).(5)For RIPost C group: whether they received RIPost C within 1 day after acute ischemic stroke affect peripheral Rv D1 and LTB4 concentration change with time and the corresponding Rv D1/LTB4 ratios.Patients were divided into different groups in accordance with the NIHSS score before and after the treatment and ΔNIHSS of patients.According to the NIHSS score before treatment,Rv D1 and LTB4 of patients with mild ischemic stroke were higher 7 days after RIPost C than those of patients with moderate ischemic stroke(P<0.05).According to the NIHSS score after treatment,Rv D1,LTB4 and Rv D1/LTB4 ratios of patients of NIHSS 2~4 group were higher than those of the rest groups(P<0.05).Rv D1 and Rv D1/LTB4 ratios ofΔNIHSS 0~3 group were higher than those of ΔNIHSS 4~8 group(P<0.05).Rv D1 in patients with diabetes or dyslipidemia was higher than that in patients with normal blood glucose and lipids,and the differences were statistically significant(P<0.05).Rv D1 concentration was positively correlated with homocysteine before treatment(r=0.356,P=0.028),and NLR was negatively correlated with Rv D1 after treatment(r=-0.345,P=0.034).Conclusion:(1)RIPost C is beneficial to the recovery of neurological function after acute ischemic stroke.(2)Rv D1/LTB4 can be one of the indicators reflecting the changes of peripheral inflammation after acute ischemic stroke.(3)RIPost C may play a neuroprotective role in patients with acute ischemic stroke by altering the concentration of inflammatory resolution related mediators such as Rv D1 and LTB4 in peripheral blood.(4)Factors influencing the changes of Rv D1 and LTB4 in peripheral blood of patients with acute ischemic stroke include time of onset,diabetes and neurological deficits before treatment.(5)Factors influencing the changes of Rv D1 and LTB4 in peripheral blood of patients after RIPost C include time of treatment application,neurological deficits before treatment,diabetes,dyslipidemia,homocysteine and so on. |
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