Correlation Analysis Of Blood Glucose,plasma Homocysteine And Stability Of Carotid Plaque

Ischemic stroke is often acute onset,most patients left different levels of sequelae,which has a great impact on the quality of life of patients.In recent years,the mortality rate of ischemic stroke has a downward trend,but the number of new patients is still growing rapidly,and the disability rate of survival patients is still high.The incidence of ischemic stroke is closely related to unstable carotid plaque.Therefore,we must seek accurate and reliable medical means to diagnose unstable carotid plaques early,and timely and effectively intervene in the treatment so as to reduce the incidence rate of stroke and reduce the disability rate.Objective:To explore the correlation between the different levels of blood glucose and plasma homocysteine（Hcy）and the stability of carotid plaque in patients with carotid plaque complicated with cerebral infarction with the type of large-artery atherosclerosis,so as to provide a reference for reducing patients with LAA cerebral infarction.Methods:1 Collecting the medical histories of the inpatients in the neurosurgery and neurology in our our hospital from July 2019 to June 2020,who conform to the LAA cerebral infarction combined carotid plaques and are over the age of 40.The patients with interference factors(thyroid diseases,pregnancy or lactation,application medicine treatment by folic acid,hormone,vitamin B₁₂and B₆,recently suffered the operation,trauma and severe infection,malignant tumor and other serious organ dysfunction)were excluded.According to Naghavi classification criteria of carotid plaques:1)Unstable plaque:The acoustic characteristics are low echo or heterogeneous echo mainly with low echo,the surface of the patch is not smooth,uneven,there are a lot of lipid components inside,and the fibrous cap is thin or there are cracks;2)Stable plaque:The acoustic characteristics are mainly strong echo or isoecho,the surface is smooth,the internal lipid composition is less,the fibrous cap is thicker.These cases were classified into the Unstable carotid plaque（UCP）group and the Stable carotid plaque（SCP）group.2 Record the patients’age,gender,previous history about hypertension and diabetes mellitus and personal history about smoking and drinking.The location,shape and echo of carotid plaques and stenosis of carotid artery in the carotid ultrasound report were recorded.Hcy,fasting plasma glucose and blood lipid indexes such as low density lipoprotein-cholesterol,high density lipoprotein-cholesterol,triglycerides and total cholesterol,were recorded in the laboratory intravenous plasma test reports.3 The general data of the two groups were tested for normality and compared by suitable methods,and statistical methods such as Spearman correlation analysis,multivariate Logistic regression analysis,ROC curve and area under ROC curve were used to explore the correlation between the different levels of blood glucose and plasma Hcy and the stability of carotid plaque.Results:1 312 patients were included in the two groups for this study.There were 209 cases in UCP group,and 146 cases（69.86%）were male.The average age of the UCP groupwas 65.48±8.75 years old.There were 103cases in SCP group,and 64 cases（62.14%）were male.The average age of the SCP groupwas 64.23±10.88 years old.Sex ratio,age,previous history about diabetes mellitus and hypertension,personal history about smoking and drinking and blood lipid indexes between groups,the difference was not statistically significant（P>0.05）.FPG and Hcy level to the stability of carotid plaque,the difference was statistically significant（P<0.05）.2 The results of the Spearman correlation analysis showed that FPG（r=0.139,P<0.05）,plasma Hcy（r=0.113,P<0.05）were negatively correlation correlated with stability of the carotid plaque.3 The results of the multivariate Logistic regression model with FPG and Hcy as independent variables and the stability of carotid plaque as dependent variable showed that FPG（OR=1.158,P<0.05）and plasma Hcy（OR=1.025,P<0.05）may be independent risk factors affecting the stability of carotid plaque.We obtained the equation:Logit（P）=-0.673+0.147*FPG+0.025*Hcy.4 Draw the ROC curve of FPG and Hcy.We obtained the optiaml cut-off value of FPG for the diagnosis of unstable carotid plaque was5.15mmol/L,the corresponding specificity and sensitivity were 55.3%and62.2%,and the AUC was 0.585（95%CI 0.518-0.653,P<0.05）.We obtained the optiaml cut-off value of Hcy for the diagnosis of unstable carotid plaque was 14.5μmol/L,the corresponding specificity and sensitivity were 50.5%and 60.8%,and the AUC was 0.569（95%CI 0.499-0.640,P<0.05）.The specificity,sensitivity and the AUC of FPG combined with Hcy in the diagnosis of unstable carotid plaques were 51.5%,69.4%and 0.620（95%CI 0.551-0.689,P<0.05）.5 The difference of AUC between FPG and Hcy was 0.0156,and the difference was not statistically significant（P>0.05）;the AUC difference between FGP and（FPG+Hcy）was 0.0353,and the difference was not statistically significant（P>0.05）.Conclusion:1 In patients with carotid plaque complicated with cerebral infarction with the type of large-artery atherosclerosis,the level of blood glucose and plasma Hcy are correlated with unstable carotid plaque.2 Blood glucose and plasma Hcy levels are the high-risk factors affecting the stability of carotid plaque,and are negatively correlation correlated with stability of the carotid plaque.