Study Of IMA And Other Hematological Characteristics In Patients With Severe Stenosis/occlusion Of MCA With AIS

Objective: To investigate the relationship between serum IMA levels and other hematological characteristics and severe middle cerebral artery(MCA) stenosis/occlusion in patients with acute ischemic stroke(AIS),and to provide an auxiliary diagnostic basis for the early diagnosis of AIS patients with severe MCA stenosis/occlusive.Methods: In this study,169 patients with AIS admitted to our emergency stroke clinic were included from 2019 to 2020.All diagnosed by MRI/CT imaging,and whether the major intracranial arteries were severely stenosed/occluded in patients with AIS were determined by MRA.According to the presence or absence of severe stenosis/occlusion,they were divided into two groups: non-severe stenosis/occlusion group and severe stenosis/occlusion group.The group of severe stenosis/occlusion was again divided into the group of severe stenosis/occlusion of other vessels and the group of severe stenosis/occlusion of MCA according to whether the MCA was severely stenosed/occluded or not.Twenty-nine healthy individuals and 53 patients without coagulation abnormalities were included as control group.The patients' serum IMA levels were measured,and the IMA to albumin ratio(IMAR),ischemic modified albumin index(IMA index)adjusted for albumin,serum hypersensitive C-reactive protein(Hs-CRP),serum amyloid A(SAA),blood routine,coagulation routine,small and dense low-density lipoprotein(sd LDL-c),lipids,blood Cholinesterase(CHE),albumin(ALB),uric acid(UA),etc.The differences of the above laboratory indexes between the groups were compared,and a comprehensive analysis was performed with the general data of the patients.Results: In this study,blood IMA,IMAR levels,WBC,NUT,INR,FDP and DD were significantly higher in the group with severe stenosis/occlusion of intracranial large arteries than in the group with non-severe stenosis/occlusion in AIS patients(P =0.008,P = 0.023,P = 0.010,P = 0.013,P = 0.041,P = 0.005,P = 0.006,P = 0.012),while TG,C/H,CHE levels were significantly lower than in the other group(P =0.035,P = 0.045,P = 0.006);blood IMA,IMAR level,INR,TT were significantly higher than those of other vascular severe stenosis/occlusion groups(P = 0.001,P =0.000,P = 0.043,P = 0.007),while IMA index,ALB,CHE levels were significantly lower than those of the other group(P = 0.000,P = 0.000,P = 0.001);there were no statistical differences in sd LDL-c,Hs-CRP,SAA and other indexes between the groups(P > 0.05).IMA,IMAR,Hs-CRP,SAA,WBC,NUT and neutrophil-to-lymphocyte ratio(NLR),INR,antithrombin III(AT3),prothrombin time(PT),FDP,fibrinogen(FIB),DD,DFR,sd LDL-c,TG,C/H,UA,and blood glucose(GLU)levels were significantly higher in AIS patients compared to control group were significantly higher(P = 0.003,P = 0.000,P = 0.000,P = 0.012,P =0.000,P = 0.000,P = 0.000,P = 0.000,P = 0.001,P = 0.000,P = 0.000,P = 0.000,P= 0.000,P = 0.000,P = 0.000,P = 0.000,P = 0.0017,P = 0.000,P = 0.000,P = 0.000,P = 0.001,P = 0.000),ALB,IMA index,lymphocyte value(LYW),and high-density lipoprotein(HDL)were significantly lower(P = 0.000,P = 0.000,P = 0.000,P =0.000),and the rest were not statistically different(P > 0.05).In the AIS patient group in this study,IMA levels increased with age and ALB decreased with age.Multiple linear regression analysis showed that 55.5% and 76.6% of the variation in IMA and IMA index could be explained by changes in ALB,DD,APTT,and AT3;86.4% of the variation in IMAR could be explained by changes in ALB,DD,and CHE.ROC curve analysis showed that among AIS patients,their AUCs for determining whether they had severe stenosis/occlusion of intracranial major arteries for IMA and IMAR were 0.623 and 0.605,respectively,and the best combination for determining that AIS patients had severe stenosis/occlusion of intracranial major arteries was admission NIHSS score + CHE(AUC=0.783).The AUCs of IMA,IMAR,and IMA index levels to determine that patients with AIS had severe stenosis or occlusion of the MCA were0.702,0.732,and 0.654,respectively.The best combination to determine that patients with AIS had severe stenosis or occlusion of the MCA was IMAR combined with the admission NIHSS score(AUC = 0.827).In AIS patients with severe stenosis/occlusion of intracranial major arteries,the AUC of patients' IMA,IMAR and IMA index levels to determine whether they had severe stenosis or occlusion of the MCA were 0.703,0.777,and 0.748,respectively,and there was no optimal combination for determining AIS patients with severe stenosis/occlusion of intracranial major arteries as having severe stenosis or occlusion of the MCA.Conclusion: 1.Patients with severe middle cerebral artery stenosis/occlusion have higher levels of IMA,IMAR,DD and lower levels of ALB,IMA Index,CHE.2.IMA,IMAR,and IMA index used together have some auxiliary diagnostic value in patients with severe stenosis/occlusive AIS of the MCA;3.IMAR combined with admission NIHSS score and CHE is the best combination to determine patients with AIS as having severe stenosis or occlusive MCA.