The Correlation Of Monocyte To High-density Lipoprotein Ratio And TOAST Classification And The Stability Of Intracranial Artery Plaque

Monocyte to high-density lipoprotein ritao(MHR)was first established by Mehmet et al.They found that CKD patients had a low level of HDL and a high level of blood monocyte count.They merged the two components as “MHR” and proved it as an independent predictor for malign cardiovascular outcomes.Since then,the value of MHR has become a hotspot of investigation in many atherosclerotic disorders.But the the area of neurovascular science,there is a lack of data relative to subtypes of acute ischemic stroke(AIS),especially in the relationship between MHR and the stability of Intracranial artery plaque.Stroke has became the first most common cause of deaths in China according the WHO’ report in 2019.The stroke-incidence rate was 267.7(241.3-322.0)per 100000 people and increased by 86.0%(73.2-99.0)from 1990.Chinese countryside has higher stroke-incidence rate compared with cities.Therefore,it is important to find an economical,fast and reproducible biomarker to quantify the amount of inflammation and oxidative stress in daily practice,especially in the rural areas of China.For Asian population,intracranial large artery atherosclerosis is the main type in acute ischemia stroke.The present study retrospectively reviewed patients with AIS in Center of Cerebrovascular Disorders of Changhai Hospital affiliated with Naval Military Medical University,and aims to evaluate the association between MHR and the etiology of ischemic stroke by analyzing the differences in MHR among TOAST type,and in addition further analyzed the relationship between MHR and The stability of Intracranial artery plaque by 3-dimensional high-resolution magnetic resonance imaging(3D-HRMRI),to provide a reliable biomarker for atherosclerotic cause of AIS.PartⅠ Association of monocyte-to-high-density lipoprotein-cholesterol ratio with Acute Ischemic Stroke and TOAST classificationObjects: The monocyte to high-density lipoprotein ratio(MHR)has been accepted as a novel inflammatory marker of cardiovascular disease,but there is a lack of data relative to subtypes of acute ischemic stroke(AIS).The present study aims to evaluate the association between MHR and the etiology of ischemic stroke in AIS patients.Mothods: 389 consecutive patients with AIS were retrospectively reviewed and categorized according to TOSAT etiological classification.Of them,141 patients(36.2%)were classified as large-artery atherosclerosis(LAA),114(29.3%)as small-artery occlusion(SAO),49(12.6%)as cardioembolism(CE),and 85(21.9%)as other subtypes,including 17 as other determined etiologies and 68 patients as non-determined etiologies.In addition,398 check-up subjects were recruited as controls.Results: MHR in AIS patients was significantly higher than that in controls(0.42±0.19 vs.0.25±0.12,P<0.001).Binary logistic regression analysis showed that MHR was independently correlated with the presence of AIS(OR=2.24,95%CI 1.89-2.67,P<0.001).LSD multiple comparison showed that MHR in LAA patients(0.51±0.21)was significantly higher than that in SAO patients(0.39±0.18,P<0.001),CE patients(0.31±0.10,P<0.001),and other subtypes(0.42±0.21,P=0.002).Multinomial logistic regression analysis indicated that MHR was an independent factor of LAA subtype(LAA vs.SAO,OR 0.70,95%CI 0.60-0.83,P<0.001;LAA vs.CE,OR 0.49,95%CI 0.37-0.65,P<0.001;LAA vs.others,OR 0.78,95% CI 0.67-0.92,P=0.003).Conclusion: Our data indicate that MHR was associated with AIS and could serve as an independent predictor of LAA in AIS patients.Part II The Correlation of monocyte to high-density lipoprotein ratio and the Stability of Intracranial Artery Plaque.Objective: The aim of the present study was to assess the value of MHR in acute cerebral infarction patients and the characteristics of intracranial plaque in culprit artery by 3-dimensional high-resolution magnetic resonance imaging(3D-HRMRI),and then to investigate the relation between MHR and the stability of intracranial plaque.Methods: A total of 635 patients who underwent 3D-HRMRI for intracranial vessel wall imaging in Center of Cerebrovascular Disorders of Changhai Hospital affiliated with Naval Military Medical University from January 2019 to July 2020 were included in this study and 147 acute cerebral infarction patients matched with the inclusion criteria were as case groups.These patients were divided into groups as follows: no plaque 27 cases 、monodiseased artery 72 cases and multiple-diseased arteries 48 cases.Through binary logistic regression and Spearman correlation analysis,the association between MHR and the stability of intracranial culprit plaque was evaluated.Receiver operating characteristic(ROC)curves were constructed to define the optimum cut-off value of MHR for predicting the sensitivity and specificity when diagnosing the stability of intracranial culprit plaque.During a followup period of 12 months(median time),the Cox proportional hazards regression analyses were used to estimates the association with MHR levels and end points.Results: There was a moderate positive correlation between the enhancement of plaque and the MHR(r=0.469,P<0.001)through Spearman correlation analysis.After adjustment for age,hypertension history,plaque burden,stenosis degree of intracranial culprit artery,remodeling ratio,and other risk factors,there exist a significant association between MHR and the enhancement of culprit plaque(OR=2.13 95%CI 1.45-3.14,P<0.001)In binary logistic regression analysis.Based on the ROC curve analysis,the AUC of MHR was calculated as 0.821(95% CI,0.726–0.915,P<0.001),with a sensitivity of 0.75 and a specificity of 0.80.The optimal cut-off value of the MHR level was 0.52 ×109/mmol through Youden index.During a follow-up period of 12 months(10.49,13.51),patients in the lower MHR group(MHR<0.52)had a 2.21-fold increased risk of decline of the enhancement of plaque(HR=3.21,95%CI 1.92-5.36,P<0.001)compared with patients in the higher MHR group(MHR≥0.52).Conclusion: The present study shows that MHR was positively correlated with the enhancement of intracranial atherosclerotic plaque,and MHR could be a biomarker of the stability of atherosclerotic plaque.