| Objective:Neurological deterioration that appears within the first week following the onset of stroke is progressive ischemic stroke(PIS).It is a complex state involving many causes and mechanisms.PIS is associated with increased mortality and morbidity.Early prediction of neurological deterioration,identification of the responsible mechanisms is the basis of an effective therapy.The aim of the study is to investigate whether the level of Homocysteine(hcy)can predict PIS by comparing the PIS group with the non-progressive ischemic stroke group(NPIS)and mechanism.Methods:A total of 103 patients who presented within the 24 hours after the onset of ischemic stroke were involved.All the patients was scored when they presented and when the state of an illness changed within the first week.PIS was diagnosed when the increase of the patient's NIHSS exceeded 2 scores,the others diagnosed NPIS.The PIS group involves 53 patients,the NPIS group involves 50 patients.All the patients were recorded the history of hypertension,diabetes,coronary heart disease,atrial fibrillation,cerebrovascular disease,smoke and drink,and detected white blood cell count(WBC),neutrophils percentage,lymphocyte percentage, platelet count(PLT),platelet distribution width(PDW),mean platelet volume(MPV), prothrombin time INR(PT INR),activated partial thromboplastin time(APTT), Fibrinogen(FIB),thrombin time(TT),Serum potassium,Creatinine,fasting blood glucose,Triglycerides(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein A(ApoA),apolipoprotein B(ApoB),ApoB/ApoA,erythrocyte sedimentation rate(ESR),platelet aggregation rate,Homocysteine(Hcy),high-sensitivity C-Reactive Protein(hs-CRP).Moreover,The patients were assessed by transcranial Doppler(TCD),color doppler ultrasonography of the carotid and basal cerebral arteries,Cranial CT or MRI.They were scored and detected cranial CT or MRI again when the state of illness changed in a week.Compare all these between two groups. Results:1 the results of single factor analysis:There were 16(30.19%)cases with cerebrovascular disease in PIS group(53 cases), and 7(14.00%)cases with cerebrovascular disease in NPIS group(50 cases).The incidence of cerebrovascular disease between two groups have significant difference(P＜0.05).The PIS group's average score when the patiens presented is 12.26±3.80,the NPIS group's average score is 5.64±5.30,the two scores have significant difference(p＜0.05).The average level of early fasting blood glucose is(6.65±3.49)mmol/L in PIS group,and(5.95±2.29)mmol/L in NPIS group.There are 39.63%patients with early hyperglycemia in PIS group,26.00%patents with hyperglycemia in NPIS group,the ratio of hyperglycemia differs significantly between the two groups(P＜0.05).In PIS group,the average level of total cholesterol(TC)is(5.05±0.97)mmol/L, high density lipoprotein cholesterol(HDL-C)is(1.06±0.26)mmol/L and apolipoprotein B(ApoB)is(0.99±0.24)g/L.In NPIS group,the average level of TC is(4.69±0.69)mmol/L,HDL-C is(0.96±0.24)mmol/L and ApoB is(0.92±0.16)g/L.there are significant difference between the two groups of TC,HDL-C and ApoB's levels(p＜0.05).The ratios of increased TC differed significantly between PIS group(18.87%)and NPIS group(0.00%)(P＜0.01).The ratios of increased ApoB differed significantly between PIS group(37.74%)and NPIS group(20.00%)(P＜0.05).There are significant difference of the ratio of increased high-sensitivity C-Reactive Protein(hs-CRP)between PIS group(50.94%)and NPIS group(32.00%)(p＜0.05).In PIS group,the level of Homocysteine(Hcy)is(36.66±27.51)μmol/L,and there are 84.91%patients increased.In NPIS group,the level of Homocysteine(Hcy)is(17.13±10.32)μmol/L,and there are 48.00%patients increased.The two factors differed significantly between the two groups(p＜0.01). 1.4 The positive ratio of carotid atherosclerosis plaque is 75.47%in PIS group, 58.00%in NPIS group.The positive ratio of unstable plaque is 46.46%in PIS group, 31.94%in NPIS group.The two ratios differed significantly between two groups(p＜0.05).2 The multivariate conditional logistic regression analysis shows that NIHSS,fasting blood glucose,Triglycerides(TG)and Homocysteine(Hcy)are the risk factors of progressive ischemic stroke.3 Spearman correlation analysis shows that the history of hypertension,diabetes and cerebrovascular disease,NIHSS,carotid atherosclerosis,creatinine and hs-CRP were positively correlated to hyperhomocysteinemia.Conclusions:1 NIHSS,fasting blood glucose,Triglycerides and Homocysteine are the risk factors of progressive ischemic stroke.2 Hyperhomocysteinemia is the independent risk factor of progressive ischemic stroke.3 The history of hypertension,diabetes and cerebrovascular disease,NIHSS,carotid atherosclerosis,creatinine and hs-CRP have positive correlation to hyperhomocysteinemia.
|
PDF Full Text Request