Serum Levels Of Soluble Cd40 Ligand, Matrix Metalloproteinase-3 Concentration Of Acute Ischemic Cerebrovascular Disease Clinical Research

PartⅠThe Study of Relationship between Serum sCD40L ,MMP-3 and Acute Ischemic Cerebrovascular DiseaseObjective To vestigate relationships between soluble CD40 ligand (sCD40L), matrix metalloproteinase-3 (MMP-3) and formation of carotid atherosclerosis and acute ischemic cerebrovascular disease .Methods 100 patients with the first ever acute ischemic cerebrovascular disease were selected as experimental group,and 20 persons without acute ischemic cerebrovascular disease were selected as control group. All subjects were detected intima-media thickness and plaque in the carotid artery by the use of the carotid ultrasound method, and detected whether there had been infarctions in brain tissues by CT / MRI. According to the results, 100 patients were divided into four groups, including no plaque and no infarction group, no plaque and infarction group, plaque and no infarction group, plaque and infarction group. Serum sCD40L, MMP-3 concentrations of all the subjects were measured by enzyme-linked immunosorbent assay. Neurological defict scores were performed in patients attacked cerebral infarction. Other indicators were detected by automatic biochemical analyzer, such as, glucose, total cholesterol, triglycerides, low-density lipoprotein and et al.Results①Except no plaque and no infarction group, the Serum sCD40L,MMP-3 concentrations of patients with acute ischemic cerebrovascular disease were significantly higher than those of the normal control group(p≤0.01).②The serum sCD40L,MMP-3 concentrations of plaques and no infarction group were significantly higher than those of no plaque and no infarction group (p<0.01). The serum sCD40L,MMP-3 concentrations of plaques and infarction group were significantly higher than those of plaques and no infarction group(p<0.01).The serum sCD40L,MMP-3 concentrations of no plaque and infarction group were higher than those of no plaque and no infarction group (p<0.05). The serum sCD40L,MMP-3 concentrations of plaque and infarction group were significantly higher than those of no plaque and infarction group (p<0.01).③serum sCD40L levels existed positively correlation with serum MMP-3 levels of the patients with acute ischemic cerebrovascular disease(r=0.805 p<0.001).④The levels of serum sCD40L,MMP-3 were positively correlation with neurological defict scores respectively in the patients with acute cerebral infarction. (r=0.723 p<0.001, r=0.576 p<0.001).⑤The levels of serum sCD40L of infarction area (diameter> 1.5 cm) were higher than those of infarction area (diameter <1.5 cm) in patients with cerebral infarction (p<0.05). Conclusions CD40/CD40L signaling pathway and matrix metalloproteinase-3 participate the plaque formation of carotid atherosclerosis and likely participate ischemic injury in brain tissue, so the levels of serum sCD40L,MMP-3 may reflect the stability of carotid plaque, they are important risk factors of acute ischemic cerebrovascular disease.PartⅡEffects of Type 2 Diabetes Mellitus on the Serum sCD40L Concentrations of Patients with Acute Cerebral Infarction.Objective To investigate the effects of type 2 diabetes mellitus on the serum sCD40L concentrations of patients with acute cerebral Infarction.Method All subjects were from the first part of study, including 60 cases of patients with acute cerebral infarction (33 cases with type 2 diabetes mellitus), and the control group of 20 peoples (8 cases with type 2 diabetes mellitus). Their carotid intima-media thickness and plaque situation were detected by carotid ultrasonograghy. According to the test results, all subjects were divided into the group with type 2 diabetes and the group without type 2 diabetes, and the group with type 2 diabetes was divided into two groups, the control group (no plaque, plaque), infarction group (no plaque, plaque ), the group without type 2 diabetes was divided into two groups too, the control group (no plaque , plaque), infarction group (no plaque, plaque). Serum sCD40L concentrations were measured by using enzyme-linked immunosorbent assay.Results 1,Between the two groups, serum sCD40L concentrations with type 2 diabetic patients were significantly higher than those in patients without type 2 diabetes (p <0.05). 2,In each group, serum concentrations of sCD40L were the highest in infarction group (plaque), serum concentrations of sCD40L were lowest in the control group(no plaque), and the two groups showed the same trend.Conclusion Type 2 diabetes mellitus lead to atherosclerosis, microvascular disease and high blood coagulation state and can up-regulate CD40L expression, CD40/CD40L signaling pathways may be activated in the course of inducing cerebrovascular disease.PartⅢEffects of Atorvastatin on Serum sCD40L Levels of Patients with Carotid Atherosclerosis Objective To explore the effects of atorvastatin on serum sCD40L concetrations of patients with carotid atherosclerosis, and to investigate the effect that atorastatin blocked CD40-CD40L signal pathway.Methods All subjects were from the first part of study, 64 patients of carotid atherosclerosis were randomly divided into control group and experimental group, every group was 32 cases. control group was given diet control and experimental groups were given atorvastatin treatment. All subjects were followed up 12 weeks and detected serum sCD40L, blood total cholesterol, triglyceride, low-density lipoprotein respectively before treatment, the fourth week, the 12th week.Results After atorvastatin therapy, the concentrations of indicators in the fourth week, the 12th week were significantly lower than the levels before treatment (p<0.01)and concentrations of indicators of the 12th week were lower than those of the fourth week (p<0.05). The control group had no significant changes in the above indicators. but the levels of serum sCD40L had no statistical significance between abnormal LDL group and normal LDL group (p <0.05) of before and after atorvastatin therapy(4th week and 12th week).Conclusions Atorvastatin significantly reduced serum sCD40L concentrations of patients with carotid atherosclerosis, It is not yet considered that abnormal level of low-density lipoprotein has effect on the role of atorvastatin that can reduce serum sCD40L concentrations. it also has new anti-atherosclerosis mechanism in addition to lipid-lowering effect.