The Relationship Between The Serum IL-6,CRP，sCD40L And Carotid Plaque Stability In Patients With Acute Cerebral Infarction

BackgroundCerebral infarction,also known as ischemic stroke is a common disease and frequently-occuring disease in cerebrovascular diseases. Studies have shown that,the instability of carotid atherosclerotic plaques is the important reason for ischemic cerebro vascular disease.At present,the ultrasonic detecting carotid artery is the most commonly used means of plaque instability,but need to advanced instruments,and greatly influenced by the operator. So,find a simple and effective serological index to predict the stability of the plaques,reduce the incidence of acute cerebral infarction has important clinical significance.Someone proposed,the inflammation plays an important role in the prosess of atherosclerosis. Through the detection of the levels of soluble Cluster of differentiation 40 ligand (sCD40L),c-reaction protein (CRP) and interleukin 6(IL-6) to investigate the relationship between three indexs and carotid plaques.ObjectiveTo investigate the relationship between carotid plaque stability and the serum IL-6, CRP and sCD40L in patients with acute cerebral infarction, provide the basis for early prevention and treatment of disease of head blood-vessel.Method(1) We selected 95 patients with acute cerebral infarction, all patients were in the fourth national cerebrovascular disease diagnosis standard of the development of the academic conference,and were diagnosed by brain computed tomography scan (CT) or (and) head magnetic resonance imaging (MRI).(2) According to the examination results of carotid artery ultra- sonographic,cerebral infarction group were divided into vulnerable plaques group (VP) 29 cases,stable plaques group (SP) 31 cases and no plaques group (NP) 35 cases.Control group:50 cases (VP Ocases,SP 8 cases and NP 42 cases)of healthy persons without clinical evidence of cerebral infarction,that were conformed by CT or (and) MRI.(3) All included subjects were measured serum interleukin-6(IL-6), sCD40L concentrations with enzyme-linked immuneeosorbent assay (ELISA) within 48 hours of onset and the 14th day, and to determine the admission c-reaction protein(CRP),blood pressure (BP),body mass index (BMI),the next day fasting blood glucose (FBG) and blood lipids.The US National Institutes of Health Stroke Scale (NIHSS) was adopted for neurological assessment of patients with cerebral infarction, admission to hospital the next day for the acute phase,14 days for recovery. According to the results of CT or (and) MRI,patients was divided into large infarction area group,middling infarction area group and small infarction area group by infarct volume,serum levels of IL-6,CRP,sCD40L among different groups will be observed.Analysis the datas of each group and the correlation between IL-6,CRP,sCD40Land carotid artery plaque.Result(1)The rates of patients with carotid atherosclerotic plaques in acute cerebral infarction group is 63.2%,and the rates of patients with unstable plaque is 30.1%.(2)The levels of systolic blood pressure,diastolic blood pressure,fasting blood glucose, cholesterol,triglyceride and low density lipoprotein in patients with acute cerebral infarction is higher than normal control group obviously(P<0.05).(3)Within 48 hours after the patients had been ill,the serum levels of IL-6,CRP and sCD40L were significantly higher than healthy controls(P<0.05).(4) within 48 hours after the patients had been ill (P<0.05);At 14th day, the serum levels of IL-6,CRP and sCD40L were significantly lower than Within 48 hours(P<0.05); Within 48 hours and at 14th day, the serum levels of IL-6,CRP and sCD40L in VP group were significantly higher than in SP group,NP group and healthy controls(P<0.05).(5)The serum sCD40L is related positively to the level of serum IL-6(r=0.874, P=0.000),the level of CRP(r=0.816,P=0.000),the infarct volume(r=0.197,P=0.039) and admission NIHSS(r=0.227,P=0.016);The serum IL-6 is related positively to the level of serum CRP(r=0.786,P=0.000),the infarct volume(r=0.215,P=0.021) and admission NIHSS(r=0.465,P=0.000);The serum CRP is related positively to the infarct volume (r=0.195,P=0.041) and admission NIHSS(r=0.284,P=0.006).(6)There is significant difference of the scores of NIHSS between within 48 hours and at 14th day in subgroup of patients with acute cerebral infarction(VP group,SP group,NP group)(P<0.05); Within 48 hours, the scores of NIHSS in subgroup of patients with acute cerebral infarction had no significant difference(P>0.05); At 14th day, the scores of NIHSS in subgroup of patients with acute cerebral infarction had no significant difference(P>0.05).(7)With the increase of the volume of infarcts, the serum levels of IL-6,CRP and sCD40L increased significantly(P<0.05).Conclusion(1)IL-6,CRP and sCD40L,which are markedly increased in the patients with acute cerebral infarction,the results suggest that higher serum IL-6,CRP and sCD40L may be involved to the development of carotid atherosclerosis and plaque,and they play an important role in the process.(2)sCD40L was positively correlated with IL-6,CRP,they can reflect the severity of patients with cerebral infarction.