The Changes Of Serum Hs-CRP & LDL Levels And Clinical Significance In Patients With Acute Cerebral Infarction Of Different TOAST Types

Objective:Cerebral infarction was one of the main diseases that seriously endanger human health,and it was the first,cause of long-term disability.70%cerebral infarction was caused by thrombosis in original position or embolism from other position.Cerebral infarction was a kind of disease which caused by many causes,especially cerebral artery atherosc-lerosis.In recent years,the relationship between the high sensitive C-reactive protein(hs-CRP)&low density lipoprotein(LDL)and acute cerebral infarction became a new hot issue.The level of hs-CRP often increased in patients with acute cerebral infarction,The increased hs-CRP induced inflammatory reaction which related with atherosclerosis occurrence and development,It caused atherosclerotic rupture,thrombosis,and finally resulted in acute cerebral infarction.LDL was responsible for the transport of cholesterol in the body,riched in polyunsaturated fatty acids,easily oxidized into ox-LDL.Through a series of pathological changes,LDL promoted the formation of atherosclerosis and ultimately led to thrombosis.Abroad studies showed that hs-CRP and LDL accelerated the occurrence and development of acute cerebral infarction.Civil studies also reported the change of hs-CRP and LDL in the acute cerebral infarction.However,the changes of hs-CRP&LDL in different TOAST subtypes were still not explored.The aim of this study was to explor the effection and clinical significance of hs-CRP and LDL in patients with different TOAST subtypes,and provided the theoretical foundation for assessment acute cerebral infarction of different TOAST subtypes.Methods:374 patients with acute cerebral infarction in the Second Hospital of Hebei Medical University from October 2013 to January 2016 were selected as cerebral infarction group.60 healthy volunteers were selected from the health examination center in the Second Hospital of Hebei Medical University as control group.All cases were in accordance with the inclusion criteria:①accorded with diagnostic criteria of the Fourth National Conference on cerebrovascular disease in 1995;② first onset of cerebral infarction;③time of onse<72 h;④ aged from 18 to 89 years old;⑤CT/MRI confirmed cerebral infarction;⑥ detailed demographic data,blood routine,biochemistry routine,coagulation routine,electrocardiogram,echocardiography,etc;⑦signed informed consent.Exclusion criteria:① severe disorders of consciousness;②hemorrhagic cerebral infarction,transient ischemic attack;③subarachnoid hemorrhage and various causes of cerebral hemorrhage;④Liver and kidney dysfunction or heart failure;⑤Severe infection,tuberculosis,malignant disease,surgery and trauma antibiotics within 2 weeks;⑥Taking antibiotics and Cyclooxygenase2(COX-2)inhibitors within 1month;⑦recently treated with hormone drugs,immune inflammation inhibitor;⑧recently treated with carbamazepine,phenytoin,isoniazid,chlorpromazine,phenothiazines;⑨hospital-acquired infection;⑩other possible fctors which maybe affected hs-CRP level:thyroid disease,stomach disease,chronic wasting disease,autoimmune disease,acute myocardial infarction,other thromboembolic disease and so on.Based on TOAST criteria,all patients with acute cerebral infarction were further classified into different stroke subtypes:1)large artery atherosclerosis(LAA),including 158 cases;2)small artery occlusion(SAO),including 171 cases;3)cardiac embolism(CE),including 45 cases.All of the subjects were drawed 3ml blood from elbow vein in the next morning.The hs-CRP was measured by Immnoturbidimetry method.LDL was measured by direct determination method.Results:The distributions of TOAST types:LAA 158/374 cases(42%),SAO subtype 171/374 cases(45%)and CE subtype 45/374 cases(12%).The history of hypertension,diabetes,coronary heart disease,hyperlipidemia,smoking and drinking in cerebral infarction group were higher than in control group(P<0.05).The hs-CRP was significantly higher in cerebral infarction group than in control group,there was statistical significance(P<0.05).The hs-CRP in the CE subtype group was the highest among control group and other subtypes group(P<0.O5).Compared with LAA and SAO subtype group,the hs-CRP had statistical significance(P<0.OS).Compared with LAA and SAO subtype group,hs-CRP had statistical significance(P<0.OS).Compared with LAA subtype group and CE subtype group,there were no statistical significance(P>0.05).Compared with LAA subtype group and control group,the hs-CRP had no statistical significance(P＞0.05).The LDL was obviously increased in LAA subtype group.Compared LAA subtype group with control group,there was statistical significance(P<0.05).There was statistical significance between SAO subtype group and control group(P<0.05).There was no statistical significance between CE subtype group and control group(P>0.05).There was no statistical significance between LAA subtype group and SAO subtype group(P>0.05).There was no statistical significance between SAO subtype group and CE subtype group(P>0.05).The Spearman correlation analysis showed positive correlation between hs-CRP and LDH(r=0.164,P=0.001),as well as NIHSS score(r=0.183,P=0.000)· After adjusting age,gender,smoking,drinking,diabetes,hypertension,hyperlipidemia and hyperlipidemia history.The binary logistic regression analysis showed that hs-CRP(P=0.012,OR=2.068)was the independent risk factors of CE.Conclusion:Among the three of TOAST subtypes,the hs-CRP is an independent risk factor for CE subtype,which can be used as an etiological index of ischemic stroke classification in the early stage.For LAA subtype,LDL is also a specific biochemical indexes,which has important clinical value to early predict the occurrence of LAA.The hs-CRP and LDL are closely related with the degree of neurologic deficit after cerebral infarctio.The two indexes have great clinical significance to anticipate stroke severity and poor prognosis.