Study On The Correlation Between Cerebral Microbleeds And Vascular Endothelial Injury Markers ICAM-1, ENOS And STM In Patients With Cerebral Infarction

Background and purposeC erebral infarction(CI)is a common acute cerebrovascular disease,with a high incidence,disability rate,and the incidence and mortality of stroke in China are significantly higher than the level in foreign countries.At present,there are more than 270 million patients with cardiovascular and cerebrovascular diseases in China,and more than two-thirds of the patients with cerebrovascular diseases are diagnosed as cerebral infarction.Cerebral microbleeds(CMBs)refers to the parenchymal subclinical damage of the brain,which is caused by the rupture of intracerebral microvascular or microleakage of blood in the brain.After the occurance of cerebral microbleeds,the dissolvable chalybeate components in the blood will be engulfed and digested by phagocytes,then it makes the formation of the highly paramagnetic hemosiderin.The highly paramagnetic hemosiderin deposits around the tiny blood vessels in the brain,and in nuclear magnetic resonance imaging,it appears as low signal region or signal deletion region.The incidence of CMBs is different in patients with various types of cerebrovascular diseases and the healthy elderly,among which the incidence is about 34% in patients with ischemic stroke.The exact pathogenesis of CMBs remains to be studied,and it has been reported to be associated with the destruction of vascular endothelial and blood-brain barriers.The injury and activation of the blood vessel endothelium can be evaluated by determination of the soluble endothelial markers of serum in circulation.Endothelial function can be reflected by the levels of the Intercellular adhesion molecule-1(ICAM-1),Endothelial nitric oxide synthase(eNOS)regulatory proteins and Soluble thrombomodulin(sTM)through different ways.In this study,the contents of ICAM-1,eNOS and sTM in serum of patients with cerebral infarction were collected and analyzed to explore the correlation between CMBs and ICAM-1,eNOS and sTM,markers of vascular endothelial injury in patients with c erebral infarction.It is expected to be helpful for the clinical diagnosis and treatment of CMBs.method106 cases were collected from July,2017 to June,2018 in Hebei university affiliated hospital,whom with cerebral infarction(acute onset within 72 hours)of confirmed by brain MRI and SWI examination.Among them,without cerebral microbleeds in 37 cases andcombined with cerebral microbleeds in 69 cases.According to the result of brain MRI,they were divided into two groups :without cerebral microbleeds group(group Ⅰ)and with cerebral microbleeds group(group II).In the acute phase and three months later,collect basic information 、 serum biochemical parameters and serum of group Ⅰ and group II,using enzyme-linked immunoassay(ELISA)quantitative determination of ICAM-1、eNOS、sTM(ELISA kit for the same batch unified procurement).According to the collected data,the relationship between cerebral microbleeds in patients with cerebral infarction and general basic data of patients,iCAM-1,eNOS and sTM content was investigated by statistical methods.The difference of P<0.05 was statistically significant.Logistic multivariate regression analysis was used to analyze the independent risk factors of cerebral microbleeds.ROC curve was used to detect the predictive value of the above factors for the occurrence of cerebral microbleeds.resultsCompare with endothelial injury marker levels of two groups,levels of eNOS 、ICAM-1 and sTM in groupⅡof patients were significantly higher than the levels of groupⅠ(P <0.05).Three months later,group Ⅱ patients of cerebral infarction convalescence serum ICAM-1 and sTM level is still higher than the group of patients,for group I patients recovery of serum eNOS level higher than Ⅱ group of patients,the difference was statistically significant(P < 0.05).Logistic multivariate regression analysis showed that ICAM-1,eNOS and sTM contents were independent risk factors affecting the occurrence of cerebral microbleeds in patients,and the difference was statistically significant(P<0.05).ROC curve results showed that the area under the sTM curve was 0.765,and the sensitivity and specificity of predicting CMBs in patients with cerebral infarction were 0.875 and 0.752 respectively.The area under the iCAM-1 curve was 0.746,and the sensitivity and specificity of predicting CMBs in patients with c erebral infarction were 0.824 and 0.726,respectively.The area under the eNOS curve was 0.728,and the sensitivity and specificity of predicting CMBs in patients with cerebral infarction were 0.764 and 0.687,respectively.conclusionThe increased of iCAM-1,eNOS and sTM are closely related to the cerebral microbleeds after cerebral infarction.The detection of icam-1,eNOS and sTM content can provide a certain reference for the diagnosis of cerebral microbleeds,and provide a basis for the earlyintervention,treatment and prognosis of patients with cerebral microbleeds after cerebral infarction.