Analysis Of Serological Markers For Stability Of Responsible Middle Cerebral Artery Plaque In AIS Patients

Objective: This research analyses the clinical data of patients with acute ischemic stroke who were confirmed to have vulnerable plaques in the responsible middle cerebral artery by using High Resolution Magnetic Resonance Imaging(HRMRI),and detects the metabolism of homocysteine(Hcy)and other amino acids and serum free fatty acids(FFA)level,thus to discusse the risk factors of vulnerable plaques in the symptomatic middle cerebral artery and look for relevant serum markers,so as to provide an economic and convenient method for clinical evaluation of vulnerable plaques and guide the secondary prevention of acute cerebrovascular events.Methods: From January 2016 to November 2020,89 patients with acute ischemic stroke which was confirmed by magnetic resonance diffusion functional imaging at the second hospital of Dalian medical university were choosed as research objects.Accroding to evaluation of the plaque stability of responsible middle cerebral artery by HRMRI,the enrolled patients were divided into stable plaque group(n = 30)and vulnerable plaque group(n = 59).The gender,age,body mass index(BMI),smoking history,drinking history,hypertension history and diabetes history of each group were recorded.The morning fasting venous blood was collected to detect the routine blood biochemical indexes.The metabolism of homocysteine and other amino acids and the level of serum free fatty acids were detected by liquid chromatography tandem mass spectrometry.SPSS 23.0 software was used for statistical analysis.The variables with statistically significant differences in univariate analysis were analyzed by multivariate logistic regression analysis to screen out independent influencing factors.Receiver operating characteristic curve(ROC)curve was drawn to evaluate the diagnostic value of observation indexes.And p < 0.05 was considered as statistically significant.Results:1.There was no statistically significant difference in gender,age,BMI,history of smoking,drinking,hypertension and diabetes between the two groups(p > 0.05).2.Compared with stable plaque group,the levels of TB(12.05±4.39 μmol/L vs 17.26 ± 5.36 μmol/L),CB(4.20 ± 1.91 μmol/L vs 5.59 ± 2.99 μmol/L),UCB(7.84 ± 2.90 μmol/L vs 12.15 ± 3.62 μmol/L)in vulnerable plaque group were lower,and the levels of hs-CRP(5.50 ± 3.38 g/ml vs 2.74 ± 2.90 g/ml)were higher.The difference was statistically significant(p < 0.05).There was no statistical significance in the levels of RBC,WBC,PLT,Fbg,UA,Hb A1 c,TG,TC,HDL-C,LDL-C,ESR between the two groups(p > 0.05).3.There was no significant difference in Hcy,Met and Cys levels between the two groups(p > 0.05).There was no significant difference in other 20 amino acids and 26 acyl carnitine(p > 0.05).4.Compared with stable plaque group,the levels of capric acid(C10:0)(10.33 ± 5.09 nmol/ml vs 12.94 ± 4.46 nmol/ml)in vulnerable plaque group were decreased,and the levels of palmitic acid(C16:0)(4505.98 ± 961.86 nmol/ml vs 4023.33 ± 950.48 nmol/ ml),stearic acid(C18:0)(1462.47 ± 269.67 nmol/ml vs 1329.05 ± 269.70 nmol/ml)were increased,and the difference was statistically significant(p < 0.05).5.Multivariate Logistic regression analysis showed that low level of UCB(OR = 0.549,p = 0.048)and capric acid(C10:0)(OR = 0.840,p = 0.036),high level of palmitic acid(C16:0)(OR = 1.024,p = 0.015)and stearic acid(C18:0)(OR = 1.023,p = 0.015)were were independent risk factors for vulnerable plaque in symptomatic middle cerebral artery(p < 0.05).6.Compared with capric acid(C10:0),palmitic acid(C16:0)and stearic acid(C18:0),UCB showed the highest diagnostic value with AUC of 0.761(95% CI: 0.651 ~ 0.871,p < 0.05).When the maximum Youden index was 0.443,the sensitivity was 61.0% and the specificity was 83.3%.The diagnostic value of palmitic acid(C16:0)and stearic acid(C18:0)was lower(AUC < 0.7),while it got improved when the four markers combined.The AUC was 0.825(95% CI: 0.736 ~ 0.915,p < 0.05).When the maximum Youden index was 0.549,the sensitivity was 81.4% and the specificity was 73.3%.Conclusions:1.UCB,capric acid(C10:0),palmitic acid(C16:0)and staric acid(C18:0)are expected to be serum markers to evaluate the stability of atherosclerotic plaques;2.The combined application of the above four indicators in the diagnosis of vulnerable plaque is significantly better than that of each single indicator,which provides a new idea for economic and convenient evaluation of vulnerable plaques and guidance of secondary prevention of acute ischemic cerebrovascular events.