Risk Factors Analysis Of Progressive Ischemic Stroke

Background Stroke is the leading cause of death and disability among adults in our country,and it has the characteristics of high morbidity,disability,and mortality which brings serious pain and heavy economic burden to the family and society.Progressive Ischemic Stroke(PIS)is a refractory cerebrovascular disease,and its recurrence,morbidity and mortality were higher than the common type of stroke.The pathogenesis of PIS is very complicated,and inflammation plays an important role in the pathogenesis of PIS which is a research focus in the field of neuroscience.Studying the related risk factors of PIS can provide a basis for early clinical identification and intervention,so as to bring better prognosis for patients with PIS.Part 1: A retrospective study on the risk factors of Progressive Ischemic StrokeObjective To investigate the risk factors that can predict the Progression of Ischemic Stroke.Methods According to the enrollment and exclusion criteria of this study,there were 214 patients in total were collected retrospectively and were divided into two groups,namely patients with PIS group and non concurrent PIS group,according to the scoring standard of neurological deficit.Of two groups,the general information,past medical history,clinical symptoms,laboratory examination and imaging results were collected and compared by the Logistic regression to explore the risk factors.All patients were diagnosed of acute ischemic stroke(AIS)and were treated in the Third Affiliated Hospital of Guangzhou Medical University between January 2017 andDecember 2019.Results In 214 patients with AIS,53 cases in PIS group,including 32 cases of atherosclerotic cerebral infarction,5 cases of cardioembolic cerebral infarction,14 cases of arteriolar occlusive cerebral infarction,and 2 cases of Cerebral infarction of other etiology.161 cases without PIS group,including 61 cases of atherosclerotic cerebral infarction,18 cases of cardioembolic cerebral infarction,72 cases of arteriolar occlusive cerebral infarction,2 cases of Cerebral infarction of other etiology,8 cases of Cerebral infarction of unknown etiology.1.PIS and NPIS: In single factor analysis,smoking history,atrial fibrillation history,hemiplegia,WBC,CRP,fasting blood glucose,unstable carotid plaque,radiation coronary infarction,infarct volume,stenosis of responsible vascular were the eleven risk factors P<0.05,indicating that there are significant differences among the above eleven risk factors in the PIS group and the NPIS group;and in the multivariate logistic regression analysis showed smoking history,atrial fibrillation history,hemiplegia,elevated fasting blood glucose,elevated CRP,radiation coronary infarction,severe stenosis of responsible vascular,unstable carotid plaque and PIS related(P<0.05).2.Comparison of TOAST classification between PIS group and NPIS group: In single factor analysis,gender,age,Total Cholesterol,fasting blood glucose,CRP,stenosis of responsible vascular were the six risk factors(P<0.05),indicating that there are significant differences among the above risk factors in the atherosclerotic PIS group and the NPIS group;and in the multivariate logistic regression analysis showed gender,age,elevated fasting blood glucose,elevated CRP,severe stenosis of responsible vascular and atherosclerotic PIS related(P<0.05).In single factor analysis,there was significant differences in atrial fibrillation history,INR between the cardioembolic PIS group and the NPIS group(P<0.05);and in the multivariate logistic regression analysis showed atrial fibrillation history,INR and cardioembolic PIS not related(P>0.05).In single factor analysis,there are significant differences among gender,hemiplegia in the arteriolar occlusive PIS group and in the NPIS group(P<0.05);in the multivariate logistic regression analysis showed gender and arteriolar occlusive PIS related(P<0.05).Conclusions Smoking history,atrial fibrillation history,hemiplegia,elevated fasting blood glucose,elevated CRP,radiation coronary infarction,severe stenosis of responsible vascular,and unstable carotid plaque are the risk factors of PIS;gender,age,CRP,fasting blood glucose and stenosis of responsible vascula are the risk factors of atherosclerotic PIS;Gender is the risk factor of the progression of arteriolar occlusive cerebral infarction.AIS patients with the above risk factors are at higher risk of disease progression.Part 2: The role of cytokines in predicting the progression of ischemic strokeObjective To investigate the inflammatory risk factors that can predict the progression of ischemic stroke.Methods According to the enrollment and exclusion criteria of this study,there were 127 patients in total were collected and were divided into two groups,namely patients with PIS group and non concurrent PIS group,according to the scoring standard of neurological deficit.Of two groups,the general information,the risk factors related to PIS in the first part,the serum cytokines levels were collected and compared by the Logistic regression to explore the risk factors.All patients were diagnosed of acute ischemic stroke(AIS)and were treated in the Third Affiliated Hospital of Guangzhou Medical University.Results In 127 patients with AIS,27 cases in PIS group and 100 cases without PIS group.In single factor analysis,IL-5,IL-6,IL-8,TNF-α were the four risk factors P<0.05,indicating that there are significant differences among the above four risk factors in the PIS group and the NPIS group;and in the multivariate logistic regression analysis showed elevated IL-6,elevated IL-8,elevated TNF-α and PIS related.Conclusions elevated level of serum IL-6,IL-8,TNF-α are the independent risk factors for predicting PIS.AIS patients with the above risk factors are at higher risk of disease progression.