Changes Of Plasma Glycocalyx And Its Effect On Prognosis In Patients With Acute Ischemic Stroke Treated With Endovascular Therapy

Objective:The degradation of glycocalyx can cause blood-brain barrier dysfunction,resulting in brain edema and cerebral hemorrhage.At present,most studies only describe the dynamic changes of glycocalyx in the plasma of patients with acute mild ischemic stroke,but there are no studies on the changes of glycocalyx and its effect on prognosis in patients with macrovascular occlusion.Therefore,this study detected the level of glycocalyx components in plasma of patients with acute ischemic stroke treated by endovascular treatment in the first affiliated Hospital of Jinan University,and analyzed its dynamic changes and its effect on prognosis.Methods: From November 1,2019 to November 30,2020,71 patients with acute anterior circulation occlusion were included in this study.Venous blood samples were collected before operation,0 h,12 h,36 h,3 days and 7 days after operation,and the plasma glycocalyx components(HA,HS,SDC-1)were quantitatively detected by enzyme-linked immunosorbent assay(ELISA).The main outcome indicators of this study were the m RS score of 90 days after endovascular treatment(0-3 as a good prognosis)and the mortality within 90 days.The secondary indicators were symptomatic intracranial hemorrhage and malignant brain edema.A linear mixed effect model was used to explore the relationship between the dynamic changes of glycocalyx in plasma and the clinical outcome 90 days after operation.Results: After endovascular treatment,the levels of HA,HS and SDC-1 in plasma fluctuated and lasted until 7 days after operation.The difference was that the levels of HA and HS decreased 12 hours after operation,and then fluctuated at 36 hours and 3days after operation,while SDC-1 was at a high level before operation and decreased significantly at 0 hours after operation,and then continued to increase slightly.In the patients with poor prognosis,the level of plasma HA increased continuously after 36 hours of endovascular treatment,while the level of SDC-1 increased significantly before endovascular treatment,and the levels of HA in the patients with poor prognosis were significantly higher than those in the control group at 36 hours,3 days and 7 days after operation(P < 0 05).In the death group,the differences of HA and SDC-1 levels were more significant.There was no significant difference in plasma HS level between the two control groups.Pearson correlation analysis showed that the increase of NIHSS score at 36 hours after endovascular treatment was positively correlated with the increase of SDC-1 level at the corresponding time point.Conclusions:(1)The content of glycocalyx in plasma of patients with acute ischemic stroke after endovascular treatment fluctuated and lasted for at least 7 days.(2)The significant increase of HA after endovascular treatment increased the occurrence of severe adverse events and was related to adverse prognosis,while the significant increase of plasma SDC-1 level before endovascular treatment was related to the occurrence of severe adverse events and higher mortality.(3)The degradation of glycocalyx is related to the deterioration of neurological function.