Effect Of Remote Ischemic Postconditioning On Expression Of Inflammatory Factors And NF-κb Pathway In Peripheral Neutrophil During Acute Cerebral Infarction

Objective:（1）To detect the changes of inflammatory factors and NF-κB pathway in peripheral neutrophils during acute cerebral infarction.（2）To explore the effects of remote ischemic postconditioning（RIPost C）on expression of NF-κB pathway and inflammatory factors in the peripheral neutrophils of patients with acute cerebral infarction.Methods:（1）According to the inclusion criteria and exclusion criteria,patients admitted to the Department of Neurology of The First Hospital of Jilin University from May 2021 to November 2021 who were diagnosed as acute cerebral infarction within 72 hours of the onset were selected as the subjects,and adults without acute cerebral infarction and other inflammatory diseases matched in age and gender were recruited at the same time.They were divided into RIPost C（remote ischemic postconditioning）group and routine treatment group and control group.The volunteers were recruited as the control group,and the patients were divided into the conventional treatment group and the RIPost C group according to their wishes.In the RIPost C group,both upper limbs were treated simultaneously with conventional drug therapy,i.e.,bilateral upper limbs were completely ischemic for 5 minutes/reperfusion for 5 minutes in a cycle of 5cycles each time,once in the morning and once in the evening,for a week.Patients in the conventional treatment group received conventional therapy.General information of them were recorded,and the RIPost C group and the conventional treatment group were given NHISS scores before the treatment and 7 days after treatment and m RS before the treatment and 3 month after discharge.（2）Fasting peripheral blood of patients in the RIPost C group and the conventional treatment group were collected before the treatment,3 days after thetreatment,and 7 days after the treatment（denoted as 0d,3d,and 7d,respectively）.In the control group,fasting peripheral blood was also collected at the same time.Then neutrophils were extracted.The m RNA expression of IL-1β,IL-2,IL-4,IL-6,IL-8,IL-10,IL-12,IL-17α,IFN-γ,TGF-β1,TNF-α and NF-κB signaling pathway in neutrophils were comparatively quantitatively analyzed by Real-Time PCR（real time polymerase chain reaction）.The effects of different groups and onset time on the above indexes were analyzed.Results:（1）The changes in NIHSS scores and m RS scores before and after treatment were more significant in the RIPost C group than in the conventional treatment group（P<0.05）.（2）The m RNA expressions of IL-1β,IL-4,IL-6,IL-8,IL-10,IL-17α and TNF-α in peripheral neutrophils of patients patients with acute cerebral infarction were increased（P<0.05）,while TGF-β1 was significantly decreased（P<0.05）,IL-2,IL12,IFN-γ were not significantly changed（P>0.05）;Compared with the conventional treatment group,the m RNA expressions of IL-6 and TGFβ1 in peripheral blood neutrophils of patients in RIPost C group were significantly increased（P<0.05）,while the expression of IL-1β was decreased（P<0.05）,and there was no statistical difference in the expression levels of cofactors（P>0.05）.（3）The m RNA level of IL-1β,IL-6,IL-8,TGF-β1 and TNF-α in the peripheral blood of patients with acute cerebral infarction changed with the time of onset.The IL-1β level was firstly increased and then decreased,IL-6 was increased and TGF-β1was decreased,with statistical significance（P<0.05）.Besides there was no statistical difference in the change trend of residual factors（P >0.05）.（4）The m RNA expressions of genes of NF-κB pathway（TAK1 and IκB）in peripheral neutrophils of patients with acute cerebral infarction was increased（P<0.05）,while the expression of IKKβ was not significantly changed（P>0.05）.In conventional treatment group,the expression trend of TAK1,IKKβand IκB had no statistical difference（P>0.05）;Compared with conventional treatment group,TAK1 m RNA expression in peripheral blood neutrophils of patients in RIPost C group was lower than that in control group（P<0.05）,while there was no significant difference in IKKβ and IκB（P>0.05）.Conclusion:（1）The addition of RIPost C on the basis of conventional treatment can improve the neurological deficit and prognosis of patients with acute cerebral infarction more than conventional treatment.（2）The expressions of IL-1β、IL-4、IL-6、IL-8、IL-10、IL-17α、TNF-α in peripheral neutrophils of patients with acute cerebral infarction increased,while TGF-β1 expression decreased,in addition,NF-κB pathway was activated.（3）RIPost C may play a neuroprotective role by inhibiting the levels of IL-1β,promoting the expression of IL-6 and TGF-β,inhibiting the activation of NF-κB pathway in neutrophils.