The Relationship Between Serum NPY And Post Ischemic Stroke Epilepsy

Objective To describe the incidence and occurrence time of epilepsy in patients with acute ischemic stroke,investigate the clinical risk factors and independent risk factors and study the risk prediction value of neuropeptide Y(NPY)in patients of post ischemic stroke epilepsy.Method The first part:the patients with acute ischemic stroke with the first onset who were hospitalized in Xuzhou first people’s hospital from January 2015 to December 2018 were followed up for one year.To describe the incidence and occurrence time of epilepsy in patients with acute ischemic stroke.In addition,peripheral blood of patients with acute ischemic stroke was collected from 8:00 a.m to 9:00 a.m after fasting for at least 10-12 hours within 24 hours after admission,and stored in a freezer at-80℃ for testing.The second part:in this study,ischemic stroke patients with post ischemic stroke epilepsy and ischemic stroke patients without epilepsy were recruited.General basic information,tobacco and alcohol addiction,related risk factors of atherosclerotic stroke,NIHSS score,lesion site,arterial system,bleeding after ischemic stroke in the two groups and subtypes of epilepsy,VEEG and NHS3 score of ischemic stroke patients with post ischemic stroke epilepsy were collected and analyzed.Serum NPY levels of patients in the two groups were detected to analyze and evaluate whether serum NPY was associated with post ischemic stroke epilepsy,and whether it was an independent predictor.The differences of serum NPY levels in different cerebral infarction sites were studied.Furthermore,the effect of serum NPY on the prognosis of patients with post ischemic stroke epilepsy was further analyzed.Meanwhile,The optimal truncation value of NPY for predicting the risk of epilepsy after ischemic stroke was obtained by ROC curve.According to the cut-off value of serum NPY,all the patients were divided into two groups:the low NPY group and the high NPY group and the proportion of epileptic patients in the two groups was analyzed.To further demonstrate the relationship of serum NPY and the risk of post ischemic stroke epilepsy,pooled patients were categorized into three subgroups according to serum NPY tertiles,and the percentages of patients with post ischemic stroke epilepsy in each group were analyzed.In addition,we further analyzed the association of serum NPY with subtypes of epilepsy,VEEG and NHS3 score.Results 2218 patients with acute ischemic stroke were followed up for one year,and 198 patients were diagnosed with epilepsy after acute ischemic stroke with an incidence of 8.93%.The mean time of diagnosis of PISE after stroke onset was 63.41 ± 18.34 days.Compared with group of ischemic stroke patients without epilepsy,ischemic stroke patients with post ischemic stroke epilepsy were more likely to have higher NIHSS score at admission(48cases vs 37cases),higher proportion of cortex lesion(53cases vs 38 cases),internal carotid system damage(64cases vs 58cases),and bleeding after ischemic stroke(22 cases vs 10cases)(Pvalue<0.05).More importantly,serum NPY level significantly decrease-d in patients in case group compared with patients in control group(85.00(80.00,90.00)ng/ml vs 107.50(95.00,115.00)ng/ml,p<0.05).However,there was no statistically significa-nt difference for other factors including age,sex,status of smoking and drinking,hypertension,diabetes,hyperlipidemia and coronary heart disease between these two groups(P>0.05).In univariate logistic regression models,lesion site(OR:2.68,95%CI:1.425.07,Cortex vs Subcortex),arterial system(OR:0.45,95%CI:0.22-0.94,Vertebral basilar artery vs Internal carotid),bleeding after ischemic stoke(OR:2.99,95%CI:1.31-6.80),NIHSS score(OR:1.18,95%CI:1.12-1.25,perlscore increase)and serum NPY(OR:0.44,95%CI:0.34-0.56,per5ng/ml increase)were found to be associated with post ischemic stro-ke epilepsy.After the multivariate adjustment,bleeding after ischemic stroke(OR:8.84,95%CI:1.58-44.61),NIHSS score at admission(OR:1.25,95%CI:1.13-1.39)and serum NPY(OR:0.38,95%CI:0.27-0.54)were still associated with post ischemic stroke epilepsy(P<0.05).For serum NPY,every 5ng/ml increment of serum NPY was associated with 62%risk decrease of post-ischemic stroke epilepsy(P<0.05).T test showed that the serum NPY level of patients with cerebral infarction lesions in the cortex(98.63± 15.14ng/ml)was significantly higher than that of patients with cerebral infarction lesions in the cortex(92.09± 14.91 ng/ml),and the difference was statistically significant.The area under curve(AUC)of NPY was 0.910(95%CI:0.856-0.949,P value<0.001).The optimal cut-off point of NPY was 90 ng/ml with a sensitivity of 84.62%and a specificity of 86.05%.According to the cut-off value of serum NPY,all the patients were divided into two groups:low NPY group(NPY≤90ng/ml,N=78)and high NPY group(NPY>90ng/ml,N=86).The proportion of patients with post ischemic stroke epilepsy was much higher in low NPY group(84.6%)than that in high NPY group(14.0%).In addition,pooled patients were categorized into three subgroups according to serum NPY tertiles(NPY<85 ng/ml,NPY between 85-105 ng/ml,and NPY≥105ng/ml).The percentage of patients with post-ischemic stroke epilepsy decreased from 90.0%in the Tertile 1(NPY<85ng/ml)to 60.6%in the Tertile 2(NPY 85-105ng/ml)and 3.5%in the Tertile 3(NPY≥105ng/ml,P<0.001).6patients with normal VEEG showed NPY(97.50±6.89)ng/ml,72patients with abnormal VEEG showed NPY(82.57±8.43)ng/ml.Compared with normal VEEG patients,the NPY levels of patients with abnormal VEEG were significantly lower,and the difference was statistically significant(P<0.05).While 60 patients with partial seizures showed NPY(83.00±9.08)ng/ml,18 patients with partial seizures followed by generalized seizures showed NPY(86.11±9.48)ng/ml(P>0.05).The relationship between NHS3 score and NPY was analyzed by spearman rank correlation showed that r=-0.802(p<0.001).Conclusion Our study found that serum NPY levels were different depending on different sites of ischemic stroke.The risk of post ischemic stroke epilepsy was significantly increased in ischemic stroke patients with low serum NPY.The lower the level of serum NPY,the more severe the seizure.Serum NPY was closely related to post ischemic stroke epilepsy and has risk prediction value for post ischemic stroke epilepsy.