| Background and AimsAcute cerebral infarction is a common cerebrovascular disease which often results in a series of clinical symptoms and pathological changes. Many studies have proved that the changes of some inflammatory factors and hormones after acute stroke correlate with the development and outcome of stroke. First, the poststroke evaluation of ET-l(endothelin-l), which not only deteriorates focal deficit through reducing cerebral blood flow but also stimulates the secretion of excitatory aminoacids, promote intracellular calcium concentration and accelerates the death of neuron. Second, the evaluation of INS(insulin), it often means IR (insulin resistance). The hyperglycemia associated with IR often results in serious lactic acidosis and energy metabolic obstacle of ischemic cerebral tissue. Third, the poststroke change of TNF-a(tumor necrosis factor-a), being induced to express by acute ischemic cerebrovascular disease (ICVD), It improves endothelial cell penertrating quality, leads to the collection of inflammatory cell in ischemic brain. However, recent documents report that hyperglycemia, TNF-a partly play protective roles in the process of ICVD. Some studies suggested that TNF-a level correlate with ischemic endurance. Others considered that hyperglycemia also had positive effects on the outcome of stroke, which depended on local cerebral blood flow.Our aims were to find how ET-1 . INS TNF-a, FBG levels change and what effect they have on cerebral infarction. In our study 78 patients with acute cerebral infarction were divided into three groups, namely, simple cerebral infarction group, cerebral infarctioncomplicated with hypertension group and cerebral infarction complicated with hypertension and diabetes group. Then ET-1 TNF-a INS and FBG levels were determined within 72 hours of onset of symptoms and the neurological assessment and size of infarction were measured. All data were analyzed aimed to observe whether there are elevations in peripheral blood of ET-1, INS, FBG and TNF-a levels in the patients of acute cerebral infarction; whether there are correlations between the levels of ET-1, INS, FBG and TNF-a and neurological and score size of infarction; the interrelation of ET-1, INS, FBG and TNF-a; the influence of hypertension and diabetes on above-mentioned change. Methods78 consecutive patients with acute cerebral infarction from Department of Neurology, Henan Armed Police Hospital from January 2004 to December 2004, were indued in the study while the control group was composed of 26 age- and sex-matched heathly subjects of medical examination. All patients were divided into three groups, namely, simple cerebral infarction group, cerebral infarction complicated with hypertension group and cerebral infarction complicated with hypertension and diabetes group. Fasting blood samples were collected at 7 o'clock or so in the morning from all cases within 72 hours of onset of symptoms and control group subjects and centrifugalized. Then ET-1 TNF-a INS and FBG levels were determined by radioimmunoassay. All data were analyzed by SAS 6.12 software package. Reasults1. There were statistical significance among TNF-a mean of each group, p=0.0001. TNF-a mean of simple CI group, CI complicated with hypertension group and CI complicated with hypertension and diabetes group were higher than that of control group, P<0.05, TNF-a mean of CI complicated with hypertension group was the highest of all.2. There were statistical significance among INS mean of each group, p=0.0022. INS mean of CI complicated with hypertension group and CI complicated with hypertension and diabetes group were higher than that of control group. INS mean of CI complicated with hypertension and diabetes group was higher than that of simple CI group, P<0.05.3. There were statistical significance among ET-1 mean of each group, p=0.0001. ET-1 mean of simple CI group, CI complicated with hypertension group and CI complicated withhypertension and diabetes group were higher than that of control group, P<0.05, ET-lmean of CI complicated with hypertension group and CI complicated with hypertension and diabetes group were higher than that of simple CI group, P<0.05.4. There were statistical significance among FBG mean of each group,p=0.0001. FBG mean of CI complicated with hypertension group and CI complicated with hypertension and diabetes group were higher than that of control group, P<0.05. FBG mean of CI complicated with hypertension and diabetes group was higher than that of CI complicated with hypertension group and simple CI group, P<0.05.5. All subjects of each group were respectivly divided into two groups according to worse neurological score or not. We found that there were no correlation between the levels of ET-K TNF- a > INS and GLU and the worse neurological score .6. There was positive correlation between the values of INS and ET-1 in CI complicated with hypertension group and CI complicated with hypertension and diabetes group, P<0.05. In CI complicated with hypertension group there was also positive correlation between the values of INS and FBG, P=0.03.7. In CI complicated with hypertension group there was linear regession equation between the values FBG and neurological scores on admission, r2=0.47, P<0.05; while no linear regession equation between the values of INS, ET-1, TNF-a and neurological scores. In other groups there was not any linear regession equation between the values of ET-1> TNF-a > INS and FBG and neurological scores.8. In CI complicated with hypertension group there was linear regession equation between the values of FBG and size of infarction, r2=0.14, P=0.062, while no linear regession equation between the values of INS, ET-1, TNF-a and size of infarction. In other groups there was not any linear regession equation between the values of ET-1 > TNF-a > INS and FBG and size of infarctionConclusions1. There were reactive elevations in peripheral blood of TNF-a, ET-1 levels in the patients of acute cerebral infarction, there were higher TNF-a, ET-1 levels, elevated INS, FBG levels when complicated with hypertension, there were significantly positive .correlations between peripheral blood levels of INS and ET-1, FBG,respectivly, which proved IR statein those patients, So we concluded IR state of hypertension and ET-1 corporately accelerate the development of ischemic stroke.2. There were no relations between TNF-a, ET-1, INS levels and seriousness and prognosis of CI; the neurological scores were only related with FBG levels in peripheral blood in acute cerebral infarction complicated with hypertension group as well as between FBG levels and size of infarction in the group, which demonstrate transient hyperglycemia had more effect on CI than that of complicated with diabetes or normal glycemia.3. There were not the relationships between TNF-a and ET-1 or INS in acute cerebral infarction patients, which suggested TNF-a contribute to the development of cerebral infarction with hyprtension through different mechanism.4. TNF-a , ET-1 and INS not only were reactive inflammatory factors and hormones after CI but also took part in the mechanism of CI.
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