The Plasma Levels Of Lipoprotein-associated Phospholipase A2,Transorming Growth Factor-bet1 And Clinical Significances In Patients With Atherosclerotic Cerebral Infarction

Objective By detecting the plasma levels of lipoprotein-associated phospholipase A2(Lp-PLA2) and transforming growth factor-beta1(TGF-β1) in patients with acute atherosclerotic cerebral infarction to explore the relationship between Lp-PLA2, TGF-β1 and the volume of cerebral infarction,the severity of neurological impairment as well as the occurrence of cerebral vascular incident within one year and to assist us with assessing the state and the prognosis of ACI.Methods Patients with acute atherosclerotic cerebral infarction(n=128) and no stroke control subjects(n=58) entered the study.Lp-PLA2 and TGF-β1 plasma concentrations were detected by enzyme linked immunosorbent assay(ELISA) in patients with acute atherosclerotic cerebral and the normal controls.In the meantime, cranium MRI were carried out in order to calculate the volume of cerebral infarction, according to the National Institute of Health Stroke Scale(NIHSS score) to assess the degree of neurological impairment and investigate the occurrence of cerebral vascular incident by following up one year for the patients with ACI.All measured values were analyzed by the 16.0 SPSS software.Results(1) The plasma levels of Lp-PLA2 were higher in ACI(65.30±10.03μg/L) than that of the controls(28.30±11.15μg/L),the differences had statistical significances(t= 22.506,P = 0.000 );The plasma levels of TGF-β1 were lower in ACI (19.13±9.47 ng/L) than that of the controls(22.01±7.92 ng/L),the differences had statistical significances(t=-15.785,P=0.000).(2) The plasma levels of Lp-PLA2 were negatively correlated with HDL-C(r_s =-0.804,P=0.000),while positively correlated with TC and LDL-C(r_s=0.919, P=0.000;r_s=0.914,P=0.000);The plasma levels of TGF-β1 were positively correlated with HDL-C(r_s=0.806,P=0.000),while negatively correlated with TC and LDL-C(r_s=-0.926,P=0.000;r_s=-0.912,P=0.000);The plasma levels of Lp-PLA2 were negatively correlated with the plasma levels of TGF-β1(r=-0.934,P =0.000).(3) The plasma levels of Lp-PLA2 raised with the increasing of the volume of cerebral infarction[(53.64±5.20μg/L),(65.30±10.03μg/L),(67.56±4.44μg/L)],but the differences of interclass had no statistical significances(F=0.845,P=0.296); The plasma levels of TGF-β1 decreased with the volume of cerebral infarction increasing[(22.13±8.56ng/L),(20.49±8.64 ng/L),(18.83±9.47 ng/L)],but the differences of interclass had no statistical significances(F=0.945,P=0.392).(4) The plasma levels of Lp-PLA2 raised with the exacerbating of neurological impairment[(53.45±5.47μg/L),(65.68±6.07μg/L),(77.11±5.12μg/L)] and the differences of interclass had statistical significances(F=132.93,P=0.000); The plasma levels of TGF-β1 decreased with the exacerbating of neurological impairment[(26.13±8.56ng/L),(22.49±8.64ng/L),(18.83±9.47ng/L)]and the differences of interclass have statistical significances(F=116.34,P=0.000).The severity of neurological impairment had a significantly positive correlation with Lp-PLA2(r_s=0.829,P =0.001 ) while had a significantly negative correlation with TGF-β1(r_s=-0.785,P=0.005).(5) By following up one year for the patients with ACI,it showed that the plasma levels of Lp-PLA2 in the cerebral vascular incident group(71.56±7.12μg/L) was higher than that of the non-cerebral vascular incident group(62.31±9.68μg/L),and the differences of interclass had statistical significances(t′=6.049,P= 0.000),while the plasma levels of TGF-β1 in the cerebral vascular incident group (16.57±8.93ng/L) was lower than that of the of the non-cerebral vessels incident group(22.64±8.24 ng/L ),and the differences of interclass have statistical significances (t=-3.798,P=0.000).(6) The group of ACI was respectively divided into another four groups by median and other two quartiles of the plasma levels of Lp-PLA2 and TGF-β1 and then calculated the incidence of cerebral vascular incident respectively.The incidence of cerebral vascular incident in the fourth quartile group of the plasma levels of Lp-PLA2(≥72.85μg/L) was the highest,the differences of interclass had statistical significances(P=0.000,P=0.000,P = 0.000);The incidence of cerebral vascular incident in the first quartile group of the plasma levels of TGF-β1(＜14.40 ng/L) was the lowest,the differences of interclass had statistical significances(P=0.001,P= 0.000,P=0.000).(7) By receiver operating characteristic(ROC ) curve analysis,it indicated that if choose the plasma levels of Lp-PLA2≥72.85μg/L and TGF-β1＜14.40ng/L as the diagnostic point,it would be statistically significant to forecast cerebral vascular incident for patients with ACI within one year(P=0.000,P=0.000).(8) By gradually Logistic regression,it indicated that Lp-PLA2 was a independent risk factor(B=0.095,OR=1.100,P=0.001) while TGF-β1 was a independent protection factor(B=-0.101,OR=0.904,P=0.002) for the prognosis of ACI.Conclusion(1) ACI patients had higher plasma levels of Lp-PLA2 and lower plasma levels of TGF-β1.These were correlated with the severity of neurological impairment,but they had nothing to do with the volume of cerebral infarction.(2) Lp-PLA2 is a independent risk factor while TGF-β1 is a independent protection factor for the prognosis of ACI.Higher plasma levels of Lp-PLA2 and lower plasma levels TGF-β1 appear to be valuable to forecast cerebral vascular incident in patients with ACI within one year.