Association Of Plasma Soluble CD40L And Soluble P-selectin With Large-artery Atherosclerosis Stroke

Objective : Through testing the level of plasma soluble CD40 L and soluble P-selectin in the large-artery atherosclerosis(LAA)stroke patients,combined with the extent and severity of cerebral atherosclerosis,the destabilization of atherosclerotic plaque and the NIHSS score,we aimed to investigate the association of plasma soluble CD40L(s CD40L)and soluble P-selectin(s Pselectin)with LAA stroke.Methods:We recruited 120 LAA stroke patients in acute phase and 60 controls.To evaluate the extent and severity of cerebral atherosclerosis,patients were divided into 3 subgroups by the number of cerebral-arteries with atherosclerotic stenosis(?50%)or occlusion.The neurological function of patients was assessed with the NIHSS scores.Patients with responsible arteries involving the internal carotid artery system were detected microembolic signals(MES).The plasma levels of s CD40 L and s P-selectin were measured by ELISA.The performance of s CD40 L and s P-selectin in diagnosing LAA stroke were studied by an ROC curve.Results:The plasma s CD40 L and s P-selectin levels were significantly increased in LAA stroke patients than controls(t =-11.960?-13.036,both P < 0.001).Both of them are independent risk factors of LAA stroke(OR = 1.006?1.100,P = 0.016?0.033).Significant variations were found in 3 subgroups by the number of cerebral-arteries with atherosclerotic stenosis(both P < 0.01).Further studies of post-hoc multiple comparisons with the Mann-Whitney test adjusted by Bonferroni method showed that the multiple group has higher levels of s CD40 L and s P-selectin than the single group(P < 0.001 and P = 0.002,respectively).And there was positive correlation of s CD40 L and s P-selectin with the increase of the number of cerebral atherosclerotic arteries(r = 0.330?0.359,both P < 0.001).Significant variations were also found that MES positive patients had higher s CD40 L and s P-selectin levels than the MES negative patients(both P < 0.001).The LAA stroke patients' s CD40 L and s P-selectin levels were also correlated with the NIHSS scores separately(r = 0.490?0.415,both P < 0.001).The AUC for the s CD40 L and s P-selectin levels in diagnosing an large-artery atherosclerosis stroke was 0.887 and 0.920,respectively.The optimal cut-off values were 307.00 pg/m L and 22.62 ng/m L and 0.020;the sensitivity and the specificity of the cut-off values were 81.7% and 91.7%,86.7% and 90%,respectively.Whereas there was no difference between them(Z = 1.26,P = 0.2077).Conclusions:We conclude that LAA stroke patients have high levels of s CD40 L and s P-selectin which could be used for assessing the worsening extent and severity of cerebral atherosclerosis,the destabilization of atherosclerotic plaque,and the severity of neurological dysfunction in large-artery atherosclerosis stroke patients.Plasma s CD40 L and s P-selectin take part in the pathogenesis of atherosclerosis through platelet activation and inflammation mechanisms,which could be clinical markers of the severity of cerebral atherosclerosis in LAA stroke.