Study On The Correlation Between ADAMTS-4 And α-SMA Expression And The Stability Of Carotid Artery Plaque

Objective:To investigate the correlation between A disintegrin-like and metalloproteinase with thrombospondin type Ⅰ motifs-4(ADAMTS-4)and Alpha-smooth muscle actin(α-SMA)expression and the stability of carotid atherosclerotic plaque in patients with carotid artery stenosis.At the same time,the relationship between clinical indicators and the stability of carotid atherosclerotic plaque was analyzed,so as to determine the influencing factors of carotid plaque stability,provide a reference for the intervention treatment of patients with carotid artery stenosis,and thus provide help for the individualized diagnosis and treatment of carotid artery stenosis patients.Method:This study analyzed 44 patients with carotid atherosclerotic stenosis and carotid endarterectomy admitted to the department of Neurosurgery of Guangdong Provincial People’s Hospital from August 2017 to December 2019.General clinical data of the patients were collected,including:gender,age,history of hypertension,history of diabetes,surgical location,postoperative hospitalization days,total hospitalization days,and hospitalization expenses.Blood parameters were collected,including:platelet count,neutrophil count,lymphocyte count,platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR).The fasting elbow venous blood of the patient was taken in the second morning after admission,and the ADAMTS-4 level in serum was detected by ELISA.The patients were divided into stable plaque group and vulnerable plaque group according to the preoperative imaging results.The expression of ADAMTS-4 and α-SMA in plaque tissue in both groups were measured by immunohistochemistry,and the expression differences of ADAMTS-4 and α-SMA were detected.Result:Of the 44 patients,38 were female(86.4%)and 6 were male(13.6%).Among them,the age range from 48 to 83 years old,average age 68.0±8.8 years,and 28 cases(63.6%)had a history of high blood pressure,15 cases(34.1%)had a history of diabetes.Among the patients,15 were in stable group(34.1%),29 in vulnerable group(65.9%),18 on the left(38.6%),and 26 on the right(61.4%).The patients were discharged 4-20 days after surgery,with a median of 7.0(5.3-7.8)days.The 44 patients had a total length of stay of 6-31 days,with a median length of stay of 14.0(12.0-18.0)days.Gender,age,history of hypertension,history of diabetes,platelet count,neutrophil count,lymphocyte count,NLR,surgical location,postoperative hospitalization days,total hospitalization days,and hospitalization expenses showed no statistically significant differences between the two groups(P>0.05).The PLR was significantly different between the two groups(Z=-2.860,P=0.004<0.05).Serum ADAMTS-4 levels showed statistically significant differences between the two groups(t=-5.683,P=0.000<0.05).In the immunohistochemical staining of carotid plaque in 44 patients,ADAMTS-4 was positively expressed in 5 patients in stable group and 26 patients in vulnerable group,with statistically significant difference between the two groups(Z=-3.330,P=0.001<0.05).There were 14 positive expressions of α-SMA in stable group and 8 positive expressions in vulnerable group,and the difference between the two groups was statistically significant(Z=-4.446,P=0.000<0.05).Increased platelet to lymphocyte ratio resulted in increased vulnerability to carotid atherosclerotic plaque in patients with carotid artery stenosis(rs=0.436,P=0.003<0.05).Increased serum ADAMTS-4 level was associated with increased plaque vulnerability(rs=0.636,P=0.000<0.05).The expression of ADAMTS-4 in plaque was correlated with plaque vulnerability.The higher ADAMTS-4 in plaque was expressed,the more vulnerable the plaque was(rs=0.508,P=0.000<0.05).The expression of α-SMA in plaque was correlated with plaque stability.The higher α-SMA in plaque was expressed,the more stable the plaque was(rs=-0.678,P=0.000<0.05).Conclusion:1.PLR was correlated with the stability of carotid atherosclerotic plaque.And with the increase of PLR,the vulnerability of carotid plaque increased.2.The expression of ADAMTS-4 in serum and plaque was associated with the stability of carotid atherosclerotic plaque.The higher the expression of PLR and ADAMTS-4 in serum and plaque,the more vulnerable the plaque was3.The expression of α-SMA in plaque was correlated with the stability of carotid atherosclerotic plaque.The higher α-SMA in plaque was expressed,the more stable the plaque was.