A Correlation Study Between The Serum Level Of Angiopoietin-like Protein 4 And Acute Cerebral Infarction

[Objective] By analyzing the serum level of Angiopoietin-like protein 4(ANGPTL4),blood lipid level and risk factors in acute cerebral infarction group and control group,the relationship between the serum level of ANGPTL4 and acute cerebral infarction was preliminarily explored in order to explore the early biomarkers of acute cerebral infarction,provide new clinical evaluation methods and prevention and treatment targets for acute cerebral infarction.[Methods] From August 2017 to July 2019,the patients with acute cerebral infarction(acute cerebral infarction group)and the healthy persons who were examined at the same time(control group)were collected continuously in the neurology department of the First Affiliated Hospital of Fujian Medical University or the Longyan Affiliated Hospital of Fujian Medical University.According to TOAST classification,the acute cerebral infarction group was divided into five subgroups: large atherosclerosis group,cardiogenic embolism group,small artery occlusion group,other etiology group and unknown etiology group.Data of all subjects were collected,including: gender,age,risk factors of cerebral infarction(smoking,drinking,hypertension,diabetes,atrial fibrillation,etc.),ESRs score and biochemical indicators(TG,TCHOL,HDL-C,LDL-C,Hcy,FPG,UA),the serum level of ANGPTL4,carotid IMT and carotid plaque nature.NIHSS was evaluated in all patients with acute cerebral infarction.Spss22.0 statistical software was used to analyze the data: The Friedman test was used to compare the serum level of ANGPTL4 in different periods of acute cerebral infarction group,the Bonferroni method was used to correct the significance level;The Mann-Whitney U test or Chi square test of the Mann Whitney method was used to compare the clinical data between the two groups;The binary logistic regression model was used to analyze the risk factors and protective factors of acute cerebral infarction;The Kruskal Wallis H test was used to compare the serum level of ANGPTL4 between the groups.If the difference was statistically significant,then the two groups were compared;The Spearman correlation analysis was used between the level of serum ANGPTL4 and other clinical data.[Results]According to the inclusion and exclusion criteria,470 cases were collected in the groups,337 in the acute cerebral infarction group and 133 in the control group;126in the acute cerebral infarction group,51 in the cardiogenic embolism group,44 in the small artery occlusion group,10 in the other etiology group and 106 in the unknown etiology group.After statistical analysis:1.Comparison of the serum level of ANGPTL4 in different periods of acute cerebral infarction group:The serum level of ANGPTL4 in the first week of admission(P=0.024)and the second week of admission(P=0.006)were lower than those in the next day of admission;There was no significant difference between the serum level of ANGPTL4 in the first week of admission and the second week of admission.2.Comparison of clinical data between the acute cerebral infarction group and the control group: The serum level of ANGPTL4 in the acute cerebral infarction group was higher than that in the control group(P=0.041);Among the two groups,there was significant difference in sex(P<0.001),carotid plaque nature(P<0.001),hypertension(P<0.001),diabetes mellitus(P<0.001),atrial fibrillation(P<0.001),smoking(P=0.042),ESRs score(P<0.001),age(P=0.018),carotid artery IMT(P<0.001)and HDL-C(P<0.001).3.Logistic regression analysis on the influencing factors of acute cerebral infarction:The serum level of ANGPTL4(OR=1.000,95%CI 1.000-1.001,P=0.002),carotid artery unstable plaque(OR=2.373,95%CI 1.317-4.275,P=0.004),hypertension(OR=2.871,95%CI 1.624-5.077,P<0.001),atrial fibrillation(OR=10.900,95%CI 2.485-47.824,P=0.002)was the risk factors of cerebral infarction,the level of HDL-C(OR=0.438,95%CI 0.239-0.804,P=0.008)was the protective factor of cerebral infarction.4.Statistical analysis between the serum level of ANGPTL4 and the other clinical data:(1)The serum level of ANGPTL4 in the atherosclerotic group(P=0.013)and the stable plaque group(P<0.001)was higher than that in the unstable plaque group,and there was no significant difference between the atherosclerotic group and the stable plaque group.(2)There was a positive correlation between the serum level of ANGPTL4 and NIHSS score(r=0.276,P<0.001);The serum level of ANGPTL4 in the non mild group was higher than that in the mild group(P<0.001)and the control group(P<0.001),and there was no significant difference between the mild group and the control group;The serum level of ANGPTL4 in the moderate cerebral infarction group(P<0.001)and the severe cerebral infarction group(P<0.001)was higher than that in the mild cerebral infarction group(P< 0.001),the serum level of ANGPTL4 in the moderate cerebral infarction(P < 0.001)and severe cerebral infarction(P < 0.001)was higher than that in the control group,and there was no significant difference between the control group and the mild cerebral infarction group,the moderate cerebral infarction group and the severe cerebral infarction group.(3)There was no significant difference in the serum level of ANGPTL4 among the subgroups of acute cerebral infarction group.(4)The serum level of ANGPTL4 was positively correlated with UA(P=0.009),Hcy(P=0.031),FPG(P=0.044).[Conclusion]The serum level of ANGPTL4 is higher in the early stage of acute cerebral infarction,which is positively correlated with the severity of cerebral infarction.It was obviously increased in the non mild stroke and the moderate or severe cerebral infarction,and it was expected to be an early biomarker for predicting the severity of acute cerebral infarction.ANGPTL4 might play an important role in stabilizing the carotid plaque.