| Objective:To investigate the expression and dynamic changes of pro-resolving mediators of MaR1 and AnxA1 in serum of patients with acute cerebral infarction,and to explore whether remote ischemic postconditioning plays a neuroprotective role by up-regulating pro-resolving mediators.Methods:Based on the enrollment and exclusion criteria,49 patients with acute cerebral infarction within 72 hours of onset who were hospitalized in the Department of Neurology,The First Hospital of Jilin University from August2020 to January 2021 were enrolled in our study.Their general clinical data,NIHSS scores and laboratory results were recorded.According to the patients’ own will,they were divided into the conventional treatment group(n=26)and the remote ischemic postconditioning(RIPost C)group(n=23).The conventional treatment group was given routine medication of cerebral infarction,including anti-platelet aggregation,improving circulation and nerve nutrition etc;while in the RIPost C group,on the basis of the routine medication,the ischemic adaptation instrument was used to perform ischemic postconditioning on the bilateral upper limbs of patients.That is,the double upper limbs ischemia for 5-min/reperfusion for 5-min constitutes a cycle,repeats 5 cycles,in the morning and evening everyday,consecutively treat for 1week.In addition,a total of 10 non-cerebral infarction patients with age and sex matched and no recent inflammation-related diseases were recruited as the control group during the same period,and their basic information was recorded.The blood samples of patients in the conventional treatment group and the RIPost C group were collected before treatment,1 day after treatment and 7days after treatment respectively,while those in the control group were collected only on the enrollment day.The contents of MaR1 and AnxA1 in serum were determined by enzyme linked immunosorbent assay(ELISA),and the levels of IL-2,IL-4,IL-6,IL-10,IL-17 A,TNF-α and IFN-γ in serum were measured by cytometric bead array(CBA).Use SPSS 25.0 and Graph Pad Prism 8 for data analysis and chart making.Results:(1)The MaR1 levels of patients in the conventional treatment group on the day of enrollment(within 3d of onset),1d after enrollment(within 4d of onset)and 7d after enrollment(7-10 d of onset)were significantly higher than those in the control group(P<0.05),and there was no obvious trend of change over time(P>0.05).There were no significant differences in serum levels of AnxA1 between the conventional treatment group and the control group at three time points(P>0.05),and there was no obvious trend of change over time(P>0.05).(2)The levels of MaR1 in the serum of patients with acute cerebral infarction were negatively correlated with patients’ NIHSS scores(r=-0.461,P<0.05);no significant correlations were observed between the serum levels of AnxA1 and NIHSS scores(P>0.05).(3)In the conventional treatment group,the serum levels of AnxA1 were positively correlated with the levels of IL-10 at the corresponding time(r=0.415,P=0.003;r=0.314,P=0.028;r=0.376,P=0.008),and negatively correlated with the levels of TNF-α(r=-0.483,P<0.01;r=-0.357,P=0.012;r=-0.445,P=0.001),there were no significant correlations between the serum level of AnxA1 and the levels of IL-2,IL-4,IL-6,IL-17 A and IFN-γ(P>0.05);no obvious correlations were observed between the levels of serum MaR1 and the levels of above inflammatory cytokines(P>0.05).(4)No significant differences were observed regarding the serum level of AnxA1 between the RIPost C group and the conventional treatment group at each time point(P>0.05).The serum levels of MaR1 of 7 days after RIPost C were significantly higher than that in the conventional treatment group at the same time point(P<0.05).There were no significant changes in MaR1 and AnxA1 levels with time in RIPost C group.(5)There were no significant differences in NIHSS scores between the conventional treatment group and the RIPost C group before treatment(P>0.05),but the NIHSS scores in the two groups after treatment were lower than that before treatment(P<0.05).The NIHSS scores of RIPost C group after 7 days treatment were significantly lower than that of conventional treatment group at the same time point(P<0.05).Conclusion:(1)Patients with acute cerebral infarction can initiate the process of inflammatory resolution in the early stage,induce the up-expression of pro-resolving mediators factor of MaR1,and continue to express at a high level in the acute stage(within 7-10 days of onset).(2)The serum levels of MaR1 in the early stage of acute cerebral infarction may be an important factor affecting the severity of the disease.High level of MaR1 may reduce the neurological impairment and play a neuroprotective role.(3)Serum AnxA1 in the acute phase of cerebral infarction may have an immunomodulatory effect on the expression of inflammatory factors.It may play a protective role by up-regulating the level of anti-inflammatory factor IL-10 and down-regulating the level of pro-inflammatory factor TNF-α.(4)RIPost C within 72 hours of onset has a therapeutic effect on patients with acute cerebral infarction,RIPost C combined with routine treatment can better improve the clinical symptoms of patients.(5)The expression levels of MaR1 increased after 1 week of RIPost C,which may be a potential mechanism for its neuroprotective effect. |
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