The Diagnostic Function Of Lipoprotein-associated Phospholipase A2 In Acute Ischemic Stroke Patients With Early Cognitive Decline

Objective:The study discussed the differences of level of lipoprotein-associated phospholipase A2(Lp-PLA2)between two groups of acute ischemic stroke(AIS)patients-the cognitive impairment(CI)group and the non-cognitive impairment(NCI)group,as well as the correlation of Lp-PLA2 to the cognitive function of the AIS patients.To compare with LpPLA2,this study also analyzed the relationships between other inflammatory biomarkers(homocysteine,fibrinogen and hsCRP)and cognition.Moreover,the white matter lesions(WML)in patients suffered from AIS were examined by MRI.And this study investigated the association of cognitive impairment and inflammation to WML.All in all,the study intended to discuss the diagnostic value of Lp-PLA2 in the early cognitive decline of the AIS patients.Method:There were 106 AIS patients in total which were collected from the stroke center and neurology wards of the 1st Affiliated Hospital of Soochow University(June 2020 to December 2020).After the permission of the participants,their cognitive functions were examined 7-10 days after admission,and according to the results,they were distinguished into two groups-the cognitive impairment(CI)group(n=73)and the non-cognitive impairment(NCI)group(n=33).Moreover,their blood samples were collected the second morning after their admission for the analysis of Lp-PLA2 and other inflammatory biomarkers and so on.Subsequently,they were all required to take an MRI scan(3.0T)within 7-10 d after the onset of AIS.The researcher used the Fazekas score to evaluate the WMLs of the participants.The SPSS 25.0 software was applied to analyze the data and compare cognitive functions,inflammatory biomarkers and WMLs.The GraphPad Prism 8.0 software was utilized to make the figures.Results:1.Demographic statisticsOnly age,NIHSS and Barthel Index are significantly different between the CI group and NCI group(p ≤0.05).There was no significant difference in other baseline data between CI group and NCI group.2.Description of the cognitive function analysis(1)Making the cutoffs as 27,the positive rate of MMSE was 64.15%,the percentage of severity(from more to less)was mild>moderate>severe.The two most damaged cognitive domains of MMSE are orientation and language.(2)Making the cutoffs as 26,the positive rate of MoCA was 88.68%,the percentage of severity(from more to less)was mild>moderate>severe.The two most damaged cognitive domains of MoCA are delayed recall and language.(3)According to the recommended cutoffs of MoCA in 2019 China Vascular Cognitive Impairment Guideline of Diagnosis and Treatment,the positive rate of early cognitive decline after AIS in this study was 68.87%.3.The comparison of Lp-PLA2 and other inflammatory biomarkers between CI and NCI groupsThe level of plasma Lp-PLA2,Hcy,Fbg and hsCRP all showed significant differences between CI and NCI groups(p ≤0.05).4.The correlation between inflammatory biomarkers and cognition(1)Correlation of levels of Lp-PLA2,Hcy,hsCRP and scores of MMSE was negative;correlation of levels of Lp-PLA2,Hcy,Fbg,hsCRP and scores of MoCA was negative as well.(2)Correlation of levels of Lp-PLA2 and scores of MMSE-orientation and MoCAdelayed recall was negative;correlation of levels of Hcy and scores of MMSEorientation/language and MoCA-delayed recall was negative;correlation of levels of hsCRP and scores of MMSE-orientation/language was negative.There were no correlation relationships between level of Fbg and cognitive domains of MMSE/MoCA.5.White matter lesions and cognition/inflammatory biomarkers(1)Between CI and NCI groups,there were significant difference in score of deep WMLs and total score of Fazekas scale,while there was no significant difference in score of peri-ventricle WMLs.(2)The participants were set into four groups(normal,mild,moderate,severe)according to the results of Fazekas scale.The cognitive function between groups has significant difference.It was indicated by the linear regression that the cognitive function was negatively correlated to the WML severity.(β<0,p≤0.05)(3)Only the levels of Lp-PLA2 had significant difference between four groups,while other inflammatory biomarkers didn’t have statistically significance.It was suggested by the Logistic regression that the WML severity was positively correlated to the level of plasma Lp-PLA2.(β>0,p ≤0.05)6.Diagnostic value of the inflammatory biomarkers between CI and NCI groups(1)Only the ROC curves of Lp-PLA2,homocysteine,fibrinogen had the significance in diagnosing the early cognitive decline in AIS patients.(A=0.69,A=0.64,A=0.62 respectively)(2)The multivariable Logistic regression test of the CI and NCI groups showed that the level of Lp-PLA2 was independently correlated to the cognitive function after AIS.(p=0.032,B=0.015,OR=1.015)Conclusion:1.In acute ischemic stroke patients,the rate of early cognitive decline is quite prominent,the cognitive domains that are most susceptible to damages are orientation,delayed recall and language.2.Among AIS patients,the levels of plasma inflammatory biomarkers(Lp-PLA2,homocysteine,fibrinogen and hsCRP)increase significantly in the early cognitive decline group and the correlation between inflammation and cognition is negative.The level of LpPLA2 might be the independent predictor of early cognitive decline.3.Among AIS patients,the white matter lesions are more severe in the early cognitive decline group and the WMLs are positively correlated to the inflammation and negatively correlated to cognitive function.4.After the onset of AIS,human bodies begin the inflammatory cascade,which leads to severer white matter lesions,damage of cognitive networks,and subsequently cognitive decline.Thus,inflammatory markers such as Lp-PLA2 might be one of the diagnostic biomarkers of early cognitive decline after acute ischemic stroke,which might be of significance to discover the PSCI high-risk population.