Correlation Between Serum CTSL And Acute Large-artery Atherosclerosis Cerebral Infarction

Objective Stroke is currently the main cause of death and disability in adults worldwide,bringing a heavy burden of disease to countries around the world.Atherosclerotic cerebral infarction is one of the common types of ischemic stroke.The main pathogenesis is thrombosis and tube wall occlusion on the basis of atherosclerosis.Cysteine cathepsin L(CTSL)is a key protein involved in lipid metabolism,arterial remodeling,and apoptosis.CTSL can promote macrophage apoptosis and reduce the stability of atherosclerotic plaque.In addition,CTSL also enhances the migration and invasion of white blood cells,participates in inflammation within the plaque,and induces plaque instability.CTSL is closely related to the occurrence and development of coronary atherosclerotic heart disease.Therefore,we speculate that CTSL may be involved in the occurrence and development of atherosclerotic cerebral infarction,and may be a biological marker to predict the disease progression and poor prognosis of atherosclerotic cerebral infarction.The purpose of this study is to explore the correlation between serum CTSL and acute atherosclerotic cerebral infarction,and provide reference value for clinical diagnosis,treatment,prediction of progress and poor prognosis of acute atherosclerotic cerebral infarction.Methods The study enrolled 121 patients with acute cerebral infarction classified by TOAST as large aortic atherosclerotic type,40 patients with small artery occlusion cerebral infarction and 40 healthy controls.Collect the history of the research object,routine blood indicators(red blood cells,white blood cells,neutrophils,neutrophil percentage,platelets),biochemical indicators(fasting blood sugar,triglyceride,total cholesterol,low density lipoprotein,HDL,creatinine,alanine aminotransferase,aspertate aminotransferase,homocysteine),glycosylated hemoglobin,D-dimer,infarct volume,NHISS score and other related data.Collect fasting blood samples from the study subjects on the day of admission or in the morning of the next day,and measure the serum CTSL level using the CTSL enzyme linked immunosorbent assay kit.Stroke progression is defined as the appearance of new neurological symptoms and signs within 7 days of stroke or an increase in NHISS(National Institutes of Health Stroke Scales,)score of more than 2 points.Poor prognosis was defined as a score greater than 2 on the Modified Rankin Scale(MRS)3 months after onset.A binary logistic regression model was used to analyze the relationship between serum CTSL levels and disease progression and poor prognosis.The ROC curve was drawn,and the best critical value for predicting the disease progression and poor prognosis of acute atherosclerotic cerebral infarction was obtained.Results The serum CTSL level in patients with large atherosclerotic cerebral infarction(LAA)was significantly higher than that in healthy control(HC)(1293.99±63.53 pg/mL vs 1060.55 ± 98.88 pg/mL,P<0.05)and small artery occlusion(SAO)(1293.99± 63.53 pg/mL vs 1226.94 ± 73.76 pg/mL,P<0.05).Patients with LAA cerebral infarction were divided into two groups according to whether or not they had stroke progression.The serum CTSL level in patients with stroke progression was significantly higher than that in patients without stroke progression(1335.02 ± 39.71 pg/mL vs 1283.31 ± 64.36 pg/mL,P<0.05).Multivariate regression analysis showed that infarction volume(OR 1.189,95%CI 0.063-0.572,P<0.05)and serum CTSL level(OR 1.024,95%CI 1.012-1.036,P<0.05)were independent risk factors for the progression of cerebral infarction in LAA.Patients with LAA cerebral infarction were divided into two groups according to whether their prognosis was poor.It was found that the serum CTSL level of patients with poor prognosis was significantly higher than that of patients with good prognosis(1325.54 ± 53.57 pg/mL vs 1261.92 ± 56.71 pg/mL,P<0.05).Multivariate regression analysis showed that admission NHISS score(OR 5.423,95%CI 2.439-12.055,P<0.05),infarction volume(OR 1.022,95%1.002-1.206,P<0.05),and serum CTSL level(OR 1.031,95%1.014-1.047,P<0.05)were independent risk factors for poor prognosis of LAA cerebral infarction.Analysis of the ROC curve showed that the best predictive value of serum CTSL level for predicting stroke progression in acute LAA cerebral infarction was 1300.36pg/mL,with a sensitivity of 88.0%,and a specificity of 60.4%;The best predictive value of serum CTSL level for predicting poor prognosis of acute LAA cerebral infarction is 1296.37pg/mL,with a sensitivity of 73.0%and a specificity of 70.0%.Conclusions The increase of serum CTSL level was significantly associated with the progression of acute atherosclerotic cerebral infarction and the 3 month poor prognosis.The increase of serum CTSL level is an independent risk factor for the progression of acute atherosclerotic cerebral infarction and the poor prognosis of 3 months.The increase of serum CTSL level can predict the progression of acute atherosclerotic cerebral infarction and the adverse prognosis of 3 months.