Correlation Analysis Of Serum GITR And GITRL Levels With Carotid Atherosclerotic Plaque Properties In Patients With Acute Ischemic Stroke

Objective:To investigate the correlation between serum glucocorticoid-induced tumor necrosis factor receptor(GITR)and its ligand(GITR ligand,GITRL)levels and the properties of carotid atherosclerotic plaques(CAS)in patients with acute ischemic stroke(AIS).Methods:A total of 125 AIS patients who were admitted to the Department of Neurology,Affiliated Hospital of Chengde Medical University within 72 hours of onset and received cervical vascular ultrasound within 48 hours of admission were collected.According to the ultrasonic results,the patients were divided into intima thickening group(35 cases),non-vulnerable plaque group(40 cases)and vulnerable plaque group(50 cases).In addition,39 healthy subjects were selected as control group.Serum GITR and GITRL levels in each group were detected by ELISA,and the differences among the groups were compared.Spearman correlation analysis was used to analyze the related factors affecting the occurrence of CAS vulnerable plaques in AIS patients,and logistic regression was used to analyze the independent influencing factors of CAS plaque vulnerability in AIS patients.ROC curve was used to analyze the predictive value of GITR and GITRL for CAS vulnerable plaques in AIS patients.P < 0.05 was considered to be statistically significant.Results:1.Serum GITR levels in control group,intima thickening group,non-vulnerable plaque group and vulnerable plaque group were128.92±24.07 pg/m L,161.76±30.74 pg/m L,181.46±28.71 pg/m L,201.93±25.59 pg/m L,respectively,which showed an obvious increasing trend.The difference was statistically significant(P < 0.001).Serum GITRL levels in control group,intima thickening group,non-vulnerable plaque group and vulnerable plaque group were 798.27±244.73 pg/m L,966.02±205.74 pg/m L,1245.20±214.47 pg/m L,1365.53±213.11 pg/m L,respectively.There was a significant increasing trend,and the difference was statistically significant(P < 0.001).2.Spearman correlation analysis showed that serum GITR(r=0.440,P< 0.001),GITRL(r=0.450,P < 0.001)levels were positively correlated with the presence of CAS vulnerable plaque in AIS patients.3.Multivariate logistic regression analysis showed that GITR and GITRL levels were independent risk factors for CAS plaque vulnerability in AIS patients(P < 0.001).4.The optimal cut-off point of serum GITR level for the diagnosis of CAS vulnerable plaque formation in AIS patients was 188.63 pg/m L,the sensitivity was 68.0%,the specificity was 69.3% and the area under ROC curve was 0.759(95%CI: 0.677～0.842,P < 0.001).The optimal cut-off point of serum GITRL level for the diagnosis of CAS vulnerable plaque formation in AIS patients was 1086.89 pg/m L,its sensitivity was 92.0%,specificity was 52.0%,and area under ROC curve was 0.765(95%CI: 0.684-0.846,P <0.001).Conclusions:1.Serum GITR and GITRL levels in AIS patients were significantly increased and correlated with CAS plaque vulnerability.2.In this study,serum GITR and GITRL levels in the vulnerable plaque group were significantly higher than those in the non-vulnerable plaque group and intima thickening group.Serum GITR and GITRL levels were independent risk factors for CAS vulnerable plaques in AIS patients,and could be used as sensitive indicators to evaluate CAS plaque vulnerability in AIS patients.