Association of Plasma CysC and hs-CRP Level with Carotid Atherosclerosis in Patients with Cerebral Infarction
|Keywords||Cystatin C high-sensitivity c-reactive protein cerebral infartion carotid atherosclerosis|
Background and objectiveCerebral infarction (CI), also known as cerebral ischemic stroke, refers to local brain tissue ischemic necrosis or softening on the account of the brain blood circulation disorders, including ischemia and hypoxia.Atherosclerotic thrombotic cerebral infartion is the most common type of cerebral infarction. On the basis of atherosclerosis, vcerebral blood-vessel canal narrow, out-of-the-way or thrombosis, result in local brain tissue blood supply disruption, the occurrence of ischemia and hypoxia, eventually leading to the corresponding clinical signs and symptoms. The key link and pathophysiological basis of Atherosclerotic thrombotic cerebral infartion is atherosclerosis. Cystatin C (CysC), also known as the cystine protease inhibitor C, is a typical endogenous cysteine protease inhibitor, whose primary role is to regulate cysteine protease, such as:organization of the activity of the protease, papain, ficin, matrix metalloproteinases and so on, thus involved in extracellular matrix degradation and reconstruction. It is a small molecule with a positively charged protein, which is susceptible to glomerular filtration,almost absolutely reabsorpted in the proximal tubule,but not secreted in the tubular. So it is mostly uesd as the sensitive indicator of the evaluation of glomerular filtration rate(GFR) in the past.Recent studies show that cystatin C involved in the process of atherosclerosis, and thus is closely related to the occurrence of cerebral infarction,However, the specific ways through which CysC participate in atherosclerosis are not clear. Atherosclerosis is commonly konwn as a chronic inflammatory process.Many studies have found that high sensitivity c-reactive protein (hs-CRP), which is one of the indicators reflecting inflammation, is closely related to the development and progression of atherosclerosis.In the present study, we tested plasma levels of cystatin C and hs-CRP, evaluated the correlation between the two indexes and the relationship between both the two indexes and crouse score. Through these analysis, we explored the relationship between carotid atherosclerosis and plasma CysC, CRP in patients with cerebral infarction.Materials and Methods1.Research objective A total of232patients with CI including142cases of male and90cases of female, who was in hospital in the department of Neurology of the First Affiliated Hospital of Zhengzhou University, was selected.Inclusion criteria:All was compliance with the diagnostic criteria of cerebral infartion which is instituted in the forth cerebrovascular disease academic meeting in1995,and confirmed by head CT(or)MRI. Exclusion criteria:①gout, blood system diseases, malignant tumors, recently taking the B vitamins, folic acid;②the obvious liver and renal insufficiency;③acute myocardial infarction and other vascular embolic disease;④hyperthyroidism and other chronic wasting disease;⑤ecent infection, autoimmune disease, estrogen, and2weeks of surgery or trauma history.2.Method Plaque were detected in232patients with Color doppler ultrasound in72h. The crouse score which reflect the extent of atherosclerosis was scored. And according to Doppler, all the patients were divided into plaque group and control group. The clinical data of each patient were asked and recorded, including age, sex, history of hypertension, history of diabetes, smoking history, drinking history, using of drugs and past history. The plasma level of cystatin C,hs-CRP, fasting blood glucose(FBG),triglyceride(TG), total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C), lipoprotein-a (LP-a),fibrinogen (FIB),homocysteine(t-HCY)were detected.3. Statistical analysis The data were analyzed using Software16.0.Quantitative data were analyzed by t test;Qualitative data were analyzed by chi-square test;The significant indexes were analyzed by logistic regression analysis.The difference was statistically significant as P<0.05,and all the analysis were two-sided test.Results1.The comparison of the general data between the two groupIn all232cases,there were142cases in plaue group and90cases in control group.There were statistically different in age,TG, LDL-C, FIB,t-HCY(P<0.05), while not statistically different in gender, smoking history, drinking history, history of hypertension,history of diabetes,FBG and TC,HDL-C,LP-a between Plaque group and control group(P>0.05).2.The comparison of the plasma CysC,hs-CRP between the two groupIn plaque group,the average plasma CysC level was (1.29±0.33) mg/L,while control group(1.03±0.45) mg/L; In plaque group,the average plasma hs-CRP level was(4.16±4.37) mg/L,while control group was (2.43±2.62) mg/L;The levels of CysC and hs-CRP in plaque group were significantly higher than those in control group.3.Logistic regression analysisWhen using carotid artery plaque as the dependent variable, these significant indexes as independent variables,multivariate logistic regression analysis indicated that age,t-HCY, CysC,hs-CRP were the risk factors for carotid atherosclerotic plaque.4.Correlation Analysis(1)CysC was neither related with age (p=0.138, P=0.101)nor hs-CRP (ρ=0.102, P=0.122). (2) In plaque group, CysC was related with the crouse score(ρ=0.143,P=0.02),and also hs-CRP (ρ=0.144,P=0.02).(3) There was correlation between plasma CysC and hs-CRP (p=0.248, P=0.003).Conclusions1.Plasma CysC and hs-CRP levels were both related to the occurrence and extent of carotid atherosclerosis, may be then participate in the development of carotid atherosclerosis.2. CysC, hs-CRP, age, t-HCY were the risk factors of carotid atherosclerosis.