Introduction <p>Stroke is a disease with a high incidence, disability rate and mortality rate, imposing a heavy economic and social burden on patients. Exploring the risk factors associated with its pathogenesis and identifying effective therapeutic approaches have significant practical importance. Through years of clinical practice and experience, our research team has observed that patients with immune dysfunction often exhibit more severe vascular damage. Some patients with cerebrovascular disease do not have traditional risk factors for cerebrovascular disease, such as hypertension or diabetes and so on, but they have severe vascular damage. There may be an underlying immune-related etiology. Immunometabolism impacts macrophage biology and contributes to atherosclerosis. Whether there is a correlation between the body’s immune status and large vessel occlusion remains to be further explored. Research on comorbidities in cerebrovascular disease deserves attention. To explore the related risk factors affecting acute cerebral infarction with intracranial large vessel occlusion, especially the correlation between immune-related indicators and intracranial large vessel occlusion, so as to better control risk factors and carry out accurate secondary prevention, improve the treatment effect and prognosis of patients, reduce disease recurrence and improve the patients’ life quality.</p> Methods <p>(1) The inclusion criteria of the study were patients with cerebral infarction of large artery atherosclerosis type and patients with onset-to-admission time within 7 days. The exclusion criteria were patients with cardioembolic stroke, atrial fibrillation and other etiologies. Patients with acute cerebral infarction were included and divided into acute cerebral infarction group with and without major vascular occlusion according to whether or not they had major vascular occlusion. Clinical data of the patients were collected, analyzed and compared for the risk factors of acute cerebral infarction with large blood vessel occlusion. (2) Patients with acute cerebral infarction with large vessel occlusion were divided into single-vessel occlusion group and multi-vessel occlusion group according to the range of vessels involved in large vessel occlusion, the related risk factors affecting the degree of vascular occlusion were analyzed. (3) Patients with acute cerebral infarction were divided into primary cerebral infarction group and recurrent cerebral infarction group according to whether they had cerebral infarction in the past, the related risk factors affecting the recurrence of cerebral infarction were analyzed. (4) According to the presence or absence of microbleed lesions, the patients were divided into cerebral microbleed group and non-cerebral microbleed group, the related risk factors affecting cerebral microbleed were analyzed.</p> Results <p><OrderedList> <ListItem> <ItemNumber>(1)</ItemNumber> <ItemContent> <p>We analyzed risk factors between acute cerebral infarction with and without large vascular occlusion group. Univariate regression analysis showed that NIHSS scores of the two groups were significantly different. Patients in acute cerebral infarction with large vascular occlusion group have more severe clinical symptoms. CRP, LDL, RF, T3, T4, TPOAb, TgAb, C3, anti-cardiolipin antibody, and β<sub>2</sub> glycoprotein I antibody were risk factors for large vessel occlusion. Multivariate regression was included according to <i>P</i> < 0.05 in univariate analysis. Multivariate regression analysis showed that NIHSS scores of the two groups were significantly different. CRP, LDL, complement C3, RF and β<sub>2</sub> glycoprotein I antibody had significant differences and were independent risk factors for acute cerebral infarction with large vessel occlusion.</p> </ItemContent> </ListItem> <ListItem> <ItemNumber>(2)</ItemNumber> <ItemContent> <p>We analyzed risk factors between single-vessel occlusion group and multi-vessel occlusion group. Single-factor regression analysis found that hypertension, RF, T3, T4 and CRP were risk factors for multi-vessel occlusion. Multivariate regression was included according to <i>P</i> < 0.05 in univariate analysis, multi-factor regression found that T3, T4 and RF had significant differences and were independent risk factors for multi-vessel occlusion.</p> </ItemContent> </ListItem> <ListItem> <ItemNumber>(3)</ItemNumber> <ItemContent> <p>We analyzed risk factors between primary cerebral infarction and recurrent cerebral infarction group. Age, diabetes, LDL, complement C3 and anti-cardiolipin antibody were risk factors for the recurrence of cerebral infarction. Multivariate regression was included according to <i>P</i> < 0.05 in univariate analysis. Age, diabetes, LDL and complement C3 had significant differences and were independent risk factors for the recurrence of cerebral infarction. Then, we analyzed risk factors between primary cerebral infarction with large vessel occlusion group and recurrent cerebral infarction with large vessel occlusion group. In univariate analysis, no risk factors were found. Multivariate regression was included according to <i>P</i> < 0.1 in univariate analysis, age and PLT had significant differences and were found to be independent risk factors for the recurrence of cerebral infarction with large vessel occlusion.</p> </ItemContent> </ListItem> <ListItem> <ItemNumber>(4)</ItemNumber> <ItemContent> <p>We analyzed risk factors between cerebral microbleed group and non-cerebral microbleed group. Univariate analysis showed that CRP was a risk factor for cerebral microbleed in patients with acute cerebral infarction. Multivariate regression was included according to <i>P</i> < 0.1 in univariate analysis. Multivariate regression showed that hypertension, alcohol consumption and TgAb were independent risk factors for cerebral microbleed in patients with acute cerebral infarction. Then, we analyzed risk factors between cerebral microbleed with large vessel occlusion group and non-cerebral microbleed with large vessel occlusion group. Single-factor analysis found that diabetes and CRP were risk factors for cerebral microbleed in acute cerebral infarction patients with large vessel occlusion. Multivariate regression was included according to <i>P</i> < 0.05 in univariate analysis and multi-factor regression found that diabetes was an independent risk factor for cerebral microbleed in cerebral infarction patients with large vessel occlusion.</p> </ItemContent> </ListItem> </OrderedList></p> Conclusions <p><OrderedList> <ListItem> <ItemNumber>(1)</ItemNumber> <ItemContent> <p>There were significant differences in NIHSS scores between acute cerebral innfarction patients with and without large vessel occlusion. CRP, LDL, complement C3, RF and β<sub>2</sub> glycoprotein I antibody were associated with acute cerebral innfarction with large vessel occlusion.</p> </ItemContent> </ListItem> <ListItem> <ItemNumber>(2)</ItemNumber> <ItemContent> <p>T3, T4 and RF were associated with multiple vessel occlusion.</p> </ItemContent> </ListItem> <ListItem> <ItemNumber>(3)</ItemNumber> <ItemContent> <p>Age, diabetes, LDL and complement C3 were associated with cerebral infarction recurrence. Age and PLT were associated with the recurrence of cerebral infarction with large vessel occlusion.</p> </ItemContent> </ListItem> <ListItem> <ItemNumber>(4)</ItemNumber> <ItemContent> <p>Hypertension, alcohol consumption and TgAb were associated with cerebral microbleed in patients with acute cerebral infarction. Diabetes is associated with cerebral microbleed in cerebral infarction patients with large blood vessel occlusion.</p> </ItemContent> </ListItem> </OrderedList></p>

Analysis of risk factors for non-cardioembolic (large-artery atherosclerotic) cerebral infarction with and without intracranial large vessel occlusion: focus on immune-related markers

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2025年12月1日

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Yinglian Zhou,
Shuang Li,
Jin Fu

摘要

Introduction

Stroke is a disease with a high incidence, disability rate and mortality rate, imposing a heavy economic and social burden on patients. Exploring the risk factors associated with its pathogenesis and identifying effective therapeutic approaches have significant practical importance. Through years of clinical practice and experience, our research team has observed that patients with immune dysfunction often exhibit more severe vascular damage. Some patients with cerebrovascular disease do not have traditional risk factors for cerebrovascular disease, such as hypertension or diabetes and so on, but they have severe vascular damage. There may be an underlying immune-related etiology. Immunometabolism impacts macrophage biology and contributes to atherosclerosis. Whether there is a correlation between the body’s immune status and large vessel occlusion remains to be further explored. Research on comorbidities in cerebrovascular disease deserves attention. To explore the related risk factors affecting acute cerebral infarction with intracranial large vessel occlusion, especially the correlation between immune-related indicators and intracranial large vessel occlusion, so as to better control risk factors and carry out accurate secondary prevention, improve the treatment effect and prognosis of patients, reduce disease recurrence and improve the patients’ life quality.

Methods

(1) The inclusion criteria of the study were patients with cerebral infarction of large artery atherosclerosis type and patients with onset-to-admission time within 7 days. The exclusion criteria were patients with cardioembolic stroke, atrial fibrillation and other etiologies. Patients with acute cerebral infarction were included and divided into acute cerebral infarction group with and without major vascular occlusion according to whether or not they had major vascular occlusion. Clinical data of the patients were collected, analyzed and compared for the risk factors of acute cerebral infarction with large blood vessel occlusion. (2) Patients with acute cerebral infarction with large vessel occlusion were divided into single-vessel occlusion group and multi-vessel occlusion group according to the range of vessels involved in large vessel occlusion, the related risk factors affecting the degree of vascular occlusion were analyzed. (3) Patients with acute cerebral infarction were divided into primary cerebral infarction group and recurrent cerebral infarction group according to whether they had cerebral infarction in the past, the related risk factors affecting the recurrence of cerebral infarction were analyzed. (4) According to the presence or absence of microbleed lesions, the patients were divided into cerebral microbleed group and non-cerebral microbleed group, the related risk factors affecting cerebral microbleed were analyzed.

Results

(1)

We analyzed risk factors between acute cerebral infarction with and without large vascular occlusion group. Univariate regression analysis showed that NIHSS scores of the two groups were significantly different. Patients in acute cerebral infarction with large vascular occlusion group have more severe clinical symptoms. CRP, LDL, RF, T3, T4, TPOAb, TgAb, C3, anti-cardiolipin antibody, and β₂ glycoprotein I antibody were risk factors for large vessel occlusion. Multivariate regression was included according to P < 0.05 in univariate analysis. Multivariate regression analysis showed that NIHSS scores of the two groups were significantly different. CRP, LDL, complement C3, RF and β₂ glycoprotein I antibody had significant differences and were independent risk factors for acute cerebral infarction with large vessel occlusion.

(2)

We analyzed risk factors between single-vessel occlusion group and multi-vessel occlusion group. Single-factor regression analysis found that hypertension, RF, T3, T4 and CRP were risk factors for multi-vessel occlusion. Multivariate regression was included according to P < 0.05 in univariate analysis, multi-factor regression found that T3, T4 and RF had significant differences and were independent risk factors for multi-vessel occlusion.

(3)

We analyzed risk factors between primary cerebral infarction and recurrent cerebral infarction group. Age, diabetes, LDL, complement C3 and anti-cardiolipin antibody were risk factors for the recurrence of cerebral infarction. Multivariate regression was included according to P < 0.05 in univariate analysis. Age, diabetes, LDL and complement C3 had significant differences and were independent risk factors for the recurrence of cerebral infarction. Then, we analyzed risk factors between primary cerebral infarction with large vessel occlusion group and recurrent cerebral infarction with large vessel occlusion group. In univariate analysis, no risk factors were found. Multivariate regression was included according to P < 0.1 in univariate analysis, age and PLT had significant differences and were found to be independent risk factors for the recurrence of cerebral infarction with large vessel occlusion.

(4)

We analyzed risk factors between cerebral microbleed group and non-cerebral microbleed group. Univariate analysis showed that CRP was a risk factor for cerebral microbleed in patients with acute cerebral infarction. Multivariate regression was included according to P < 0.1 in univariate analysis. Multivariate regression showed that hypertension, alcohol consumption and TgAb were independent risk factors for cerebral microbleed in patients with acute cerebral infarction. Then, we analyzed risk factors between cerebral microbleed with large vessel occlusion group and non-cerebral microbleed with large vessel occlusion group. Single-factor analysis found that diabetes and CRP were risk factors for cerebral microbleed in acute cerebral infarction patients with large vessel occlusion. Multivariate regression was included according to P < 0.05 in univariate analysis and multi-factor regression found that diabetes was an independent risk factor for cerebral microbleed in cerebral infarction patients with large vessel occlusion.

Conclusions

(1)

There were significant differences in NIHSS scores between acute cerebral innfarction patients with and without large vessel occlusion. CRP, LDL, complement C3, RF and β₂ glycoprotein I antibody were associated with acute cerebral innfarction with large vessel occlusion.

(2)

T3, T4 and RF were associated with multiple vessel occlusion.

(3)

Age, diabetes, LDL and complement C3 were associated with cerebral infarction recurrence. Age and PLT were associated with the recurrence of cerebral infarction with large vessel occlusion.

(4)

Hypertension, alcohol consumption and TgAb were associated with cerebral microbleed in patients with acute cerebral infarction. Diabetes is associated with cerebral microbleed in cerebral infarction patients with large blood vessel occlusion.