Aybala Neslihan ALAGÖZ, Bilgehan ATILGAN ACAR, Belma DOĞAN GÜNGEN, Yeşim GUZEY ARAS, Türkan ACAR

A New Marker in Acute Ischemic Stroke Patients: Monocyte / HDL Ratio

Objective: Stroke is a major cause of global morbidity and mortality. Ischemic stroke is usually marked by cell death associated with inflammation and oxidative stress, and the role of inflammation in neurological diseases has become increasingly obvious. In our study, we studied the monocyte / HDL ratio (MHR) which can support the theory of inflammation in stroke and can be used in clinical practice. MHR can be used a prognostic marker in stroke patients base on this theory. Methods: Our study registered 91 acute ischemic stroke patients (47 females and 44 males) and 50 healthy controls. Results: MHR was elevated in the patient group and correlated with high-sensitivity C-reactive protein (hsCRP). MHR was higher in patients with high a National Institutes of Health Stroke Scale (NIHSS) than those with a low NIHSS (p=0.050) as well as in patients with a larger infarct area and in than those with a smaller area (p=0.050). The MHR correlated with both the clinical condition and infarct area in acute ischemic stroke patients, which underscores the value of MHR as a new marker. Conclusions: This cross-sectional study of 91 acute ischemic stroke patients indicates that inflammation markers and MHR are correlated with clinical status and even radiological parameters.

Akut İskemik İnme Hastalarında Yeni Bir Markır: Monosit / HDL Oranı

Amaç: İnme, dünyada major bir morbidite ve mortalite sebebidir. İskemik inmede genellikle inflamasyon ve oksidatif strese bağlı hücre ölümü görülür. Nörolojik hastalıklarda inflamasyonun rolü giderek daha da belirginleşmektedir. Çalışmamızda inmede inflamasyon teorisini destekleyebilen ve klinik uygulamada kullanılabilecek monosit / HDL oranını (MHO) inceledik. Gereç ve Yöntem: Çalışmamızda 91 akut iskemik inme hastası (47 kadın ve 44 erkek) ve 50 sağlıklı kontrol kaydedildi. Bulgular: Hasta grubunda MHO yüksek idi ve yüksek duyarlılıkta C-reaktif protein (hsCRP) ile korele idi. MHO, Ulusal Sağlık Enstitüleri İnme Ölçeği (NIHSS) skoru yüksek olan hastalarda, düşük NIHSS'li (p = 0.050) olanların yanı sıra, ve de daha büyük bir infarkt alanı olanlarda daha küçük infarkt alanına sahip olanlara (p = 0.050) göre daha yüksekti. MHO, yeni bir belirteç olarak, akut iskemik inme hastalarında, hem klinik durum hem de infarkt alanı ile koreledir. Sonuç: 91 akut iskemik inme hastasının, bu cross-sectional çalışması, inflamasyon belirteçlerinin ve MHO'nin; klinik durum ve hatta radyolojik parametrelerle körele olduğunu göstermektedir.

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1. Sengupta D, Bardhan J, Baran A, et al. Correlation between lipid profile and carotid intima media thickness in cerebral ischemia. Indian J PhysiolPharmacol. 2014 Oct-Dec;58(4):354-64.

2. Chehaibi K, Trabelsi I, Mahdouani K, et al. Correlation of oxidative stress parameters and inflammatory markers in ischemic stroke patients. J Stroke Cerebrovasc Dis. 2016 Nov;25(11):2585-2593.

3. Lénárt N, Brough D, Dénes Á. Inflammasomes link vascular disease with neuroinflammation and brain disorders. J Cereb Blood Flow Metab. 2016 Oct;36(10):1668-1685.

4. Taleb S. Inflammation in atherosclerosis. Arch Cardiovasc Dis. 2016 Aug 29. pii: S1875-2136(16)30112-7.

5. Canpolat U, Çetin EH, Cetin S, et al. Association of monocyte-to-HDL cholesterol ratio with slow coronary flow is linked to systemic inflammation. ClinApplThrombHemost. 2016 Jul;22(5):476-82.

6. Ancuta P, Wang J, Gabuzda D. CD16+ monocytes produce IL-6, CCL2, and matrix metalloproteinase-9 upon interaction with CX3CL1-expressing endothelial cells. J Leukoc Biol. 2006; 80(5):1156-1164.

7. Kanbay M, Solak Y, Unal HU, et al. Monocyte count/HDL-C ratio and cardiovascular events in patients with chronic kidney disease. IntUrolNephrol. 2014;46(8): 1619-1625.

8. Bolayır A,Gokce SF, Cigdem B, et al. Monocyte/high density lipoprotein ratio predicts the mortality in ischemic stroke patients. Neurol Neurochir Pol. 2018 Mar;52(2):150-155. doi: 10.1016/j.pjnns.2017.08.011. Epub 2017 Aug 24.

9. Adams HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of ORG 10172 in Acute Stroke Treatment. Stroke. 1993; 24:35–41.

10. Brott T, Adams HP, Jr., Olinger CP et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20(7):864-70.

11. Minić GA. Leucocyte count indicates carotid plaque instability in stroke patients. Vojnosanit Pregl. 2016 Jun;73(6):515-25.

12. Matsuo R, Ago T, Hata J, et al. Plasma C-reactive protein and clinical outcomes after acute ischemic stroke: A prospective observational study. PLoS One. 2016 Jun 3;11(6):e0156790.

13. Leuschner F, Rauch PJ, Ueno T et al. Rapid monocyte kinetics in acute myocardial infarction are sustained by extramedullary monocytopoiesis. J Exp Med. 2012 Jan 16;209(1):123-37.

14. Ghattas A, Griffiths HR, Devitt A, et al. Monocytes in coronary artery disease and atherosclerosis: Where are we now? J Am CollCardiol. 2013;62(17):1541-1551.

15. Murphy AJ, Chin-Dusting JP, Sviridov D, et al. The anti-inflammatory effects of high density lipoproteins. Curr Med Chem. 2009;16(6):667-675.

16. Murphy AJ, Woollard KJ. High-density lipoprotein: A potent inhibitor of inflammation. ClinExpPharmacol Physiol. 2010;37(7): 710-718.

17. Yvan-Charvet L, Pagler T, Gautier EL, et al. ATP-binding cassette transporters and HDL suppress hematopoietic stem cell proliferation. Science. 2010;328(5986):1689-1693.

18. Murphy AJ, Woollard KJ, Hoang A et al. High-density lipoprotein reduces the human monocyte inflammatory response. Arterioscler Thromb Vasc Biol. 2008 Nov; 28(11): 2071-7.

19. Wang N, Lan D, Chen W, et al. ATP-binding cassette transporters G1 and G4 mediate cellular cholesterol efflux to high-density lipoproteins. Proc Natl Acad Sci USA. 2004 Jun 29;101(26):9774-9.

20. Westerterp M, Gourion-Arsiquaud S, Murphy AJ, et al. Regulation of hematopoietic stem and progenitor cell mobilization by cholesterol efflux pathways. Cell Stem Cell. 2012 Aug 3;11(2):195-206.

21. Qiao JH, Tripathi J, Mishra NK, et al. Role of macrophage colony-stimulating factor in atherosclerosis: studies of osteopetrotic mice. Am J Pathol. 1997 May;150(5):1687-99.

22. Mestas J, Ley K. Monocyte-endothelial cell interactions in the development of atherosclerosis.Trends Cardiovasc Med. 2008 Aug;18(6):228-32.

23. Woollard KJ, Geissmann F. Monocytes in atherosclerosis: Subsets and functions. Nat Rev Cardiol. 2010 Feb;7(2):77-86. Rev.

24. Palmerini T, Coller BS, Cervi V, et al. Monocyte-derived tissue factor contributes to stent thrombosis in an in vitro system. J Am Coll Cardiol. 2004 Oct 19;44(8):1570-7.

25. Cicek G, Kundi H, Bozbay M, et al. The relationship between admission monocyte HDL-C ratio with shortterm and long-term mortality among STEMI patients treated with successful primary PCI. Coron Artery Dis. 2016 May;27(3):176-84.

26. Algin A, Inan I. The role of radiologic, clinical and biochemical parameters in prediction of stroke mortality. Neurosciences (Riyadh). 2019 Apr;24(2):110-114.

27. Yaghi S, Herber C, Boehme AK, et al. The Association between Diffusion MRI-Defined Infarct Volume and NIHSS Score in Patients with Minor Acute Stroke. J Neuroimaging 2017; 27: 388-391.

ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez