Homocysteine, interleukin‑1β, and fasting blood glucose levels as prognostic markers for diabetes mellitus complicated with cerebral infarction and correlated with carotid intima‑media thickness

Dai,Zhenxiang; Jiao,Yang; Fan,Qingxian; Qi,Anning; Xiao,Liang; Li,Jingwei

doi:10.3892/etm.2019.8326

Homocysteine, interleukin‑1β, and fasting blood glucose levels as prognostic markers for diabetes mellitus complicated with cerebral infarction and correlated with carotid intima‑media thickness

Authors:
- Zhenxiang Dai
- Yang Jiao
- Qingxian Fan
- Anning Qi
- Liang Xiao
- Jingwei Li
View Affiliations

Affiliations: Department of Neurology, People's Hospital of Liuhe District of Nanjing, Nanjing, Jiangsu 211500, P.R. China, Department of Medical Imaging, People's Hospital of Liuhe District of Nanjing, Nanjing, Jiangsu 211500, P.R. China, Department of Laboratory Medicine, People's Hospital of Liuhe District of Nanjing, Nanjing, Jiangsu 211500, P.R. China, Department of Emergency, People's Hospital of Liuhe District of Nanjing, Nanjing, Jiangsu 211500, P.R. China, Department of Neurology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu 210008, P.R. China
Published online on: December 13, 2019 https://doi.org/10.3892/etm.2019.8326
Pages: 1167-1174
Copyright: © Dai et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Diabetes mellitus complicated with cerebral infarction (DMCI) has a high incidence and disability rate. Therefore, identification of biomarkers for the early prediction of the development and progression of cerebral infarction (CI) is of great significance for the prevention and treatment of this disease. The roles of serum homocysteine (Hey), interleukin‑1β (IL‑1β), and fasting blood glucose (FBG) in DMCI and their correlations with carotid intima‑media thickness (CIMT) were explored. A total of 124 patients with DMCI (DMCI group) and 103 patients with diabetes mellitus (DM) (DM group) admitted to the People's Hospital of Liuhe District of Nanjing were enrolled in this study. A further 100 healthy controls undergoing physical examinations during the same period (HC group) were also enrolled. CIMT value was detected by carotid artery ultrasound. Hey and FBG levels were determined by a fully automatic biochemical analyzer. The IL‑1β level was detected by enzyme‑linked immunosorbent assay (ELISA). The levels of Hey, IL‑1β, and FBG and the CIMT value in the DMCI and DM groups were significantly higher than those in the HC group (P<0.001). The levels and the value in the DMCI group were significantly higher than those in the DM group (P<0.001). Hey, IL‑1β, and FBG levels were positively correlated with CIMT value (r=0.542, P<0.001; r=0.522, P<0.001; r=0.402, P<0.001). Receiver operating characteristic (ROC) curves showed that the sensitivity and specificity of Hey for diagnosing DMCI were 86.29 and 80.58%; those of IL‑1β were 68.55 and 86.41%; those of FBG were 69.35 and 88.35%. Multivariate logistic regression analysis revealed that systolic blood pressure (SBP), diastolic blood pressure (DBP), high‑density lipoprotein cholesterol (HDL‑C), low‑density lipoprotein cholesterol (LDL‑C), Hey, IL‑1β, FBG, and CIMT were independent risk factors for DMCI (P<0.05). In conclusion, patients with DMCI have severe atherosclerosis. Hey, IL‑1β, and FBG are involved in the development and progression of DMCI, so they can be used as predictive markers for the disease. Hey, IL‑1β, FBG, and CIMT are independent risk factors for patients with DMCI.

View Figures

View References

1	Setoodeh A, Didban A, Rabbani A, Sayarifard A, Abbasi F, Sayarifard F and Hoseinzade F: The effect of metformin as an adjunct therapy in adolescents with type 1 diabetes. J Clin Diagn Res. 11:SC01–SC04. 2017.PubMed/NCBI
2	Chawla A, Chawla R and Jaggi S: Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum? Indian J Endocrinol Metab. 20:546–551. 2016. View Article : Google Scholar : PubMed/NCBI
3	Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, Marre M, Cooper M, Glasziou P, Grobbee D, et al ADVANCE Collaborative Group, : Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 358:2560–2572. 2008. View Article : Google Scholar : PubMed/NCBI
4	Wu D, Wu C and Zhong Y: The association between paraoxonase 1 activity and the susceptibilities of diabetes mellitus, diabetic macroangiopathy and diabetic microangiopathy. J Cell Mol Med. 22:4283–4291. 2018. View Article : Google Scholar : PubMed/NCBI
5	Güven A, Hancili S, Karatoprak EY and Tasel B: Symptomatic cerebral infarction in a child with severe diabetic ketoacidosis. J Pediatr Endocrinol Metab. 27:1001–1004. 2014. View Article : Google Scholar : PubMed/NCBI
6	Zhao L and Hu FX: α-Lipoic acid treatment of aged type 2 diabetes mellitus complicated with acute cerebral infarction. Eur Rev Med Pharmacol Sci. 18:3715–3719. 2014.PubMed/NCBI
7	Zhang B, Wang D, Ji TF, Shi L and Yu JL: Overexpression of lncRNA ANRIL up-regulates VEGF expression and promotes angiogenesis of diabetes mellitus combined with cerebral infarction by activating NF-κB signaling pathway in a rat model. Oncotarget. 8:17347–17359. 2017.PubMed/NCBI
8	Wang SW, Liu Z and Shi ZS: Non-coding RNA in acute ischemic stroke: Mechanisms, biomarkers and therapeutic targets. Cell Transplant. 27:1763–1777. 2018. View Article : Google Scholar : PubMed/NCBI
9	Lin T, Liu JC, Chang LY and Shen CW: Association of C-reactive protein and homocysteine with subclinical coronary plaque subtype and stenosis using low-dose MDCT coronary angiography. Atherosclerosis. 212:501–506. 2010. View Article : Google Scholar : PubMed/NCBI
10	Konya H, Miuchi M, Satani K, Matsutani S, Yano Y, Tsunoda T, Ikawa T, Matsuo T, Ochi F, Kusunoki Y, et al: Asymmetric dimethylarginine, a biomarker of cardiovascular complications in diabetes mellitus. World J Exp Med. 5:110–119. 2015. View Article : Google Scholar : PubMed/NCBI
11	Glaser NS, Ghetti S, Casper TC, Dean JM and Kuppermann N; Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group, : Pediatric diabetic ketoacidosis, fluid therapy, and cerebral injury: The design of a factorial randomized controlled trial. Pediatr Diabetes. 14:435–446. 2013. View Article : Google Scholar : PubMed/NCBI
12	Fan X, Lo EH and Wang X: Effects of minocycline plus tissue plasminogen activator combination therapy after focal embolic stroke in type 1 diabetic rats. Stroke. 44:745–752. 2013. View Article : Google Scholar : PubMed/NCBI
13	Mohan V, Cooper ME, Matthews DR and Khunti K: The standard of care in type 2 diabetes: Re-evaluating the treatment paradigm. Diabetes Ther. 10 (Suppl 1):1–13. 2019. View Article : Google Scholar : PubMed/NCBI
14	Osei E, den Hertog HM, Berkhemer OA, Fransen PS, Roos YB, Beumer D, van Oostenbrugge RJ, Schonewille WJ, Boiten J, Zandbergen AA, et al MR CLEAN pretrial investigators, : Increased admission and fasting glucose are associated with unfavorable short-term outcome after intra-arterial treatment of ischemic stroke in the MR CLEAN pretrial cohort. J Neurol Sci. 3711–5. (201)2016. View Article : Google Scholar : PubMed/NCBI
15	American Diabetes Association: 8. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes-2018. Diabetes Care. 41 (Suppl 1):S73–S85. 2018. View Article : Google Scholar : PubMed/NCBI
16	Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, et al American Heart Association Stroke Council, : 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 49:e46–e110. 2018. View Article : Google Scholar : PubMed/NCBI
17	Charrad R, Berraïes A, Hamdi B, Ammar J, Hamzaoui K and Hamzaoui A: Anti-inflammatory activity of IL-37 in asthmatic children: Correlation with inflammatory cytokines TNF-α, IL-β, IL-6 and IL-17A. Immunobiology. 221:182–187. 2016. View Article : Google Scholar : PubMed/NCBI
18	Joung B, Lee JM, Lee KH, Kim TH, Choi EK, Lim WH, Kang KW, Shim J, Lim HE, Park J, et al KHRS Atrial Fibrillation Guideline Working Group, : 2018 Korean guideline of atrial fibrillation management. Korean Circ J. 48:1033–1080. 2018. View Article : Google Scholar : PubMed/NCBI
19	Liu L, Ding J, Leng X, Pu Y, Huang LA, Xu A, Wong KSL, Wang X and Wang Y: Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017. Stroke Vasc Neurol. 3:117–130. 2018. View Article : Google Scholar : PubMed/NCBI
20	McCoy CE, Langdorf MI and Lotfipour S: American Heart Association/American Stroke Association Deletes Sections from 2018 Stroke Guidelines. West J Emerg Med. 19:947–951. 2018. View Article : Google Scholar : PubMed/NCBI
21	Sun YP, Cai YY, Li HM, Deng SM, Leng RX and Pan HF: Increased carotid intima-media thickness (CIMT) levels in patients with type 1 diabetes mellitus (T1DM): A meta-analysis. J Diabetes Complications. 29:724–730. 2015. View Article : Google Scholar : PubMed/NCBI
22	Neumiller JJ and Umpierrez GE: 2018 Standards of care update: Pharmacologic approaches to glycemic management in people with type 2 diabetes. Diabetes Spectr. 31:254–260. 2018. View Article : Google Scholar : PubMed/NCBI
23	American Diabetes Association: Standards of medical care in diabetes-2018 abridged for primary care providers. Clin Diabetes. 36:14–37. 2018.PubMed/NCBI
24	Matsumoto K, Sera Y, Nakamura H, Ueki Y and Miyake S: Correlation between common carotid arterial wall thickness and ischemic stroke in patients with type 2 diabetes mellitus. Metabolism. 51:244–247. 2002. View Article : Google Scholar : PubMed/NCBI
25	Eikelboom JW, Hankey GJ, Anand SS, Lofthouse E, Staples N and Baker RI: Association between high homocyst(e)ine and ischemic stroke due to large- and small-artery disease but not other etiologic subtypes of ischemic stroke. Stroke. 31:1069–1075. 2000. View Article : Google Scholar : PubMed/NCBI
26	Huang J, Zhang X, Li J, Tang L, Jiao X and Lv X: Impact of glucose fluctuation on acute cerebral infarction in type 2 diabetes. Can J Neurol Sci. 41:486–492. 2014. View Article : Google Scholar : PubMed/NCBI
27	Yang N, Lin M, Wang BG, Zeng WY, He YF, Peng HY, Zeng J, Wu ZY and Zhong Y: Low level of low-density lipoprotein cholesterol is related with increased hemorrhagic transformation after acute ischemic cerebral infarction. Eur Rev Med Pharmacol Sci. 20:673–678. 2016.PubMed/NCBI
28	You S, Zhong C, Xu J, Han Q, Zhang X, Liu H, Zhang Y, Shi J, Huang Z, Xiao G, et al: LDL-C/HDL-C ratio and risk of all-cause mortality in patients with intracerebral hemorrhage. Neurol Res. 38:903–908. 2016. View Article : Google Scholar : PubMed/NCBI
29	Zhang XL, Fu HJ, Yang GR, Wan G, Li D, Zhu LX, Xie RR, Lv YJ, Zhang JD, Li YL, et al Beijing Communities Diabetes Study Group, : The effects of cardiovascular risk factor combined anti-platelet therapy and the risk of cerebrovascular events in patients with T2DM in an urban community over 96-months follow-up: The Beijing communities diabetes study 19. Diabetes Res Clin Pract. 144:236–244. 2018. View Article : Google Scholar : PubMed/NCBI
30	Kirkman MS, Mahmud H and Korytkowski MT: Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes mellitus. Endocrinol Metab Clin North Am. 47:81–96. 2018. View Article : Google Scholar : PubMed/NCBI
31	Wu W, Guan Y, Xu K, Fu XJ, Lei XF, Lei LJ, Zhang ZQ, Cheng Y and Li YQ: Plasma homocysteine levels predict the risk of acute cerebral infarction in patients with carotid artery lesions. Mol Neurobiol. 53:2510–2517. 2016. View Article : Google Scholar : PubMed/NCBI
32	Fayfman M, Pasquel FJ and Umpierrez GE: Management of hyperglycemic crises: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Med Clin North Am. 101:587–606. 2017. View Article : Google Scholar : PubMed/NCBI
33	Olamoyegun M, Ibraheem W, Iwuala S, Audu M and Kolawole B: Burden and pattern of micro vascular complications in type 2 diabetes in a tertiary health institution in Nigeria. Afr Health Sci. 15:1136–1141. 2015. View Article : Google Scholar : PubMed/NCBI