Serum level of Apolipoprotein A1 in Patients with Acute Stroke

Abstract

At present, the absence of a widely available and sensitive diagnostic and prognostic test for acute cerebral ischemia remains a significant limitation in the diagnosis, prognosis and management of stroke. At many community hospitals, a formal stroke team or neurologist may not be available, MR-based technology is unlikely to become widely available for most patients presenting to nonacademic facilities with acute stroke syndromes, Thus, an additional benefit of obtaining a panel of markers might be useful to help stroke patients. Our study represent one of the studies to detect a rapid, objective, clinically accurate, available diagnostic and prognostic tool for stroke patients. We prospectively included 60 patients with first ever cerebrovascular stroke who admitted to Ain Shams University Hospital within 24 hours from stroke onset and they were matched with 30 healthy individuals matched in age and sex. All the patients were subjected to full clinical history and examination, kidney function, lipid profile, diffusion weighted magnetic resonance imaging(DWI), Magnetic resonance angiography (MRA), carotid duplex and echo. Patient’s neurological status was assessed via  Summary And Conclusion 72 National Institute of Health and Stroke scale (NIHSS) which was done on admission and after 3 months. A venous blood sample was taken (2ml) within first 24 hours of stroke onset, and assayed for Apo A-1 level by Human Apo A-1 ELISA kit. And the results were as follows:  Apo A1 level could be used to discriminate between cases and controls at a level of 6.2 ug/ml, with 94.9% sensitivity and 86.6% specificity  Apo A-1 level measured in anterior strokes ranged from 2.8 to 4.45ug/ml with median 4.2ug/ml while in posterior strokes ranged from 2.5 to 4.1ug/ml with median 3ug/ml and thus revealing a statistical significance difference between anterior and post stroke indicating that lower level of Apo A1 act as a predictor for posterior stroke rather than anterior stroke. However according to the size, there was no significant correlation between Apo A1 level and stroke size.  There is an inverse relationship between the level of Apo A-1 and the clinical outcome expressed by NIHSS score and their prognosis after 3 month.  Cases who showed recurrence of stroke in the first 3 months after the incident of the first stroke had low level of apo A-1 (mean 3.65± 0.87 ug/ml ) compared  Summary And Conclusion 73 to those who didn’t show recurrence of the stroke ( mean 4.46 ± 3.85 ug/ml ).  Furthermore, cases that had low level of Apo A1-1 show high mortality risk than cases of high level of Apo A-1.  Among the 60 patients with ischemic stroke, 30 patients were having normal cholesterol level,normal triglyceride level, normal LDL and normal HDL but all of them have low level of Apo A-1 indicating that that apoA1 was a strongpredictor of ischemic stroke, independent of other lipid parameters.