- Email: [email protected]
Investigation of Vaspin Level in Patients with Acute Ischemic Stroke
Investigation of Vaspin Level in Patients with Acute Ischemic Stroke € Hasan S. Cura, MD,* Hasan H. Ozdemir, MD,† Caner F. Demir, MD,‡ _ Serpil Bulut, MD,‡ Nevin Ilhan, MD,x and Mehmet Fatih Inci, MDjj
Background: Cerebrovascular event is a clinical condition characterized by symptoms and findings pertaining to loss of focal cerebral function because of the vascular causes. Atherosclerosis has a forefront role in the pathogenesis of stroke. Inflammation has an important place in the formation of atherogenesis and atherosclerosis. Visceral adipose tissue–derived serpin (vaspin) is a new adipokine, which is identified recently, associated with obesity and diabetes and also has a proinflammatory characteristic. This study was intended to investigate the relation between vaspin and stroke and stroke and other risk factors. Methods: A total of 50 patients with stroke, as 28 men (56%) and 22 women (44%), and a total of 50 healthy individuals, as 25 men (50%) and 25 women (50%), were enrolled in the study. Blood samples were taken in the acute period (first 48 hours) in the patient group, and serum vaspin levels were measured. Vaspin level was also measured in the control group. The association of vaspin with the lipid parameters, gender, and the severity of internal carotid artery (ICA) stenosis in the patient group was evaluated. Stenotic plaques in ICA were classified as normal, mild (stenosis under 50%), moderate (stenosis 50%-69%), severe (stenosis 70%-99% to preocclusion), and occlusion. Results: No statistically significant difference was found between 2 groups in terms of age and gender (P . .05). Vaspin levels were found to be significantly higher in the patient group (164.73 6 153.76 ng/mL) compared with the control group (116.21 6 34.60 ng/mL) (P , .05). However, no relation was established between vaspin level and the severity of ICA stenosis. Conclusions: Vaspin levels have been shown to increase in acute ischemic stroke patients. The increased vaspin levels may vary depending on several factors in acute period of ischemic stroke. Key Words: Vaspin—ischemic stroke—carotid artery stenosis—cerebrovascular event—carotid artery ultrasound. Ó 2013 by National Stroke Association
Introduction From the *Neurology Clinics, Turhal State Hospital, Tokat; †Neurology Clinics, Bismil State Hospital, Diyarbakır; ‡Department of Neurology, Fırat University Medical School, Elazı g; xDepartment of Biochemistry, Fırat University Medical School, Elazı g; and _ € Imam jjDepartment of Radiology, S€ utc¸u University Medical School, Kahramanmaras, Turkey. Received January 11, 2013; revision received March 15, 2013; accepted March 19, 2013. Conflict of interest: The authors declared no conflicts of interest. € Address correspondence to Hasan H. Ozdemir, MD, Neurology Clinics, Bismil State Hospital, Diyarbakır 21500, Turkey. E-mail: [email protected]. 1052-3057/$ - see front matter Ó 2013 by National Stroke Association http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.03.023
Stroke is the third most common cause of death around the world, after coronary heart disease and cancers. Prevalence of this disease, which generally occurs in the elderly patients, increases along with the extension of average lifetime. The most important cause of ischemic strokes is atherothrombotic events.1 The role of atherosclerosis in ischemic strokes varies between 27% and 43%.2 Some studies have found that adipokines are released at the atherosclerotic plaques, and they show their local and endocrinal effects on lesions.3 Visceral adipose tissue–derived serpin (vaspin) is an important and a new adipocytokine with regulation characteristics in
Journal of Stroke and Cerebrovascular Diseases, Vol. -, No. - (---), 2013: pp 1-4
1
H.S. CURA ET AL.
2
glucose and lipid mechanism. The correlation of its serum concentrations with the tests regarding obesity and lipid distribution gives rise to the thought that vaspin is a new molecule candidate for causing obesity-related atherosclerosis.4 The objective of our study was to investigate whether the plasma vaspin level has a predictive importance diagnostically in the acute period of ischemic cerebrovascular disease and its relation between carotid stenosis level in the patient group.
Materials and Methods Fifty patients, who admitted to the Neurology Clinic of our hospital within the first 48 hours with the manifestation of acute ischemic stroke, diagnosed with ischemic stroke, hospitalized, and followed between March 2010 and January 2012 were enrolled in this study. And the control group consisted of 50 healthy subjects having no previous cerebrovascular disease, compatible with the patient group in terms of age and gender. Approval was obtained from the Firat University Medical Faculty Clinical Research Ethics Committee for the study (number: 21). Diagnosis of acute ischemic stroke was put by at least 2 neurologists and 1 radiologist in the patients, who had acute focal neurological deficit lasting more than 24 hours and for whom there were no other reason except cerebrovascular disease that could cause such neurological deficit, through a complete neurological assessment including neuroradiological imaging such as cranial computed tomography and/or cranial magnetic resonance imaging (MRI). In all patients, physical examination and neurological examination, complete blood count, liver and kidney function tests, electrocardiogram, electrolyte levels and lipid profile, cranial computed tomography, cranial MRI, and diffusion MRI with carotid system color Doppler ultrasonography (CDUS) examination were performed. The patients with recovering neurological findings within 24 hours, the patients diagnosed with hemorrhagic cerebrovascular disease through clinical and neuroradiological assessment, and the patients with previous ischemic stroke were excluded from the study. The patients with heart disease, which could lead to cardioembolism such as atrial fibrillation, severe heart failure, and valvular heart disease, malignant hypertension, Cushing syndrome or obesity secondary to any of the congenital diseases, central nervous system vasculitis, congenital vascular disease, trauma, dissection, and cerebral venous thrombosis; the patients with thyroid and kidney dysfunction and liver failure; and the patients with local and systemic infections were excluded from the study. For evaluating the serum vaspin level of within the first 48 hours, the patients diagnosed with acute ischemic
stroke and hospitalized, venous blood sample of 5 cc were collected. Blood samples were centrifuged at 1500g for 10 minutes to get the serums. The serums obtained were put in 2 separate eppendorf tubes for each patient and stored at 220 C by avoiding repeated freezing– thawing procedures until the analysis. Same procedure was also applied to the cases selected for the control group. Serum vaspin levels were studied by using Adipobiotech-branded Human Visceral Adipose Tissue– Derived Serine Protease Inhibitor (VASPIN) ELISA kit (Adipo Bioscience, Inc., Santa Clara, CA). Informed consent forms were requested from the patients and the healthy individuals before the procedures.
Carotid Artery CDUS Technique Examinations were performed by using 10-MHz linear probe at General Electric Logiq-9 model CDUS (General Electric, Milwaukee, OH). As the patients were in supine position, necks were at extension, and the head was facing toward the opposite of the examination side, 2-sided carotid arteries were examined from supraclavicular region through mandibular angle by using power Doppler ultrasonographic examination. First, presence of plaque was investigated by B-mode examination. When plaque was established, the site, size, and surface characteristics of the plaque were determined. CDUS examination was performed in the longitudinal and transverse plane in color mode. Spectral waveform was taken in the main carotid artery from about 2 cm proximal to the bifurcation and center of the vessel, just distal to the ICA bulb. Flow was measured with a 30 -60 angle to the lumen as a standard. Peak systolic velocity (PSV) and enddiastolic velocity in ICA and main carotid artery were recorded. PSV ratios (PSV in ICA/common carotid artery) were calculated over these values. For stenosis grading (%) of the plaques examined, Society of Radiologist in Ultrasound criteria were used.5 Stenotic plaques in ICA were classified as normal, mild (stenosis under 50%), moderate (stenosis 50%-69%), severe (stenosis 70%-99% to preocclusion), and occlusion.
Statistical Analysis For statistical analyses, the statistics program SPSS 12.0 was used. Results were submitted as 6standard deviation. Student t test was used for comparing parametric data between the groups, and chi-square test was used for comparing categorical data. Normality of the parametric data distribution was evaluated by Kolmogorov– Smirnow test. For the parameters showing no normal distribution, logarithmic conversions were applied before the statistical analyses. Difference of the nonparametric data among more than 2 groups was evaluated by Kruskal–Wallis test. In all statistical assessments, P value less than .05 was considered statistically significant.
INVESTIGATION OF VASPIN LEVEL IN PATIENTS WITH ACUTE ISCHEMIC STROKE
Results A total of 100 people, as 50 patients diagnosed with cerebrovascular event and 50 healthy individuals consisting the control group, were enrolled in the study. Of patients with stroke, 28 were men (56%) and 22 were women (44%). Of the control group, 25 were men (50%) and 25 were women (50%). No significant gender difference was found between patient group and control group. The mean age of the patient group was 69.58 6 12.21 (40-97) years compared with 67.06 6 10.19 (42-88) years in the control group. No statistically significant difference was found between the 2 groups (P . .05). There were 15 (30%) diabetic, 17 (34%) hypertensive, and 7 (14%) obese patients in the stroke group.6,7 There were 14 (28%) diabetic, 15 (30%) hypertensive, and 6 (12%) obese patients in the control group. There was no statistically significant difference between groups. Mean serum vaspin levels were found to be 164.73 6 153.76 ng/mL in the stroke group compared with 116.21 6 34.60 ng/mL in the control group. Serum vaspin levels were higher in the stroke group than the control group. The difference between the 2 groups reached the statistically significant level (P , .05). When considered the relation of serum vaspin levels with the gender in the patient group, the mean value was 163.53 6 165.77 ng/mL in men compared with 166.26 6 140.81 ng/mL in women. No statistically significant difference was found between serum vaspin levels of men and women (P . .05). Mean serum vaspin levels were found to be 170.73 6 123.76 ng/mL in the diabetic stroke group compared with 126.21 6 34.60 ng/mL in the diabetic control group. The difference between the 2 groups reached the statistically significant level (P , .05). Mean serum vaspin levels were found to be 160.73 6 35.76 ng/mL in the hypertensive stroke group compared with 118.21 6 32.60 ng/mL in the hypertensive control group. The difference between the 2 groups reached the statistically significant level (P , .05). Mean serum vaspin levels were found to be 172.73 6 35.76 ng/mL in the obese stroke group compared with 130.21 6 12.60 ng/mL in the obese control group. The difference between the 2 groups reached the statistically significant level (P , .05). No significant relation was established between the severity of ICA stenosis (stenosis 0%-50%, 50%-70%, and above 70%) identified at Doppler ultrasonography and the serum vaspin levels of the patient group (P . .05) (Table 1).
Discussion Stroke is an important cause of mortality and morbidity in adults. Because more than half of the people who had stroke and survived become dependent on others in their
3
Table 1. Vaspin levels according to the Doppler stenosis severity in the patient group (Kruskal–Wallis test) Doppler USG (stenosis severity)
N
Vaspin (ng/mL)
P
0%-50% stenosis 50%-70% stenosis 70%-99% stenosis Occlusion
44 3 3 —
171.53 6 162.88 121.54 6 2.90 108.08 6 14.58
..05
Abbreviations: USG, ultrasonography; vaspin, visceral adipose tissue–derived serpin.
daily activities, it is the most common cause of long-term neurological disability in adults.8 One of the most important causes of ischemic strokes is atherosclerosis.1 Atherosclerosis is an inflammatory disease, characterized by atherosclerotic plaques because of accumulation of lipids on extracellular matrix and active smooth muscle cell surface in the arterial wall. These atherosclerotic plaques contribute to the formation of ischemic diseases such as coronary artery disease, transient ischemic attack, and stroke.9 Vaspin is an important and a new adipocytokine with regulation characteristics in glucose and lipid mechanism. Vaspin is considered to be a member of the serpins.10 Vaspin is a member of serine protease family, identified recently, and is known to be expressed in the visceral adipose tissue with obesity and when insulin concentrations reach the peak level in Otsuka Long– Evans Tokushima Fatty rats.11 Vaspin from adipose tissue–origin factors is considered to be an important contributing factor in the relation between visceral adiposity and atherosclerosis.11 There are studies suggesting that there is a relation between the serum levels of adiponectines and gender. Youn et al4 reported that serum vaspin levels showed difference between men and women by enzyme-linked immunosorbent assay method developed by them. And in our study, serum vaspin levels showed no significant difference between the genders. Elevated serum concentrations of vaspin were associated with obesity and impaired insulin sensitivity, whereas type 2 diabetes was reported to be against this relation.4 It is not known what kind of a relation there is among the serum vaspin levels, insulin sensitivity, and glucose metabolism in humans.10 It has been reported that human vaspin lipid messenger RNA expression is specific to the lipid reservoir and its concentrations in serum increase in obesity.12 It was suggested that adipose tissue–originated factors, including also adipokines, in obese patients might contribute to the premature and accelerated atherosclerosis.13 Although there are a number of studies investigating the relation between vaspin levels and obesity, diabetes, and cardiovascular disease in the literature, there are
H.S. CURA ET AL.
4
limited number of studies investigating the relation between cerebrovascular diseases and vaspin. In a study by Aust et al,14 no relation was found between carotid artery stenosis and serum vaspin concentration; however, it was shown that low concentration of serum vaspin was correlated with recent ischemic event in the patients with carotid artery stenosis. Although they could not conclude from these findings that serum vaspin levels might cause atherosclerosis, considering the negative relation between vaspin and blood pressure, they suggested that vaspin might be associated with coronary artery disease and cerebral stroke through hypertension. In our study, the relation between vaspin level and carotid stenosis in the patient group was evaluated. Even though there was not any significant difference in vaspin levels between the groups according to the severity of stenosis, it has been observed that as the stenosis ratio increase, vaspin levels decrease gradually. This study has some limitations. First, the number of the patients that fall into the groups other than the 0%-50% stenosis group is quite small, and second, we did not compare vaspin levels of our study population with the area of infarction. In the literature, there was not any study measuring the serum vaspin level in the patients with acute ischemic stroke. In our study, vaspin level in the patient group was found to be higher compared with the control group, and the difference between the 2 groups reached the statistically significant levels. And no statistically significant difference was found between carotid stenosis severity and serum vaspin levels in the patient group. Consequently, vaspin levels may vary depending on several factors, and vaspin levels increase in acute period of ischemic stroke.
References 1. Kumral E, Balkır K. Serebrovask€ uler _ Istanbul: G€ unes¸ Kitabevi, 2002.
Hastalıklar.
2. Bogousslavsky J, Van Mele G, Regli F. The Lausanne Stroke Registry: analysis of 1000 consecutive patients with first stroke. Stroke 1998;19:1083-1092. 3. Tedgui A, Mallat Z. Cytokines in atherosclerosis: pathogenic and regulatory pathways. Physiol Rev 2006; 86:515-581. 4. Youn BS, Kloting N, Kratzsch J, et al. Serum vaspin concentrations in human obesity and type 2 diabetes. Diabetes 2008;57:372-377. 5. Grant EG, Benson CB, Moneta GL, et al. Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis— Society of Radiologists in Ultrasound Consensus Conference. Ultrasound Q 2003;19:190-198. 6. World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva: WHO Document Production Services, 2006. pp. 1-41. 7. Mancia G, De Backer G, Dominiczak A, et al. The task force for the management of arterial hypertension of the European Society of Cardiology. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28:1462-1536. 8. Wolfe CDA. The impact of stroke. Br Med Bull 2000; 56:275-286. 9. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685-1695. 10. Li Q, Chen R, Moriya J, et al. A novel adipocytokine, visceral adipose tissue-derived serine protease inhibitor (vaspin) and obesity. J Int Med Res 2008;36:625-629. 11. Hida K, Wada J, Eguchi J, et al. Visceral adipose tissuederived serine protease inhibitor: a unique insulinsensitizing adipocytokine in obesity. Proc Natl Acad Sci U S A 2005;102:10610-10615. 12. Kloting N, Berndt J, Kralisch S, et al. Vaspin gene expression in human adipose tissue: association with obesity and type 2 diabetes. Biochem Biophys Res Commun 2006;339:430-436. 13. Fantuzzi G, Mazzone T. Adipose tissue and atherosclerosis: exploring the connection. Arterioscler Thromb Vasc Biol 2007;27:996-1003. 14. Aust G, Richter O, Rohm S, et al. Vaspin serum concentrations in patients with carotid stenosis. Atherosclerosis 2009;204:262-266.
Background: Cerebrovascular event is a clinical condition characterized by symptoms and findings pertaining to loss of focal cerebral function because of the vascular causes. Atherosclerosis has a forefront role in the pathogenesis of stroke. Inflammation has an important place in the formation of atherogenesis and atherosclerosis. Visceral adipose tissue–derived serpin (vaspin) is a new adipokine, which is identified recently, associated with obesity and diabetes and also has a proinflammatory characteristic. This study was intended to investigate the relation between vaspin and stroke and stroke and other risk factors. Methods: A total of 50 patients with stroke, as 28 men (56%) and 22 women (44%), and a total of 50 healthy individuals, as 25 men (50%) and 25 women (50%), were enrolled in the study. Blood samples were taken in the acute period (first 48 hours) in the patient group, and serum vaspin levels were measured. Vaspin level was also measured in the control group. The association of vaspin with the lipid parameters, gender, and the severity of internal carotid artery (ICA) stenosis in the patient group was evaluated. Stenotic plaques in ICA were classified as normal, mild (stenosis under 50%), moderate (stenosis 50%-69%), severe (stenosis 70%-99% to preocclusion), and occlusion. Results: No statistically significant difference was found between 2 groups in terms of age and gender (P . .05). Vaspin levels were found to be significantly higher in the patient group (164.73 6 153.76 ng/mL) compared with the control group (116.21 6 34.60 ng/mL) (P , .05). However, no relation was established between vaspin level and the severity of ICA stenosis. Conclusions: Vaspin levels have been shown to increase in acute ischemic stroke patients. The increased vaspin levels may vary depending on several factors in acute period of ischemic stroke. Key Words: Vaspin—ischemic stroke—carotid artery stenosis—cerebrovascular event—carotid artery ultrasound. Ó 2013 by National Stroke Association
Introduction From the *Neurology Clinics, Turhal State Hospital, Tokat; †Neurology Clinics, Bismil State Hospital, Diyarbakır; ‡Department of Neurology, Fırat University Medical School, Elazı g; xDepartment of Biochemistry, Fırat University Medical School, Elazı g; and _ € Imam jjDepartment of Radiology, S€ utc¸u University Medical School, Kahramanmaras, Turkey. Received January 11, 2013; revision received March 15, 2013; accepted March 19, 2013. Conflict of interest: The authors declared no conflicts of interest. € Address correspondence to Hasan H. Ozdemir, MD, Neurology Clinics, Bismil State Hospital, Diyarbakır 21500, Turkey. E-mail: [email protected]. 1052-3057/$ - see front matter Ó 2013 by National Stroke Association http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.03.023
Stroke is the third most common cause of death around the world, after coronary heart disease and cancers. Prevalence of this disease, which generally occurs in the elderly patients, increases along with the extension of average lifetime. The most important cause of ischemic strokes is atherothrombotic events.1 The role of atherosclerosis in ischemic strokes varies between 27% and 43%.2 Some studies have found that adipokines are released at the atherosclerotic plaques, and they show their local and endocrinal effects on lesions.3 Visceral adipose tissue–derived serpin (vaspin) is an important and a new adipocytokine with regulation characteristics in
Journal of Stroke and Cerebrovascular Diseases, Vol. -, No. - (---), 2013: pp 1-4
1
H.S. CURA ET AL.
2
glucose and lipid mechanism. The correlation of its serum concentrations with the tests regarding obesity and lipid distribution gives rise to the thought that vaspin is a new molecule candidate for causing obesity-related atherosclerosis.4 The objective of our study was to investigate whether the plasma vaspin level has a predictive importance diagnostically in the acute period of ischemic cerebrovascular disease and its relation between carotid stenosis level in the patient group.
Materials and Methods Fifty patients, who admitted to the Neurology Clinic of our hospital within the first 48 hours with the manifestation of acute ischemic stroke, diagnosed with ischemic stroke, hospitalized, and followed between March 2010 and January 2012 were enrolled in this study. And the control group consisted of 50 healthy subjects having no previous cerebrovascular disease, compatible with the patient group in terms of age and gender. Approval was obtained from the Firat University Medical Faculty Clinical Research Ethics Committee for the study (number: 21). Diagnosis of acute ischemic stroke was put by at least 2 neurologists and 1 radiologist in the patients, who had acute focal neurological deficit lasting more than 24 hours and for whom there were no other reason except cerebrovascular disease that could cause such neurological deficit, through a complete neurological assessment including neuroradiological imaging such as cranial computed tomography and/or cranial magnetic resonance imaging (MRI). In all patients, physical examination and neurological examination, complete blood count, liver and kidney function tests, electrocardiogram, electrolyte levels and lipid profile, cranial computed tomography, cranial MRI, and diffusion MRI with carotid system color Doppler ultrasonography (CDUS) examination were performed. The patients with recovering neurological findings within 24 hours, the patients diagnosed with hemorrhagic cerebrovascular disease through clinical and neuroradiological assessment, and the patients with previous ischemic stroke were excluded from the study. The patients with heart disease, which could lead to cardioembolism such as atrial fibrillation, severe heart failure, and valvular heart disease, malignant hypertension, Cushing syndrome or obesity secondary to any of the congenital diseases, central nervous system vasculitis, congenital vascular disease, trauma, dissection, and cerebral venous thrombosis; the patients with thyroid and kidney dysfunction and liver failure; and the patients with local and systemic infections were excluded from the study. For evaluating the serum vaspin level of within the first 48 hours, the patients diagnosed with acute ischemic
stroke and hospitalized, venous blood sample of 5 cc were collected. Blood samples were centrifuged at 1500g for 10 minutes to get the serums. The serums obtained were put in 2 separate eppendorf tubes for each patient and stored at 220 C by avoiding repeated freezing– thawing procedures until the analysis. Same procedure was also applied to the cases selected for the control group. Serum vaspin levels were studied by using Adipobiotech-branded Human Visceral Adipose Tissue– Derived Serine Protease Inhibitor (VASPIN) ELISA kit (Adipo Bioscience, Inc., Santa Clara, CA). Informed consent forms were requested from the patients and the healthy individuals before the procedures.
Carotid Artery CDUS Technique Examinations were performed by using 10-MHz linear probe at General Electric Logiq-9 model CDUS (General Electric, Milwaukee, OH). As the patients were in supine position, necks were at extension, and the head was facing toward the opposite of the examination side, 2-sided carotid arteries were examined from supraclavicular region through mandibular angle by using power Doppler ultrasonographic examination. First, presence of plaque was investigated by B-mode examination. When plaque was established, the site, size, and surface characteristics of the plaque were determined. CDUS examination was performed in the longitudinal and transverse plane in color mode. Spectral waveform was taken in the main carotid artery from about 2 cm proximal to the bifurcation and center of the vessel, just distal to the ICA bulb. Flow was measured with a 30 -60 angle to the lumen as a standard. Peak systolic velocity (PSV) and enddiastolic velocity in ICA and main carotid artery were recorded. PSV ratios (PSV in ICA/common carotid artery) were calculated over these values. For stenosis grading (%) of the plaques examined, Society of Radiologist in Ultrasound criteria were used.5 Stenotic plaques in ICA were classified as normal, mild (stenosis under 50%), moderate (stenosis 50%-69%), severe (stenosis 70%-99% to preocclusion), and occlusion.
Statistical Analysis For statistical analyses, the statistics program SPSS 12.0 was used. Results were submitted as 6standard deviation. Student t test was used for comparing parametric data between the groups, and chi-square test was used for comparing categorical data. Normality of the parametric data distribution was evaluated by Kolmogorov– Smirnow test. For the parameters showing no normal distribution, logarithmic conversions were applied before the statistical analyses. Difference of the nonparametric data among more than 2 groups was evaluated by Kruskal–Wallis test. In all statistical assessments, P value less than .05 was considered statistically significant.
INVESTIGATION OF VASPIN LEVEL IN PATIENTS WITH ACUTE ISCHEMIC STROKE
Results A total of 100 people, as 50 patients diagnosed with cerebrovascular event and 50 healthy individuals consisting the control group, were enrolled in the study. Of patients with stroke, 28 were men (56%) and 22 were women (44%). Of the control group, 25 were men (50%) and 25 were women (50%). No significant gender difference was found between patient group and control group. The mean age of the patient group was 69.58 6 12.21 (40-97) years compared with 67.06 6 10.19 (42-88) years in the control group. No statistically significant difference was found between the 2 groups (P . .05). There were 15 (30%) diabetic, 17 (34%) hypertensive, and 7 (14%) obese patients in the stroke group.6,7 There were 14 (28%) diabetic, 15 (30%) hypertensive, and 6 (12%) obese patients in the control group. There was no statistically significant difference between groups. Mean serum vaspin levels were found to be 164.73 6 153.76 ng/mL in the stroke group compared with 116.21 6 34.60 ng/mL in the control group. Serum vaspin levels were higher in the stroke group than the control group. The difference between the 2 groups reached the statistically significant level (P , .05). When considered the relation of serum vaspin levels with the gender in the patient group, the mean value was 163.53 6 165.77 ng/mL in men compared with 166.26 6 140.81 ng/mL in women. No statistically significant difference was found between serum vaspin levels of men and women (P . .05). Mean serum vaspin levels were found to be 170.73 6 123.76 ng/mL in the diabetic stroke group compared with 126.21 6 34.60 ng/mL in the diabetic control group. The difference between the 2 groups reached the statistically significant level (P , .05). Mean serum vaspin levels were found to be 160.73 6 35.76 ng/mL in the hypertensive stroke group compared with 118.21 6 32.60 ng/mL in the hypertensive control group. The difference between the 2 groups reached the statistically significant level (P , .05). Mean serum vaspin levels were found to be 172.73 6 35.76 ng/mL in the obese stroke group compared with 130.21 6 12.60 ng/mL in the obese control group. The difference between the 2 groups reached the statistically significant level (P , .05). No significant relation was established between the severity of ICA stenosis (stenosis 0%-50%, 50%-70%, and above 70%) identified at Doppler ultrasonography and the serum vaspin levels of the patient group (P . .05) (Table 1).
Discussion Stroke is an important cause of mortality and morbidity in adults. Because more than half of the people who had stroke and survived become dependent on others in their
3
Table 1. Vaspin levels according to the Doppler stenosis severity in the patient group (Kruskal–Wallis test) Doppler USG (stenosis severity)
N
Vaspin (ng/mL)
P
0%-50% stenosis 50%-70% stenosis 70%-99% stenosis Occlusion
44 3 3 —
171.53 6 162.88 121.54 6 2.90 108.08 6 14.58
..05
Abbreviations: USG, ultrasonography; vaspin, visceral adipose tissue–derived serpin.
daily activities, it is the most common cause of long-term neurological disability in adults.8 One of the most important causes of ischemic strokes is atherosclerosis.1 Atherosclerosis is an inflammatory disease, characterized by atherosclerotic plaques because of accumulation of lipids on extracellular matrix and active smooth muscle cell surface in the arterial wall. These atherosclerotic plaques contribute to the formation of ischemic diseases such as coronary artery disease, transient ischemic attack, and stroke.9 Vaspin is an important and a new adipocytokine with regulation characteristics in glucose and lipid mechanism. Vaspin is considered to be a member of the serpins.10 Vaspin is a member of serine protease family, identified recently, and is known to be expressed in the visceral adipose tissue with obesity and when insulin concentrations reach the peak level in Otsuka Long– Evans Tokushima Fatty rats.11 Vaspin from adipose tissue–origin factors is considered to be an important contributing factor in the relation between visceral adiposity and atherosclerosis.11 There are studies suggesting that there is a relation between the serum levels of adiponectines and gender. Youn et al4 reported that serum vaspin levels showed difference between men and women by enzyme-linked immunosorbent assay method developed by them. And in our study, serum vaspin levels showed no significant difference between the genders. Elevated serum concentrations of vaspin were associated with obesity and impaired insulin sensitivity, whereas type 2 diabetes was reported to be against this relation.4 It is not known what kind of a relation there is among the serum vaspin levels, insulin sensitivity, and glucose metabolism in humans.10 It has been reported that human vaspin lipid messenger RNA expression is specific to the lipid reservoir and its concentrations in serum increase in obesity.12 It was suggested that adipose tissue–originated factors, including also adipokines, in obese patients might contribute to the premature and accelerated atherosclerosis.13 Although there are a number of studies investigating the relation between vaspin levels and obesity, diabetes, and cardiovascular disease in the literature, there are
H.S. CURA ET AL.
4
limited number of studies investigating the relation between cerebrovascular diseases and vaspin. In a study by Aust et al,14 no relation was found between carotid artery stenosis and serum vaspin concentration; however, it was shown that low concentration of serum vaspin was correlated with recent ischemic event in the patients with carotid artery stenosis. Although they could not conclude from these findings that serum vaspin levels might cause atherosclerosis, considering the negative relation between vaspin and blood pressure, they suggested that vaspin might be associated with coronary artery disease and cerebral stroke through hypertension. In our study, the relation between vaspin level and carotid stenosis in the patient group was evaluated. Even though there was not any significant difference in vaspin levels between the groups according to the severity of stenosis, it has been observed that as the stenosis ratio increase, vaspin levels decrease gradually. This study has some limitations. First, the number of the patients that fall into the groups other than the 0%-50% stenosis group is quite small, and second, we did not compare vaspin levels of our study population with the area of infarction. In the literature, there was not any study measuring the serum vaspin level in the patients with acute ischemic stroke. In our study, vaspin level in the patient group was found to be higher compared with the control group, and the difference between the 2 groups reached the statistically significant levels. And no statistically significant difference was found between carotid stenosis severity and serum vaspin levels in the patient group. Consequently, vaspin levels may vary depending on several factors, and vaspin levels increase in acute period of ischemic stroke.
References 1. Kumral E, Balkır K. Serebrovask€ uler _ Istanbul: G€ unes¸ Kitabevi, 2002.
Hastalıklar.
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