高迁移率族蛋白B1预测急性缺血性卒中静脉溶栓后出血性转化

High-mobility group box-1 protein predicts hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke

目的探讨血清高迁移率族蛋白B1(high-mobility group box-1 protein,HMGB1)对急性缺血性卒中患者静脉溶栓后出血性转化(hemorrhage transformation,HT)的预测价值。方法前瞻性纳入2017年2月至2019年9月期间在安徽省亳州市利辛县人民医院接受静脉溶栓治疗的急性缺血性卒中患者。在入院次日清晨抽取空腹血检测血清HMGB1水平,静脉溶栓后24 h进行头颅CT复查确定是否发生HT。比较HT组与非HT组人口统计学和基线临床资料。采用多变量logistic回归分析确定静脉溶栓后HT的独立危险因素。采用受试者工作特征(receiver operator characteristic,ROC)曲线分析血清HMGB1水平对HT的预测价值。结果共纳入182例患者,HT组22例,非HT组160例。HT组年龄、空腹血糖、血清HMGB1以及具有心房颤动病史和起病前规律服用抗血小板药的患者比例显著高于非HT组,差异均有统计学意义(P均<0.05)。多变量logistic回归分析表明,血清HMGB1水平增高[优势比(odds ratio,OR)2.145,95%可信区间(confidence interval,CI)1.467~3.138;P=0.002]、起病前规律服用抗血小板药(OR 5.496,95%CI 1.700~17.768;P=0.004)以及基线空腹血糖水平增高(OR 1.333,95%CI 1.024~1.736;P=0.033)是静脉溶栓后发生HT的独立危险因素。ROC曲线分析显示,血清HMGB1水平预测静脉溶栓后HT的曲线下面积为0.788(95%CI 0.721~0.845;P<0.001)。最佳截断值为7.97μg/L时的敏感性和特异性分别为72.73%和82.50%。结论基线HMGB1水平增高能预测急性缺血性卒中患者静脉溶栓后发生HT的风险。

Objective To investigate the predictive value of serum high-mobility group box-1 protein(HMGB1)for hemorrhage transformation(HT)after intravenous thrombolysis in patients with acute ischemic stroke.Methods From February 2017 to September 2019,patients with acute ischemic stroke underwent intravenous thrombolysis in Lixin County People's Hospital,Bozhou,Anhui Province were enrolled prospectively.In the morning of the day after admission,fasting blood was collected to detect the level of serum HMGB1.Twenty-four hours after intravenous thrombolysis,CT reexamination was performed to determine whether HT occurred.The demographic and baseline clinical data were compared between the HT group and the non-HT group.Multivariate logistic regression analysis was used to determine the independent risk factors for HT after thrombolysis.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum HMGB1 level to HT.Results A total of 182 patients were enrolled in the study,including 22 in the HT group and 160 in the non-HT group.The age,fasting blood glucose,serum HMGB1 level,and the proportion of history of atrial fibrillation and regular antiplatelet medication before onset in the HT group was significantly higher than those in the non-HT group,and the differences were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that the increased serum HGMB1 level(odds ratio[OR]2.145,95%confidence interval[CI]1.467-3.138;P=0.002),taking antiplatelet drugs regularly before onset(OR 5.496,95%CI 1.700-17.768;P=0.004)and increased baseline fasting blood glucose level(OR 1.333,95%CI 1.024-1.736;P=0.033)were the independent risk factors for HT after intravenous thrombolysis.ROC curve analysis showed that the area under the curve of serum HMGB1 level predicting HT after intravenous thrombolysis was 0.788(95%CI 0.721-0.845;P<0.001).The sensitivity and specificity were 72.73%and 82.50%,respectively,when the best cutoff value was 7.97μg/L.Conclusion The increased baseline HMGB1 level may predict the risk of HT after intravenous thrombolysis in patients with acute ischemic stroke.