血清CTRP3,CTRP9水平对急性缺血性脑卒中患者静脉溶栓后出血转化的预测价值

The predictive values of the serum ctrp3 and ctrp9 levels in the haemorrhagic transformation in patients with acute ischemic stroke after intravenous thrombolysis

目的探讨急性缺血性脑卒中(AIS)患者静脉溶栓后血清中补体Cq1/肿瘤坏死因子相关蛋白(CTRP)3,CTRP9水平与出血转化(HT)的关系。方法选取2016年1月-2019年1月本院192例AIS患者为研究对象,根据患者静脉溶栓1周左右是否发生HT分为HT组(42例)和无HT组(150例);收集2组一般资料,酶联免疫吸附(ELISA)法检测血清中CTRP3,CTRP9水平,Pearson相关性分析AIS患者静脉溶栓后CTRP3与CTRP9水平的相关性;绘制受试者工作特性曲线(ROC)分析血清中CTRP3,CTRP9水平对AIS患者静脉溶栓后HT的诊断价值,Logistic分析影响AIS患者静脉溶栓后HT的因素。结果 HT组年龄、心脏房颤史、NIHSS评分、THRIVE评分、FBG水平、梗死面积、梗死体积高于无HT组(P<0.05),TC、血清中CTRP3,CTRP9水平低于无HT组(P<0.05)。Pearson相关性分析显示,AIS患者静脉溶栓后CTRP3与CTRP9水平呈正相关(r=0.417,P<0.05)。Logistic回归分析显示,年龄、心脏房颤史、FBG水平高是AIS患者静脉溶栓后发生HT的危险因素;TC,CTRP3,CTRP9水平高是AIS患者静脉溶栓后发生HT的保护因素。ROC曲线显示,血清中CTRP3,CTRP9水平预测AIS患者静脉溶栓后HT的ROC曲线下面积分别为0.772、0.744,截断值分别为716.24、220.56 ng/mL,对应敏感性分别为81.0%、59.5%,特异性分别为64.0%、79.3%。二者联合预测AIS患者静脉溶栓后HT的ROC曲线下面积为0.847,敏感性为76.2%、特异性为75.3%。结论 AIS静脉溶栓后HT患者血清中CTRP3,CTRP9表达水平降低,二者水平呈正相关,均对AIS患者静脉溶栓后出血转化有一定预测价值,可作为AIS患者静脉溶栓后发生HT的潜在预测指标。

Objective To investigate the relationships between the serum complement Cq1/tumor necrosis factor related protein(CTRP) 3, CTRP 9 levels and haemorrhagic transformation(HT) of patients with acute ischemic stroke(AIS) after intravenous thrombolysis.Methods 192 AIS patients in our hospital from January 2016 to January 2019 were selected as the study objects, and according to whether HT occurred in one week after intravenous thrombolysis, they were divided into HT group(42 cases) and non HT group(150 cases). The general information of two groups were collected, the levels of CTRP3 and CTRP9 in serum were detected by enzyme-linked immunosorbent assay(ELISA), Pearson correlation analysis showed the correlation between CTRP3 and CTRP9 in AIS patients, the diagnostic values of CTRP3 and CTRP9 in serum for HT in AIS patients were analyzed by ROC, and Logistic analysis was used to analyze the factors affecting HT in AIS patients.Results The age, history of atrial fibrillation, NIHSS score, THRIVE score, FBG, infarct area and infarct volume of HT group were higher than those of non HT group(P<0.05), while the levels of TC, serum CTRP3 and CTRP9 in HT group were lower than those in non HT group(P<0.05). Pearson correlation analysis showed that there was the positive correlation between CTRP3 and CTRP9 levels in AIS patients(r=0.417, P<0.05). Logistic regression analysis showed that the age, history of atrial fibrillation and high level of FBG were the risk factors of HT in AIS patients, and the high levels of TC, CTRP3 and CTRP9 were the protective factors of HT in AIS patients. The ROC curve showed that the areas under the ROC curve of serum CTRP3 and CTRP9 levels predicting HT in AIS patients were 0.772 and 0.744, and the cutoff values were 716.24 and 220.56 ng/mL respectively, the corresponding sensitivities were 81.0% and 59.5%, and the specificities were 64.0% and 79.3%. The area under ROC curve of combination predicting HT in AIS patients was 0.847, the sensitivity was 76.2%, and the specificity was 75.3%.Conclusion The levels of serum CTRP3 and CTRP9 in patients with AIS and HT were decreased, and they were positively correlated, both of them had a certain predictive value for the haemorrhagic transformation in patients with AIS, and might be used as potential indicators for the occurrence of HT in patients with AIS.