急性脑梗死患者rt-PA静脉溶栓后脑出血转化与血清TXB2、sICAM-1、PTX3水平的相关性研究

Correlation between cerebral hemorrhage transformation and serum TXB2,sICAM-1 and PTX3 levels in patients with acute cerebral infarction after rt-PA intravenous thrombolysis

目的探讨血清血栓素B2(TXB2)、可溶性细胞间黏附分子-1(sICAM-1)、正五聚体蛋白3(PTX3)水平变化对急性脑梗死(ACI)患者重组组织型纤溶酶原激活物(rt-PA)静脉溶栓后脑出血转化的影响。方法选取本院收治的82例ACI患者为研究对象,rt-PA静脉溶栓后24 h行CT检查,依据是否发生脑出血转化将其分为转化组和非转化组。分析溶栓后脑出血转化的相关影响因素及溶栓后12 h血清TXB2、sICAM-1、PTX3对脑出血转化的预测价值。结果82例患者中,20例发生脑出血转化,62例未发生脑出血转化。转化组的溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、总胆固醇、纤维蛋白原水平高于非转化组(P<0.05)。溶栓后12、24 h,非转化组的血清TXB2、sICAM-1、PTX3水平低于转化组(P<0.05)。Logistic回归分析结果显示,溶栓前NIHSS评分、TXB2、sICAM-1、PTX3为溶栓后脑出血转化的相关危险因素(P<0.05)。血清TXB2、sICAM-1、PTX3联合预测脑出血转化的曲线下面积(AUC)大于单项预测(P<0.05)。结论溶栓前NIHSS评分及血清TXB2、sICAM-1、PTX3为ACI患者接受rt-PA静脉溶栓后发生脑出血转化的危险因素,而血清TXB-2、sICAM-1、PTX3联合检测对脑出血转化具有较高的预测效能。

Objective To investigate the effects of changes in serum thromboxane B2(TXB2),soluble intercellular adhesion molecule-1(sICAM-1)and pentraxin 3(PTX3)levels on cerebral hemorrhage transformation in patients with acute cerebral infarction(ACI)after intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA).Methods A total of 82 patients with ACI admitted in our hospital were selected as the research objects.CT examination was performed at 24 h after rt-PA intravenous thrombolysis.According to whether cerebral hemorrhage transformation occurred,the patients were divided into transformation group and non-transformation group.The related influencing factors of cerebral hemorrhage transformation after thrombolysis and the predictive value of serum TXB2,sICAM-1 and PTX3 at 12 h after thrombolysis on cerebral hemorrhage transformation were analyzed.Results Among 82 patients,20 cases had cerebral herhorrhage transformation,and 62 cases had no cerebral herhorrhage transformation.The National Institute of Health Stroke Scale(NIHSS)score before thrombolysis,total cholesterol and fibrinogen levels in the transformation group were higher than those in the non-transformation group(P<0.05).At 12 and 24 h after thrombolysis,the levels of serum TXB2,sICAM-1 and PTX3 in the non-transformation group were lower than those in the transformation group(P<0.05).Logistic regression analysis result showed that NIHSS score before thrombolysis,TXB2,sICAM-1 and PTX3 were related risk factors for cerebral hemorrhage transformation after thrombolysis(P<0.05).The area under the curve(AUC)of serum TXB2,sICAM-1 and PTX3 combined prediction of cerebral hemorrhage transformation was greater than that of single prediction(P<0.05).Conclusion The NIHSS score before thrombolysis and serum TXB2,sICAM-1 and PTX3 are risk factors for cerebral hemorrhage transformation in ACI patients after rt-PA intravenous thrombolysis,while the combined detection of serum TXB2,sICAM-1 and PTX3 has high predictive efficacy for cerebral hemorrhage transformation.