急性缺血性脑卒中溶栓后脑出血转化患者血清AGEs、IBIL、CTRP-3水平观察

Observation of serum AGE,IBIL and CTRP-3 levels in patients with cerebral hemorrhage transformation after thrombolytic therapy in acute ischemic stroke

目的观察急性缺血性脑卒中(AIS)溶栓后脑出血转化患者血清晚期糖基化终末产物(AGE)、间接胆红素(IBIL)、补体C1q肿瘤坏死因子相关蛋白-3(CTRP-3)水平。方法回顾性分析2022年1月至2023年1月在临汾市中心医院接受治疗的92例AIS患者的临床资料,所有患者均进行溶栓治疗,经磁共振成像检查,依据溶栓治疗后24 h是否发生脑出血转化将患者分为脑出血转化组(n=22)和非脑出血转化组(n=70)。比较两组基础资料信息[性别、年龄、体重指数、糖尿病、高血压、高血脂、吸烟史、发病至溶栓时间、收缩压、舒张压、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分]和AGE、IBIL、CTRP-3水平,采用多因素Logistic回归分析对影响AIS患者溶栓后脑出血转化的危险因素进行分析,绘制受试者工作特征(ROC)曲线评价血清AGE、IBIL、CTRP-3水平预测AIS溶栓后脑出血转化的效能。结果两组性别构成比、年龄、体重指数、糖尿病、高血压、高血脂、吸烟史、发病至溶栓时间、收缩压、舒张压比较,差异均无统计学意义(P>0.05);脑出血转化组溶栓前NIHSS评分、AGE、IBIL水平分别为(14.68±2.41)分、(510.91±51.16)ng/L、(13.69±2.27)μmol/L,均显著高于非脑出血转化组[(11.64±1.91)分、(447.69±49.46)ng/L、(10.17±1.79)μmol/L],而CTRP-3水平(250.13±25.69)ng/mL,显著低于非脑出血转化组[(284.57±28.92)ng/mL],差异均有统计学意义(P<0.05)。经多因素Logistic回归分析证实,溶栓前NIHSS评分、AGE、IBIL水平及CTRP-3水平是影响AIS患者溶栓后脑出血转化的危险因素(P<0.05);经ROC曲线分析证实,血清AGE、IBIL、CTRP-3水平均可用于AIS溶栓后脑出血转化的预测,曲线下面积分别为0.829、0.927、0.836(P<0.05)。结论溶栓前NIHSS评分及AGE、IBIL、CTRP-3水平的异常表达会增大AIS患者溶栓后脑出血转化的风险,可将以上指标作为评估患者病情和溶栓后脑出血转化情况的标志物,为临床病情评估和治疗提供参考。

Objective To observe the levels of advanced glycation end product(AGE),indirect bilirubin(IBIL)and complement C1q tumor necrosis factor related protein-3(CTRP-3)in patients with cerebral hemorrhage transformation after thrombolysis in acute ischemic stroke(AIS).Methods The clinical data of 92 patients with AIS treated in Linfen Central Hospital from January 2022 to January 2023 were retrospectively analyzed.All patients underwent thrombolytic therapy.Patients were divided into cerebral hemorrhage transformation group(n=22)and non-cerebral hemorrhage transformation group(n=70)according to whether cerebral hemorrhage transformation occurred 24 h after thrombolytic therapy by magnetic resonance imaging.Basic data information of the two groups[gender,age,body mass index,diabetes,hypertension,hyperlipidemia,smoking history,onset to thrombolysis time,systolic blood pressure,diastolic blood pressure,National Institutes of Health Stroke Scale(NIHSS)score before thrombolysis]and AGE IBIL,CTRP-3 levels were compared.And the risk factors affecting intracerebral transformation after thrombolysis in AIS patients were analyzed by multivariate Logistic regression,and the receiver operating characteristic(ROC)curve was drawn to evaluate the efficacy of serum AGE,IBIL and CTRP-3 levels in predicting intracerebral transformation after AIS thrombolysis.Results There were no significant differences in sex composition ratio,age,body mass index,diabetes,hypertension,hyperlipidemia,smoking history,onset to thrombolysis time,systolic blood pressure and diastolic blood pressure between the two groups(P>0.05).The NIHSS score before thrombolysis,the levels of AGE and IBIL in the cerebral hemorrhage transformation group were(14.68±2.41)points,(510.91±51.16)ng/L and(13.69±2.27)μmol/L,respectively,which were significantly higher than those in the non-cerebral hemorrhage transformation group[(11.64±1.91)points,(447.69±49.46)ng/L,(10.17±1.79)μmol/L],while the CTRP-3 level was(250.13±25.69)ng/mL,which was significantly lower than the non-cerebral hemorrhage transformation group[(284.57±28.92)ng/L],and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis confirmed that NIHSS score,AGE,IBIL level and CTRP-3 level before thrombolysis were risk factors affecting intracerebral hemorrhage transformation in AIS patients after thrombolysis(P<0.05).ROC analysis confirmed that serum AGE,IBIL and CTRP-3 levels could be used to predict intracerebral hemorrhage transformation after AIS thrombolysis,and the areas under the curve were 0.829,0.927 and 0.836,respectively(P<0.05).Conclusion Abnormal expressions of NIHSS score,AGE,IBIL level and CTRP-3 level before thrombolysis may increase the risk of intracerebral transformation after thrombolysis in AIS patients.These indicators can be used as markers to evaluate the patient's condition and intracerebral transformation after thrombolysis,and provide references for clinical evaluation and treatment of the disease.