Predictive value of serum CTRP-3 and D-dimer for hyperacute transformation after thrombolysis in patients with cerebral infarction and their correlation with brain injury / 中华全科医师杂志

ABSTRACT

Objective:To evaluate serum complement C1q tumor necrosis factor related proteins-3 (CTRP-3) and D-dimer (D-D) in predicting hyperacute transformation after thrombolysis in patients with cerebral infarction, and their correlation with brain injury.Methods:One hundred and sixty patients with cerebral infarction admitted in our hospital from August 2016 to August 2019 were enrolled in the study. The hyperacute transformation occurred in 29 cases after intravenous thrombolysis (occurrence group) and did not occur in 131 cases (non-occurrence group). The serum CTRP-3, D-D levels and other factors that may cause hyperacute transformation were compared between the occurrence group and the non-occurrence group. Logistic regression analysis was used to analyze the risk factors of cerebral hemorrhage. The predictive values of serum CTRP-3 and D-D for hyperacute transformation in patients with cerebral infarction were analyzed with receiver operating characteristic (ROC)curve. The correlation between serum CTRP-3, D-D and brain injury was analyzed by Pearson correlation coefficient method.Results:The National Institute of Health stroke scale (NIHSS) score [(18.6±2.2) points vs. (14.0±2.1) points, t=10.62, P<0.01], proportion of infarct diameter >5 cm [69.0%(20/29) vs. 39.7%(52/131), χ 2=8.22, P<0.01], trial fibrillation rate[72.4%(21/29) vs. 44.3%(59/131), χ 2=7.52, P<0.01], and serum D-D levels [(3.02±0.31) mg/L vs. (2.24±0.23) mg/L, t=15.44, P<0.01] of the occurrence group were significantly higher than those of the non-occurrence group; while the serum CTRP-3 levels were lower than those of the non-occurrence group [(251.3±26.9) μg/L vs. (285.7±29.2) μg/L, t=5.82, P<0.01], the onset-to-needle time (OTN) was longer than that of the non-onset group [(4.61±0.43) h vs. (2.96±0.52) h, t=15.91, P<0.01]. Logistic regression analysis showed that pre-thrombosis NIHSS ( OR=1.69, 95 %CI 1.02-2.15, P<0.01), proportion of infarct diamete r>5 cm ( OR=3.73, 95 %CI 1.96-5.10, P=0.001), atrial fibrillation ( OR=2.14, 95 %CI 1.25-2.96, P<0.01), OTN ( OR=3.44, 95 %CI 1.85-5.02, P<0.01), serum DD ( OR=2.37, 95 %CI 1.56-3.30, P<0.01) and serum CTRP-3 ( OR=2.9 d, 95 %CI 1.91-4.25, P<0.01) were risk factors for hyperacute transformation in patients with cerebral infarction. ROC results showed that the area under the curve (AUC) of CTRP-3 and D-D for predicting hyperacute transformation in patients with cerebral infarction were 0.723 and 0.796, respectively; and the AUC of the combination of two indicators was 0.823. The anterior cerebral infarction occurred in 28 cases, the posterior cerebral infarction occured in 132 cases. The NIHSS score were(18.7±2.1)points and (14.0±1.9)points,respectively,and the modified Rankin Scale(mRS) score were(3.8±0.5)points and(3.2±0.6) points. Pearson correlation analysis showed that the serum CTRP-3 was negatively correlated with the NIHSS score of brain damage in patients with anterior circulation cerebral infarction ( r=-0.72, P<0.01), and the correlation was less strong with the NIHSS score in patients with posterior circulation cerebral infarction ( r=-0.35, P<0.01). The serum D-D was strongly positively correlated with NIHSS score of brain damage in patients with anterior circulation cerebral infarction ( r=0.88, P<0.01), and it was less strong with NIHSS score in patients with posterior circulation cerebral infarction ( r=0.24, P<0.01). The serum CTRP-3 was strongly positively correlated with brain injury mRS score ( r=0.80, P<0.01), and serum D-D was strongly negatively correlated with brain injury mRS score ( r=-0.76, P<0.01). Conclusion:The combined detection of serum CTRP-3 and D-D has a high predictive value for the occurrence of cerebral hemorrhage in hyperacute transformation after thrombolysis in patients with cerebral infarction, and two indicators have a certain correlation with brain injury of patients.