急性脑梗死患者血清CTRP-3、D-二聚体、sTREM2水平及相关临床特征与溶栓后出血性转化的关系

Associations of serum levels of CTRP-3, D-dimer, and sTREM2 and relevant clinical features with HT after thrombolysis in patients with acute cerebral infarction

摘要:

目的 探讨急性脑梗死患者血清补体C1q/肿瘤坏死因子相关蛋白3（CTRP-3）、D-二聚体、可溶性髓样细胞触发受体2（sTREM2）水平及相关临床特征与溶栓后出血性转化（HT）的关系。方法 回顾性分析2018年9月—2022年9月在青海省人民医院接受溶栓治疗的120例急性脑梗死患者的临床资料，根据患者溶栓后是否发生HT分为HT组（30例）、非HT组（90例）。比较两组患者的临床资料及血清CTRP-3、D-二聚体、sTREM2水平。采用多因素逐步Logistic回归分析急性脑梗死患者溶栓后发生HT的危险因素；绘制受试者工作特征（ROC）曲线，分析急性脑梗死患者溶栓后HT预测模型预测HT发生的价值。结果 HT组心房颤动（以下简称房颤）、大面积脑梗死、入院NIHSS评分≥ 15分占比高于非HT组（P <0.05），血清CTRP-3水平低于非HT组（P <0.05），D-二聚体、sTREM2水平高于非HT组（P <0.05）。血清CTRP-3、D-二聚体、sTREM2水平预测急性脑梗死患者溶栓后发生HT的敏感性分别为66.7%（95% CI：0.598，0.756）、70.0%（95% CI：0.607，0.812）、80.0%（95% CI：0.714，0.889），特异性分别为73.3%（95% CI：0.636，0.821）、86.7%（95% CI：0.778，0.923）、86.7%（95% CI：0.747，0.942）。多因素Logistic逐步回归分析结果显示，房颤［O^R=1.237（95% CI：1.103，1.387）］、大面积脑梗死［O^R=2.338（95% CI：1.292，4.231）］、入院NIHSS评分≥ 15分［O^R=2.087（95% CI：1.231，3.538）］、CTRP-3 ≤ 269.265 μg/L ［O^R=3.006（95% CI：1.508，5.992）］、D-二聚体≥ 2.625 mg/L ［O^R=2.649（95% CI：1.374，5.107）］、sTREM2 ≥ 314.675 ng/L ［O^R=2.328（95% CI：1.411，3.841）］是急性脑梗死患者溶栓后发生HT的危险因素（P <0.05）。根据多因素Logistic逐步回归分析结果建立急性脑梗死患者溶栓后HT预测模型，Logit（P） = -33.887 + 0.213×房颤+ 0.849×大面积脑梗死+0.736×入院NIHSS评分+ 1.101×CTRP-3 + 0.974×D-二聚体+ 0.845×sTREM2；ROC曲线分析结果表明，预测模型预测HT发生的敏感性为93.3%（95% CI：0.841，0.991），特异性为87.8%（95% CI：0.808，0.976）。结论 血清CTRP-3、D-二聚体、sTREM2水平与急性脑梗死患者溶栓后HT有关，预测价值较高，且急性脑梗死患者溶栓后HT预测模型预测HT优于各项指标单独预测。

Abstract:

Objective To investigate the associations of serum levels of complement C1q/ tumor necrosis factor-related protein 3 (CTRP-3), D-dimer, and soluble triggering receptor expressed on myeloid cells 2 (sTREM2) and relevant clinical features with hemorrhagic transformation (HT) after thrombolysis in patients with acute cerebral infarction.Methods Clinical data of 120 patients with acute cerebral infarction who received thrombolytic therapy in Qinghai Provincial People's Hospital from September 2018 to September 2022 were retrospectively analyzed. According to whether patients developed HT after thrombolytic therapy, they were divided into HT group (n = 30) and non-HT group (n = 90). The clinical data and serum levels of CTRP-3, D-dimer and sTREM2 were compared between the two groups. Multivariable Logistic regression was performed to analyze the risk factors for HT after thrombolysis in patients with acute cerebral infarction. The value of the prediction model for HT after thrombolysis in patients with acute cerebral infarction was analyzed via the receiver operating characteristic (ROC) curve.Results The proportions of patients with atrial fibrillation, large hemispheric infarction and NIHSS score at admission ≥ 15 in the HT group were higher than those in the non-HT group (P < 0.05). The serum level of CTRP-3 in the HT group was lower than that in the non-HT group (P < 0.05), while serum levels of D-dimer and sTREM2 in the HT group were higher than those in the non-HT group (P < 0.05). The sensitivities of serum levels of CTRP-3, D-dimer and sTREM2 in predicting HT after thrombolysis in patients with acute cerebral infarction were 66.7% (95% CI: 0.598, 0.756), 70.0% (95% CI: 0.607, 0.812), and 80.0% (95% CI: 0.714, 0.889), with the specificities being 73.3% (95% CI: 0.636, 0.821), 86.7% (95% CI: 0.778, 0.923), and 86.7% (95% CI: 0.747, 0.942). Multivariable Logistic regression analysis revealed that atrial fibrillation [O^R = 1.237 (95% CI: 1.103, 1.387) ], massive cerebral infarction [O^R = 2.338 (95% CI: 1.292, 4.231) ], NIHSS score at admission ≥15 [O^R = 2.087 (95% CI: 1.231, 3.538) ], level of CTRP-3 ≤ 269.265 μg/L [O^R = 3.006 (95% CI: 1.508, 5.992) ], level of D-dimer ≥ 2.625 mg/L [O^R = 2.649 (95% CI: 1.374, 5.107) ] and level of sTREM2 ≥ 314.675 ng/L [O^R = 2.328 (95% CI: 1.411, 3.841) ] were risk factors for HT after thrombolysis in patients with acute cerebral infarction (P < 0.05). The prediction model for HT after thrombolysis in patients with acute cerebral infarction was established based on the multivariable Logistic regression analysis, where the equation was established as Logit (P) = -33.887 + 0.213× atrial fibrillation + 0.849× large cerebral infarction + 0.736 × NIHSS score at admission + 1.101 × CTRP-3 + 0.974 × D-dimer + 0.845 × sTREM2. The ROC curve analysis demonstrated that the sensitivity and the specificity of the prediction model for HT after thrombolysis were 93.3% (95% CI: 0.841, 0.991) and 87.8% (95% CI: 0.808, 0.976), respectively.Conclusions Serum levels of CTRP-3, D-dimer and sTREM2 are associated with and of predictive value for HT after thrombolysis in patients with acute cerebral infarction, and the performance of the prediction model is superior to that of each indicator alone.