The predictive value of CT combined with multiple test indicators for hemorrhagic transformation after thrombolysis in patients with acute ischemic stroke

Li Shiwei; Zhang Bing; Li Caiyan

doi:10.3969/j.issn.1674-3245.2023.06.005

Abstract：Objective To investigate the predictive value of combined CT assay analysis of plasma lipoprotein-related phospholipase Lp-PLA2,resistin,lipocalin and PDGF and VEGF on post-thrombolytic hemorrhagic transformation(HT)in patients with acute ischemic stroke(AIS).Methods Two hundred patients with AIS who attended our hospital from April 2021 to April 2023 and underwent deep venous examination were divided into a control group(170 patients)and a test group(30 patients)according to whether HT occurred within 2 hours after receiving thrombolytic therapy.Peripheral blood was collected from AIS patients before thrombolytic treatment,and plasma was centrifuged to detect Lp-PLA2 and other levels using enzyme-linked immunosorbent assay(ELISA).Lateral circulation score and CBS score were measured by D-CTA.Logistic regression analysis was performed to determine the factors affecting HT after thrombolytic treatment in AIS patients.ROC analysis curves were used to assess the effect of plasma Lp-PLA2,resistin and other factors on HT after thrombolytic treatment.The predictive value of plasma Lp-PLA2 and resistin on the occurrence of HT after thrombolysis in AIS patients was assessed by ROC analysis curve.Results Compared with the control group,plasma Lp-PLA2 and resistin were significantly higher,and lipocalin concentration was significantly lower in the test group(t =-6.749,-8.123,15.11,6.736,4.829,P<0.05).Increased plasma Lp-PLA2 and resistin were risk factors for HT after thrombolytic therapy in AIS patients(P<0.05),but lipocalin and D-CTA collateral circulation score were protective factors(P<0.05).The AUCs for plasma Lp-PLA2 concentration,plasma resistin concentration,plasma lipocalin concentration,PDGF concentration,VEGF,D-CTA and CBS were 0.865,0.919,0.850,0.831,0.788,0.732 and 0.878,respectively.The sensitivities were 81.3%,81.3%,87.5%,81.3%,86.3%,78.9%and 83.2%,respectively,with specificities of 88.3%,86.2%,777%,85.3%,79.3%,81.4%and 78.4%,respectively,and Jordans of 0.696,0.675,0.652,0.665,0.653,0.603 and 0.616,respectively.Conclusion Increased D-CTA collateral circulation score and CBS score combined with increased plasma Lp-PLA2 and resistin are risk factors for the development of HT after thrombolysis in AIS.At the same time,elevated concentrations of lipocalin in vivo indicate that it is a protective factor.All of these factors have a predictive effect on the occurrence of HT after thrombolytic therapy,with the combination having the highest predictive value.