Predictive value of serum Netrin-1 combined with HAT score for hemorrhagic transformation after thrombolytic ther-apy for acute cerebral infarction

Xu Guodong; Dong Xiaoli; Liang Xiaohui; Ma Liang

doi:10.3969/j.issn.1671-6450.2025.01.004

Abstract：Objective To investigate the predictive value of serum Netrin-1(NTN-1)combined with hemorrhage af-ter thrombolysis(HAT)score for hemorrhagic transformation after thrombolytic therapy in acute cerebral infarction(ACI).Methods Three hundred and twelve ACI patients who received intravenous thrombolysis treatment in Neurointerventional Department of Hebei provincial people's hospital from February 2021 to June 2024 were selected.According to the hemor-rhagic transformation after thrombolytic therapy,the patients were divided into hemorrhagic transformation group and non-hemorrhagic transformation group.In addition,according to the expression level of serum NTN-1,the patients were divided into high expression group and low expression group.The general data of all ACI patients were collected and the HAT score was counted.The expression level of serum NTN-1 was detected by enzyme-linked immunosorbent assay.Results There was no significant difference in gender,age,smoking history,history of transient ischemic attack,hyperlipidemia,hy-pertension,body mass index,time from onset to admission,and TOAST classification between hemorrhagic transformation group and non-hemorrhagic transformation group(P＞0.05).The baseline NIHSS score and proportion of diabetes in hemor-rhagic transformation group were higher than those in non-hemorrhagic transformation group(t/x2=4.168,4.837,P=＜0.001,0.028).The HAT score of the hemorrhagic trans formation group was higher than that of the non-hemorrhagic transformation group,and the serum NTN-1 level was lower than that of the non-hemorrhagic transformation group(t=6.035,5.727,all P＜0.001);the hemorrhagic transformation rate of the high expression group was lower than that of the low expression group(x2/P=6.318/0.012).Logistic regression analysis showed that higher serum NTN-1 level was a protective factor for hemor-rhagic trans formation after thrombolytic therapy in ACI patients,while higher baseline NIHSS score,diabetes mellitus and higher HAT score were risk factors[OR(95％CI)=0.773(0.629-0.949),1.621(1.180-2.227),1.775(1.081-2.915),2.768(1.330-5.761)];The AUC of serum NTN-1,HAT score and the combination of the two in predicting hemorrhagic transformation af-ter thrombolytic therapy in ACI patients were 0.778,0.786 and 0.884,respectively.The combination of the two was superior to their respective predictive efficacy(DeLong method was used to compare the differences)(Z=2.063,1.984,P=0.037,0.046).Conclusion The expression level of serum NTN-1 is closely related to the risk of hemorrhagic transformation after throm-bolytic therapy in ACI patients.Serum NTN-1 combined with HAT score has a high predictive value for hemorrhagic trans-formation after thrombolytic therapy in ACI patients.