Dissertation
Dissertation > Medicine, health > Neurology and psychiatry > Neurology > Cerebrovascular disease > Acute cerebrovascular disease ( stroke)

Correlation among the Three Plasma Biomarkers with Hemorrhagic Transformation in Acute Cerebral Infarction

Author YuanWenXiao
Tutor AnZhongPing
School Tianjin Medical University
Course Neurology
Keywords matrix metalloproteinase-9 glial fibrillary acidic protein fibronectincerebral ischemia cerebral hemorrhage gradient echo atrial fibrillation
CLC R743.3
Type Master's thesis
Year 2012
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Objective:To investigate the correlation among the plasma MMP-9, plasma GFAP and plasma FN concentrations with the hemorrhagic transformation in acute cerebral infarction, and to learn the influence of the common risk factors for stroke hemorrhagic transformation.Methods:78cases of hospitalized patients in neurology stroke unit ward of the Lake Hospital of Tianjin with acute cerebral infarction were collected during2009.09.01-2010.05.01, which were consistent with the cerebral infarction group inclusion criteria.60healthy volunteers were collected which were consistent with the standards of healthy controls. There is a comprehensive collection of relevant clinical information and clinics. Blood specimens were collected on admission for patients with acute cerebral infarction, and in the physical examination for healthy volunteers. The concentrations of plasma MMP-9, plasma GFAP and plasma FN were quantitatively determinated by ELISA..All the patients reviewed in7-10days after the onset of the first MRI. Gradient echo sequence shows low signal to hemorrhagic transformation.78patients were divided into groups based on whether patients have hemorrhagic transformation or not. Compared respectively of the differences of plasma MMP-9, plasma GFAP and plasma FN concentration between the cerebral infarction group and control group, the HT group and the non-HT group, and to explore the predictive value of hemorrhagic transformation of plasma MMP-9, plasma GFAP and plasma FN concentration. Using logistic regression analysis to investigate the impact of major risk factors for HT.Results:1. A total of78patients were included. The average age was (62.85±11.18). male52cases (66.67%) and female26cases (33.33%).60cases of healthy volunteers were also included. The average age was (64.02±13.97) years old. male35cases (58.33%), female25cases (41.67%).11cases (14.1%) showed HT.2. The plasma MMP-9concentration of patients with cerebral infarction group was (1104.10±348.25) ug/L, significantly higher than that (932.49±300.34) ug/L of control group(P=0.003). The plasma concentration of MMP-9in HT group was (1372.89±362.24) ug/L, significantly higher than that (1059.98±328.01)ug/L of non-HT group (P=0.005).3. The plasma GFAP concentration of patients with cerebral infarction group was (2798.46±1072.66) ng/L, significantly higher than that (2173.37±867.77) ng/L of control group(P=0.000). The plasma concentration of GFAP in HT group was (3660.03±629.64) ng/L, significantly higher than that (2657.01±1066.89) ng/L of non-HT group (P=0.003).4. The plasma FN concentration of patients with cerebral infarction group was (3988.43±1272.02) ug/L, significantly higher than that (2584.41±1582.31) ug/L of control group(P=0.003). The plasma FN concentration in HT group was (4835.04±756.30) ug/L, significantly higher than that (3849.44±1289.18) ug/L of non-HT group (P=0.016).5. Plasma MMP-9concentration (OR=0.997, P=0.010), plasma GFAP concentration (OR=1.001, P=0.006), plasma Fn concentration (OR=1.001. P=0.025) was independently associated with HT.6. In common risk factors for stroke, atrial fibrillation was independently associated with HT (OR=5.810, P=0.008).7. The MMP-9concentration greater than1232.74ug/L can predict the occurrence of non-thrombolytic hemorrhagic transformation.The accuracy rate was about70.5%; The GFAP concentration greater than3055.71ng/L can predict the occurrence of non-thrombolytic hemorrhagic transformation.The accuracy rate was about65.4%; The FN concentration greater than4296.89ug/L can predict the occurrence of non-thrombolytic hemorrhagic transformation.The accuracy rate was about69.2%;8. Combinding with plasma MMP-9and GFAP or FN predict the accuracy of HT occurrence in70.5%; combinding with plasma GFAP and FN predict the accuracy of HT occurrence in67.9%.9. Combineding with plasma MMP-9, plasma GFAP and plasma FN predict the sensitivity of non-thrombolytic hemorrhagic transformation of72.7%, the specificity of71.6%and negative predictive value94.1%, accuracy was71.8%.Conclusion:1. Plasma MMP-9concentration, GFAP concentration or FN concentration increased was independently associated with acute ischemic stroke in patients with spontaneous bleeding.2.Combineding with plasma MMP-9concentration, GFAP concentration and FN concentration predict HT occurred better than the separate use of plasma MMP-9concentration, the concentration of GFAP or FN concentration prediction and three pairwise joint forecast.3. It has potential predictive value for the acute ischemic stroke patients with spontaneous bleeding when the plasma of MMP-9levels below1232.74ug/L or plasma GFAP level below3055.71ng/L or plasma FN level was lower than4296.89ug/L.It had potential clinical value for the choice of thrombolytic therapy in patients after thrombolytic therapy to reduce the risk of hemorrhagic transformation.4. In the common stroke risk factors, atrial fibrillation is an independent risk factor for hemorrhagic transformation. Atrial fibrillation in patients prone to hemorrhagic transformation.

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