溶栓前A2b受体水平与脑缺血出血转化的关系研究

目的 探讨腺苷A2b受体在急性脑缺血溶栓治疗后发生出血转化(hemorrhagic transformation,HT)中的应用价值。方法 收集2015年1月-2017年3月就诊于本院的缺血性脑卒中患者83例,治疗后根据CT和MRI复查表现分为HT组和非HT组,比较2组患者外周血单个核细胞腺苷A2b受体mRNA的表达情况,分析其对脑缺血溶栓治疗后发生HT的预测价值,经logistic回归分析脑缺血溶栓治疗后发生HT的危险因素,比较HT组和非HT组治疗后不同腺苷A2b受体mRNA表达水平患者的NIHSS评分。结果(1)经溶栓治疗后CT和MRI检查显示发生HT者有36例,占43.4%;(2)HT组患者外周血单个核细胞腺苷A2b受体mRNA的表达水平(0.83±0.19)明显高于非HT组(0.49±0.21),利用ROC曲线分析腺苷A2b受体预测脑缺血患者经溶栓治疗后发生HT的预测值为0.63,此时AUC=0.716, 95%CI=0.628～0.837,P<0.001;(3)经多因素非条件Logistic回归分析显示,腺苷A2b受体表达水平是脑缺血患者经溶栓治疗后发生HT的独立危险因素(OR=0.916, 95%CI=0.899～0.969,P=0.032);(4)经溶栓治疗后HT组中腺苷A2b受体>0.63的NIHSS评分最高,而非HT组腺苷A2b受体<0.63的NIHSS评分最低。结论 腺苷A2b受体表达水平是脑缺血患者经溶栓治疗后发生HT的独立危险因素,对患者经溶栓治疗后发生HT具有预测价值。

The relationship between the level of A2b receptor before thrombolysis and the hemorrhage transformation after cerebral ischemia

ObjectiveTo investigate the value of adenosine A2b receptor in hemorrhagic transformation after acute cerebral ischemia with thrombolytic therapy.Methods 83 cases of patients with ischemic stroke in our hospital from January 2015 to March 2017 were collected. 83 cases were divided into HT group and non-HT group after treatment according to the CT and MRI manifestation. The adenosine A2b receptor mRNA expression level of peripheral blood mononuclear cells was Compared in two groups. The predictive value for HT was assessed. The risk factors for HT after cerebral ischemia with thrombolytic therapy were analyzed by logistic regression analysis. The NIHSS score of the different adenosine A2b receptor mRNA expression level patients after treatment was compared in group HT and non HT groups.Results(1)CT and MRI detection showed that HT in the 83 patients with acute cerebral ischemic stroke were 36 cases(43.4%).(2)The adenosine A2b receptor mRNA expression level of peripheral blood mononuclear cells of patients in HT group(0.83±0.19)was significantly higher than that in non-HT group(0.49±0.21). Using ROC curve analysis, adenosine A2b receptor level predicted the occurrence of HT after cerebral ischemia with thrombolytic therapy, the predictive value was 0.63(AUC=0.716, 95%CI=0.628～0.837, P<0.001).(3)Multivariate logistic analysis showed that the adenosine A2b receptor level was the independent risk factor for HT after cerebral ischemia with thrombolytic therapy(OR=0.916, 95%CI=0.899～0.969, P=0.032).(4)After thrombolytic treatment, the NIHSS score of adenosine receptor level >0.63 patients in the HT group was the highest. The NIHSS score of adenosine A2b receptor level <0.63 patients in non HT group was the lowest.Conclusion The adenosine A2b receptor level was the independent risk factor for HT after cerebral ischemia with thrombolytic therapy.The Adenosine A2b receptor level had a predictive value on HT after cerebral ischemia with thrombolytic therapy.