Value of serum Nod-like receptor protein 3 and reactive oxygen species to the prediction of hemorrhagic transformation after mechanical thrombectomy for anterior circulation large-vessel occlusion-acute ischemic stroke
Objective To observe the changes of the serum levels of Nod-like receptor protein 3(NLRP3)and reactive oxygen species(ROS)between patients with hemorrhagic transformation(HT)after mechanical thrombectomy(MT),and to explore the values of serum NLRP3 and ROS to the prediction of HT after MT in patients with anterior circulation large-vessel occlusion-acute ischemic stroke(LVO-AIS).Methods Among 134 patients with anterior circulationLVO-AIS underwent MT in the First Affiliated Hospital of Hebei North University from January 2021 to December 2022,42 patients developed postoperative HT(HT group),and 92 patients developed no HT(no-HT group).The gender,age,underlying diseases(hypertension,diabetes,atrial fibrillation),smoking habits,location of occlusive blood vessels(intracranial segment of internal carotid artery,middle cerebral artery),etiological classification,admission blood pressure,Alberta Stroke Program Early CT score(ASPECTS),rates of bridging MT,stenting and balloon implantation,time from onset to recanalization(ORT),and time from puncture to recanalization(PRT)were compared between two groups.The fasting peripheral blood samples were collected the day after admission,and serum levels of NLRP3,ROS,C-reactive protein(CRP),D-dimer and lipid were detected.Multivariate logistic regression was used to analyze the influencing factors of postoperative HT after MT in patients with anterior circulation LVO-AIS.ROC curves were plotted to evaluate the values of admission ASPECTS,NLRP3,ROS and PRT to the prediction of HT after MT in anterior circulation LVO-AIS patients.Results(1)The admission ASPECTS was lower in HT group[5(3,5)]than that in no-HT group[6(5,7)](U=9.183,P＜0.001),ORT and PRT were longer in HT group[(515.14±84.56),(96.31± 29.98)min]than those in no-HT group[(486.27±70.99),(64.74±15.68)min](t=2.054,P=0.042;t=8.003,P＜0.001),the serum levels of NLRP3,ROS and CRP were higher in HT group[(144.38±17.10)μg/L,(512.21± 117.49)u/mL,23.00(13.80,27.60)mg/L]than those in no-HT group[(129.15±5.99)μg/L,(380.48± 78.36)u/mL,17.40(14.50,20.30)mg/L](t=7.605,P＜0.001;t=7.659,P＜0.001;U=6.585,P=0.004),and there were no significant differences in the underlying diseases,smoking habits,occlusive blood vessels,etiological classification,rate of bridging MT,rate of stenting and balloon implantation,D-dimer and lipid level and other data between two groups(P＞0.05).(2)The admission ASPECTS(OR=0.058,95％CI:0.010-0.331,P=0.001),NLRP3(OR=1.345,95％CI:1.149-1.574,P＜0.001),ROS(OR=1.014,95％CI:1.005-1.022,P=0.002)and PRT(OR=1.107,95％CI:1.024-1.196,P=0.011)were the influencing factors of HT after MT in patients with anterior circulation LVO-AIS.(3)When the optimal cut-off values of admission ASPECTS,NLRP3,ROS and PRT were 5.5,134.9 μg/L,437.0 u/mL and 73.5 min,the AUCs for predicting HT after MT in anterior circulation LVO-AIS patients were 0.848(95％CI:0.771-0.924,P＜0.001),0.805(95％CI:0.708-0.903,P＜0.001),0.844(95％CI:0.767-0.920,P＜0.001),and 0.802(95％CI:0.720-0.884,P＜0.001),the sensitivities were 82.61％,91.52％,82.61％and 72.83％,and the specificities were 80.95％,71.43％,76.19％and 71.43％,respectively.The AUC of the combination of them four for predicting HT was 0.989(95％CI:0.976-1.001,P＜0.001),the sensitivity was 95.65％,and the specificity was 97.62％.Conclusion The increased levels of serum NLRP3 and ROS,low admission ASPECTS,and prolonged PRT increase the risk of HT after MT in patients with anterior circulation LVO-AIS,and the combination of them four has a high predictive value.
acute ischemic strokeanterior circulation large-vessel occlusionmechanical thrombectomyhemorrhagic transformationNod-like receptor protein 3reactive oxygen species
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