Predictive Value of Apelin and Vaspin on Hemorrhagic Transformation in Patients with Acute Ischemic Stroke after Intravenous Thrombolysis and Analysis of Related Factors

Abstract

Background: Acute ischemic stroke (CIS) is a high-risk condition among the elderly, and intravenous thrombolytic therapy (ITT) is the most effective means for it. However, ITT is prone to induce hemorrhagic transformation (HT) that further threatens the life and health of patients. As paramount substances in cardiovascular and cerebrovascular diseases, adipocyte factor (Apelin) and serine protease inhibitor (Vaspin) are strongly bound up with CIS.

Objective: To analyze the predictive significance of Apelin and Vaspin on HT in CIS patients after ITT and offer effective reference to HT prevention in the future.

Methods: A total of 109 CIS patients treated with intravenous thrombolysis (IT) in two hospitals between June 2017 and February 2018 were enrolled. Among them, 48 patients who suffered HT after therapy were assigned to the research group (Res group) and the other 61 patients who did not suffer it after therapy were assigned to the control group (Con group). Serum Apelin, Vaspin, inflammatory factors, and oxidative stress levels were quantified, and receiver operating characteristic (ROC) curves were drawn for analyzing the predictive value of Apelin and Vaspin on HT after ITT and their associations with inflammatory factors and oxidative stress. CIS patients who suffered HT were followed up for 3 years for prognostic significance analysis of Apelin and Vaspin.

Results: After ITT, the Res group showed lower Apelin and Vaspin levels than the Con group (all P < 0.05), and patients with a higher HT grade had lower Apelin and Vaspin levels (all P < 0.05). The joint detection of Apelin and Vaspin showed a sensitivity of 77.08% and a specificity of 73.77% for forecasting HT in CIS patients after thrombolytic therapy (all P < 0.001). In addition, after thrombolytic therapy, the Res group presented higher levels of interleukin-1β (IL-1β) and IL-6 as well as malondialdehyde (MDA) than the Con group, and the levels had negative associations with Apelin and Vaspin (all P < 0.05). The Res group showed a lower superoxide dismutase (SOD) level than the Con group, and the level presented a positive association with Apelin and Vaspin (all P < 0.05). According to Logistic analysis, IL-1β, IL-6, and MDA were independent risk factors for HT in CIS patients after IT, while Apelin, Vaspin, and SOD were independent protective factors (all P < 0.05). According to the follow-up results, Apelin and Vaspin demonstrated excellent value in forecasting the death of patients with both CIS and HT (P < 0.05), and their lower levels indicate a higher risk of death (all P < 0.05).

Conclusion: Apelin and Vaspin can help effectively forecast the occurrence of HT in CIS patients after ITT as independent protective factors of HT, so they are of a high clinical application value.

Figure 1

Comparison of Apelin and Vaspin. (a) Comparison of Apelin. (b) Comparison of Vaspin vs. Con group, ^∗P < 0.05 vs. T1, ^#P < 0.05 vs. T2, and ^&P < 0.05.

Figure 2

Associations of Apelin and Vaspin with HT grade. (a) Associations of Apelin with HT grade. (b) Associations of Vaspin with HT grade vs. Con group, ^∗P < 0.05 vs. T1, ^#P < 0.05 vs. T2, and ^&P < 0.05. Value of Apelin and Vaspin in forecasting HT.

Figure 3

Value of Apelin and Vaspin in forecasting HT. (a) ROC curve of Apelin in forecasting HT after IT. (b) ROC curve of Vaspin in forecasting HT after IT. (c) ROC curve of Apelin combined with Vaspin in forecasting HT after IT.

Figure 4

Comparison of inflammatory factors between the two groups. (a) Comparison of IL-1β. (b) Comparison of IL-6 vs. Con group, ^∗P < 0.05 vs. T1, ^#P < 0.05 vs. T2, and ^&P < 0.05.

Figure 5

Comparison of oxidative stress reaction between the two groups. (a) Comparison of SOD. (b) Comparison of MDA vs. Con group, ^∗P < 0.05 vs. T1, ^#P < 0.05 vs. T2, and ^&P < 0.05.

Figure 6

Associations of Apelin and Vaspin with prognosis. (a) Comparison of Apelin between the dead patients and the surviving patients. (b) Comparison of Vaspin between the dead patients and the surviving patients. (c) ROC curve of Apelin in forecasting the death of CIS patients with HT after thrombolysis. (d) ROC curve of Vaspin in forecasting the death of CIS patients with HT after thrombolysis. (e) Survival curve of the high and low Apelin groups. (f) Survival curve of the high and low Vaspin groups. ^#P < 0.05.