The Prediction Effect Of The Serum C-FN, MMP-9, NSE Concentrations On Hemorrhage Transformation In Acute Ischemic Stroke Patients Without Thrombolytic Therapy

Background and objective—Hemorrhage transformation(HT) means hemorrhage in the ischemic region caused by vessels reperfusion of after cerebral infarction. Sometime it influences prognosis of the patients significantly. HT is contributed the destruction of neurovascular unit which is comprised of the extracellular matrix, endothelial cells, astrocytes, neurons, and pericytes. Recently, the serum concentrations of c-Fn, MMP-9, NSE have been indicated to correlate with HT after thrombolytic therapy significantly. However, the risk of hemorrhage can be caused even without thrombolytic agents administration. The present study investigated the influence of HT on clinical prognosis and observed the relationship between the serum concentrations of c-Fn, MMP-9, NSE and HT in the patients without thrombolytic therapy to explore the potential biology makers of HT.Methods—95 patients (mean age,63.8±14 years) with acute cerebral infarction were included in the present study. All the patients admitted within the first 48 hours whose NIHSS scores≥5 points from November 2008 to March 2010 in ShenZhen people's hospital. The serum concentrations of c-Fn,MMP-9 and NSE were detected on admission by enzyme-linked immuno-absorbent assay kits. The cerebral infarction volumes were evaluated by CT or MRI scans within 5 days after episode. The development of HT without thrombolytic therapy was monitored for 2 weeks. The types of HT were classified according to the European Cooperative Acute Stroke Study (ECASS)-II criteria. The neurological function was evaluated by NIH Stroke Scale(NIHSS). And the prognosis after 90 days was evaluated by improved Rankin measuring scale (MRS).Results—HT happened in 44 (46.3%) patients. Of these patients,18 were HI-1,13 were HI-1,9 were PH-1,4 were PH-2. There were significant differences between the HT group and the non-HT group (P<0.05) by univariate analysis in the cerebral infarction volumes (97.4±74.9cm3 versus 62.1±66.2cm3),the percents with a atrial fibrillation history (47.7% versus 19.6%),the serum c-Fn concentrations (6.9±1.7μg/mL versus 3.6±1.0μg/mL), the serum MMP-9 concentrations (156.3[95.6,191.4]ng/mL versus 70.6 [48.9,106.7] ng/mL), the serum NSE concentrations (27.4[22.2,32.9]ng/mL versus 15.3[11.4,20.8]ng/mL). Only the serum concentrations of c-Fn (OR,21.8[2.9-165.2];P=0.003), MMP-9 (OR,1.8[1.1-3.0];P=0,017), NSE(OR,1.2[1.0-1.5];P=0.026) were independent predictors of HT after adjusted confounding factors by non-conditional logistic analysis. The scores of MRS at the 90th day had no significant difference between HT and non-HT group.Conclusion—High serum concentrations of c-Fn, MMP-9 and NSE are independent biological markers to predict the incidence of HT in patients without thrombolytic therapy. The serum c-Fn, MMP-9 and NSE concentrations can be used as the index that predict HT of patients without thrombolytic therapy.