血清HDAC4和MYD88水平与急性脑梗死rt-PA静脉溶栓后出血转化的关系研究  

Relationship between serum HDAC4 and MYD88 levels and hemorrhagic transformation after intravenous thrombolysis with rt-PA in acute cerebral infarction

作　　者：刘昌佳 郝洁[2] 刘敏肖[1] 李银[1] 唐进松[1] 李凡 李鑫[3] LIU Changjia;HAO Jie;LIU Minxiao;LI Yin;TANG Jinsong;LI Fan;LI Xin(Department of Neurology,the Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China;Department of Clinical Laboratory,the Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China;Department of Acupuncture,the Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China)

机构地区：[1]河北北方学院附属第二医院神经内科,河北张家口075100 [2]河北北方学院附属第二医院检验科,河北张家口075100 [3]河北北方学院附属第二医院针灸科,河北张家口075100

出　　处：《国际检验医学杂志》2024年第11期1313-1317,共5页International Journal of Laboratory Medicine

基　　金：河北省中医药管理局科研计划项目(2022424)。

摘　　要：目的探讨急性脑梗死(ACI)患者血清组蛋白去乙酰化酶4(HDAC4)和髓样分化蛋白88(MYD88)水平与重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后发生出血转化的关系。方法选取2020年5月至2022年5月在该院就诊并进行rt-PA静脉溶栓治疗的169例ACI患者作为研究对象,并根据患者进行rt-PA静脉溶栓后是否发生出血转化将其分为转化组(46例)和非转化组(123例),另外选取同期在该院进行体检的156例体检健康者作为对照组。采用酶联免疫吸附试验对各组血清HDAC4、MYD88水平进行检测,并对转化组和非转化组的一般资料进行比较;采用Pearson相关对ACI患者血清HDAC4和MYD88水平的相关性进行分析;采用多因素Logistic回归分析影响ACI患者rt-PA静脉溶栓后出血转化的相关因素;进一步通过受试者工作特征(ROC)曲线评估HDAC4、MYD88水平及二者联合对ACI患者rt-PA静脉溶栓后出血转化的诊断价值。结果ACI组血清HDAC4水平低于对照组,血清MYD88水平高于对照组,差异均有统计学意义(P<0.05);非转化组和转化组ACI患者的性别、年龄、体重指数、空腹血糖及高血脂、冠心病占比比较,差异均无统计学意义(P>0.05),而患者心房颤动占比、美国国立卫生研究院卒中量表(NIHSS)评分、发病至溶栓时间比较,差异均有统计学意义(P<0.05);转化组较非转化组血清HDAC4水平降低,血清MYD88水平升高,差异有统计学意义(P<0.05);Pearson相关分析结果显示,ACI患者血清HDAC4水平与MYD88呈负相关(r=-0.401,P<0.001);多因素Logistic回归分析显示,心房颤动、发病至溶栓时间、NIHSS评分、MYD88水平是ACI患者rt-PA静脉溶栓后发生出血转化的危险因素,HDAC4水平是ACI患者rt-PA静脉溶栓后发生出血转化的保护因素(P<0.05);血清HDAC4、MYD88联合检测ACI患者rt-PA静脉溶栓后发生出血转化的曲线下面积为0.876,灵敏度和特异度分别为65.22%和98.37%,优于HDAC4和MYD88单独诊断(Z二者联Objective To investigate the relationship between serum histone deacetylase 4(HDAC4)and myeloid differentiation protein 88(MYD88)levels and hemorrhagic transformation after intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in patients with acute cerebral infarction(ACI).Methods A total of 169 patients with ACI who were treated with rt-PA intravenous thrombolysis in this hospital from May 2020 to May 2022 were selected as the research objects,and they were divided into transformation group(46 cases)and non-transformation group(123 cases)according to whether hemorrhagic transformation occurred after rt-PA intravenous thrombolysis.In addition,156 healthy people who underwent physical examination in the hospital during the same period were selected as the control group.Enzyme-linked immunosorbent assay was used to detect the serum levels of HDAC4 and MYD88 in each group,and the general data of transformation group and non-transformation group were compared.Pearson correlation was used to analyze the correlation between serum HDAC4 and MYD88 levels in ACI patients.Multivariate Logistic regression analysis was used to analyze the related factors of hemorrhagic transformation in ACI patients after intravenous thrombolysis with rt-PA.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of HDAC4,MYD88 levels and their combination for hemorrhagic transformation in ACI patients after rt-PA intravenous thrombolysis.Results The serum level of HDAC4 in ACI group was significantly lower than that in control group,and the serum level of MYD88 in ACI group was significantly higher than that in control group(P<0.05).There were no significant differences in gender,age,body mass index,fasting blood glucose,hyperlipidemia,and coronary heart disease between the non-transformation group and the transformation group(P>0.05),while there were significant differences in atrial fibrillation,National Institute of Health Stroke Scale(NIHSS)score,and the time from onset to thrombo

关 键 词：组蛋白去乙酰化酶4 髓样分化蛋白88 急性脑梗死 静脉溶栓 出血转化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]