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.