Predictive value of CTP parameters combined with serum PAC-1 level and HAT score for hemorrhagic transformation after intravenous thrombolysis in acute cerebral infarction
10.3969/j.issn.1673-4130.2025.20.003
- VernacularTitle:CTP参数联合血清PAC-1水平、HAT评分对急性脑梗死静脉溶栓后出血性转化的预测价值
- Author:
Zhixi CHEN
1
;
Wei YAO
;
Wei LIU
;
Jie WANG
;
Xingning ZHOU
Author Information
1. 成都市三六三医院放射科,四川成都 610041
- Keywords:
acute cerebral infarction;
CT perfusion imaging;
platelet activator combined-1;
hemor-rhage after thrombolysis;
hemorrhagic transformation
- From:
International Journal of Laboratory Medicine
2025;46(20):2446-2451
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the predictive value of CT perfusion imaging(CTP)parameters com-bined with platelet activator combined-1(PAC-1)level and hemorrhage after thrombolysis(HAT)score for hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute cerebral infarction(ACI).Methods A total of 162 patients with ACI who were treated with intravenous thrombolysis in Cheng-du 363 Hospital from January 2022 to April 2023 were selected.All patients underwent head CT examination(including plain scan and CTP)before intravenous thrombolytic therapy,and serum PAC-1 level and HAT score were measured at admission.According to whether HT occurred after intravenous thrombolysis,the pa-tients were divided into HT group(HT group)and non-HT group(non-HT group).The differences of CTP parameters,serum PAC-1 level and HAT score between the two groups were compared.Multivariate Logistic regression was used to analyze the independent risk factors of HT after intravenous thrombolysis in ACI pa-tients.The predictive value of CTP parameters combined with serum PAC-1 and HAT scores alone and in combination for HT after intravenous thrombolysis in ACI patients was evaluated by drawing the receiver op-erating characteristic(ROC)curve and calculating the area under the curve(AUC).Results The cerebral blood flow and blood volume in the HT group were significantly lower than those in the non-HT group(P＜0.05),while the serum PAC-1 level,peak time,mean transit time,flow extraction product,and HAT score were significantly higher than those in the non-HT group(P＜0.05).Multivariate Logistic regression analysis showed that CTP integration parameters which were composed of cerebral blood flow,cerebral blood volume,peak time,mean transit time and flow extraction product,serum PAC-1 level and HAT score were independ-ent risk factors for HT after intravenous thrombolysis in ACI patients(P＜0.05).ROC curve analysis showed that CTP integration parameters,serum PAC-1 level and HAT score all had certain predictive value for HT in ACI patients after intravenous thrombolysis,and their AUC and 95％CI were 0.766(95％CI:0.605-0.915),0.702(95％CI:0.451-0.955)and 0.741(95％CI:0.551-0.923),respectively.The com-bined application of CTP integration parameters,serum PAC-1 levels,and HAT scores significantly improved the predictive performance,and its AUC was 0.856(95％CI:0.750-0.951),which was higher than those of each index alone(Zcombination-CTP=2.177,P=0.032,Zcombination-PAC-1=2.917,P=0.004,Zcombination-HAT=2.537,P=0.013).Conclusion The combination of CTP integration parameters which are composed of cerebral blood flow,cerebral blood volume,peak time,mean transit time and flow extraction product,and serum PAC-1 level and HAT score has high predictive value for HT after intravenous thrombolysis in ACI patients,and has high clinical application potential.
