Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2021; 9(30): 9070-9076
Published online Oct 26, 2021. doi: 10.12998/wjcc.v9.i30.9070
Serum calcium, albumin, globulin and matrix metalloproteinase-9 levels in acute cerebral infarction patients
Ting-Ting Zhong, Gang Wang, Xiao-Qin Wang, Wei-Dan Kong, Xiao-Yu Li, Qian Xue, Yu-An Zou
Ting-Ting Zhong, Gang Wang, Xiao-Qin Wang, Wei-Dan Kong, Xiao-Yu Li, Qian Xue, Yu-An Zou, Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
Author contributions: Zhong TT designed and managed the study; Wang G, Wang XQ, Kong WD, LI XY and Zou YA collected and analyzed the data; Zhong TT, Wang G, Wang XQ, Kong WD, LI XY, Xue Q and Zou YA wrote the manuscript; Xue Q reviewed the manuscript; All authors approved the final version of the manuscript.
Supported by Scientific Research Fund of Hebei Health Commission, No. 20210197.
Institutional review board statement: The study was reviewed and approved by the First Affiliated Hospital of Hebei North University Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare having no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qian Xue, MSc, Chief Physician, Department of Neurology, The First Affiliated Hospital of Hebei North University, No. 12 Changqing Road, Zhangjiakou 075000, Hebei Province, China. xueqian6199@163.com
Received: June 30, 2021
Peer-review started: June 30, 2021
First decision: July 26, 2021
Revised: August 9, 2021
Accepted: August 16, 2021
Article in press: August 16, 2021
Published online: October 26, 2021
Processing time: 112 Days and 23.2 Hours
Abstract
BACKGROUND

Hemorrhagic transformation (HT) is a common complication in patients with cerebral infarction. However, its pathogenesis is poorly understood. The knowledge of factors that may increase risk for HT may help in improving the safety of thrombolytic therapy.

AIM

To investigate the predictive value of serum calcium, albumin, globulin and matrix metalloproteinase-9 (MMP-9) levels for HT after intravenous thrombolysis (IVT) in patients with acute cerebral infarction.

METHODS

Five hundred patients with acute cerebral infarction who received IVT with alteplase within 4.5 h after the onset of disease between January 2018 and January 2021 at our hospital were selected as the study subjects. They were divided into groups based on computed tomography scan results of the brain made within 36 h after thrombolysis. Forty patients with HT were enrolled in an observation group and 460 patients without HT were enrolled in a control group. Serum calcium, albumin, globulin and MMP-9 levels were compared between the two groups. Regression analysis was used to discuss the relationship between these indices and HT.

RESULTS

The previous history of hypertension, diabetes, atrial fibrillation, cerebrovascular diseases, smoking and alcohol intake were not associated with HT after IVT in patients with acute cerebral infarction (all P > 0.05). The National Institutes of Health stroke scale (NHISS) score was associated with HT after IVT in patients with acute cerebral infarction (P < 0.05). The serum calcium and albumin levels were lower in the observation group than in the control group (all P < 0.05). The levels of globulin and MMP-9 were significantly higher in the observation group than in the control group (all P < 0.05). Logistic regression analysis showed that NHISS score, serum calcium, albumin, globulins and MMP-9 were independent factors influencing the occurrence of HT following IVT in patients with cerebral infarction (P < 0.05).

CONCLUSION

Serum calcium, albumin, globulin and MMP-9 levels are risk factors for HT after IVT in patients with acute cerebral infarction. Moreover, NHISS score can be used as a predictor of post-thrombolytic HT.

Keywords: Stroke; Intravenous thrombolytic therapy; Intracranial hemorrhage; Blood calcium; Albumin; Globulin

Core Tip: To better understand the pathogenesis of hemorrhagic transformation (HT) may help to avoid clinically relevant brain hemorrhages in patients with acute cerebral infarction treated with intravenous thrombolysis (IVT). The present study assessed the relationship between factors, including serum calcium, albumin, globulin and matrix metalloproteinase-9 levels (MMP-9), and the occurrence of HT following IVT in patients with acute cerebral infarction by comparing clinical and laboratory features between the HT and non-HT groups. National Institutes of Health stroke scale score, serum calcium, albumin, globulins and MMP-9 were independent factors influencing occurrence of HT in patients with cerebral infarction treated with IVT-recombinant tissue plasminogen activator.