Increased Serum Alkaline Phosphatase as a Predictor of Symptomatic Hemorrhagic Transformation in Ischemic Stroke Patients with Atrial Fibrillation and/or Rheumatic Heart Disease
Increased Serum Alkaline Phosphatase as a Predictor of Symptomatic Hemorrhagic Transformation in Ischemic Stroke Patients with Atrial Fibrillation and/or Rheumatic Heart Disease
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血清碱性磷酸酶升高是伴有房颤和/或风湿性心脏病的缺血性中风患者症状出血性转化的预测因子
DOI：
10.1016/j.jstrokecerebrovasdis.2016.06.017
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发表时间：
2016-10-01
影响因子：
2.5
通讯作者：
Liu, Ming
中科院分区：
文献类型：
--
作者：
Liu, Junfeng;Wang, Deren;Liu, Ming
背景和目的：碱性磷酸酶（ALP）升高被认为是临床实践中肝功能的标志物。此外，已经确定肝功能可促进出血性转化（HT）。然而，ALP 水平是否在中风后 HT 中发挥作用仍然是一个悬而未决的问题，特别是在心源性中风患者中。方法：我们前瞻性地连续招募患有心房颤动和/或风湿性心脏病的缺血性中风患者。收集入院后 48 小时内的基线数据，包括 ALP 水平。 ALP 水平分为三等分。根据脑磁共振成像和欧洲-澳大利亚急性中风研究 III 的定义评估是否存在 HT、出血性梗塞 (HI)、实质血肿 (PH) 和症状性 HT。我们使用逻辑回归来检查 ALP 水平与 HT、HI、PH 和症状性 HT 风险之间的关联。结果：最终纳入的 130 名患者（56 名男性；平均年龄：63 岁）中，50 名（38.5%）出现 HT，13 名（10.0%）出现症状性 HT。 ALP 水平与 HT、HI 和 PH 风险无关。然而，在调整年龄、性别、丙氨酸转氨酶水平、天冬氨酸转氨酶水平、抗血小板治疗、抗凝治疗和溶栓治疗后，与第一个 ALP 三分位患者相比，第三个三分位患者出现症状性 HT 的可能性高出 8.96 倍（95% 置信区间：1.33-60.21；P=.02）。结论：ALP 水平升高可能有助于识别患有心房颤动和/或风湿性心脏病的缺血性卒中患者的高危症状性 HT。然而，需要对更大的队列进行进一步的研究来确定我们的结果。
Background and Objective: Elevated alkaline phosphatase (ALP) is considered as a marker of liver function in clinical practice. Furthermore, it has been identified that liver function can contribute to hemorrhagic transformation (HT). However, whether ALP levels play a role in HT after stroke remains an open question, especially in cardioembolic stroke patients. Methods: We prospectively and consecutively enrolled ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease. Baseline data including ALP levels within 48 hours after admission were collected. ALP levels were divided into tertiles. The presence of HT, hemorrhagic infarction (HI), parenchymal hematoma (PH), and symptomatic HT was evaluated according to brain magnetic resonance imaging and European-Australasian Acute Stroke Study III definitions. We used logistic regression to examine the associations between ALP levels and risk of HT, HI, PH, and symptomatic HT. Results: Of the 130 patients (56 male; mean age: 63 years) included finally, 50 (38.5%) developed HT and 13 (10.0%) developed symptomatic HT. ALP levels were not associated with risk of HT, HI, and PH. However, compared with the first ALP tertile, patients in the third tertile were 8.96 times more likely to have symptomatic HT (95% confidence interval: 1.33-60.21; P=.02) after adjusting for age, gender, alanine aminotransferase levels, aspartate aminotransferase levels, antiplatelet therapy, anticoagulation therapy, and thrombolysis therapy. Conclusion: Elevated ALP levels may help identify highrisk symptomatic HT in ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease. However, further studies with larger cohorts are needed to identify our results.