摘要： 目的 探讨脑梗死患者血浆胶质纤维酸性蛋白水平变化对非溶栓性出血性转化的预测作用。方法 选择78 例入院时间< 72 h 且头部MRI 检查无出血的急性脑梗死患者，发病7 ~ 10 d 后复查MRI，梯度回波序列显示低信号为出血性转化；酶联免疫吸附法定量检测血浆胶质纤维酸性蛋白水平；并探讨影响出血性转化的可能危险因素。结果 78 例患者中11 例梯度回波序列呈现低信号。脑梗死组患者血浆胶质纤维酸性蛋白水平［（2798.46 ± 1072.66）ng/L］与正常对照组［（2173.37 ± 867.77）ng/L］之间，差异有统计学意义（P = 0.000）；其中出血性转化组血浆胶质纤维酸性蛋白水平［（3660.03 ±629.64）ng/L］明显高于非转化组［（2657.01 ± 1066.89）ng/L］和正常对照组［（2173.37 ± 867.77）ng/L；（P =0.000，P = 0.005）］。多因素Logistic 逐步回归分析显示，血浆胶质纤维酸性蛋白水平及房颤为出血性转化的危险因素（P = 0.005，P = 0.017）。结论 急性脑梗死患者发病72 h 内血浆胶质纤维酸性蛋白水平高于2856.90 ng/L，对非溶栓性出血性转化的发生具有预测意义，可作为预测非溶栓性出血性转化的标志物之一。

关键词: 神经胶质原纤维酸性蛋白质, 脑梗死, 出血性转化, 梯度回波序列, Logistic 模型

Abstract: Objective To study the predictive effect of glial fibrillary acidic protein (GFAP) on the non-thrombolytic hemorrhagic transformation in brain infarction patients. Methods In this study there were 78 acute brain infarct patients at the mean age of (62.85 ± 11.18) years old. Fifty-two patients were males (66.67%) and 26 were females (33.33%). All patients were admitted to the hospital less than 72 hours after onset. No hemorrhagic findings were seen on the head magnetic resonance imaging (MRI) (including multiplanar gradient-recalled echo) in the patients. All of them were not selected for thrombolytic therapy. On 7-10 d after the first MRI at the onset, low signal for hemorrhagic transformation was seen on multiplanar gradient-recalled echo. The patients were divided into 2 groups based on whether patients presented hemorrhagic transformation or not, and 60 healthy volunteers [35 (58.33%) males and 25 (41.67%) females] without history of cerebrovascular diseases were selected as control group with mean age of (64.02 ± 13.97) years old. The plasma GFAP level in the hemorrhagic transformation group, the non-hemorrhagic transformation group and the control group was quantitatively analysed by enzyme-linked immunosorbent assay (ELISA), the differences between groups were compared, and the factors that may affect the hemorrhagic transformation were explored. Results Among 78 patients, low signals on gradient-echo MR image were found in 11 cases. Plasma GFAP level in brain infarct patients [(2798.46 ± 1072.66) ng/L] were significantly higher than that in the control group [(2173.37 ± 867.77) ng/L, P = 0.000]. Plasma GFAP level in hemorrhagic transformation group (3660.03 ± 629.64) ng/L were significantly higher than that in non-hemorrhagic transformation group (2657.01 ± 1066.89) ng/L and control group (P = 0.000, P = 0.005, respectively). GFAP levels in plasma were correlated with hemorrhagic transformation (P = 0.005). Atrial fibrillation was correlated with hemorrhagic transformation (P = 0.017). Logistic stepwise polynomial regression analysis indicated that plasma GFAP level and atrial fibrillation were risk factors for hemorrhage transformation. Conclusion Plasma GFAP concentration higher than 2856.90 ng/L may predict the occurrence of non-thrombolysis hemorrhagic transformation in acute brain infarction patients admitted within 72 hours after onset. The plasma GFAP level may be one of the markers for the prediction of non-thrombolytic hemorrhagic transformation.

Key words: Glial fibrillary acidic protein, Brain infarction, Hemorrhagic transformation, Multiplanar gradient-recalled echo, Logistic models