Prediction And Relevance Of Serum FSTL1、β Amyloid Levels On The Transformation Of Acute Cerebral Infarction Hemorrhage In High And Middle Altitudes

Objective Acute cerebral infarction(ACI)is a common cerebrovascular disease,in which hemorrhage transformation(HT)is a complication of ACI and often leads to deterioration of the disease.Therefore,timely and effective prediction of HT is an important part of disease prevention and treatment.In this study,the predictive value of Follistatin-like 1(FSTL1)and amyloid beta(Aβ)in the serum of patients with acute cerebral infarction in middle and high altitude areas was investigated to determine their predictive value of HT and related risk factors.Methods 1.114 patients with acute cerebral infarction from March 2021 to October 2021 were selected as the ACI group,and then the ACI group was divided into HT group(41 cases),control group(73 cases)according to whether hemorrhagic transformation occurred,and 76 healthy controls were selected in the same time period.general baseline data were collected from all enrolled patients:age,sex,altitude of residence,history of hypertension,history of heart disease,history of The general baseline data of all enrolled patients were collected:age,sex,altitude of residence,history of hypertension,history of heart disease,history of diabetes mellitus,whether thrombolytic therapy was performed and admission NHISS score,infarct volume;laboratory indexes after admission:homocysteine,uric acid,creatinine,hemoglobin,platelets,HDL,LDL,eosinophils.The levels of serum FSTL1 andβ-amyloid were detected in all enrolled study subjects.2.HT subgroup:the HT group was divided into two groups according to the patient’s admission NIHSS score:mild and moderate illness group(NHISS score<10),and severe illness group(NHISS score≥10);The HT group was divided into four groups by TOAST typing:LAA,CE,SAO,and NHD;HT patients were grouped according to the altitude of their residence,medium altitude group(1500m-2500m)and high altitude group(2500m-4000m);HT was divided by ECASS II typing Patients were divided into four groups:HI1-2,PH1-2;infarct volume was calculated according to cranial CT or MRI imaging,three groups according to infarct volume:large infarct volume group(>10cm~3),medium infarct volume group(5-10cm~3),and small infarct volume group(<5cm~3).3.SPSS26.0 statistical software was used to analyze and compare the ACI group with healthy control group The differences in serum FSTL1 and Aβlevels between the HT and NHT groups and HT subgroups were analyzed using SPSS26.0 statistical software,and the ROC diagnostic curves of FSTL1 and Aβfor HT were plotted to analyze the correlation between serum FSTL1and Aβlevels and each clinical data,Laboratory index and finally to explore the risk factors associated with the occurrence of HT in ACI patients.Results 1.Serum FSTL1 and Aβlevels were higher in all ACI patients than in the healthy control population(P<0.05);2.Serum FSTL1 and Aβlevels,uric acid level,hemoglobin,platelets,eosinophils,infarct volume,NHISS score at admission,in the HT and NHT groups were statistically significant(P<0.05).And the differences in age,altitude,gender,history of hypertension,history of heart disease,History of diabetes,glycosylated hemoglobin,creatinine,cystatin C,homocysteine,LDL,and HDL between HT and NHT groups were not statistically significant(P>0.05).3.Multi-factor logistic regression analysis showed that uric acid level,admission NHISS score,serum FSTL1,and Aβlevel were 4.The differences in FSTL1 and Aβlevels between the mild and moderate disease groups and the severe disease group in the HT group were statistically significant(P<0.05);The serum FSTL1 level of LAA type was higher than that of CE,SAO,NHD type(P<0.05)in the TOAST classification of the HT group.There were no significant differences in serum Aβ.There was no statistically significant difference in serum FSTL1 and Aβlevels in the HT group between mid-altitude and high-altitude(P>0.05);there was no statistically significant difference in serum FSTL1 and Aβlevels between ECASS II types in the HT group(P>0.05);the difference in serum FSTL1 and Aβlevels between different infarct volumes in the HT group was statistically significant(P<0.05).5.The results of ROC curve analysis showed that the AUC of serum FSTL1 to predict the risk of HT in patients with ACI was 83.10%,the best cut-off value:24.61 ng/ml,sensitivity:82.9%,specificity:72.6%,positive predictive value:62.96%,negative predictive value:88.33%;the AUC of serum Aβto predict the risk of HT in patients with ACI The AUC for predicting HT risk in patients was:90.90%,best cut-off value:166.84 ng/ml,sensitivity:87.8%,specificity:79.5%,positive predictive value:70.59%,negative predictive value:92.06%.6.Among the correlations of serum FSTL1 and Aβwith clinical data and biochemical indices:serum FSTL1 was positively correlated with NHISS score(r=0.499,P=0.000);positive correlation with hemoglobin(r=0.242,P=0.010);negative correlation with eosinophils(r=-0.265,P=0.004);positive correlation with Hyc correlation(r=0.251,P=0.007).Serum Aβwas positively correlated with NHISS score(r=0.523,P=0.000);positive correlation with hemoglobin(r=0.264,P=0.008);positive correlation with uric acid(r=0.196,P=0.037);and negative correlation with eosinophils(r=-0.224,P=0.017).Conclusions Serum FSTL1 and Aβlevels in ACI patients at middle and high altitudes have some value in predicting hemorrhagic transformation,Patients with LAA ACI are more likely to develop HT,while indirectly assessing the degree of neurological deficits.serum FSTL1 and Aβlevels,admission NHISS score,uric acid level,and hemoglobin level in ACI patients are independent risk factors for hemorrhagic transformation.