Clinical Neurosciences Research Laboratory, Neurovascular Area, Department of Neurology, Hospital Clínico Universitario, IDIS, University of Santiago de Compostela, Santiago de Compostela, Spain.
Atherosclerosis. 2013 Jan;226(1):165-71. doi: 10.1016/j.atherosclerosis.2012.10.072. Epub 2012 Nov 17.
Platelet derived growth factor-CC (PDGF-CC) isoform is activated by tissue plasminogen activator (tPA) regulating blood brain barrier permeability after ischemia. We aimed to study the association of PDGF isoforms serum levels with hemorrhagic transformation (HT) and edema after thrombolytic treatment in ischemic stroke.
We studied 129 patients with ischemic stroke treated with tPA within the first 4.5 h (h) from stroke onset. CT was performed on admission and at 24-36 h. On the 2nd CT, HT was classified according to ECASS II criteria, and severe brain edema was diagnosed if extensive swelling causing any shifting of the structures of the midline was detected. PDGF-AA, PDGF-AB, PDGF-BB and PDGF-CC serum levels were analyzed by ELISA on admission (before tPA bolus), at 24 and 72 h.
Patients who developed HT showed only higher levels of PDGF-CC isoform on admission and at 24 h (all p < 0.0001). In the multivariate analysis, PDGF-CC levels on admission (OR, 1.02; CI 95%, 1.00-1.04) and at 24 h (OR, 1.05; CI 95%, 1.02-1.08) were independently associated with HT after adjustment by confounding factors. On the other hand, patients with severe edema showed also higher levels of PDGF-CC on admission and at 24 h (p < 0.0001), but this statistical association was lost in the logistic regression analysis. PDGF-CC levels ≥ 175 ng/mL at 24 h predict the development of PH with a sensitivity of 90% and specificity of 88% (area under the curve 0.936; p < 0.0001).
Increased PDGF-CC levels after tPA treatment is associated with HT.
血小板衍生生长因子-CC（PDGF-CC）异构体通过组织型纤溶酶原激活物（tPA）激活，调节缺血后血脑屏障通透性。我们旨在研究 PDGF 异构体血清水平与缺血性卒中溶栓治疗后出血性转化（HT）和水肿的关系。
我们研究了 129 例在卒中发病后 4.5 小时内接受 tPA 治疗的缺血性卒中患者。入院时和 24-36 小时进行 CT 检查。在第 2 次 CT 上，根据 ECASS II 标准对 HT 进行分类，如果广泛肿胀导致中线结构任何移位，则诊断为严重脑水肿。入院时（tPA 推注前）、24 小时和 72 小时通过 ELISA 分析 PDGF-AA、PDGF-AB、PDGF-BB 和 PDGF-CC 血清水平。
发生 HT 的患者在入院时和 24 小时时仅表现出更高的 PDGF-CC 异构体水平（均 p<0.0001）。在多变量分析中，入院时（OR，1.02；95%CI，1.00-1.04）和 24 小时（OR，1.05；95%CI，1.02-1.08）时的 PDGF-CC 水平与调整混杂因素后的 HT 独立相关。另一方面，严重水肿的患者在入院时和 24 小时时也表现出更高的 PDGF-CC 水平（p<0.0001），但在逻辑回归分析中这种统计学关联消失了。24 小时时 PDGF-CC 水平≥175ng/mL 预测 PH 的发生，具有 90%的敏感性和 88%的特异性（曲线下面积 0.936；p<0.0001）。
tPA 治疗后 PDGF-CC 水平升高与 HT 相关。
