Study on the relationship between glial fibrillary acidic protein and non-thrombolytic hemorrhagic transformation

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. DOI：10.3969/j.issn.1672-6731.2011.06.00