Abstract:

Objective

To investigate the relationship between serum nucleotide - binding oligomerization domain-like receptor protein 3 （NLRP3） inflammasome and its downstream inflammatory factors and hemorrhagic transformation （HT） and prognosis in patients with large artery atherosclerotic（LAA） cerebral infarction after thrombolysis.

Methods

Two hundred and fifty-five patients with LAA cerebral infarction treated with intravenous thrombolysis in Neurology Department of Baoji People's Hospital between June 2019 and June 2023 were selected，and divided into HT group and non-HT group based on whether they developed HT after thrombolysis. The levels of serum NLRP3 inflammasome and its downstream inflammatory factors [cysteinyl aspartate specific protease 1 （Caspase-1），interleukin（IL） -1β，IL-18] were compared in two groups.After a 3-month follow-up，the patients with LAA cerebral infarction were divided into a good prognosis group and a poor prognosis group based on their prognosis.Using multivariate Logistic regression，the risk variables for a poor outcome in individuals with LAA cerebral infarction were examined. The predictive value of NLRP3 inflammasome and its downstream inflammatory factors for HT and poor prognosis in LAA cerebral infarction after thrombolysis patients were analyzed by receiver operating characteristic （ROC） curve.

Results

After thrombolysis，62 patients developed HT （HT group），while 193 patients did not develop HT （non-HT group）. The levels of serum NLRP3，Caspase-1，IL-1β and IL-18 in HT group were higher than those in non-HT group （P＜0.05）. The results of ROC curve analysis showed that the area under the curve （AUC） of serum NLRP3，Caspase-1，IL-1β，IL-18 alone and combined detection in predicting HT after thrombolysis in patients with LAA cerebral infarction were 0.683，0.769，0.700，0.679，0.887，respectively，and the combined detection had the highest predictive efficacy. During a 3-month follow-up，184 patients had a good prognosis （good prognosis group） and 71 patients had a poor prognosis （poor prognosis group）. The serum NLRP3，time from onset to thrombolysis，Caspase-1，National Institutes of Health stroke scale （NIHSS）score，IL-1β，HT ratio and IL-18 level in the poor prognosis group were higher than those in good prognosis group，and the differences were statistically significant（P＜0.05）.Multivariate Logistic regression analysis showed that the increase of time from onset to thrombolysis，the increase of NIHSS score，the occurrence of HT，the increase of serum NLRP3，Caspase-1，IL-1β and IL-18 levels were independent risk factors for patients' poor prognosis following a cerebral infarction caused by LAA （P＜0.05）. The results of ROC curve analysis showed that the AUC of serum NLRP3，Caspase-1，IL-1β，IL-18 alone and combined detection in predicting the poor prognosis of patients with LAA cerebral infarction were 0.734，0742，0.672，0.701，0.883，respectively，the combined detection had the highest predictive efficiency.

Conclusion

The elevated levels of serum NLRP3，Caspase-1，IL-1β and IL-18 in patients with LAA cerebral infarction are risk factors for poor prognosis，combined detection has a high predictive value for HT and poor prognosis after thrombolysis.

Key words: Large artery atherosclerotic cerebral infarction, Intravenous thrombolysis, NLRP3, Hemorrhagic transformation, Prognosis