| Objective:to explore the risk factors for hemorrhagic transformation(HT)after acute cerebral ischemia in middle cerebral artery(MCA)territory.Methods: we retrospectively collected 552 cases of patients with acute cerebral ischemia within 24 hours from symptom onset in MCA territory without thrombolysis from the affiliated hospital of Qingdao university neurology during January 2013 to January2016.Recheck brain CT or MRI within 2 weeks after symptom onset or when neurological deficit deterioration happened.According to the recheck brain CT scan or MRI with or without intracranial hemorrhage,patients were divided into HT group or non-HT group.Using SPSS 21.0 statistical software for data processing and analysis.If the data meet normal distribution,measurement data were expressed as Mean ± SD;If the data meet non-normal distribution,measurement data were expressed as quartile;Qualitative data were described as percentages.First,Influencing factors were analyzed by univariate Binary Logistic regression analysis,When univariate Binary Logistic regression analysis show P<0.05 and 95%CI does not contain 1,we consider that those factor has statistical significance.Then,multivariate Binary logistical regression analysis was utilized to detect the independent impact factors of HT and SICH,If multivariate Binary Logistic regression analysis show P<0.05 and 95%CI does not contain 1,we consider that this factor is independent risk factors for HT after acute cerebral infarction in MCA blood supply area.The sensitivity and specificity of predictive performance were assessed by the curve of receiver operating characteristic(ROC).Results: univariate Binary Logistic regression analysis show: Gender(male),atrial fibrillation,NIHSS score,fasting blood glucose levels,LDL-C,platelet count<180×10^9/L,early infarct signs of CT were statistically significant between the HT groups and non-HT group.Then,put those factors into Multivariate Binary Logistic regression analysis,Multivariate Binary Logistic regression analysis demonstrated that Atrial fibrillation(OR=2.526,95%CI:1.460~4.371),NIHSS score(OR=1.073,95%CI:1.021~1.128),fasting blood glucose levels(OR=1.175,95%CI:1.073~1.286),early infarct signs of CT ≧ 1/3 MCA blood supply area(OR=3.705,95%CI:2.014~6.825)are independent risk factors for HT after acute cerebral infarction in MCA blood supply area(P< 0.05).The etiology of ischemic stroke(TOAST):Binary Logistic regression analysis demonstrated that cardioembolism are independent risk factor for HT(OR=10.739,95%CI:4.360~26.452)and SICH(OR=2.750,95%CI:1.089~6.943)after MCA blood supply area acute cerebral infarction.The use of antiplatelet or anticoagulant drugs: the use of premorbid antiplatelet drugs(OR = 3.095,95% CI: 1.837 ~ 5.215)and the use of premorbid anticoagulant drugs(OR =2.169,95% CI: 1.291 ~ 3.643)are risk factor for HT after MCA blood supply area acute cerebral infarction.The use of antiplatelet or antithrombotic drugs after the onset of acute cerebral infarction in MCA blood supply area has no significant difference between the HT groups and non-HT groups(P>0.05).compared with the non-HT group,GRASPS the model(OR = 1.059,95% CI: 1.034 ~1.084),the SEDAN model(OR = 1.538,95% CI: 1.252 ~ 1.888),the HAT model(OR =2.337,95% CI: 1.916 ~ 2.850)are independent risk factors for HT after acute cerebral infarction in MCA blood supply area(P < 0.05).For GRASPS model,predict sensitivity and specificity were 60.0 % and 63.8%,respectively,the area under curve(AUC)and the best diagnostic boundary values were 0.643(95%CI : 0.587~0.699)and 76 point,respectively.For SEDAN model,predict sensitivity and specificity were 65.0% and 51.4%,The AUC and the best diagnostic boundary values were 0.615(95%CI:0.560~0.669)and1 point,respectively.For HAT model,the predicts sensitivity and specificity were 65.0 %and 70.8 %,respectively.The AUC and the best diagnostic boundary values were 0.730(95%CI:0.676~0.785)and 2 point,respectively.Conclusion:1.Atrial fibrillation,NIHSS score,fasting blood glucose levels,platelet count<180×10^9/L,early infarct signs of CT< 1/3 MCA blood supply area and early infarct signs of CT ≧ 1/3 MCA blood supply area are independent risk factors for HT after acute cerebral infarction in MCA blood supply area.2.Cardioembolism are risk factor for HT after MCA blood supply area acute cerebral infarction.3.Only the use of premorbid antiplatelet drugs and the use of premorbid anticoagulant drugs are risk factor for HT after acute cerebral infarction in MCA blood supply area.4.It is demonstrated that HAT,GRASPS and SEDAN models are some predictive values for predicting HT in non-thrombolysis acute cerebral infarction,and HAT model shows the highest predictive value.Three indexes of HAT score are all risk factors for HT.If HAT score contains atrial fibrillation,may better predict HT after acute cerebral infarction in MCA blood supply area. |
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