Analysis Of The Risk Factors Of Hemorrhage Transformation In Hyperacuteischemic Stroke Treated With Rt-PA

Background:Stroke is one of the diseases that seriously affect human health,acute ischemic stroke which accounts for about 60-80%of stroke is the most common type of stroke.Thrombolytic therapy is the most important measure to restore cerebral ischemia and reperfusion.Rt-PA thrombolytic therapy for acute ischemic stroke is currently widely used,and can reduce the patient’s death,morbidity and improve patient’s prognosis.But the hemorrhage after thrombolytic transformation events often lead to worse prognosis,which limits the promotion and application of intravenous thrombolytic therapy.The mechanism how rt-PA intravenous thrombolysis leads to hemorrhagic transformation is very complex,and the risk factors of international research are not uniform,so defining the risk factors lead to HT after rt-PA thrombolytic therapy for ischemic stroke has important clinical significance.Objective:To define the risk factors associated with hemorrhage transformation in ischemic stroke patients who were treated by intravenous thrombolysis with rt-PA and to instruct the clinical treatment.To investigate the risk factors of hemorrhage transformation caused by rt-PA intravenous thrombolysis in hyperacute ischemic stroke to guide clinical work.Methods:Choosing 220 patients with acute ischemic stroke who were treated with rt-PA intravenous thrombolysis in The Second Hospital Of Dalian Medical University from January 2013 to November 2017.The patients were divided into two groups:hemorrhage group（n=22）and control group（n=198）.Screening and recording 28factors which include age,sex,histories of hypertension,atrial fibrillation,coronary heart disease,diabetes mellitus,ischemic cerebrovascular disease,stress-induced hyperglycemia,hyperlipidemia Serum,renal insufficiency,hypocalcemia,smoking history,recently（<3 months）taking anti-platelet drug history,early craniocerebral CT findings,demyelination of white matter,anterior/posterior circulation stroke,hemoglobin content,total leukocytes,platelet count,fibrinogen content,serum uric acid level,degree of neurological deficits,onset to thrombolysis time,systolic blood pressure at 24 hours(SBP_24h-max)Systolic blood pressure(SBP_24h-min),SBP_baseline before thrombolysis,DBP_baseline before thrombolysis.These 28 factors were univariate analysis as independent variables.T test was used for normal distribution andχ² test was used for classification data.Whether patients with hemorrhagic transformation as a dependent variable（Y）and the univariate analysis was positive as the independent variable,stepwise Logistic regression was used to find out the risk factors.Result:1.Univariate analysis:In the 220 cases of this study,（1）there were 132 cases with history of hypertension,of which 18（13.6%）cases suffered HT in this group,P=0.029 compared with those of no-hypertension.（2）Among 62 cases suffered diabetes,9（14.5%）cases suffered hemorrhagic transformation in this group,P=0.03 compared with those of no-diabetes.Among 23 cases of stress hyperglycemia,6（26.1%）cases suffered hemorrhagic transformation in this group,P=0.001 compared with those of no-diabetes.（3）Among 47 cased included in present study suffered atrial fibrillation,9（18.4%）cases suffered HT in this group,P=0.019 compared with those of no-atrial fibrillation.（4）Among 165 cases of anterior circulation stroke,18 cases（10.9%）had hemorrhagic transformation.Among them,54 cases had retrospective stroke,of which 3cases（5.6%）had hemorrhagic transformation.The posterior circulation stroke was significantly different from the anterior circulation stroke（P=0.05）.（5）Compared the mean NIHSS score（12.85±9.98）before thrombolysis suffered HT with the mean NIHSS score（6.33±5.75）before thrombolysis suffered no-HT,P=0.00.（6）Compared the mean value of serum uric acid（295.96±36.85）umol/L suffered HT with the mean value of serum uric acid（350.81±70.34）mmol/L before thrombolysis suffered no-HT,P=0.00.（7）Compared the mean value of SBP_baseline（167.32±27.34）mmHg suffered HT with the mean value of SBP_baseline（154.16±24.08）mmHg before thrombolysis suffered no-HT,P=0.015.Compared the mean value of DBP_baseline（94.48±16.67）mmHg suffered HT with the mean value of DBP_baseline（87.06±12.66）mmHg before thrombolysis suffered no-HT,P=0.018.Compared the mean value of SBP_max in 24h after thrombolysis（187.14±25.19）mmHg suffered HT with the mean value of DBP_baseline（173.60±21.70）mm Hg before thrombolysis suffered no-HT,P=0.008.（8）Compared mean time from onset to thrombolytic therapy（3.33±0.98）h suffered HT with the mean time from onset to thrombolytic therapy（2.56±0.91）h suffered no-HT,P=0.00.（9）Factors as age,sex,histories of ischemic cerebrovascular disease and coronary heart disease,hyperlipidemia,hypocalcemia,renal insufficiency,early craniocerebral CT signs,demyelination of white matter,hemoglobin content,total white blood cells,platelet count,fibrinogen content,SBP_24h-min recently（<3 months）taking anti-platelet drug history,smoking history,had no significant difference in P>0.05 between hemorrhagic transformation group and non-hemorrhagic transformation group.2.Multiple Stepwise Logistics Regression Analysis:The above-mentioned 11 factors with significant differences were subjected to multiple stepwise logistic regression analysis.The results showed that there were 3 factors with significant significance at the level ofα=0.05,according to the order of OR value:Onset to thrombolytic time,NIHSS score before thrombolysis,serum uric acid levels.Conclusion:Onset to thrombolytic time and the degree of nerve defects are the main risk factors for the rt-PA intravenous thrombolytic therapy for ischemic stroke,high levels of uric acid can reduce the incidence of bleeding after thrombolysis...