Analysis Of Prognosis And Correlative Factors For Hemorrhage Transformation Of Intravenous Thrombolysis In Patients With Acute Ischemic Stroke

Objective:The current situation of intravenous thrombolytictreatment in acute ischemic stroke patients in Nanchong is not clear.etrospective analysis of the correlative factors for the prognosis and hemorrhagic transformation after intravenous thrombolysis treatment in patients with acute ischemic stroke.Methods:We recruited a large sample of acute ischemic stroke patients treated by intravenous thrombolytic therapy from the Department of Neurology of four tertiary hospitals in Nanchong in this cross-sectional study between January 2016 and June 2018.According to the 90 day modified ankin scale（m S）score,patients were divided into good prognosis group（m S<2）and poor prognosis group（m S≥2）and variables with significant differences in univariate analysis were used to analysis the correlative factors for poor prognosis of acute ischemic stroke patients after intravenous thrombolysis treatmentin multivariate logistic regression analysis.According to the brain image rechecked after thrombolysis 24 to 36 hours,patients were divided into symptomatic intracranial hemorrhage（sICH）group and non-sICH group and variables with significant differences in univariate analysis were used toanalysis the correlative factors for sICH of acute ischemic stroke patients after intravenous thrombolysis treatment in multivariate logistic regression analysis.Results:A total of 282 patients including 106 females and 176 males with acute ischemic stroke were recruited and the average age was 67.07±11.36 years in this cross-sectional study.220（78.0%）patients received intravenous thrombolysis treatment using recombinant tissue plasminogen activator（rt-PA）and 62 patients（22.0%）received intravenous thrombolytic treatment using urokinase.The average baseline National institutes of health stroke scale（NIHSS）score was 11.75±6.15 points,The onset to treatment time（OTT）was 209.06±56.24 minutes and the door to needle time（DNT）was 89.94±25.77 minutes.13（4.6%）patients died and there were good prognosis in 149（52.8%）patients after intravenous thrombolytic treatment.99.3%of patients with acute ischemic stroke in3A grade hospital group received intravenous thrombolytic treatment using rt-PA,while only57.9%of patients with acute ischemic stroke in 3B grade hospital group received intravenous thrombolytic treatment using rt-PA.The DNT time in3B gradehospital group was significantly shorter than 3A grade hospital group（83.61+25.76 vs 96.64+24.11,P<0.001）,The 7-day NIHSS score of acute ischemic stroke patients in 3A grade hospital group was significantly higher than 3B grade hospital group（7.25±6.26 vs 5.09±6.17,P=0.008）,The average hospitalization days of acute ischemic stroke patients in 3A grade hospital group were significantly longer than that in 3B grade hospital group,The prognosisof acute ischemic stroke patients in 3B grade hospital group was significantly better than that in 3A grade hospital group.Univariate analysis showed that the proportion of female patients in good prognosis group was significantly lower than that in poor prognosis group,the baseline NIHSS score in good prognosis groupwas significantly lower than that in poor prognosis group（9.14±4.94 vs 14.68±6.07,P<0.001）,the proportion of arterial high-density sign of brain CT before thrombolysisin good prognosis group was significantly lower than that in poor prognosis group（0.02%vs 12.0%,P=0.001）,the Onset to treatment time（OTT）in good prognosis group was significantly shorter than that in poor prognosis group（200.21±56.24 vs 218.98±54.76,P=0.015）,the proportion of good recanalization assessed by modified Thrombolysis In Cerebral Infarction Score（mTICI）in good prognosis group was significantly higher than that in poor prognosis group（87.4%vs 37.0%,P<0.001）,the 2hour systolic blood pressure（SBP）,24-hour successive variation of SBP(SV_SBP)after thrombolysis and 24 hour SBP in good prognosis group were significantly lower than those in poor prognosis group;the leukocyte count,neutrophil count and IN value in good prognosis group of patients with acute ischemic stroke were significantly lower than those in poor prognosis group;homocysteine in good prognosis group was higher than that in poor prognosis group.Logistic regression indicatedthat female,longer OTT,higher baseline NIHSS score,poor cranial vascular recanalization,higher24-hour SBPand higher24-hour SV_SBPafter thrombolysis were associated with poor prognosis.31 patientssuffered from sICH in current study.The proportion of arterial high-density sign of brain CT before thrombolysis in sICH group was significantly higher than that in non-sICH group（19.4%vs 5.3%,P=0.003）in univariate analysis.The baseline NIHSS score,24-hour SBP and SV_SBPBP after thrombolysis in sICH group were significantly higher than those in non-sICH group.Logistic regression indicatedarterial high-density sign of brain CT before thrombolysis and higher 24-hour SBP after thrombolysis were associated with sICH.Conclusion:1.Intravenous thrombolytic treatment,which had achieved considerable progress in Nanchong,was effective and safe.2.The increasing trend of intravenous thrombolytic treatment for acute ischemic stroke patients in 3B grade hospital was obvious and the prognosis is better than that in 3A grade hospital.3.Female,longer OTT,higher baseline NIHSS score,poor cranial vascular recanalization,higher 24-hour SBP and higher24-hour SV_SBPBP after thrombolysis were correlative factors of poor prognosis in Nanchong patients with acute ischemic stroke.4.The arterial high-density sign of brain CT before thrombolysis and higher 24-hour SBP after thrombolysis were correlative factors of sICH in Nanchong patients with acute ischemic stroke.