| Objective:To explore the risk factors of HT after rt-PA in patients with acute cerebral infarction;To explore the influence of different blood glucose levels on HT after intravenous thrombolysis,clinical prognosis and the distribution of TCM syndrome elements before thrombolysis;To explore the evolution of TCM syndrome elements before and after thrombolysis,and further study whether there were syndrome elements related to the occurrence of HT.Methods:This study included 225 patients who used rt-PA after Acute Cerebral Infarction in Shenzhen Hospital of Traditional Chinese Medicine from January 2017 to January 2021.Firstly,They were divided into two groups:60 cases of hemorrhage transformation group and 195 cases of non-hemorrhage transformation group according to whether bleeding in mind within 1 week after thrombolysis,and compared the baseline data and related clinical indicators between the two groups.Secondly,according to the random blood glucose level,they were divided into three groups:normal blood glucose group(3.9mmol/L<random blood glucose<7.8mmol/L),slightly high blood glucose group(7.8mmol/L≤random blood glucose<11.1mmol/L)and high blood glucose group(random blood glucose≥11.1mmol/L),to further explore the influence of the degree of blood glucose on the occurrence of HT、poor clinical prognosis and the distribution of TCM syndrome elements before thrombolysis;Finally,discussing the evolution of TCM syndrome elements before and after thrombolysis.Results:1.Comparing the baseline data can kown that there were no differences in age(P=0.067>0.05)、gender(P=0.167>0.05)、time from onset to thromblysis(P=0.855>0.05)、NIHSS scores before thrombolysis(P=0.258>0.05).In terms of past history,there were differences in the history of hype-rtension(P=0.001<0.01)、cerebral infarction(P=0.017<0.05),atrial fibri-llation(P=0.017<0.01)and the diabetes(P=0.000<0.01).In terms of blood routine and coagulation,there were no significant differences in white blood cells(P=0.126>0.05)、neutrophils%(P=0.073>0.05),platelets(P=0.282>0.05)、activated partial prothrombin time(P=0.220>0.05).In terms of blood lipids,there were differences in low-density lipoprotein(P=0.024<0.05),but no differences in triglycerides(P=0.820>0.05)or cholester-ol(P=0.111>0.05).In terms of blood pressure,there were differences in pulse pressure difference(P=0.000<0.01),but no significant differences in systolic blood pressure(P=0.092>0.05)or diastolic blood pressure(P=0.102>0.05).In terms of blood sugar,there were differences in random blood sugar(P=0.000<0.01),fasting blood glucose(P=0.000<0.01),and HbA1c(P=0.000<0.01).2.The binary logistic regression results indicated that random blood glucose(OR=1.188,P=0.000),HbAlc(OR=2.562,P=0.000),and Qi-deficiency syndrome(OR=1.102,P=0.001)before thrombolysis were risk factors of HT.3.The blood glucose levels of the three groups had significant differences in HT(P=0.000<0.01)and poor long-term prognosis(P=0.003<0.01).There were no differences in short-term poor prognosis(P=0.092>0.05).When blood sugar≥11.1mmol/L,hemorrhage transformation and clinical prognostic adverse events were significantly increased.4.There were no differences in the elements of wind syndrome、fire syndrome、phlegm syndrome、blood stasis syndrome、Yin deficiency or Yang hyperactivity syndrome,but there were significant differences in the Qi-deficiency syndrome.The proportion of Qi-deficiency in the normal blood sugar group was 49.0%,in the slightly higher blood sugar group was 63.8%,in the high blood sugar group was 67.4%.5.There were significant differences in TCM syndrome before and after intravenous thrombolysis.The distribution of syndromes before thrombolysis was stasis syndrome>wind syndrome>phlegm syndrome>Qi-deficiency>yin Deficiency-yang hyperactivity syndrome>Fire syndrome.The distribution of syndromes after thrombolysis was Qi-deficiency syndrome>Stagnation syndrome>Yin-deficiency-yang hyperactivity syndrome>Phlegm syndrome>Wind syndrome>Fire syndrome.6.There were significant differences in the short-term poor prognosis(P=0.010<0.05)and the long-term poor prognosis(P=0.000<0.01)of the Qi-deficiency and the non-qi-deficiency groups before intravenous thrombolysis.The Qi-deficiency group had a worse clinical prognosis.Conclusion:1.The history of hemorrhage transformation combined with hypertension,cerebral infarction,atrial fibrillation and diabetes were significantly higher than those of non-hemorrhagic transformation group.The difference of pulse pressure in blood pressure was higher than that in non-bleeding group.Random blood glucose,fasting blood glucose and glycosylated hemoglobin were higher than those in the non-bleeding group.2.Random blood glucose、HbAlc and Qi-deficiency syndrome were risk factors for HT.The increase in random blood glucose by one unit,the risk of hemorrhagic transformation increased by 1.188[1.082-1.306]times.The increase in HbAlc by one unit,the risk of hemorrhagic transformation increased by 2.562[1.802-3.643]times.The occurrence of Qi-deficiency syndrome,the risk of hemorrhagic transformation increased by 1.102[1.068-1.240]times.3.The increase of blood glucose level mainly affected the long-term poor prognosis of patients with thrombolysis.At the same time,when random blood glucose≥11.1 mmol/L,the incidence of hemorrhagic transformation and poor prognosis were significantly increased.4.The higher the blood sugar level,the higher the distribution of Qi-deficiency syndrome elements before thrombolysis.5.The distribution of TCM syndrome before thrombolysis was stasis syndrome>wind syndrome>phlegm syndrome>Qi-deficiency syndrome>Yin deficiency and Yang hyperactivity syndrome>Fire syndrome.After thrombolysis,the distribution of syndromes was Qi-deficiency syndrome>Stasis syndrome>Yin deficiency and Yang hyperactivity syndrome>Phlegm Syndrome>Wind Syndrome>Fire Syndrome.We can kown that after thrombolysis,the TCM syndrome of the patient changed from positive syndrome to deficiency syndrome.6.Qi-deficiency syndrome before thrombolysis significantly increased the incidence of short-term and long-term clinical adverse prognosis. |
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