Clinical Research About Hemorrhagic Transformation After Acute Cerebral Infarction Without Thrombolytic Treatment

Objective:Hemorrhagic transformation?HT?was well recognized as a common complication in patients with ischemic stroke.HT after acute ischemic stroke contributed to early mortality and adversely functional recovery.It reached 10% to 40% in patients with ischemic stroke.The risk of HT was especially higher when patients received thrombolytic reperfusion therapy with tissue plasminogen activator?rTPA?.Thrombolytic reperfusion therapy was restricted because of HT.At present,most of clinical studies were focused on the patients with rTPA thrombolysis.With CT and MR had been applicated widely,the diagnostic rate of HT was increased obviously in patients without thrombolytic treatment.The affected factors,functional defects,treatment therapy and prognosis of HT were still not very clear.The purpose of this study:?1?Explored the correlation factors of HT without thrombolytic treatment in order to have a new idea about the occurrence of HT and predict the types of HT.?2?Analysed the relationship between different treatment and the outcome,and provided safe and effective proofs for clinical treatment of HT.Methods:317 patients who admitted to the neurology department of the second hospital of Hebei Medical University and diagnosed HT after acute ischemic stroke with unthrombolytic treatment were included.The data were collected about the basic information?age,gender?,past medical history?hypertension,diabetes,atrial fibrillation?,laboratory data,neuroimaging information?CT,CTA,MRI,DWI,MRA and so on?and the therapy after HT.The laboratory data included the level of Cho,LDL,Ca²⁺ and platelet.The drug included antiplatelet,statins,anticoagulant,anti-freeradical therapy and chinese medicine?activating blood circulation to dissipate blood stasis?.The above informations were further divide into varied grades:?1?The level of Cho,LDL,Ca²⁺ and platelet were divided into different grades according to the normal level.?2?HT was classified into hemorrhagic infarction?HI?and parenchymal hemorrhage?PH?.?3?In accordance with the TOAST criteria,all patients with acute cerebral infarction were further classified into different stroke subtypes:large-artery atherosclerosis?LAA?,cardioembolism?CE?,small-artery occlusion?SAO?,stroke of other determined etiology?SOE?and stroke of undetermined etiology?SUE?.?4?All strokes were divided into three grades on the basis of infraction size.Lacunar infarction?infraction diameter?1.5cm?,small infarction?1.5-3.0cm?,large infarction??3.0cm or affected two or more major arterial areas?.?5?All patients were marked by the score of the National Institutes of Health Stroke Scale?NIHSS?at admission,the moment after HT and discharged.The NIHSS score was divided into two grades?lower grade<14 score,higher grade?14 score?.The clinical outcomes were divided into two grades.NIHSS reduced more than 2 scores meant improvement and other meant non-improvement at discharge or one month after HT compared with the moment after HT.This project included two parts:?1?Logistic regression was applied to assess the association between the factors of diabetes,Cho,LDL,Ca²⁺,platelet,TOAST types,NIHSS score at admission and HT classification?HI and PH?.?2?Logistic regression was applied to assess the association between therapy,TOAST types,NIHSS score at the moment after HT and clinical outcomes.Resuts:1 In the 317 patients with HT,Binary logistic regression was applied.The influence factors contained the diabetes history,laboratory data,infarction diameter,TOAST types,NIHSS score at admission,and HT classification as observations.There were correlation between the Ca²⁺ level?P=0.012<0.05,OR =0.503<1,95% CI:0.294⁰.861?,platelet level?P=0.046<0.05,OR=5.485>1,95% CI:1.032²9.145?,TOAST types?SAO,CE compared with LAA,P=0.008 <0.05,0.013<0.05,OR=6.253>1,2.733>1,95% CI: 1.600²4.441,1.234⁶.053?and HT types.The rest did not find the correlation.2 In the 223 patients with HI,Binary logistic regression was applied.The influence factors included TOAST types,NIHSS score,therapy at the moment after HT,and clinical outcomes as observations.There were correlation between anticoagulant therapy?P=0.030<0.05,OR=0.372<1,95% CI:0.152 ⁰.909?,the level of NIHSS?P=0.000<0.05,OR=0.204<1,95% CI: 0.085 0.486?and clinical outcomes.The rest did not find the correlation.3 In the 94 patients with PH,Binary logistic regression was applied.The influence factors included TOAST types,NIHSS score,therapy at the moment after HT,and clinical outcomes as observations.There were correlation between statins therapy?P=0.001<0.05,OR=31.248>1,95% CI: 4.077 239.471?,antiplatelet therapy?P=0.030<0.05,OR=0.116<1,95% CI: 0.017 0.815?and clinical outcomes.The rest did not find the correlation.Conclusions:1 The Ca²⁺ level,platelet level,TOAST types were independent factors of HT classification.The patients with lower Ca²⁺ level,lower platelet level,SAO or CE of TOAST types were easily lead to PH of HT classification.2 Among the patients with HI,anticoagulant therapy,level of NIHSS were independent factors of clinical outcomes.The anticoagulant therapy,higher NIHSS?>14 score?preferred to aggravate clinical prognosis.It was benefit not to use anticoagulant therapy in patients with HI of HT classification.3 Among the patients with PH,statins therapy and antiplatelet therapy were independent factors of clinical outcomes.The statins therapy and non-antiplatelet therapy preferred to improve clinical improvement.It was benefit to use statins therapy and not to use antiplatelet therapy in patients with PH of HT classification.