The Study Of Relationship Between Cerebral Microbleeds And Hemorrhagic Transformation After Rt-PA Thrombolysis

Objective:To discuss the relationship of different subtypes of hemorrhagic transformation after intravenous recombinant tissue lasminogen activator in patients with cerebral microbleeds and acute ischemic stroke.Methods:Retrospective analysis of the patients with the therapy of intravenous recombinant tissue lasminogen activator at the Department of Neurology,the Fourth Central Hospital of Tianjin,from July 2014 to December 2016,A total of 113 patients with acute ischemic stroke who underwent Magnetic Resonance Imageing(MRI)within 180 days prior to thrombolytic therapy were enrolled in this study.In addition to the conventional sequences,the SWI sequence was also performed,the number of cerebral microbleeds was counted in the SWI sequence and the severity was assessed(according to the SWI sequence,the patient’s cerebral microbleeds number was graded: mild,1-2,moderate 3-9,severe ≥ 10;divided into cortex-subcortex and non-cortex-subcortex).All patients after thrombolysis within 48 hours were underwent CT or MRI examination.Record all clinical datas(Age,sex,NIHSS score,blood pressure,atrial fibrillation,diabetes,blood lipids,smoking history,drinking history),imaging datas(lacunar infarction,leukoaraiosis),and some laboratory dates(blood sugar,fibrinogen).The patients were divided into two groups which were non-hemorrhagic transformation group and hemorrhagic transformation group according to whether there was bleeding after treatment,Which hemorrhagic transformation group can be divided into hemorrhagic infarction and parenchymal hematoma type,the significance between the above factors in the hemorrhagic transformation group and the non-hemorrhagic transformation group was compared,and the correlation between cerebral microbleeds and hemorrhagic transformation was explored.To analyze the risk factors of hemorrhagic transformation,SPSS 19.0 software package was used to analyze the data,the quantitative data were compared with the t-test and the dichotomous data were compared with X2 or Fisher test;Multivariate logistic regression was used to analyze the influencing factors of hemorrhagic transformation,and the independent influencing factors of different subcultures were analyzed with reference to non-hemorrhagic transformation.The influence differernt parts of cerebral hemorrhage on cerebral microbleeds data were compared with X2 test.The patients were divided into micro-hemorrhagic(+)group and micro-hemorrhagic(-)group according to whether there was cerebral microbleeds before thrombolysis.The difference between the two groups was compared between the two groups,the risk factors of CMBs were compared by X2 test and t test.The independent risk factors of CMBs were analyzed by logistic regression using CMBs as dependent variables and the factors between the groups as independent variables.Results:The average age of patients with thrombolysis was(62.29 ±8.01)years,The NIHSS score before thrombolysis was(10.34±5.56).The systolic blood pressure was(147.3±24.32 mm Hg)and 37 cases(33.0%)have atrial fibrillation.Thrombolysis combined with cerebral microbleeds was 42 cases(37.1%).23 patients(20.3%)had bleeding transformation after thrombolysis,18 patients(18.9%)were hemorrhagic cerebral infarction type,5 cases(4.4%)for the brain parenchymal hematoma type.The NIHSS score between the hemorrhagic transform group and the non-hemorrhagic transform group was(P<0.001),atrial fibrillation(P=0.005),systolic blood pressure(P=0.009),brain microbleeds(P=0.027)were statistically significant.Moderate to severe cerebral hemorrhage increased thrombolytic therapy after cerebral parenchymal hematoma hemorrhage transformation risk(OR=5.379,P=0.018).Comparison of CMBs positive group and CMBs negative group between the two groups of ages,high plasma fibrinogen,hypertension,leukoaraiosis,lacunar infarction of the difference was statistically significant;and hyperlipidemia,hyperglycemia,smoking.There was no statistically significant difference between drinking and taking antiplatelet drugs.Logistic regression analysis showed that age(OR=0.685,P<0.001),high plasma fibrinogen(OR=2.436,P<0.001),hypertension(OR=0.327,P=0.020),lacunar infarction(OR=4.925,P=0.009),leukoaraiosis(OR= 8.916,P=0.007)was an independent risk factor for CMBs.Conclusion: 1.Acute ischemic stroke patients with moderate to severe cerebral hemorrhage venous rt-PA thrombolysis after cerebral parenchymal hematoma hemorrhage transformation risk was significantly higher.2.Old age,high plasma fibrinogen,history of hypertension,lacunar infarction,leukoaraiosis as an independent risk factor for CMBs.3.Clinicians in patients with acute ischemic stroke before intravenous thrombolytic therapy should be considered before the brain micro-bleeding situation,such as the risk of CMBs found,should pay attention to multi-mode MRI examination.