| Objective: To investigate the risk factors of HT after intravenous thrombolysis with rt-PA in patients with acute cerebral infarction,and establish a nomogram prediction model to guide clinical thrombolytic therapy and improve the safety and reliability of intravenous thrombolysis.Methods: A total of 267 patients with acute cerebral infarction who were hospitalized in the Department of Neurology,Guizhou Provincial People's Hospital and treated with rt-PA intravenous thrombolysis from January 2015 to December 2019 were selected.The patients were divided into two groups: hemorrhagic transformation group(n=58)and non-hemorrhagic transformation group(n=209).According to HT related literature report combined with clinical practice,screening and recording 28 factors which include age,gender,weight,previous medical history(hypertension,atrial fibrillation,diabetes mellitus,cerebral infarction,coronary heart disease,hyperlipidemia,smoking history,history of alcohol abuse),previous medication history: recently(<6 months)taking anticoagulants,recently(< 6 months)taking antiplatelet drugs,relevant examination after admission(white blood cell count,platelet count,activated partial thromboplastin time,international standardized ratio,fibrinogen,blood glucose before thrombolysis,homocysteine,creatinine),the related data of thrombolytic:(blood pressure before thrombolysis,NIHSS score before thrombolysis,dose of thrombolytic drugs,onset to treatment time,presence of easily visible hypodensity on initial head CT scan,leukoaraiosis and large area cerebral infarction).Univariate analysis and multivariate logistic regression analysis were used to assess the independent risk factors that affected the transformation of hemorrhage after intravenous thrombolysis.The independent risk factors were then used to establish a nomogram prediction model,and the discrimination and calibration of the model were verified internally by Bootstrap heavy sampling method.From January 2020 to March2020,40 patients with acute cerebral infarction who treated with rt-PA intravenous thrombolysis in our hospital were selected and scored by the new scale to externally verify the predictive value of HT.Results: Among 267 patients with acute cerebral infarction who received intravenous thrombolysis of rt-PA,58 enrolled patients(21.72%)who suffered from HT.s ICH occurred in 9 cases(3.37%).1.Univariate analysis: the NIHSS score before thrombolysis,blood pressure before thrombolysis,white blood cell count,fibrinogen,incidence of atrial fibrillation and incidence of large area cerebral infarction,increased significantly in HT group than none-HT group.2.In the multivariate Logistic regression model,the results demonstrated that the NIHSS score before thrombolysis(OR = 1.863,95% CI: 1.355 to2.562),atrial fibrillation(OR = 3.108,95% CI: 1.565 to 6.170)and large area cerebral infarction(OR = 2.856,95% CI: 1.215 to 6.718)were independently associated with hemorrhagic transformation after intravenous thrombolysis(P < 0.05).3.According to NIHSS score before thrombolysis,atrial fibrillation and large area cerebral infarction before thrombolysis,establish a nomogram prediction model for the risk of intracranial hemorrhage after thrombolysis.The Bootstrap internal verification method was used to verify the nomogram model(AUC-ROC 0.811,95% CI: 0.772 to 0.850).The external validation(AUC-ROC 0.878,95% CI: 0.773 to 0.984),the risk of HT after intravenous thrombolysis of rt-PA can also be evaluated more accurately.Conclusion: Clinically,it is necessary to be alert to the three clinical characteristics of atrial fibrillation,high NIHSS score,and large-area cerebral infarction,which can increase the incidence of HT after rt-PA intravenous thrombolysis in patients with acute cerebral infarction.Based on these three risk factors,a nomogram prediction model is established,and it has good prediction accuracy and differentiation,which can improve the diagnostic efficiency of patients with hemorrhagic transformation after thrombolysis and provide a basis for high-risk patients to take active prevention and control measures. |
PDF Full Text Request