Influencing Factors Analysis Of Hemorrhagic Transformation After Intravenous Thrombolysis With Rt-PA In Patients With Acute Ischemic Stroke

Objective To analyze the risk factors of intracranial hemorrhagic transformation in patients with acute ischemic stroke（AIS）after intravenous alteplase thrombolysis.To explore the correlation between imaging markers and blood biochemical indexes of cerebral small vessel disease and intracranial hemorrhagic transformation after intravenous alteplase thrombolysis.Methods A retrospective collection of 150 patients with acute ischemic stroke in the Department of Neurology of the Second Affiliated Hospital of Anhui Medical University from January 2019 to March 2021,all received standard doses of recombinant tissue-type plasminogen activator（rt-PA）within 4.5 hours of onset intravenous thrombolytic therapy.According to the results of head CT examination within 24 hours after thrombolysis,they were divided into HT group and non-HT group.We compared the baseline data,laboratory indicators and imaging characteristics of the two groups.Univariate analysis and multivariate logistic regression analysis were used to determine the independent influencing factors of hemorrhagic transformation after rt-PA intravenous thrombolysis in AIS patients.Results A total of 17 out of 150 patients（11.33%）had hemorrhagic transformation after thrombolysis.The two groups of patients had significant differences in age,NIHSS score before thrombolysis,NIHSS score immediately after thrombolysis,m RS score before thrombolysis,systolic blood pressure at admission,blood uric acid,EPVS grade of basal ganglia,EPVS grade of semi-oval center,Fazekas score of paraventricular white matter and Fazekas score of deep brain white matter（P<0.05）.Multivariate logistic regression analysis showed that after adjusting for factors such as age,NIHSS scores before thrombolysis and immediately after thrombolysis,EPVS grade of basal ganglia（OR=3.623,95%CI 1.029-12.755,P=0.045）,systolic blood pressure at admission（OR=1.062,95%CI 1.014～1.112,P=0.011）,blood uric acid（OR=1.009,95%CI 1.001～1.016,P=0.022）and Fazekas score of periventricular white matter（OR=4.645,95%CI 1.099 ～19.633,P=0.037）are independent risk factors for hemorrhagic transformation after thrombolysis.Conclusion Systolic blood pressure on admission,serum uric acid,EPVS grade of basal ganglia and Fazekas score of paraventricular white matter are independent risk factors for hemorrhagic transformation after intravenous thrombolysis with rt-PA...