Objective To investigate the influencing factors of hemorrhagic transformation after intravenous thrombolytic therapy with alteplase in patients with acute ischemic stroke. Methods From January 2015 to July 2017,348 patients with acute ischemic stroke and treated with intravenous thrombolysis using alteplase were selected as the research subjects,according to the presence of hemorrhagic transformation after intravenous thrombolysis,the patients were divided into a bleeding group(32 cases)and a non-bleeding group (316 cases). The clinical data(demographic,vascular risk factors,laboratory examinations and so on)of all the subjects were retrospectively collected,multivariate logistic regression analysis was used to explore the independent risk factors of hemorrhagic transformation. Results There were significant differences in baseline blood glucose,baseline NIHSS score, time to initiation of intravenous thrombolysis, history of atrial fibrillation,and history of antiplatelet medication between the bleeding group and the non-bleeding group(P<0.05). Multivariate logistic regression analysis showed that baseline blood glucose(OR= 3.781,95% CI 1.851-11.765),baseline NIHSS score(OR=2.678,95% CI 1.384-10.441),time from onset to intravenous thrombolysis(OR=2.436,95% CI 1.324-4.488),history of atrial fibrillation(OR= 4.538,95% CI 2.036-14.132)and 24h systolicblood pressure after thrombolysis(OR = 1.581,95% CI 1.071-6.415)were independent risk factors for hemorrhagic transformation(P< 0.05). Conclusions Baseline blood glucose, baseline NIHSS score,time from onset to intravenous thrombolysis,history of atrial fibrillation and 24h systolicblood pressure after thrombolysis are risk factors associated with hemorrhagic transformation after thrombolytic therapy in acute cerebral infarct patients.%目的 探讨急性缺血性脑卒中(AIS)经阿替普酶静脉溶栓治疗后出血性转化(HT)的影响因素.方法 选取2015-01—2017-07作者医院收治的经阿替普酶静脉溶栓治疗的AIS患者348例,根据阿替普酶静脉溶栓后是否发生 HT将患者分为出血组和未出血组.回顾性收集所有研究对象的临床资料(人口统计学、血管危险因素和实验室检查指标等),采用多因素Logistic回归分析探讨ALS经阿替普酶静脉溶栓治疗后发生 HT 的独立危险因素.结果 出血组32例,未出血组316例.两组患者间基线血糖、基线美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、发病至静脉溶栓治疗时间、心房颤动史、溶栓24 h后收缩压以及抗血小板药物服用史差异均有统计学意义(均 P<0.05).多因素Logistic回归分析结果显示,基线血糖(OR=3.781,95% CI:1.851~11.765)、基线NIHSS评分(OR=2.678,95% CI:1.384~10.441)、发病至静脉溶栓治疗时间(OR=2.436,95% CI:1.324~4.488)、心房颤动史(OR= 4.538,95% CI:2.036~14.132)和溶栓24 h后收缩压(OR=1.581,95% CI:1.071~6.415)是发生 HT的独立危险因素(均 P<0.05).结论 基线血糖、基线NIHSS评分、发病至静脉溶栓治疗时间、心房颤动史和溶栓24 h后收缩压是脑梗死患者静脉溶栓后发生 HT的危险因素.
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