Risk Factors Of Hemorrhagic Transformation After Intravenous Thrombolysis With Rt-PA In Patients With Acute Cerebral Infarction

Background: Acute cerebral infarction is China’s first disability and the second deadly disease,it has the characteristics of high and easy to relapse.The application of recombinant tissue type plasminogen activator(rt-PA)in the treatment of early ischemic stroke has become the most effective treatment and has been widely used in the world.However,such an effective treatment in the reality of the ratio of clinical treatment is not satisfactory.The reason is that the price is more expensive and the time limit of thrombolytic therapy is limited,and the serious complications,such as the occurrence of bleeding after thrombolytic therapy,make many clinical workers,patients and their families to be discouraged.Because of bleeding after thrombolysis is likely to lead to progressive deterioration of the patient’s condition and even death soon.So in order to avoid the appearance of hemorrhagic transformation after thrombolysis,a lot of scholars and the team for hemorrhagic transformation may influence factors were studied,and hope to be able to predict the risk of hemorrhagic transformation and to guide clinical treatment,but the results are not the same,especially for symptomatic hemorrhage related risk factors of transformation is not consistent.Objective: Bleeding related factors into acute cerebral infarction in patients with rt-PA after intravenous thrombolysis,and combined with the related prognostic factors in GRSAPS model,to further explore the factors related to the transformation of symptomatic and non symptomatic hemorrhage in patients with acute rt-PA infarction after intravenous thrombolysis,in order to guide the clinical transformation of hemorrhage in patients with acute cerebral infarction rt-PA after intravenous thrombolysis,especially prevention and treatment of hemorrhagic transformation of symptoms.Methods: Collect 464 patients with acute cerebral infarction admitted to the First Affiliated Hospital of Dalian Medical University from January 1,2011 to-2016 were treated with intravenous thrombolytic therapy with rt-PA.According to the imaging examination after thrombolysis hemorrhage transformation,all patients were divided into hemorrhagic transformation group and non hemorrhagic transformation groups,analysis of single and multiple factors influencing factors of hemorrhagic transformation;all GRSAPS model score for the 464 patients,draw the ROC curve and calculate the area under the curve,the model of evaluation the ability to transform predicting bleeding after thrombolysis;then the hemorrhagic transformation were divided into symptomatic and asymptomatic hemorrhagic transformation groups.At the same time the related prediction factor analysis result of the first step and the GRSAPS model combined with further analysis of the risk of symptomatic and asymptomatic hemorrhagic transformation factors.SPSS21.0 software package was used to establish the database,and the data were analyzed by t test,chi square test,rank sum test,single factor analysis and multivariate non conditional Logistic regression analysis.Results:1.Occurrence of single factor and multiple factors into the blood after intravenous thrombolysis in acute cerebral infarction analysis showed that history of atrial fibrillation,hyperlipidemia,average weight,postoperative PCI and the mean baseline NIHSS score,triglyceride(more than 1.7mmol/L),hemorrhagic transformation is closely related to large artery atherosclerosis and cerebral infarction have a total of 7 risk factors and thrombolysis.The difference was statistically significant(P < 0.05).2.464 cases of acute cerebral infarction rt-PA intravenous thrombolysis in patients with GRASPS model for average score(77.94 + 0.39);the average score of 69 cases of patients with GRASPS model after thrombolysis in hemorrhagic transformation for(80.96 + 0.99);no bleeding after thrombolysis in 395 patients with average scores of GRASPS model transformation for(77.38 + 0.41).Because of the above three groups of GRASPS model,the average score distribution accords with the normal distribution,which can complete the further study,draw the ROC curve,and obtain the area under the curve.The results showed that the area under the ROC curve of GRASPS model was 0.637.According to the curve coordinate after screening,the final selection of the prediction score is 76.5,the Youden index was 0.228,specificity 73.5%,sensitivity 49.2%.3.The results of single factor analysis showed transformation of symptomatic and asymptomatic hemorrhage after intravenous thrombolysis in acute cerebral infarction: average age,average blood glucose at baseline and baseline mean NIHSS score may be associated with symptomatic hemorrhage thrombolysis after acute cerebral infarction,the difference was statistically significant(P < 0.05);multivariate analysis showed that baseline mean blood glucose and the mean baseline NIHSS score and intravenous thrombolysis in acute cerebral infarction after symptoms of bleeding,bleeding symptoms are related risk factors of acute cerebral infarction after intravenous thrombolysis,the difference was statistically significant(P < 0.05).Conclusion:1.The history of atrial fibrillation,hyperlipidemia,triglycerides(more than 1.7mmol/L),average weight,after PCI,the mean baseline NIHSS score and large artery atherosclerosis cerebral infarction is bleeding related risk factors of rt-PA conversion after intravenous thrombolysis.2.GRASPS model can be used to predict the prognosis of patients with acute cerebral infarction after intravenous thrombolysis with rt-PA.3.The baseline mean NIHSS score and baseline blood glucose level were independent risk factors for symptomatic bleeding.