| Purpose:Based on the data of patients with intravenous thrombolysis in different etiological groups,evaluate the efficiency of thrombolysis in different etiological groups and the transformation of cerebral hemorrhage after thrombolysis,analyze the risk factors of hemorrhage after thrombolysis.Methods:Retrospectively collected the clinical data of acute ischemic stroke patients who receiving intravenous thrombolysis with recombinant tissue-type plasminogen activator in the First Affiliated Hospital of Xiamen University from September 2017 to December 2019.For the patients with acute cerebral infarction combined with clinical data collected and disease characteristics,grouping is based on the Chinese ischemic stroke subclassification.Comparing the differences in baseline data and laboratory indicators between the etiological groups,the scores of the NIHSS(National Institutes of Health Stroke Scale,NIHSS)before thrombolysis in different CISS etiological groups,the time from onset to thrombolysis;Comparing the effective rate of thrombolysis,the conversion rate of hemorrhage after thrombolysis,and the correlation risk factors between the transformed group and the non-transformed group after thrombolysis.Logistic regression analysis of transforming risk factors of hemorrhage after thrombolysis.The SPSS23.0 software was used for data analysis,and P value 0.05 was used as the bound to determine whether the difference was statistically significant.Results:The inclusion criteria and exclusion criteria were strictly followed.In this study,115 patients with intravenous thrombolytic therapy were finally gathered,including 73 male patients and 42 female patients.Large artery atherosclerosis group 55 cases(47.83%),in which,the case of parent artery(plaque or thrombosis)occluding penetrating artery was 49,the case of artery-to-artery embolism was 3,the case of hypoperfusion/impaired emboli clearance was 2,the case of multiple mechanisms was 1;44 cases of cardiogenic stroke(38.26%),10 cases of penetrating artery disease(8.7%),1 case of other etiology(0.87%)and 5 cases of unknown etiology(4.34%).Other etiology and unknown etiology were grouped into 1 group.There were 17 cases of cerebral hemorrhage within 3 days after thrombolysis,including 9 cases of hemorrhagic infarction(4 cases of HI1 type)and 8 cases of parenchymal hemorrhage(6 cases of PH2 type).The distribution of hemorrhagic transformation after thrombolysis in different etiological groups was as follows:8 from large artery atherosclerosis,8 from cardiogenic stroke,and 1 from penetrating artery disease.NIHSS score decreased by 10%in 91 patients at 24 hours after intravenous thrombolysis.Firstly,compared with other etiological groups,NIHSS score before thrombolysis,parent artery(plaque or thrombosis)occluding penetrating artery from large artery atherosclerosis group(P=0.011),cardiogenic stroke(P=0.00),penetrating artery disease group(P=0.004)has a statistically significant against the non-etiological group,cardiogenic stroke group has a higher NIHSS score before thrombolysis(11.25～19.75 vs 5～13),The NIHSS score before thrombolysis was lower in the parent artery(plaque or thrombosis)occluding penetrating artery group(5～16 vs 8～18.25)and penetrating artery disease group(2.5～11.25 vs 7～17)than in the non-etiological group.Secondly,compared with other etiological groups,the time from onset to thrombolysis was longer in the large artery atherosclerosis group(P=0.023,150～232 vs 117.25～219.25)and other etiology and unknown etiology(P=0.046,201.75～241.5 vs 124.5～223),and it was shorter in the cardiogenic stroke group(P=0.001,111～195.25 vs 144～240).Thirdly,the overall effective rate of thrombolysis was 79.13%.Compared with the non-etiological group,there was no difference in the effective rate of thrombolysis among all etiological groups(P>0.05).Forthly,the overall rate of hemorrhagic transformation after thrombolysis was 14.78%.Compared with other etiological groups,the rate of hemorrhagic transformation among all the CISS etiological group showed no difference(P>0.05).Fifthly,compared with intracranial hemorrhage group and non-intracranial hemorrhage group after intravenous thrombolysis.There was significant statistical difference between the two groups in systolic blood pressure before thrombolysis(P=0.003,172.24±28.91 vs 152.1±24.53)and diastolic blood pressure(P=0.012,81.5～120.5 vs 75.75～98.25).NIHSS score before thrombolysis(P=0.098,9～20 vs 5～17)showed an increasing trend in the transformed group of intracerebral hemorrhage.Sixthly,systolic blood pressure before thrombolysis,diastolic blood pressure before thrombolysis and NIHSS score before thrombolysis were substituted into logistic regression model for analysis.The logistic regression analysis showed that the higher systolic blood pressure before thrombolysis was the independent risk factor of hemorrhagic transformation after thrombolysis(P=0.041,OR=1.027,95%CI=1.001～1.053).Conclusions:1.Compared with other CISS etiological groups,the NIHSS score before thrombolysis was lower in the parent artery(plaque or thrombosis)occluding penetrating artery from large artery atherosclerosis group and penetrating artery disease group,and it was higher in the group with cardiogenic stroke.2.Compared with other CISS etiological groups,the time from onset to thrombolysis was longer in the large atherosclerosis group,other etiology and unknown etiology group,and it was shorter in the cardiogenic stroke group.3.Compared with other CISS etiological groups,the thrombolytic efficiency of each CISS etiological group showed no difference.4.Compared with other CISS etiological groups,the rate of hemorrhagic transformation among all the CISS etiological group showed no difference.5.Higher systolic blood pressure level before thrombolysis is an independent risk factor for hemorrhage transformation after thrombolysis. |
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