| Objective This study was designed to explore the risk factors related to HT in patients with acute ischemic stroke(AIS)after intravenous thrombolysis with rt-PA,and the relationship between peripheral neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),mean platelet volume(MPV)before thrombolysis and hemorrhagic transformation(HT)after intravenous thrombolysis in acute ischemic stroke(AIS),To further explore the predictive value of the above three indicators for the transformation of bleeding after intravenous thrombolysis in acute ischemic stroke.This will help to identify high-risk patients early and provide individualized treatment plans,so as to better guide clinical practice.Method The clinical data of acute ischemic stroke patients who received standard dose rtPA intravenous thrombolytic therapy in the Third People’s Hospital of Hubei Province from March 2019 to July 2022 were collected.According to the inclusion and exclusion criteria,159 patients were finally selected.Collect the basic data of patients,such as gender,age,cerebral infarction,coronary heart disease,hypertension,atrial fibrillation,diabetes,smoking and drinking,and other medical histories,as well as auxiliary examinations such as routine blood test,renal function,coagulation function,blood sugar,blood lipids,homocysteine,head CT,head MRI,etc.before thrombolytic therapy.According to the reexamination of head CT imaging within 24 hours after thrombolysis to check whether hemorrhagic transformation occurred,it is divided into HT group and non-HT group.SPSS26.0 software was used to statistically analyze the data of the enrolled patients before and after thrombolytic therapy,and observe whether the difference was statistically significant(P<0.05 was deemed statistically significant);Counting data are expressed by rate and composition ratio,and binary variables comparison adopt chi-square tests.If the theoretical frequency 1≤T<5,continuous correction chi-square test is used;If there is a theoretical frequency T<1,Fisher’s exact test is used.The measurement data that conform to normal distribution and approximate normal distribution are expressed by mean ± standard deviation(x±s),and the inter-group comparison adopts two independent sample T-test;The measurement data of non-normal distribution is expressed by the median and interquartile interval [M(P25,P75)],and the inter-group comparison adopts Mann Whitney U-rank sum test of independent samples.According to the basic data before and after thrombolysis and laboratory indicators,the possible influencing factors related to HT were screened,and the independent factors affecting HT were explored through multivariate logistic regression analysis.Further explore the correlation between peripheral blood neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),mean platelet volume(MPV)and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke.If there is correlation,The Receiver Operating Characteristic(ROC)curves were used to further explore its predictive value for hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke and calculate the area under the curve(AUC).Result 1.A total of 159 patients were included in this study,of which 28 occurred HT after thrombolysis and The incidence rate of HT was 17.6%,of which 9 occurred symptomatic hemorrhagic transformation,and the incidence was 5.7%.2.In the single factor analysis,the general data and related clinical data between the two groups of patients showed that atrial fibrillation,systolic pressure before thrombolysis,blood glucose before thrombolysis,NIHSS score on admission,hyperdense middle cerebral artery sign were related to hemorrhagic transformation after thrombolysis,and the difference was statistically significant(P<0.05);The results of univariate analysis of the laboratory results of the two groups of patients showed that the neutrophil count before thrombolysis,lymphocyte count before thrombolysis,NLR,PLR,and triglyceride were correlated with hemorrhagic transformation after thrombolysis,and the difference was statistically significant(P<0.05),while there was no significant difference in MPV between the two groups(P>0.05);The comparison of TOAST classification between the two groups showed that the proportion of cardiogenic embolism in HT group and non-HT group was14.3% and 7.6%,and the difference between the two groups was statistically significant(P<0.05).3.Multivariate logistics regression analysis showed that high neutrophil count before thrombolysis,high level of NLR,high level of PLR,high systolic pressure before thrombolysis,high blood glucose before thrombolysis,high NIHSS score on admission,and hyperdense middle cerebral artery sign were independent risk factors for HT(P<0.05).4.ROC curve showed that the best cut-off value of NLR for predicting HT in AIS patients after intravenous thrombolysis was 6.545,the sensitivity was 53.6%,the specificity was91.6%,and the area under the curve(AUC)was 0.728(95% CI: 0.611-0.845,P<0.05).The best cut-off value of PLR for predicting HT in AIS patients after intravenous thrombolysis was 178.72,the sensitivity was 50%,the specificity was 86.3%,and the area under the curve(AUC)was 0.665(95% CI: 0.548-0.783,P<0.05).Conclusion 1.This study found that high levels of NLR and PLR at admission were independent risk factors for HT after rt-PA intravenous thrombolysis in AIS patients,while MPV was not related to HT after intravenous thrombolysis in acute ischemic stroke.2.High level of NLR and PLR are independent predictors of HT in AIS patients after rt-PA intravenous thrombolysis,which can be used as potential indicators to predict HT,among which high level of NLR is the best predictor.3.In addition,high neutrophil count before thrombolysis,high systolic pressure before thrombolysis,high blood glucose before thrombolysis,high NIHSS score on admission,and middle cerebral artery high-density sign are also independent risk factors for HT in AIS patients after rt-PA intravenous thrombolysis. |
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