| Objective: To explore the effect of total burden of imaging markers in cerebral small vessel disease(CSVD)on intracranial hemorrhage transformation after intravenous thrombolytic therapy in acute ischemic stroke,and to study the effect of total load of CSVD imaging markers on long-term prognosis after intravenous thrombolysis in acute cerebral infarction.Methods: 1.The AIS patients hospitalized in the Department of Neurology of Ji ning NO.1 Hospital from January 2021 to August 2022 were retrospectively collected,and within the time window of intravenous thrombolysis upon admission,alteplase or urokinase thrombolytic therapy was given after the conjunctigation of thrombolysis was excluded.Intracranial CT examination was completed within 24 hours after thrombolysis.According to the examination results,the patients were divided into HT group and not HT group.General baseline data,laboratory examination,imaging examination,single CSVD image marker and total load of CSVD image marker were collected from the two groups of patients,and the correlation between different factors and hemorrhage transformation after thrombolysis was analyzed.2.The Patients with AIS 3 months and 1 year after intravenous thrombolysis were assessed by the modified Rankin Scale(m RS),and divided into good prognosis group(0-2 points)and poor prognosis group(3-6 points)through follow-up methods such as telephone consultation or outpatient visit.The effects of baseline data,laboratory examination,imaging examination,single image marker of CSVD and total load on the long-term prognosis of AIS were analyzed in the two groups.ROC curve was used to analyze the predictive value of total CSVD image load on the neurological function of AIS 3 months after onset and 1 year after onset.Results: 1.According to inclusion and exclusion criteria,a total of379 patients were included in the study,with an average age of 65 years(64.72 ± 11.99),with 239 males(63.1%)and 140 females(36.9%).Among them,349 patients received intravenous thrombolytic therapy with alteplase and 30 patients received intravenous thrombolytic therapy with urokinase.Total load of CSVD imaging markers: 0 score 62 cases(16.36%),1 score 84 cases(22.16%),2 score 82 cases(21.64%),3 score84 cases(22.16%),4 score 67 cases(17.68%).Classification of total CSVD load severity: mild(0-1 points)group 146 cases,accounting for38.5%,severe(2-4 points)group 233 cases,accounting for 61.5%.There were statistically significant differences between the two groups in age,past history(hypertension,coronary heart disease,atrial fibrillation,stroke,hyper-homocysteinemia),pre-thrombolysis NIHSS score,severe stroke,massive infarction,pre-thrombolysis systolic blood pressure,uric acid,creatinine,fibrinogen,prothrombin time(PT)and homocysteine(P<0.05).AIS patients receiving alteplase thrombolytic therapy were divided into two groups: 52 patients with hemorrhage transformation(14.9%)and 297 patients with no hemorrhage transformation(85.1%).Univariate variables with statistically significant differences between the two groups were included in multivariate regression analysis,showing that: Large infarcts(OR=10.566,95%CI= 4.767～23.416),severe CSVD imaging markers total load(OR=2.56,95%CI=1.061～6.174)and CMBs(OR=2.56,95%CI=1.18～5.552)was statistically significant(P < 0.05),and was an independent risk factor for hemorrhage transformation after intravenous thrombolysis.2.The patients who received alteplase thrombolytic therapy were divided into two groups: 52 patients with hemorrhage transformation and 297 patients without hemorrhage transformation.Univariate variables with statistically significant differences were included in multivariate regression analysis.The results showed that: Large infarct(OR=10.566,95%CI=4.767～23.416),severe stroke(OR=3.348,95%CI =0.87～12.88),total load of severe CSVD imaging markers(OR=2.56,95%=1.061～6.174)and CMBs(OR=2.56,95%CI=1.18～5.552)were statistically significant(P <0.05),and were independent risk factors for hemorrhage transformation after intravenous thrombolysis therapy.3.A total of 243 patients were followed up 3months after intravenous thrombolytic therapy with alteplase.They were divided into two groups: 175 patients(72%)with good prognosis of neurological function and 68 patients(28%)with poor prognosis.Variables with statistically significant differences between the two groups were included in multivariate logistic regression analysis.NIHSS score before thrombolysis(OR=1.193,95CI%=1.089～1.308,P=0.001),severe stroke(OR=13.901,95%CI=4.821～40.079,P=0.001),massive infarction(OR=1.98,95%=1.224～3.203,P=0.005),hemorrhage transformation(OR=4.139,95%CI=1.621～10.847,P=0.003),total load of severe CSVD imaging markers(OR=2.016,95%CI=1.012～4.018,P=0.031)and total CSVD imaging markers load(OR=1.299,95%CI=1.024～1.649,P=0.046)were independent risk factors for poor prognosis after 3 months of AIS intravenous thrombolysis.A total of 131 patients were followed up 1 year after alteplase thrombolytic therapy.They were divided into two groups:102 patients(77.9%)with good neurological prognosis and 29 patients(22.1%)with poor prognosis.Multifactor regression analysis between groups:NIHSS score before thrombolysis(OR=1.292,95%CI=1.112～1.500,P<0.001),severe stroke(OR=10.767,95%CI=1.926～60.189,P=0.007),hemorrhage transformation(OR=5.564,95%CI=1.514～20.442,P=0.01),the severe total load CSVD image markers(OR=1.886,95%CI=1.02～3.485,P=0.043)and large infarction(OR=3.063,95%CI=1.15～8.155,P=0.025)was an independent risk factor for poor prognosis.4.The ROC curve of clinical prognosis at 3months and 1 year showed that the best predictive value of the total load of CSVD imaging markers for poor prognosis at 3 months of onset was1.5 points(AUC=0.761,95%CI=0.694～0.827,P < 0.001).The best predictive value of NIHSS score before thrombolysis was 6.5(AUC=0.843,95%CI= 0.7888～0.897,P < 0.001).The best predictive value of the total load of CSVD imaging markers with poor prognosis 1 year after onset was 1.5 points(AUC=0.729,95%CI= 0.629～0.828,P=0.027).The best predictive value of NIHSS score before thrombolysis was 7.5(AUC=0.845,95%CI= 0.766-0.924,P < 0.001).5.For the patients with AIS who also completed follow-up from 3 months to 1 year,the results of multivariate analysis showed that:Coronary heart disease(OR=2.698,95%CI=1.013～7.186,P=0.047),the massive infarction(OR=7.293,95%CI=1.781～29.862,P=0.006)hemorrhage transformation(OR=2.575,95%CI=2.628～65.612,P=0.002)was an independent risk factor for further improvement of neurological function.Conclusion: 1.The total load of CSVD imaging markers was correlated with intracranial hemorrhage transformation after AIS intravenous thrombolysis.Total load of severe CSVD imaging markers,large area infarction and severe stroke were independent risk factors for bleeding transformation after intravenous thrombolysis.2.The total burden of CSVD imaging markers was related to the recovery of neurological function after AIS intravenous thrombolysis.Severe CSVD imaging markers total load,hemorrhage transformation,large area infarction and severe stroke were independent risk factors for long-term poor prognosis after stroke.Total burden of CSVD imaging markers≥2scores was a predictor of long-term poor prognosis after AIS. |
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