Previous studies have identified a diverse set of predisposing factors for the occurrence of hemorrhagic transformation （HT）, but the independent clinical predictors of HT after intra- arterial thrombolysis have not been determined. In this retrospective study, we investigated the characteristics of patients with or without HT who had received intra-arterial thrombolysis therapy, using biochemical analysis, renal function test, routine blood test, blood lipid test, coagulation blood test, liver function test, random blood glucose test, time- window for intra-arterial thrombolysis, recanalization, National Institutes of Health Stroke Scale （NIHSS） score and systolic blood pressure before intra-artedal thrombolysis. The mortality rates were similar in the HT and non-HT groups （P = 0.944）. In the single- factor analysis, patients with a higher globulin level （P 〈0.002）, prothrombin time activity percentage （PTA; P = 0.026）, and NIHSS score （P = 0.002）, had a significantly increased risk of developing HT. In the multifactor logistic regression model involving globulin level, PTA, white blood cell count, and NIHSS score, the globulin level （P 〈0.001; OR, 1.185; 95% confidence interval [CI], 1.090-1.288）, PTA （P = 0.018; OR, 1.016; 95% CI, 1.003-1.029）, white blood cell count （P = 0.025; OR, 1.097; 95% CI, 1.012-1.190） and NIHSS score （P = 0.003; OR, 1.097; 95% CI, 1.031-1.166） were significantly increased in the HT group. The increase in globulin level is an independent risk factor for HT in patients receiving intra-arterial thrombolysis. The possible mechanisms may involve inflammatory cytokines, matrix metalloproteinase 9, and positive acute-phase reactants synthesized by the liver.
Yingqi XingZhen-Ni GuoShuo YanHang JinShouchun WangYi Yang
Objective To discuss the clinical ultiliazation and significance of microembolus detection by transcranial Doppler （TCD） sonography in intracranial stenosis-occlusive disease. Data sources All related articles in this review were mainly searched from PubMed published in English from 1996 to 2012 using the terms of microembolic signal, transcranial Doppler, intracranial stenosis, stroke. Study selection Original articles and reviews were selected if they were related to the clinical utilization of microembolus detection in intracranial stenosis-occlusive disease. Results Intracranial stenosis is a significant cause of cerebral emboli, and microembolus detection by TCD sonography were widely used in exploring the mechanisms of ischemic stroke with intracranial stenosis （including the middle cerebral artery stenosis and the vertebral-basilar stenosis）, evaluating the prognosis of acute stroke, evaluating the therapeutic effects, and predicting the recurrent events of stroke. Conclusion Microembolus detection by TCD sonography plays an important role in the cerebral ischemic stroke patients with intracranial stenosis.
