外周血MAR联合HRR预测急性缺血性脑卒中患者静脉溶栓后出血转化的临床价值OA

Objective To investigate the clinical value of peripheral blood monocyte count to apolipoprotein A1 ratio(MAR)combined with hemoglobin to red blood cell distribution width ratio(HRR)in predicting hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute ischemic stroke(AIS).Methods A total of 208 AIS patients receiving intravenous thrombolysis at Xingtai Central Hospital from January 2022 to February 2025 were enrolled and assigned to HT(n=36)and non-HT groups(n=172)based on whether HT occurred within 24 hours after thrombolysis.General data,including gender,age,and pre-admission medication,were collected.Peripheral blood monocyte count,apolipoprotein A1(ApoA1),hemoglobin(Hb),and red blood cell distribution width(RDW)levels were measured immediately upon admis-sion,and MAR and HRR were calculated.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of peripheral blood MAR combined with HRR for HT after intravenous thrombolysis in AIS patients.Mult-ivariate logistic stepwise regression analysis was used to identify factors influencing HT.Results The peripheral blood MAR was significantly higher and HRR was significantly lower in the HT group than in the non-HT group(P<0.05).ROC curve anal-ysis showed that the areas under the curve(AUC)for peripheral blood MAR alone,HRR alone,and their combination in predicting HT were 0.781(95%CI:0.736-0.826),0.829(95%CI:0.784-0.874),and 0.905(95%CI:0.860-0.955),respective-ly.The AUC of MAR combined with HRR was significantly greater than that of MAR or HRR alone(Z=10.705,12.057;P<0.001).No statistically significant differences were found between the non-HT and HT groups in gender composition,body mass index(BMI),proportion of smoking history,proportion of drinking history,proportion of diabetes mellitus,proportion of coronary heart disease,lesion location,pre-admission medication,or levels of homocysteine(Hcy),triglycerides(TG),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C;P>0.05).The HT group had significantly higher age,admission National Institutes of Health Stroke Scale(NIHSS)score,proportions of combined hypertension and atrial fibrillation history,and longer on-set-to-thrombolysis time than the non-HT group(P<0.05).Multivariate logistic stepwise regression analysis identified high ad-mission NIHSS score(OR=2.297,95%CI:1.347-3.897),prolonged onset-to-thrombolysis time(OR=2.465,95%CI:1.412-4.300),MAR≥0.45(OR=2.995,95%CI:1.768-5.075),and HRR≤8.51(OR=3.142,95%CI:1.773-5.570)as independent risk factors for HT after intravenous thrombolysis in AIS patients(P<0.05).Conclusion Admission NIHSS score,onset-to-thrombolysis time,peripheral blood MAR,and HRR are factors influencing HT after intravenous thrombolysis in AIS patients.Peripheral blood MAR combined with HRR demonstrates good clinical value in predicting the risk of HT.By detecting MAR and HRR immediately upon admission,combined with NIHSS score and thrombolysis time,clinicians can early assess HT risk and implement timely interventions to improve patient prognosis.