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目的:探讨血清C反应蛋白(C-reactive protein, CRP)对急性缺血性卒中静脉溶栓后出血性转化(hemorrhagic transformation, HT)的预测价值。方法:回顾性纳入2018年8月至2019年12月在南通市第一人民医院接受阿替普酶静脉溶栓治疗的急性缺血性卒中患者。在静脉溶栓治疗后24 h复查头颅CT，根据扫描结果判定是否存在HT。有症状颅内出血(symptomatic intracranial hemorrhage, sICH)定义为脑实质血肿且美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分较基线增加≥4分或患者在发病36 h内死亡。应用多变量n logistic回归模型确定CRP与溶栓后HT以及sICH的独立相关性。利用受试者工作特征(receiver operating characteristic, ROC)曲线评估血清CRP水平对溶栓后HT以及sICH的预测价值。n 结果:共纳入165例接受静脉溶栓治疗的急性缺血性卒中患者。23例(13.9%)在静脉溶栓后发生HT，其中9例为sICH。单变量分析显示，HT组血清CRP水平显著高于非HT组[(14.49±13.12)mg/L对(7.40±8.05)mg/L；n t＝2.171，n P＝0.044]。多变量n logistic回归分析显示，血清CRP水平增高为溶栓后HT的独立危险因素(优势比1.078，95%可信区间1.022～1.137；n P＝0.006)。ROC曲线分析显示，CRP预测溶栓后HT的曲线下面积为0.700(95%可信区间0.570～0.830；n P＝0.006)。最佳截断值为5.77 mg/L，对应的敏感性和特异性分别为77%和59%。sICH组CRP水平与非sICH组无显著性差异。多变量n logistic回归分析显示，仅空腹血糖水平≥7.8 mmol/L为溶栓后sICH的独立危险因素(优势比2.459，95%可信区间1.050～5.759；n P＝0.038)。n 结论:入院后24 h内血清CRP水平增高可预测急性缺血性卒中患者静脉溶栓后HT风险，但不能预测sICH发生风险。“,”Objective:To investigate the predictive value of serum C-reactive protein (CRP) for hemorrhaging transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke received alteplase intravenous thrombolysis in Nantong First People's Hospital from August 2018 to December 2019 were enrolled retrospectively. The head CT was reexamined to identify whether HT existed at 24 h after intravenous thrombolytic therapy. Symptomatic intracranial hemorrhage (sICH) was defined as parenchymal hematoma, and the National Institutes of Health Stroke Scale (NIHSS) score increased ≥4 than the baseline, or a patient died within 36 h after onset. Multivariaten logistic regression model was used to identify the independent correlation between CRP and HT and sICH after thrombolysis. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum CRP level for HT and sICH after thrombolysis.n Results:A total of 165 patients with acute ischemic stroke received intravenous thrombolysis were enrolled in the study. Twenty-three patients (13.9%) developed HT after intravenous thrombolysis, of which 9 were sICH. Univariate analysis showed that the serum CRP level in the HT group was significantly higher than that in the non-HT group (14.49±13.12 mg/L n vs. 7.40±8.05 mg/L; n t=2.171, n P=0.044). Multivariate n logistic regression analysis showed that elevated serum CRP level was an independent risk factor for HT after thrombolysis (odds ratio[n OR] 1.078, 95% confidence interval [n CI] 1.022-1.137; n P=0.006). ROC curve analysis showed that the area under the curve of CRP for predicting HT after thrombolysis was 0.700 (95% n CI 0.570-0.830; n P=0.006). The best cut-off value was 5.77 mg/L, and the corresponding sensitivity and specificity were 77% and 59%, respectively. There was no significant difference in CRP level between the sICH group and non-sICH group. Multivariate n logistic regression analysis showed that only fasting blood glucose level ≥7.8 mmol/l was an independent risk factor for sICH after thrombolysis (n OR 2.459, 95% n CI 1.050-5.759; n P=0.038).n Conclusions:Elevated serum CRP level within 24 h after admission can predict the risk of HT in patients with acute ischemic stroke after intravenous thrombolysis, but it cannot predict the risk of sICH.