目的:探讨急性缺血性卒中患者血管内治疗( endovascular therapy, EVT)后出血性转化(hemorrhagic transformation, HT)及有症状颅内出血(symptomatic intracranial hemorrhage, sICH)的预测因素。方法:回顾性分析2016年1月至2019年12月在南京医科大学附属南京医院神经内科接受EVT的急性大动脉闭塞性卒中患者的临床资料。术后复查头颅CT确定是否存在HT，sICH定义为存在脑实质血肿且美国国立卫生研究院卒中量表(National Institutes of Health Stroke Sacle, NIHSS)评分较基线增加≥4分或死亡。在术后90 d时采用改良Rankin量表评估患者临床转归，0～2分定义为转归良好。应用多变量n logistic回归分析确定EVT后HT以及sICH的独立危险因素。n 结果:共纳入443例患者，94例(21.2%)发生HT，其中24例(5.2%)为sICH。HT组年龄、空腹血糖水平、国际标准化比率、基线NIHSS评分以及心房颤动、心源性栓塞和重度卒中的患者构成比显著高于非HT组，而低密度脂蛋白胆固醇水平显著低于非HT组(n P均<0.05)。多变量n logistic回归分析显示，基线NIHSS评分较高是EVT后HT的独立危险因素[优势比(odds ratio, n OR)1.076，95%可信区间(confidence interval, n CI)1.040～1.113；n P<0.001]。sICH组与非sICH组饮酒、发病前使用抗血小板药、卒中病因学分型的患者构成比以及基线NIHSS评分差异有统计学意义(n P均<0.05)。多变量n logistic回归分析显示，基线NIHSS评分较高(n OR 1.080，95% n CI 1.025～1.137；n P＝0.004)以及心源性栓塞(n OR 3.579，95% n CI 1.101～11.631；n P＝0.034)是EVT后发生sICH的独立危险因素。此外，HT组及sICH组转归不良率和病死率均显著更高。n 结论:高基线NIHSS评分为临床预测EVT后发生HT和sICH的独立危险因素，可导致转归不良并增高死亡风险。“,”Objective:To investigate the predictors of hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH) after endovascular therapy (EVT) in patients with acute ischemic stroke.Methods:The clinical data of patients with acute ischemic stroke received EVT and admitted to the Department of Neurology, Nanjing First Hospital of Nanjing Medical University from January 2016 to December 2019 were analyzed retrospectively. Postoperative cranial CT was used to identify the presence of HT. sICH was defined as the presence of parenchymal hematoma, and the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥4 compared with baseline or died. The modified Rankin Scale was used to evaluate the clinical outcomes of patients at 90 d after EVT, and 0-2 was defined as good outcomes. Multivariable n logistic regression analysis was used to identify the independent risk factors for HT and sICH after EVT.n Results:A total of 443 patients were enrolled in the study. Ninety-four (21.2%) had HT, and 24 (5.2%) of them were sICH. Age, fasting blood glucose level, international standardized ratio, baseline NIHSS score, proportion of patients with atrial fibrillation, cardiogenic embolism and severe stroke in the HT group were significantly higher than those in the non-HT group, while low-density lipoprotein cholesterol level was significantly lower than that in the non-HT group (all n P<0.05). Multivariaten logistic regression analysis showed that higher baseline NIHSS score was an independent risk factor for HT after EVT (odds ratio [n OR] 1.076, 95% confidence interval [n CI] 1.040-1.113; n P<0.001). There were statistically significant differences in the proportion of patients in alcohol consumption, use of antiplatelet drugs before onset, the etiology of stroke, and the baseline NIHSS score between the sICH group and the non-sICH group (alln P<0.05). Multivariaten logistic regression analysis showed that the higher baseline NIHSS score (n OR 1.080, 95% n CI 1.025-1.137; n P=0.004) and cardiogenic embolism (n OR 3.579, 95% n CI 1.101-11.631; n P=0.034) were the independent risk factors for sICH after EVT. In addition, the adverse outcome rate and mortality rate were significantly higher in the HT group and the sICH group.n Conclusion:A high baseline NIHSS score is an independent risk factor for clinically predicting the occurrence of HT and sICH after EVT, which can lead to poor outcomes and increase the risk of death.