To analyse the relationship between the peripheral blood phosphatidylinositol-3-kinase (PI3K)/serine-threonine-specific protein kinase (Akt)/mammalian target of rapamycin (mTOR) signalling pathway and hemorrhagic transformation (HT) following intravenous thrombolysis in acute ischemic stroke (AIS).

Two hundred and sixty AIS patients at our hospital were chosen from June 2022 to May 2024, and given intravenous thrombolysis as a treatment. patients were divided into HT group (55 cases) and non-HT group (205 cases) according to the head CT results 48 h after thrombolysis. The peripheral blood PI3K, Akt, mTOR mRNA relative expression levels, clinical data, and laboratory indicators were compared between the two groups. the influencing factors of HT after AIS intravenous thrombolysis were analyzed by multivariate Logistic regression analysis, the peripheral blood PI3K, Akt, mTOR mRNA relative expression levels and the value of their combined prediction of HT after AIS intravenous thrombolysis were analyzed by receiver operating characteristic (ROC) curve.

The relative expression levels of PI3K mRNA, Akt mRNA, and mTOR mRNA in peripheral blood of patients in the HT group were lower than those in the non-HT group, the time from onset to thrombolysis and the National Institutes of Health stroke scale (NIHSS) score in the HT group were higher than those in the non-HT group, with statistically significant differences (P<0.05). Multivariate Logistic regression analysis revealed that the time from symptom onset to thrombolysis, NIHSS score, and the relative expression levels of PI3K, Akt, and mTOR mRNA were independent risk factors for the occurrence of HT after intravenous thrombolysis in AIS patients (P<0.05). The areas under the ROC curve (95%CI) of PI3K, Akt, mTOR, and their combined prediction of HT following intravenous thrombolysis in AIS were 0.772 (0.582-0.952), 0.728(0.498-0.937), 0.680(0.395-0.957) and 0.849(0.725-0.957), respectively, with the combination of the three having the highest predictive value.

The peripheral blood PI3K/Akt/mTOR signalling pathway relative expression levels reduce of HT following intravenous thrombolysis in AIS, and inhibition of this pathway increases the risk of HT, the combined detection of peripheral blood PI3K/Akt/mTOR signaling pathway relative has good predictive value for intravenous thrombolysis in AIS.