Objective: To investigate the predictive value of combined monitoring of serum uric acid(UA), homocysteine(Hcy)and low density lipoprotein cholesterol(LDL-C) on intracerebral hemorrhagic transformation(HT) after intravenous thrombolytic therapy with alteplase in patients with acute cerebral infarction(ACI). Methods: 173 patients with ACI who received intravenous thrombolysis with alteplase treated in Chengdu 363 Hospital Affiliated to Southwest Medical University from January 2018 to December 2020 were selected. They were divided into HT group and non HT group according to whether HT occurred after intravenous thrombolysis. The clinical data and serum UA, Hcy and LDL-C levels of the two groups were compared. The influencing factors of HT after intravenous thrombolytic therapy with alteplase in patients with ACI were analyzed by multivariate logistic regression. The predictive value of combined monitoring of serum UA, Hcy and LDL-C for HT after intravenous thrombolytic therapy with alteplase in patients with ACI was analyzed by receiver operating characteristic(ROC) curve. Results: 47 of 173 patients developed HT, with an incidence of 27.17%.Compared with non HT group, HT group was older, systolic blood pressure, diastolic blood pressure, national Institutes of Health Stroke Scale(NIHSS) score, random blood glucose before thrombolysis and Hcy level were higher, while LDL-C and UA levels were lower(P< 0.05). Multivariate logistic regression analysis showed that systolic blood pressure, NIHSS score, random blood glucose before thrombolysis and Hcy level were the risk factors of HT after intravenous thrombolysis with alteplase in patients with ACI, while UA and LDL-C levels were protective factors. The results of ROC curve analysis showed that the area under the curve(AUC) of serum UA, Hcy and LDL-C after intravenous thrombolytic therapy with alteplase in patients with ACI were 0.764, 0.794, 0.674 and 0.888 respectively, and the AUC was significantly higher in combination monitoring. Conclusion: Low levels of serum UA, LDL-C and high levels of Hcy are the influencing factors of HT after intravenous thrombolytic therapy with alteplase in patients with ACI. Combined monitoring can improve the predictive value of HT. [ABSTRACT FROM AUTHOR]