The Correlation Of Glycemic Fluctuations、process Improvement In Intravenous Thrombolysis、and E-ASPECTS Outcome Of AIS Patients

Objectives Intravenous thrombolysis(within 4.5 hours of onset)or mechanical thrombectomy(within 6 hours of onset)is the most effective treatment and recommended by domestic and foreign guidelines for AIS patients.Outcomes of patients are different expect the disease severity.This article aims to explore the relationship between prospective analysis of Glycemic fluctuations,retrospective analysis of improved intravenous thrombolysis procedures,and e-ASPECTS with AIS who treated with intravenous thrombolysis or mechanical thrombectomy.Methods AIS patients undergoing intravenous thrombolysis or mechanical thrombectomy at the Stroke Center of Shanghai Sixth People’s Hospital between June 1,2017 and February 28,2018 were prospectively and consecutively included,who would be implant CGMS for 72 h.We retrospectively included AIS patients undergoing intravenous thrombolysis or mechanical thrombectomy at the Stroke Center of the Sixth People’s Hospital of Shanghai from 2014 to 2017 to analyze the time consumption of their intravenous thrombolysis process and e-ASPECTS.Clinical data of patients were collected.The short-term neurological deterioration of patients(increased NIHSS score at 7th day compared with baseline score≥4 points)and 90-day m RS score.First,patients were divided into Glycemic fluctuations group(MAGE≥3.9mmol/L)and non-Glycemic fluctuations group(MAGE<3.9mmol/L).The differences of outcomes and the concentration of 8-iso-PGF2α between the two groups were analyzed.Second,according to short-term outcomes of patients,they were divided into short-term neurological deterioration group and short-term non-neurologically deteriorating group.According to 90-day outcomes,they were divided into good outcome group(m RS=0-1)and poor outcome group(m RS=2-6).We analyzed and contrasted the differences of the two groups.Meanwhile,we analyzed if the 120 prehospital preinformation and emergency thrombolysis team models could shorten DNT.Last,we used logistic regression to identify independent risk factors for the outcomes of AIS patients,and maked ROC curve to predict the outcome of patients who were treated with intravenous thrombolysis by e-ASPECTS score.Results The concentration of 8-iso-PGF2α in patients with Glycemic fluctuations on the first day was higher than that patients in non-Glycemic fluctuations group(37.0 vs 55.3,P=0.03).This marker decreased on the third day and there was no difference between the two groups(31.3 vs 35.6,P=0.761).After the improvement of intravenous thrombolysis process,DNT in our hospital decreased compared with before time(90 vs 65,P<0.001).120 preinformation can greatly shorten OTT(180min vs 160 min,P=0.007)and DNT(90 min vs 65 min,P <0.001).Patients were anterior circulation infarct whose e-ASPECTS could not predict poor prognosis,but 24-hour and baseline e-ASPECTS differences could independently predict poor prognosis(OR,1.358;95% CI 1.061-1.739).The sensitivity is 60.2% and the specificity is 84.9%.Conclusion Levels of oxidative stress increased in AIS patients who have Glycemic fluctuations,but that were not associated with short-term neurological deterioration.120 pre-hospital preinformation and emergency thrombolysis team intervention can shorten OTT and DNT.The difference between 24-hour and baseline e-ASPECTS in patients with anterior circulation infarct who were treated with intravenous thrombolysis is an independent risk factor for poor outcome.