| Background and Objective:Intravenous thrombolytic therapy is an important treatment for ultra-early reperfusion in patients with acute ischemic stroke,which increases good prognosis and survival.Liver function test is one of the routine biochemical examinations in clinical practice.Some studies have explored the correlation between liver function index and clinical outcome of patients with ischemic stroke,but no studies have explored the association between liver function and clinical outcome of patients receiving intravenous thrombolytic therapy.The purpose of this study was to explore whether alkaline phosphatase（ALP）,gamma-glutamyl transpeptidase（GGT）,aspartate transaminase（AST）,and globulin levels of liver function test are associated with clinical outcomes after intravenous thrombolysis in patients with acute ischemic stroke.Materials and Methods:Patients with acute ischemic stroke who received standard dose of recombinant tissue plasminogen activator（rt-PA）intravenous thrombolysis within 4.5 hours of onset in the First Hospital of Jilin University from April 2015 to December 2020 were continuously included in this study.Fasting liver function blood samples were collected within 24 hours after intravenous thrombolysis.Clinical outcomes included hemorrhagic transformation（HT）,poor 3-month outcome and 3-month death after thrombolysis.Post-thrombolytic HT was defined as cerebral hemorrhage indicated by24-hour cranial computed tomography（CT）/magnetic resonance imaging（MRI）.Clinical prognosis was assessed by the Modified Rankin Scale（mRS）at 3 months after thrombolytic therapy.Poor outcome was defined as m RS score ≥2,and death was defined as m RS score =6.ALP,GGT,AST,and globulin levels were converted into dichotomous variables based on the optimal cut-off point of the receiver Operating Characteristic Curve（ROC）analysis for each clinical outcome.Multivariate Logistic regression analysis was used to investigate the association between ALP,GGT,AST and globulin levels and hemorrhage transformation,poor 3-month outcome and 3-month death after thrombolytic therapy.Results:A total of 750 patients with acute ischemic stroke were enrolled in this study,of whom 543（72.4%）were male,aged 62（53-69）years.In the study population,452patients（60.3%）had poor 3-month outcome（m RS≥2）,117（15.6%）had hemorrhage transformation after IVT,and 42（5.6%）had 3-month death.For HT after IVT,when liver function index was used as a continuous variable,Globulin level（OR=1.055;95% CI: 1.006-1.107;P=0.028）was an independently predictor of HT after intravenous thrombolysis.ALP level（OR=1.003;95% CI: 0.995-1.011;P=0.456）,GGT level（OR=1.001;95% CI: 0.998-1.003;P=0.568）,AST level（OR=1.000;95% CI: 0.993-1.007;P=0.997）were not independently associated with HT after thrombolytic therapy.When liver function index was used as dichotomous variable,AST level ≥28.8U/L（OR=2.138;95% CI: 1.310-3.492;P=0.002）and globulin level ≥24.9g/L（OR=2.087;95% CI: 1.231-3.539;P=0.006）were independently predictors of HT after intravenous thrombolysis.For poor 3-month outcome after IVT,when liver function index was used as a continuous variable,ALP level（OR=1.009;95% CI: 1.002-1.016;P=0.010）,GGT level（OR=1.006;95% CI: 1.001-1.010;P=0.019）,globulin level（OR=1.062;95% CI:1.020-1.107;P=0.004）were independently predictors of poor 3-month outcome after intravenous thrombolysis in AIS patients.AST level（OR=1.015;95% CI: 0.996-1.035;P=0.116）was not independently associated with poor 3-month outcome.When liver function index was used as dichotomous variable,ALP level ≥71.5U/L（OR=1.597;95%CI: 1.143-2.231;P=0.006）,GGT level ≥47.3U/L（OR=1.617;95% CI: 1.092-2.394;P=0.016）,globulin level ≥26.3g/L（OR=1.480;95% CI: 1.055-2.076;P=0.023）were independently predictors of poor 3-month outcome after intravenous thrombolysis.For 3-month death after IVT,when liver function index was used as a continuous variable,ALP level（OR=1.005;95% CI: 0.992-1.017;P=0.469）,GGT level（OR=1.003;95% CI: 0.999-1.006;P=0.111）,AST level（OR=1.003;95%CI: 0.997-1.010;P=0.352）,globulin level（OR=1.018;95%CI: 0.939-1.104;P=0.669）were not independently associated with 3-month death.When liver function index was used as dichotomous variable,ALP level ≥82.8U/L（OR=2.739;95%CI: 1.270-5.909;P=0.010）,GGT level≥63.8U/L（OR=4.024;95% CI: 1.557-10.399;P=0.004）were independently predictors of 3-month death after intravenous thrombolysis in AIS patients.Conclusion:This study found that high globulin level and high AST level were independently predictors of HT after IVT.High ALP,GGT,and globulin levels were independently predictors of poor 3-month outcome.High ALP and GGT levels were independently predictors of 3-month death after thrombolytic therapy.The results of this study may provide new therapeutic targets for improving the prognosis of IVT patients. |
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