The Analysis Of Related Factors Of Early Neurological Deterioration Due To Ischemic After Intravenous Thrombolysis

Objectives:The purpose of this study is to investigate the incidence of early neurological deterioration due to ischemic(END)after intravenous thrombolysis in patients with acute ischemic stroke(AIS),and analyze the relevant factors affecting ischemic END after intravenous thrombolysis,in order to provide evidence for clinical early identification of ischemic END.Methods:Patients with AIS who underwent rt-PA intravenous thrombolysis at the First Affiliated Hospital of Dali University from September 2019 to August 2022 were collected and divided into groups according to the change of the National Institutes of Health Stroke Scale(NIHSS)score within 24 hours after thrombolysis.The continuous decrease of NIHSS score ≥ 4 points or complete improvement of symptoms within 24 hours after intravenous thrombolysis was pointed as continuous improvement.Ischemic END is defined as an increase of ≥ 4 points in NIHSS score compared with the lowest score within 24 hours after thrombolysis(brain imaging excludes bleeding conversion)General patient data,common risk factors of cerebrovascular disease,laboratory and imaging examination data were collected.Univariate analysis was used to compare the differences between the two groups,and the factors with significant differences were included in the multivariate binary logistic regression model for further analysis,to observe the relationship between them and the deterioration of neural function in the early stage of ischemia.The value of predicting ischemic END was evaluated by the subject working curve(ROC).Results:From September 2019 to August 2022,248 patients with acute cerebral infarction were treated with rt-PA intravenous therapy in our hospital,and 173 patients were included in the study according to the inclusion and exclusion criteria.There were 43 cases in the ischemic END group,with an incidence of 18.14%(43/237).Univariate analysis showed that the baseline systolic blood pressure(P=0.009),neutrophil(NEUT)(P=0.042),neutrophil/lymphocyte ratio(NLR)(P=0.004),platelet count(PLT)(P<0.001),fibrinogen(FIB)(P<0.001),venous blood glucose(GLU)(P=0.006),and collateral circulation establishment rate(P=0.011)were statistically significant between the two groups.The above indicators in the ischemic END group were higher than those in the continuous improvement group,while the aspartate aminotransferase(AST)in the ischemic END group(P=0.010),and level of serum creatinine(CREA)(P=0.030)was lower than that of continuous improvement group.There was no statistical difference in the remaining indicators between the two groups(P>0.05).Logistic regression analysis showed that systolic blood pressure(OR=1.030,P=0.026),NLR(OR=1.382,P=0.019),PLT(OR=1.023,P<0.001),FIB(OR=3.452,P<0.001)and GLU(OR=1.242,P=0.006)were risk factors for ischemic END after thrombolysis,while the establishment of collateral circulation(OR=0.231,P=0.006)was the protective factor of ischemic END.ROC curve analysis showed that the area under the curve(AUC)of NLR,PLT and FIB for predicting ischemic END were 0.667,0.799 and 0.744,respectively.Conclusions:In this study,we found that the incidence of ischemic END after intravenous thrombolysis in acute ischemic stroke is 18.14%,and ischemic END is associated with a poor prognosis.High levels of baseline systolic blood pressure,neutrophil/lymphocyte ratio,platelet count,fibrinogen and blood glucose were identified as risk factors for ischemic END after thrombolysis,while the establishment of collateral circulation was found to be a protective factor for ischemic END.