Analysis Of The Factors Affecting On Early Efficacy Of Intravenous Rt-PA Thrombolytic Therapy In Patients With Acute Cerebral Infarction

Objective:To analyze the factors affecting on early efficacy of intravenous thrombolysis with rt-PA treatment to cerebral infarction within 4.5 hours onset.Methods:The clinical, laboratory data of consecutive acute cerebral infarction patients undergoing intravenous thrombolysis therapy in Second Affiliated Hospital, Zhejiang University School of Medicine from January 2012 to August 2015 was retrospectively analyzed. The national institute of health stroke scale (NIHSS) score was recorded respectively to evaluate the recovery of neurological functions before treatment and after the treatment for 24h,3d, and 7d. Early improving efficacy was defined by a 4-point improvement in NIHSS score or complete recovery at 24h,3d, and 7d. We defined the increase of NIHSS score at 7d as the deterioration. Assessment of symptomatic intracerebral hemorrhage within the first 24h was according to ECASSⅡ criteria. The following stroke risk factors were assessed:age, sex, alcohol history, atrial fibrillation, hypertension, diabetes, prior stroke, onset-to-treatment time, admission LDL-C level, admission glucose level, admission HbAlc, admission systolic pressure, diastolic pressure, and admission NIHSS score.Results:Of the 206 acute cerebral infarction patients treated by intravenous thrombolysis with rt-PA,123 patients were males, aged 18-80 years, with an average (65.32±12.79) years old. At the seventh day of thrombolysis, the cumulative number of effective cases was 120(58.3%), and the mortality was 5(2.4%). Analysis showed that admission LDL-C level (<3.1mmol/L) and atrial fibrillation were the independent factors for the early neurological improvement (24h,3d,7d).24h NIHSS score was the predictive factor for early neurological improvement of 3d and 7d after thrombolysis (P< 0.01). Multivariate logistic regression analysis showed that atrial fibrillation (OR:4.106, 95%CI:1.314-12.833, P=0.015) and admission glucose level (> 10mmol/L)(OR:4.749,95%CI:1.196～18.857, P=0.027) were the risk factors of early deterioration; while admission diastolic pressure(OR:1.162,95%CI:1.020-1.325, P=0.024) and admission glucose (OR:1.698,95%CI:1.041-2.770, P=0.034) were the risk factors associated with death. Of the 206 patients,49 patients had hemorrhagic transformation, and 13 patients were symptomatic intracerebral hemorrhage. Multivariate logistic regression analysis showed that the admission NIHSS score (OR:1.129,95%CI:1.005-1.269, P=0.041), admission diastolic pressure(OR:1.042, 95%CI:1.002-1.084,P=0.041) and atrial fibrillation (OR:4.549,95%CI:1.093-18.933,P=0.037) were the factors associated with symptomatic intracerebral hemorrhagic transformation.Conclusion:1 The admission LDL-C level (≤3.1mmol/L) and atrial fibrillation were the independent factors that influenced the early efficacy after intravenous thrombolysis in patients with acute cerebral infarction.2 24h NIHSS score was the predictive factor of the early neurological improvement.3 The atrial fibrillation and admission glucose level(>10mmol/L) were the risk factors of early deterioration; Admission diastolic pressure and admission glucose were the risk factors associated with death.4 The admission NIHSS score, atrial fibrillation, admission diastolic pressure were the factors associated with symptomatic intracerebral hemorrhagic transformation.