| Background:Although rapid progress has been made in the diagnosis and treatment of acute cerebral infarction over the past two decades,stroke is still the second leading cause of death and disability in the world today.The main treatment goal of acute cerebral infarction is to rescue the ischemic penumbra by recanalization of occluded cerebral vessels.Intravenous thrombolysis is currently recognized as one of the effective methods for the treatment of acute cerebral infarction.Recombinant tissue Plasminogen activator is the only biological thrombolytic agent approved by the US Food and Drug Administration for the treatment of acute ischemic stroke within 4.5 hours.A number of modifiable and unmodifiable risk factors influence the outcome of intravenous rt-pa therapy,and early identification and correction by clinical physicians can help patients with acute cerebral infarction benefit the most from intravenous rt-pa therapy.Objective:To compare the effects of different factors on the clinical Prognosis of rt-pa intravenous thrombolysis for acute cerebral infarction.Methods:Eighty patients with acute cerebral infarction who underwent rt-pa intravenous thrombolysis in the Department of Neurology,Huaihe Hospital of Henan University from January 2017 to September 2018 were retrospectively selected as the study subjects.The Patients were recorded for age,gender,and history of hypertension,history of diabetes,history of coronary heart disease,history of atrial fibrillation,history of smoking and drinking,systolic blood pressure and diastolic blood pressure at admission,random venous blood glucose before thrombolysis,neutrophil lymphocyte ratio,hemoglobin,fibrinogen,urea-nitrogen creatinine ratio,Ttotal cholesterol,low-density lipoprotein,homocysteine,glycosylated hemoglobin,Baseline National Institute of Neurological Disease and Stroke(NIHSS)score before thrombolysis,thrombolytic 7d NIHSS score,the modified Rankin scale(mRS)score of thrombolytic 90 d,the onset to treatment(OTT),and the like.According to the improvement rate of the 7d NIHSS score compared with baseline NIHSS score,the patients were divided into a 7d treatment effective group with intravenous thrombolysis and a 7d treatment ineffective group.Then according to the 90 d mRS score,they were divided into a 90-day good prognosis group and a 90-day poor prognosis group.The distribution of the above indicators was statistically analyzed between different groups of 7d efficacy and 90 d prognosis.The correlation between each of the above indicators and the clinical prognosis of intravenous thrombolytic therapy is revealed;at the same time,all patients were subjected to Trail of org 10172 in acute stroke treatment(TOAST),grouped into a non-stenosis group,a mild stenosis group,a moderate stenosis group,a severe stenosis or an occlusion group according to the degree of vascular stenosis.According to the different numbers and stability of cervical vascular plaques,different groups were divided.Then,The correlation between different pathogeny types,the different degree of stenosis of the responsible vessels,the number and stability of the vascular plaques in the neck and the 7d efficacy and 90 d prognosis were statistically analyzed.Results:1.A total of 80 patients with rt-PA intravenous thrombolysis were enrolled,including 60 Patients(75%)in the 7d treatment group and 20 Patients(25%)in the 7d treatment ineffective group.Univariate analysis showed that compared to the 7d treatment-effective group,patients in the 7d treatment-ineffective group had higher indices of random venous blood glucose before thrombolysis(P=0.006),glycated hemoglobin(P=0.042),and low-density lipoprotein(P=0.024),and the onset time to thrombolysis(P=0.043)was longer.Multivariate analysis showed that random venous blood glucose before thrombolysis(OR=1.442,95% IC 1.042-1.994,P=0.027)and onset to thrombolysis time(OR=1.018,95% IC 1.003-1.033,P=0.016)are risk factors affecting the 7-day clinical prognosis in Patients with PA intravenous thrombolysis.2.According to the 90 d mRS score,51 Patients(64%)had a good prognosis in 90 days,and 29 Patients(36%)had a poor prognosis in 90 days.Univariate analysis showed that patients with older age(P=0.027)had the higher NLR ratio(P =0.026),the higher the Bbaseline NIHSS scores(P=0.001)the longer OTT(P=0.030),and the worse clinical prognosis of 90 d intravenous thrombolysis;multivariate analysis found age(OR=1.061,95% IC 1.001—1.125,P=0.045),aseline NIHSS score(OR=1.182,95% IC 1.022—1.367,P=0.024),onset to thrombolysis time(OR=1.021,95% IC 1.007—1.036,P=0.003)were risk factors for clinical prognosis of 90 d intravenous thrombolysis.3.There were significant differences in the distribution of patients with severe stenosis or occlusion of the responsible vessels between the different 7d treatment groups and the different 90 d prognosis groups(18% vs 59% P<0.001);there was no significant difference in the number and stability of vascular plaque in the neck between different 7d treatments groups;No plaques in the neck blood vessels(28% vs 7% P=0.027)and unstable vascular plaques in the neck(43% vs 73% P=0.012)were significantly different between the different 90-day prognostic groups and has a statistical significance.Conclusions:1.Random venous blood glucose before thrombolysis and onset to thrombolysis time are risk factors affecting the 7d efficacy of intravenous thrombolysis;2.Age,baseline NIHSS score and onset to thrombolysis time were risk factors affecting the clinical prognosis of 90 d intravenous thrombolysis;3.Patients with severe stenosis or occlusion of the responsible vessel had a poor 7d efficacy and a poor 90 d prognosis after intravenous thrombolysis;The treatment of intravenous thrombolysis in patients with acute cerebral infarction with unstable cerebral vascular plaque in the neck had a worse 90-day prognosis;Patients with acute cerebral infarction without vascular plaque in the neck can benefit more from intravenous thrombolytic therapy. |
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