An Analysis Of Influencing Factors And Prediction Of Short-term Prognosis In Patients With Acute Ischemic Stroke After Treatment With Recombinant Tissue Plasminogen Activator

?Objective? The purpose of this thesis was to investigate the short-term prognostic factors of patients with acute ischemic stroke(AIS)after treatment with recombinant tissue plasminogen activator(rt-PA),and to validate and compare the short-term prognostic factors of total health risks in vascular events(THRIVE)score and DRAGON score.The predictive value of the latter.In addition,the author hopes to provide relevant reference for clinical decision-making and doctor-patient communication.?Methods and Groups? 1.This thesis retrospectively analyzes the clinical data of 102 patients with acute ischemic stroke who received and treated by neurologists in Quanzhou First Hospital Affiliated to Fujian Medical University from October 2017 to November 2018 and who received rt-PA intravenous thrombolysis.In addition,according to the modified Rankin Scale(m RS)score on the 14 th day of discharge or hospitalization,patients were divided into good prognosis(0-3 points)and poor prognosis(4-6 points).Moreover,Univariate Logistic regression analysis and multivariate binary categorical non-conditional Logistic regression analysis were used to analyze the study variables.2.The thesis uses Fisher exact probability method to compare the poor prognosis rate of patients with different THRIVE and DRAGON scores,and further analyzes its linear trend.In addition,the research uses DRAGON score and THRIVE score to analyze the short-term prognosis by single-factor logistic regression,and then draw the ROC curve,and then calculates the area under the receiver operating characteristic curve(AUC-ROC).Moreover,the thesis also uses Z test to compare whether the area under curve(AUC-ROC)of the two scores have statistical significance(P < 0.05).?Results? 1.According to the selection criteria,and then excluding those patients with incomplete data and bridging for endovascular interventional therapy,102 patients are analyzed and studied in this thesis.Among them,62 patients(60.8%)had good prognosis(m RS 0-3),40 patients(39.2%)had poor prognosis(4-6),and 11 patients(10.8%)died.In addition,8 patients with symptomatic intracranial hemorrhage,14 patients with cerebral hernia and 3 patients with early early CT signs of infarction had poor short-term clinical outcomes,while 17 patients with early improvement of neurological function 24 hours after thrombolysis had good short-term prognosis.In this thesis,the author uses univariate logistic regression analysis to study the possible related factors of short-term poor prognosis.Among them,atrial fibrillation,intracranial hemorrhage transformation after thrombolysis,early cerebral artery high density sign,blood sugar before thrombolysis,D-dimer at admission,white blood cell count after thrombolysis,neutrophil count after thrombolysis,NLR after thrombolysis,uric acid,BNP and NIHSS score before thrombolysis had statistical significance(P < 0.05).After multivariate logistic regression analysis,the thesis draws a conclusion that intracranial hemorrhage transformation after thrombolysis,hyperuricemia and high NIHSS score before thrombolysis are independent risk factors for short-term poor prognosis of thrombolytic patients.In addition,the short-term risk of poor prognosis in patients with AIS after intracranial hemorrhage transformation after thrombolysis was 15.14 times higher than that in patients without intracranial hemorrhage transformation after thrombolysis(OR95% CI: 3.25-70.42,P=0.001).Moreover,the short-term risk of poor prognosis in AIS patients with hyperuricemia was 23.80 times higher than that in patients with normal uric acid(OR95% CI: 5.95-95.22,P < 0.001),while the risk of poor short-term prognosis in AIS patients increased by 1 point before thrombolysis(OR95% CI: 1.05-1.23,P=0.002).2.According to Fisher's exact probability method,the short-term poor prognosis rates of patients with different DRAGON scores and THRIVE were significantly different(P < 0.05).In addition,according to the linear trend of further analysis,DRAGON score(linear 2 = 15.59,P < 0.001)and THRIVE score(linear 2 = 17.84,P < 0.001)showed a linear trend with poor prognosis,and the higher the score,the more prone to adverse outcomes.Moreover,according to single-factor logistic regression analysis,DRAGON score(OR = 1.72,95% CI: 1.31-2.25,P < 0.001)and THRIVE(OR = 1.80,95% CI: 1.32-2.46,P<0.001)had statistical significance in predicting short-term adverse outcomes(P<0.05).In addition,according to DRAGON score,the AUC of short-term poor prognosis is predicted to be 0.735(95% CI: 0.637-0.857,P<0.001),and the area under THRIVE score curve was 0.709(95% CI: 0.601-0.817,P<0.001).In other words,DRAGON score and THRIVE score have certain diagnostic value for short-term poor prognosis of rt-PA,but Z test compares the AUC-ROC of the two scores,suggesting that there is no significant difference in the predictive value of short-term poor prognosis.?Conclusion? 1.In this research,patients with symptomatic intracranial hemorrhage,cerebral hernia or early CT signs of infarction had poor short-term prognosis,while patients with early neurological improvement 24 hours after thrombolysis had good short-term prognosis.2.Hyperuricemia,high NIHSS score before thrombolysis and intracranial hemorrhage transformation after thrombolysis are independent risk factors for short-term poor prognosis after rt-PA thrombolysis.3.THRIVE score and DRAGON score can predict short-term adverse prognosis of patients with acute ischemic stroke by rt-PA intravenous thrombolysis.In addition,the higher the score,the more likely the poor prognosis will occur.However,there was no significant difference between the two scoring systems in predicting poor short-term prognosis of rt-PA.