| ObjectiveAcute ischemic stroke is a kind of clinical disease caused by occlusion of carotid artery and vertebral artery,which accounts for 69.6%-78.1%of all stroke.With the increasing of age,the incidence of this disease increases year by year.At present,the aging trend of the population in China is becoming more and more serious,and the acute ischemic stroke has become one of the main causes of death or disability of Chinese residents.Driven by a large number of clinical studies,intravenous injection of attepase in the treatment of acute ischemic stroke within 4.5 hours has become an important thrombolysis therapy which was recognized in the guidelines for stroke prevention and treatment at home and abroad.However,intravenous thrombolysis not only brings hope to stroke patients,but also has limitations.A domestic clinical study showed that the effective rate of intravenous thrombolysis within 4.5 hours of onset(reached clinical cure or basic cure within 3 months after thrombolysis)was only32.1%.A clinical study in the United States showed that stroke patients who received atteprolase within 4.5 hours of onset had a good prognosis at 3 months(mRS score 0-2),accounting for 37.8%.This indicates that there are still quite a lot of stroke patients who have not benefited from intravenous thrombolysis,so the influencing factors related to the prognosis of thrombolysis need to be further studied.A European study,which included the medical records of 1076 patients with atteprolase thrombolysis,found that age,hypertension,diabetes,obesity,smoking,family genetic history,and the time from onset to thrombolysis,NIHSS score before thrombolysis was an independent factor for clinical prognosis at 3 months.At the same time,some non-traditional risk factors,such as fever,high fibrinogen level,low albumin level,renal insufficiency and high c-reactive protein level,may also be related to the poor prognosis of thrombolysis.The patients in a German hospital complicated with fever were randomly divided into two groups.The patients in the clinical intervention group were treated with paracetamol for cooling.The results showed that the rate of poor prognosis was significantly lower than that of the control group without clinical intervention.There are significant differences.This suggests that clinical intervention on prognostic factors can promote a good prognosis.In addition,compared with European and American countries,the proportion of intracranial arteriosclerosis is higher,the proportion of large atherosclerosis is lower,and the levels of fibrin and coagulation factor are lower in Asian stroke patients.These ethnic characteristics and differences in eating habits and lifestyles in eastern and western countries may have different effects on the curative effect and prognosis of attepase thrombolysis,so the conclusions of foreign studies are not necessarily fully applicable to our country.However,up to now,there is still a lack of quantitative research on the influencing factors related to the prognosis of attepase thrombolysis in China.There are many factors affecting the prognosis of thrombolysis in clinical treatment.Exploring the independent factors related to the prognosis of thrombolysis to predict the prognosis of thrombolysis objectively and quantitatively and to intervene these risk factors as soon as possible.It is very important for the prevention and treatment of acute ischemic stroke and the promotion of good thrombolysis.MethodsThe clinical data of patients with acute ischemic stroke treated with Artipase thrombolytic therapy from October 2017 to September 2018 at the Fifth Affiliated Hospital of Zhengzhou University were analyzed retrospectively.Patients were followed up 3 months after thrombolysis,the patient’s disability degree and independent living capacity were evaluated by the modified Rankin scale.Excluding those with incomplete baseline data and lost interviewees,162 cases(laboratory biochemical indicators and complications)were eventually included in the data.The patients with good prognosis were divided into two groups according to the(mRS)score of modified Rankin scale for 3 months after thrombolysis.The patients with mrs score of 0≤2 three months after thrombolysis were the good prognosis group(97cases).The patients with mrs score≥3 three months after thrombolysis were poor prognosis group(65 cases).The statistical analysis was carried out by spss24.0software.The measurement data in accordance with the normal distribution were expressed by the average±standard deviation,and two independent samples t test were used for the comparison between the two groups.The skewness distribution was represented by the median(quartile),the rank sum test was used for the comparison between groups,and the number of use cases for counting data was expressed,and the chi-square test or fisher accurate test was used for the comparison between groups.The statistically significant factors among univariate screening groups entered multivariate logistic regression,and the independent factors influencing the prognosis of 3 months of thrombolysis were further analyzed.ROC curve was used to evaluate the independent influencing factors and regression model to predict the prognosis of thrombolysis.ResultsIn this study,174 patients with thrombolysis were selected,12 patients lost follow-up,the loss rate was 6.9%,and 162 patients were included in the study.Among them,107(66.1%)were male and 55(33.9%)were female.111 patients with hypertension(68.5%),66 patients with coronary heart disease(40.7%),68 patients with hyperlipidemia(42.0%),30 patients with atrial fibrillation(18.5%)and 98patients with smoking(60.5%).113 cases(69.7%)were drinkers.There were 18 cases(11.1%)of complete anterior circulation infarction,78 cases(48.1%)of partial anterior circulation infarction,28 cases(17.3%)of posterior circulation infarction,38cases(23.5%)of lacunar infarction and 6 cases(3.71%)of bleeding after thrombolysis.The average body mass index(BMI)was 24.36±3.52 kg/m~2,the average time from onset to intravenous thrombolysis was 3.56±0.44 h,the mean systolic pressure was 148±16.85mm Hg,the average diastolic pressure was87.9±48.87mm Hg,and the mean blood sodium value was 136.77±6.12mmol/L.The average platelet count was 223.46×10~9,the average hemoglobin was 130.26 g/l,the average fibrin was 4.46g/L,the average total cholesterol was 4.68mmol/L,and the average low density lipoprotein was 2.86 mmol/L.The median blood glucose value(quartile)was 6.85(5.86,8.92)mmol/l,partial thromboplastin time(quartile)28.2(24.7,33.4)seconds,The median international standard ratio(quartile)was 0.97(0.92,1.02),the median thrombin time was 14.6 seconds,and the median blood homocysteine level was 13.4 mmol/l.After 3 months follow-up,97 patients(59.8%)had good prognosis and 65 patients(40.2%)had poor prognosis.Univariate analysis showed that the difference of the NIHSS score before thrombolysis,time from onset to intravenous thrombolysis,blood glucose,OCSP classification,fibrinogen,hemoglobin between the group with good prognosis and poor prognosis were statistically significant(p<0.05).The median nihss score of poor prognosis group was8.1(5.3,16.2)higher than that of good prognosis group 6.3(4.6,12.7).The mean time from onset to intravenous thrombolysis in the poor prognosis group(3.48 h)was higher than that in the good prognosis group(3.77 h),and the median blood glucose value in the poor prognosis group was 7.35 higher than that in the good prognosis group(6.48 h).In the poor prognosis group,there were 17 cases of complete anterior circulation infarction(26.2%),35 cases of partial anterior circulation infarction(53.8%),11 cases of posterior circulation infarction(16.9%)and 2 cases of lacunar infarction(3.1%).Compared with the group with good prognosis,there was significant difference among the subtypes.Multivariate analysis showed that NIHSS score,time from onset to intravenous thrombolysis,OCSP classification,hemoglobin level and fibrinogen level were independent factors affecting the prognosis of intravenous thrombolysis for 3 months.The hemoglobin OR value was 0.962,95%confidence interval was 0.981-0.994,the upper limit was less than 1,which was the prognostic protective factor,and the NIHSS score before thrombolysis,the time from onset to intravenous thrombolysis,OCSP classification and fibrinogen level were prognostic risk factors.Among the types of OCSP,the risk of poor prognosis was the lowest in lacunar infarction type,complete anterior circulation infarction type,partial anterior circulation infarction type and posterior circulation infarction type compared with lacunar infarction type.The risk of poor prognosis was 8.254,4.256 and 1.654times higher than that of lacunar infarction type.Finally,the modified Rankin scale score≥3 at 3 months after thrombolysis was used as the gold standard for defining poor prognosis.The NIHSS score before thrombolysis,the time from onset to intravenous thrombolysis,OCSP classification,blood glucose,hemoglobin,fibrinogen and regression model before thrombolysis were used as test variables,and the ROC curve analysis was carried out to evaluate the predictive ability of influencing factors and regression model for 3 months prognosis of thrombolysis.ConclusionThe NIHSS score before thrombolysis,the time from onset to intravenous thrombolysis,blood glucose,OCSP classification,fibrinogen and hemoglobin were independent factors affecting the clinical prognosis 3 months after antipyretic therapy. |
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