| Background and objectiveStroke is the leading cause of premature disability and death of adults in China.The number of deaths due to stroke is nearly 1.9 million every year.Intravenous thrombolysis with recombinant tissue plasminogen activator is the first choice for patients with ischemic stroke within 4.5 hours of onset.However,intravenous thrombolysis with tr PA is effective in restoring interrupted cerebral blood flow and in treating acute ischemic stroke Stroke(AIS)patients bring good news,but also there are certain risks,such as the occurrence of intracranial hemorrhage transformation(HT).Once HT occurs in patients with AIS after thrombolysis,the formulation of follow-up treatment will become complicated.Therefore,it is very important to look for economic,reliable and predictive markers of early HT risk after thrombolysis for improving the efficacy of intravenous thrombolysis and improving the prognosis of patients.During ischemia,calcium ion is a ubiquitous biological messenger in cells,which leads to subsequent neuronal damage by influencing a series of events.Uric acid is one of the most important antioxidants in the blood.Its concentration is almost ten times that of other antioxidants.It can remove superoxide,hydroxyl and oxygen free radicals,and is considered to have neuroprotective effect.At present,there are few reports about serum calcium,serum uric acid and early HT and prognosis of AIS patients after intravenous thrombolysis at home and abroad.It is uncertain whether serum calcium and serum uric acid can be predictors of clinical function prognosis of AIS patients after thrombolysis.This study analyzed the relationship between serum calcium and uric acid before thrombolysis and early HT after thrombolysis and 90 day prognosis of AIS patients,hoping to provide a reference for clinical prevention and treatment of early HT after intravenous thrombolysis,and also provide a new diagnosis and treatment scheme for the prognosis of AIS patients.MethodsA retrospective collection of 231 AIS patients who received rt-PA intravenous thrombolytic therapy and met the inclusion and exclusion criteria who were admitted to the hospital through the green channel of emergency stroke in the Fifth Affiliated Hospital of Zhengzhou University from March 2018 to May 2020 were retrospectively collected.Before thrombolysis,all patients completed venous blood routine,blood biochemistry and coagulation function examination in the emergency stroke green channel,and improved brain CT to exclude intracranial hemorrhage.Record the patient’s baseline general clinical data and laboratory data.According to the results of brain CT within 24-36 hours after thrombolysis,patients were divided into HT group and non-HT group;according to the 90-day modified Rankin Scale(m RS)score results,patients were divided into good prognosis group(m RS≤2 points)and poor prognosis group(m RS>2 points).SPSS25.0 statistical software was used for data analysis,and the differences in general clinical data of each group were compared.Multivariate logistic regression was used to analyze the influencing factors of HT and 90-day prognosis in AIS patients after rt-PA intravenous thrombolysis.The receiver operator characteristic(ROC)curve was drawn by medcalc19.5.6 software to evaluate the predictive value of serum calcium and uric acid before thrombolysis on HT and short-term prognosis of AIS patients after intravenous thrombolysis.Delong test was used to compare the area under each curve,P < 0.05 was statistically significant.Results1.Compared with non HT group,HT group had older age,higher proportion of hypertension,atrial fibrillation and antithrombotic history,higher NIHSS score and systolic blood pressure on admission,and lower serum calcium and uric acid levels before thrombolysis(P < 0.05).2.Multivariate logistic regression analysis showed that high NIHSS score(or =1.113,95% CI: 0.005-200,P = 0.049),atrial fibrillation(or = 1.126,95% CI:0.082-0.361,P = 0.009),the decrease of thrombolytic serum calcium(or = 0.918,95% CI: 0.323-0.790,P = 0.000)and serum uric acid(or = 0.990,95% CI:0.984-0.996,P = 0.001)before thrombolysis were independent risk factors for HT after thrombolysis.3.ROC curve analysis showed that the area under the curve of serum uric acid before thrombolysis for predicting HT after thrombolysis was 0.683(95% CI: 0.581 ～0.785,P = 0.001),the best cut-off value was 287.5μmol/L,the sensitivity was 73.0%,and the specificity was 61.3%;the area under the curve of serum calcium before thrombolysis for predicting HT after thrombolysis was 0.738(95% CI: 0.653 ～ 0.822,P = 0.000),the best cut-off value was 2.25mmol/L,the sensitivity was 52.5%,and the specificity was 83.9%;the results of Delong test showed that AUC serum calcium >AUC serum uric acid,the difference was not statistically significant(P > 0.05),the predictive efficiency of the two was similar.4.Compared with the group with good prognosis,the group with poor prognosis had older age,higher proportion of atrial fibrillation,stroke history,and hemorrhagic transformation,higher NIHSS score on admission,and lower serum uric acid level before thrombolysis(P < 0.05).5.Multivariate logistic regression analysis showed that high NIHSS score(or =1.299,95% CI: 1.173-1.439,P = 0.000),atrial fibrillation(or = 1.290,95% CI:0.102-0.387,P = 0.006)and the decrease of serum uric acid level before thrombolysis(or = 0.978,95% CI: 0.969-0.988,P = 0.000)were independent risk factors for poor prognosis 90 days after thrombolysis.6.ROC curve analysis showed that the area under the curve of serum uric acid before thrombolysis predicting 90 days prognosis after thrombolysis was 0.659(95%CI: 0.578 ～ 0.739,P = 0.000),the best cut-off value was 309.5μmol/L,the sensitivity was 66.9%,the specificity was 60.4%,and the predictive efficiency was general.Conclusion1.High NIHSS score on admission,atrial fibrillation,the decrease of serum uric acid and serum calcium before thrombolysis were independent risk factors for HT in patients with AIS after rt-PA intravenous thrombolysis.2.Serum uric acid and serum calcium before thrombolysis can be used as effective indicators to predict HT after intravenous thrombolysis in AIS patients.3.High NIHSS score on admission,atrial fibrillation,the decrease of serum uric acid level before thrombolysis were independent risk factors for poor prognosis 90 days after thrombolysis in AIS patients.4.Serum calcium before thrombolysis has nothing to do with the 90 day prognosis after thrombolysis.Serum uric acid before thrombolysis has a certain predictive value for the 90 day prognosis,but the predictive effect is general. |
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