Effect Of Blood Glucose Level On Prognosis Of Thrombolytic Therapy In Acute Ischemic Stroke

Objective: In this study,the purpose is to investigate the effects of blood glucose levels(random blood glucose and glycosylated hemoglobin after stroke)on volume of cerebral infarction,classification,location,and the efficacy and safety of thrombolytic therapy with acute ischemic stroke.Methods: A total of 523 patients with acute ischemic stroke who were hospitalized in The Xiangtan Central Hospital from October 2017 to April 2020 and were within the time window of intravenous thrombolysis(4.5h)were collected.According to the random blood glucose level at admission,they were divided into normal blood glucose group(< 7.8mmol/L),higher blood glucose group(7.8mmol/L≤ blood glucose < 11.1mmol/L),and hyperglycemia group(≥11.1mmol/L).After admission,CT and routine biochemical examinations were completed immediately.All patients refer to the Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke in 2014 for standardized treatment.After eliminating the contraindications of thrombolysis,the dose of rt-PA was calculated according to their body weight,the maximum individual dose does not exceed 90 mg,intravenous thrombolysis was performed,and CT or MRI were completed,and compare the infarct size,location,classification and the efficacy,safety of thrombolytic therapy.The collected data are analyzed by SPSS 26 statistical software.Result:1.Analysis of general data : There was no significant difference in age and gender,but the prevalence of hypertension in the high glucose group and the hyperglycemia group was higher than that in normal group,and the difference had statistical significance(P < 0.05).2.Analysis of laboratory indicators: glycosylated hemoglobin,triglyceride,total cholesterol,low density lipoprotein cholesterol,homocysteine and uric acid in the high glucose group and the hyperglycemia group were higher than those in normal blood glucose group,while high density lipoprotein cholesterol was lower than that in normal group(P < 0.05).However,there was no significant difference in creatinine,fibrinogen and glutamic pyruvic transaminase levels among the three groups(P < 0.05).3.Imaging features: There was no significant difference in infarct type and location among the three groups,but the infarct volume of the high glucose group and the hyperglycemia group was higher than that of normal group(P <0.05).4.Efficacy of intravenous thrombolysis: There was no significant difference in severity among the three groups.After thrombolytic therapy,NISHH scores of the three groups decreased at 24 h and 7d,and the normal group decreased faster(P < 0.05).The high glucose group and the hyperglycemia group had higher risk of bleeding and death after thrombolytic therapy,the difference was statistically significant(P < 0.05).5.Safety: age,onset to treatment time,door-to-needle time,blood glucose level are related to the Prognosis.The risk of bleeding and death after thrombolysis in ineffective group is higher than that in effective group,and the difference is statistically significant(P < 0.05).6.The effect of random blood glucose before thrombolysis on 24 hours after thrombolysis: When the random blood glucose before thrombolysis is 6-9mmol/L,rt-PA has the highest effective rate and lower mortality after thrombolysis 24 hours(P < 0.05).7.Stress hyperglycemia: the neurological deficit scores of the stress hyperglycemia group at 24 hours and 7 days after thrombolysis were higher than those of the control group(P <0.05).8.Influence of different Door-to-needle time and blood glucose after thrombolysis: When the Door-to-needle time<30min and the random blood glucose before thrombolysis is 6-9 mmol/L,rt-PA has the highest effective rate and lower mortality after thrombolysis 24 hours(P < 0.05).9.Influence of different glycosylated hemoglobin levels on short-term curative effect after thrombolysis: When Hb A1 c ≥6.5% before thrombolysis,the scores of 24 hours and 7 days NIHSS after thrombolysis with rt-PA decreased,but the scores of Patients with Hb A1 c < 6.5% decreased faster,and the Possibility of bleeding risk and death risk after thrombolysis was lower,the difference was statistically significant(P <0.05).Conclusions:1.The blood glucose level is not related to the infarction type and lesion location of acute ischemic stroke,but positively related to the infarction volume.The higher the blood glucose,the higher the incidence of hypertension and hyperlipidemia.2.When the random blood glucose before thrombolysis was 6-9mmol/L,the effective rate of rt-PA was the highest and the mortality was lower 24 hours after thrombolysis.However,patients with acute ischemic stroke with hyperglycemia can still improve their neurological deficits by thrombolytic therapy.3.Door-to-needle time<30min,Hb A1c<6.5%,the higher the effective rate after thrombolytic treatment for 24 hours,and the lower the possibility of bleeding transformation and death risk.