Analysis Of Influencing Factors Of Early Curative Effect And Long-term Prognosis In Patients With Acute Ischemic Stroke After Intravenous Thrombolysis With Alteplase

Objective To explore the factors influencing the early curative effect and long-term prognosis after intravenous thrombolysis with alteplase in patients with acute ischemic stroke(AIS).Methods A total of 49 patients with AIS who were hospitalized in the Department of Neurology,the first affiliated Hospital of Bengbu Medical College from January 2017 to February 2020 were selected and all of them were treated with intravenous thrombolysis with alteplase within 4.5 hours of onset.The general data of the patients and related serological indexes were collected.According to the neurological improvement rate on the 14 th day after thrombolysis,the early curative effect was divided into effective group(≥ 18%)and ineffective group[< 18% or increased score of National Institutes of Health Stroke scale(NIHSS)].According to the score of modified RANKIN scale(also known as m RS)on the 90 th day after discharge,the long-term prognosis was divided into good prognosis group(m RS score ≤ 2)and poor prognosis group(m RS score > 2).Univariate analysis and multivariate logistic regression analysis were used to analyze the independent risk factors affecting early curative effect and long-term prognosis.Results Univariate analysis showed that age,admission NIHSS score,thrombolysis time window,history of atrial fibrillation,lipoprotein(a)level and fibrinogen(FIB)level were the influencing factors of early curative effect.Admission NIHSS score,lipoprotein(a)level,history of atrial fibrillation,D-dimer level and early curative effect were the influencing factors of long-term prognosis.Multivariate logistic regression analysis showed that high admission NIHSS score(OR=1.035,95%CI:1.013～1.153),thrombolysis time window >3 h(OR=6.447,95%CI:1.740～50.120)and higher FIB level(OR=3.852,95%CI:2.717～17.537)were independent risk factors for ineffective early treatment.High admission NIHSS score(OR=1.163,95%CI:1.012～1.336)and higher lipoprotein(a)level(OR=1.008,95%CI:1.001～1.015)were independent risk factors for poor long-term prognosis.Conclusions FIB and lipoprotein(a)are serum markers of early efficacy and long-term prognosis of thrombolysis,respectively.These two indexes combined with admission NIHSS score can be used as a reference for clinicians to predict the condition and prognosis of AIS patients after intravenous thrombolysis.