Analysis Of Early Curative Effect Of Intravenous Thrombolysis For Acute Ischemic Stroke And Establishment Of Prediction Model

ObjectiveThe analysis of early curative effect of intravenous thrombolysis with alteplase is of great significance to prompt vascular recanalization and long-term prognosis of patients with acute ischemic stroke.The purpose of this study is to screen out the factors affecting early curative effect after intravenous thrombolysis and establish a regression prediction model which can evaluate the prediction model through the patients who used intravenous thrombolysis with alteplase in our hospital.The prediction model can improve the overall curative effect of thrombolysis in AIS patients.Method1.A total of 287 patients with intravenous rt-PA thrombolysis intervention in the Department of Neurology,Xiangdong Hospital Affiliated to Hunan Normal University from November 2016 to November 2020 were collected.According to the time of thrombolysis intervention,200 patients from November 2016 to March 2020 were divided into the modeling group.A total of 87 patients from April to November 2020 were assigned to the validation group,and were divided into effective thrombolysis and ineffective thrombolysis according to the prognosis criteria for the efficacy of thrombolysis.2.General clinical data,past medical history and laboratory data of the subjects were collected.In the modeling group,univariate and multivariate analyses were performed to screen the independent influencing factors for early failure after intravenous thrombolysis of rt-PA.3.The regression prediction model for the early efficacy of rt-PA thrombolysis was established,and the receiver operating curve was drawn to evaluate the differentiation and fitting degree of the model.4.The early efficacy prediction model of intravenous thrombolysis was substituted into the validation group to further evaluate the sensitivity and specificity of the model.Results1.Univariate analysis showed that the time from onset to thrombolysis,blood glucose,homocysteine,admission NIHSS score,atrial fibrillation,age,and history of hypertension had significant influence on the early curative effect of intravenous thrombolysis in AIS patients(p<0.05).2.Logistic regression analysis showed that OTT,atrial fibrillation,admission hyperglycemia and admission NIHSS score were independent influencing factors of early ineffectiveness after intravenous thrombolysis of rt-PA,and their OR values(95%CI)were 4.910(2.059-11.712),3.824(1.170-12.498)and 3.562.3.The regression prediction model is established by extracting the independent factor coefficient of regression analysis: logit(p)=-2.634+1.591X1+1.341X2+1.27X3+0.3X4(X1 = OTT < 3h = 0.3 ～4.5h = 1;X2= atrial fibrillation no =0,yes = 1;X3= blood glucose≥11.1mmol/L no =0,yes = 1;X4= original NIHSS score),the area under curve was 0.8802(S.E.:0.026,95%CI: 0.8299 ～ 0.9305,p < 0.001),which was the highest p value of Hosmer Lemeshow test was 0.247.4.The sensitivity and specificity of the validation group were 84.48%and 79.31%,and the model had good prediction function.Conclusions1.OTT,atrial fibrillation,homocysteine,admission NIHSS score,history of hypertension,admission blood glucose and age are the influencing factors of early ineffectiveness after intravenous thrombolysis with rt-PA.2.OTT,atrial fibrillation,admission NIHSS score and admission hyperglycemia are independent influencing factors of early ineffectiveness after intravenous thrombolysis of rt-PA.3.The Logistic regression prediction model for the early efficacy of AIS thrombolysis established in this study can better predict the efficacy of early thrombolysis,which is of great significance for improving the overall efficacy of AIS thrombolysis.