| Background Cerebral infarction（CI）,also known as ischemic stroke,is due to various factors leading to insufficient blood supply of brain tissue,making irreversible ischemic necrosis of local brain tissue,which is mainly manifested in a series of neurological deficit symptoms in clinical practice.CI is a common and frequently-occurring disease worldwide,which is often caused by cerebral atherosclerosis.CI has the characteristics of high recurrence,high disability and high lethality,which brings a heavy burden to society and families.Acute cerebral infarction（ACI）contains no uniform standard of time range,usually within 2 weeks after the onset of cerebral infarction,for mild patients within 1 week of onset,severe patients within 1 month of onset.The specific treatment methods for ACI are mainly intravenous thrombolysis and intravascular interventional therapy within the time window.Recombinant Human Tissue Plasminogen Activator for Injection（rt-PA）is a kind of gene recombinant protease,which can promote fibrin degradation,dissolve thrombus specifically,and has less risk of bleeding.The American Stroke Association and the Chinese Stroke Association clearly recommended that rt-PA intravenous thrombolysis should be performed for acute cerebral infarction within 4.5 h of onset.Ischemic stroke is divided into anterior circulation stroke（ACS）and posterior circulation stroke（PCS）according to the vascular dominant region.The former refers to the internal carotid artery system,and the latter involves the vertebral-basilar artery and its branches.The pathophysiological mechanisms,clinical features and prognosis of the two are not exactly the same.Understanding the difference in the effect of rt-PA intravenous thrombolysis between the two is helpful to guide the specific treatment of different parts of cerebral infarction at ultra-early stage,but the current research on the correlation between the two is limited.Objective This study aims to explore the clinical efficacy and bleeding conversion rate of patients with acute cerebral infarction before and after rt-PA treatment,and analyze the related factors affecting the efficacy of intravenous thrombolysis.Method A total of 123 ACI patients with rt-PA intravenous thrombolysis in Department of Neurology,Chaohu Hospital Affiliated to Anhui Medical University from November2019 to April 2021 were collected and divided into two groups according to the infarct location: ACS group（n = 89）and PCS group（n = 34）.The general clinical data（gender,age,past medical history,admission systolic blood pressure,admission diastolic blood pressure,onset-thrombolysis time,admission-thrombolysis time,etc.）and serological indexes（platelet,cholesterol,triglyceride,activated partial thromboplastin time,prethrombolysis blood glucose,glycosylated hemoglobin,homocysteine,etc.）of all the enrolled patients were collected,and the National Institutes of Health Stroke Scale（NIHSS）was used to evaluate the neurological deficits of all the enrolled patients.The decrease of NIHSS score 7 days after thrombolysis was used as the evaluation standard of thrombolytic efficacy.Results（1）Background data: There were statistically significant differences in gender（r= 13.308,P = 0.000）and onset-thrombolysis time（t =-2.555,P = 0.012）between ACS group and PCS group.In terms of gender,the proportion of women in ACS group was higher than that in PCS group.In terms of onset-thrombolysis time,the onsetthrombolysis time of ACS group was shorter than that of PCS group（P < 0.05）.There were no significant differences in age,medical history,systolic blood pressure,diastolic blood pressure and admission-thrombolysis time between the two groups.（2）Serological indicators: There were no significant differences in platelet,cholesterol,triglyceride,activated partial thromboplastin time,blood glucose before thrombolysis,glycosylated hemoglobin and homocysteine between ACS group and PCS group.（3）NIHSS score at different time points: There was no significant difference in NIHSS score at admission between ACS group and PCS group;NIHSS scores of PCS group at each time point（2 h,24 h,7 d）after thrombolysis were lower than those of ACS group（all P < 0.05）.（4）Thrombolytic efficacy: The effective rate of rt-PA intravenous thrombolysis in PCS group was higher than that in ACS group（r = 3.932,P = 0.047）.（5）Thrombolytic hemorrhage conversion rate: There was no significant difference between ACS group and PCS group（P > 0.05）.（6）Independent risk factors affecting thrombolytic effect: Binary Logistic regression analysis showed that infarction site（anterior circulation）,NIHSS score at admission and glycosylated hemoglobin were independent risk factors for poor thrombolytic effect of rtPA（all P < 0.05）.Conclusions Rt-PA intravenous thrombolysis is more effective for PCS patients;there was no significant difference in the conversion rate of rt-PA intravenous thrombolysis bleeding between ACS group and PCS group;anterior circulation cerebral infarction,higher NIHSS score at admission and higher glycosylated hemoglobin level suggest that rt-PA intravenous thrombolysis is not effective,which needs to be paid attention to by clinicians. |
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