Analysis Of Influencing Factors Of Different Clinical Outcomes After RT-PA Thrombolytic Therapy In Patients With Acute Cerebral Infarction

Objective: To investigate the influencing factors of different clinical outcomes after intravenous thrombolysis in patients with acute cerebral infarction.Methods: A total of 252 patients with acute cerebral infarction treated by rt-PA thrombolysis were recruited retrospectively.Clinical information of the patients was collected,including age,sex,smoking history,drinking history,hypertension,diabetes,coronary heart disease,arrhythmia,anti-platelet aggregation drugs taken within 1 week before admission,time from onset to thrombolysis,and NIHSS score before thrombolysis.Blood pressure,blood glucose,blood routine,blood lipid,liver and kidney function,highsensitivity c-reactive protein(hs-CRP),d-dimer,Homocysteine(Hcy),coagulation index,white matter lesions,etc.According to different clinical outcomes after thrombolysis.they were divided into effective group,ineffective group and early neurological deterioration(END)group.Baseline and clinical data of each group were collected were collected.Univariate analysis and logistic regression analysis were used to determine the influencing factors of different clinical outcomes in patients with acute cerebral infarction after rt-PA intravenous thrombolysis.Results:(1)In 252 patients with acute cerebral infarction,the overall effective rate was34.9%;(2)General characteristics of subjects: 252 subjects were aged 40-85 years,with an average age of 66.2±12.7 years;There were 162 males(64.3%)and 90 females(35.7.0%).There were 37 patients(42%)in the effective group,69 patients(57%)in the ineffective group,and 26 patients(60.5%)in the END group.Among the three groups,the history of diabetes in the invalid group and the END group was significantly higher than that in the effective group(P < 0.05),The occurrence of END in deep white matter hyperintensity after intravenous thrombolysis has predictive value,but there were no statistically significant differences in the distribution of baseline characteristics such as age,sex,smoking,hypertension,coronary heart disease,arrhythmia and Body mass index(BMI)(P > 0.05).(3)Laboratory examination showed that there were significant differences in NIHSS score before thrombolysis,time from onset to thrombolysis,LDL-C,h-CRP and blood homocysteine(Hcy)(P < 0.05);(4)TOAST typing showed that the proportion of large atherosclerosis in the ineffective and END groups were higher than that in the effective group,and the difference was statistically significant;(5)Logistic regression analysis showed that NIHSS score before thrombolysis,time from onset to thrombolysis,LDL-C,hs-CRP,Hcy and atherosclerosis were independent risk factors for poor prognosis after intravenous thrombolysis in patients with acute cerebral infarction.(6)Prior aspirin use are risk factors of intracranial hemorrhage after thrombolysis in acute stroke.Conclusions:(1)NIHSS score before thrombolysis,time from onset to thrombolysis,LDL-C,hs-CRP,Hcy and atherosclerosis can increase the risk of poor prognosis after intravenous thrombolysis in patients with acute cerebral infarction.(2)Previous aspirin use is a risk factor for intracranial hemorrhage after thrombolytic therapy in acute stroke.(3)Patients with DWL are prone to early neurological deterioration.