Early Neurological Deterioration After Intravenous Thrombolysis With Alteplase In Patients With Uric Acid And Acute Cerebral Infarction Related Research

Objective: Through retrospective analysis of early neurological deterioration(END)after thrombolysis in patients with acute cerebral infarction,factors affecting END were analyzed,and the correlation between uric acid level and END was discussed,so as to provide help for the treatment of END after thrombolysis.Methods: Patients with acute cerebral infarction who received alteplase intravenous thrombolysis in Inner Mongolia Forestry General Hospital from October 2018 to October2022 were continuously enrolled.According to the changes of NIHSS scores after thrombolysis,the patients were divided into non-end group and END group.The basic information,clinical manifestations and laboratory tests of the two groups were recorded,the risk factors of stroke were assessed,the differences in serum uric acid of the patients were analyzed,the influence of serum uric acid on neurological deterioration in the early stage of acute cerebral infarction after thrombolysis was discussed,and the risk factors for the occurrence of END were analyzed.Results: A total of 196 consecutive patients were collected,33 patients were excluded because they did not meet the inclusion criteria,a total of 163 patients were enrolled in the study,and 31 patients(19.02%)had END.Univariate analysis showed that the END group had higher uric acid(P<0.05),and lower fasting blood glucose(P<0.05),higher systolic blood pressure(P<0.05),higher white blood cells(P<0.05),higher D-dimer(P<0.05);Multivariate binary Logistic regression analysis showed that uric acid(OR=1.012;95%CI: 1.004-1.019;P=0.002)were significantly associated with END after thrombolysis in AIS.A B value of 0.012 is a positive value,indicating that high uric acid indicates the risk of END after thrombolysis in AIS.In addition,systolic blood pressure(OR=1.037;95%CI: 1.012-1.062;P=0.004),white blood cell(OR=1.212;95%CI:1.015-1.447;P=0.034)were the independent risk factors for END after thrombolysis.When uric acid was stratified by gender,it was found that the risk of END was significantly increased when uric acid level was greater than 350μmol/L in adult females and 420μmol/L in adult males.Receiver operating characteristic curve(ROC)analysis showed that the area under the curve(AUC)of uric acid was 0.746,which had a high predictive value for END.The optimal diagnostic cut-off value of serum uric acid was415μmol/L,the specificity was 86.4%,and the sensitivity was 54.8%.Conclusion:1.Elevated serum uric acid,white blood cell levels and systolic blood pressure are important risk factors for early neurological deterioration after thrombolysis in patients with acute cerebral infarction.2.The risk of END is significantly increased in adult women with uric acid levels greater than 350μmol/L and adult men with uric acid levels greater than 420μmol/L.3.The optimal diagnostic cut-off value of serum uric acid in this study was 415μmol/L,the specificity was 86.4%,and the sensitivity was 54.8%.