| Objective:To investigate the safety and efficacy of intravenous thrombolytic therapy in patients with wake-up ischemic stroke(WUIS)when optimized mismatched with diffusion-weighted MR imaging(DWI)-fluid-attenuated inversion recovery imaging(FLAIR).Methods:A total of 261 WUIS patients who were admitted to Yantai Yuhuangding Hospital from January 2021 to December 2022 were enrolled as the research subjects.General information,past medical history,laboratory examination results,brain CT and magnetic resonance imaging(MRI)examination results,National Institute of Health Stroke Scale(NIHSS)score and modified Rankin scale(m RS)score of the patients were collected.Two doctors with rich experience in neuroimaging diagnosis analyzed the imaging data of WUIS patients with double-blind method,and reached an agreement on whether DWI-FLAIR matched.According to the results of brain MRI examination,50 patients were grouped into DWI-FLAIR exact matched group(group A),that is,DWI positive and FLAIR positive,and received routine treatment for cerebral infarction such as antiplatelet aggregation.131patients were grouped into DWI-FLAIR partial matched group(group B),that is,DWI positive and FLAIR partial positive.72 patients who underwent intravenous thrombolysis for cerebral infarction were included in DWI-FLAIR partial matched thrombolysis group(group B1).59 patients who received conventional treatment for cerebral infarction such as antiplatelet aggregation were included in DWI-FLAIR partial matched conventional treatment group(group B2).80 patients were included in DWI-FLAIR complete mismatched group(group C),that is,DWI positive and FLAIR negative.46 patients who underwent intravenous thrombolysis for cerebral infarction were included in DWI-FLAIR complete mismatched thrombolysis group(group C1).34 patients who received conventional treatment for cerebral infarction such as antiplatelet aggregation were included in DWI-FLAIR complete mismatched conventional treatment group(group C2).The main outcome measures were the transformation of intracranial hemorrhage 24h after treatment,while the secondary outcome measures were short-term neurological function improvement at discharge(NIHSS score decreased by≥4 points compared with admission)and good prognosis at 3 months(m RS Score 0-1 points).The safety and efficacy were compared between groups.Multiple logistic regression was used to analyze the factors influencing the good prognosis of WUIS.Results:1.There were no significant differences in age,gender composition,body mass index(BMI),smoking history,drinking history,hypertension history,diabetes history,coronary heart disease history,atrial fibrillation history,fasting blood glucose,glycosylated hemoglobin,triglycerides,high-density lipoprotein,low-density lipoprotein,homocysteine,NIHSS score at admission and m RS Score at admission among these groups.The difference of total cholesterol in laboratory examination results was statistically significant(P<0.05).The proportion of patients with previous history of cerebral infarction in DWI-FLAIR exact matched group(group A)was higher than that in the sum of the other two groups(groups B and C)(18.0%vs 16.0%vs 3.8%,x~2=11.571,P=0.021),and the difference was statistically significant(P<0.05).2.No intracranial hemorrhage transformation occurred in DWI-FLAIR partial matched thrombolysis group(group B1)after intravenous thrombolysis,while DWI-FLAIR complete mismatched thrombolysis group(group C1)after intravenous thrombolysis intracranial hemorrhage transformation occurred in 2 cases(0 vs 4.3%,x~2=3.184,P=0.074).There was no significant difference between the two groups(P>0.05).The DWI-FLAIR partial matched thrombolysis group(group B1)had a lower proportion of short-term neurological improvement(NIHSS score decrease≥4 points)(29.2%vs 52.2%,x~2=6.297,P=0.012)compared with the DWI-FLAIR complete mismatched thrombolysis group(group C1).The difference was statistically significant(P<0.05).The DWI-FLAIR partial matched thrombolysis group(group B1)had a lower proportion of a 3-month good prognosis(m RS score 0-1 points)(73.6%vs 80.4%,x~2=0.722,P=0.395)compared with the DWI-FLAIR complete mismatched thrombolysis group(group C1).There was no significant difference between the two groups(P>0.05).The DWI-FLAIR partial matched thrombolysis group(group B1)had a higher proportion of short-term neurological improvement(NIHSS score decrease≥4 points)(29.2%vs 13.6%,x~2=4.583,P=0.032)and a 3-month good prognosis(m RS score 0-1 points)(76.3%vs 54.2%,x~2=5.342,P=0.021)compared with the DWI-FLAIR partial matched conventional treatment group(group B2).No intracranial hemorrhage conversion occurred in the two groups after treatment.The DWI-FLAIR complete mismatched thrombolysis group(group C1)had a higher proportion of short-term neurological improvement(NIHSS score decrease≥4 points)(52.2%vs 29.4%,x~2=4.145,P=0.042)and a 3-month good prognosis(m RS score 0-1 points)(80.4%vs 52.9%,x~2=6.878,P=0.009)compared with the DWI-FLAIR complete mismatched conventional treatment group(group C2).There were 2 cases of intracranial hemorrhage transformation after intravenous thrombolysis in group C1,while no intracranial hemorrhage transformation occurred in group C2,and there was no statistical significance between the two groups.The optimized DWI-FLAIR mismatched thrombolysis group(group B1&C1)had a higher proportion of short-term neurological improvement(NIHSS score decrease≥4 points)(38.1%vs 19.4%,x~2=8.759,P=0.003)and a 3-month good prognosis(m RS score 0-1 points)(76.3%vs 53.8%,x~2=11.801,P=0.001)compared with the DWI-FLAIR partial matched and complete mismatched conventional treatment group(group B2&C2).There were 2 cases of intracranial hemorrhage transformation after intravenous thrombolysis in group B1&C1,while no intracranial hemorrhage transformation occurred in group B2&C2,and there was no statistical significance between the two groups.3.Multiple logistic regression analysis showed that coronary heart disease history(OR=6.034,95%CI:1.328～27.419,P=0.020),NIHSS score at admission(OR=1.418,95%CI:1.069～1.882,P=0.015),NIHSS score at discharge(OR=0.645,95%CI:0.497～0.838,P=0.001)and m RS score at admission(OR=0.131,95%CI:0.068～0.252,P<0.001)were independent predictors of the 3-month prognosis of patients with WUIS.Conclusion:1.There is no significant difference in intracranial hemorrhage transformation between DWI-FLAIR partially matched WUIS patients and DWI-FLAIR completely unmatched WUIS patients after intravenous thrombolysis,and intravenous thrombolysis is safe for DWI-FLAIR partially matched WUIS patients.The intracranial hemorrhage conversion risk of WUIS patients with DWI-FLAIR partial match was not significantly different from WUIS patients with DWI-FLAIR complete mismatch.It is safe to optimize DWI-FLAIR mismatch,expand the range of DWI-FLAIR mismatch,and allow venous thrombolysis in WUIS patients with DWI-FLAIR partial match.2.DWI-FLAIR partial matched WUIS patients who received intravenous thrombolytic therapy showed better short-term neurological improvement and 3-month prognosis than those who received conventional therapy such as antiplatelet aggregation.DWI-FLAIR complete mismatched WUIS patients who received intravenous thrombolytic therapy showed better short-term neurological improvement and 3-month prognosis than those who received conventional therapy such as antiplatelet aggregation.It is effective to optimize DWI-FLAIR mismatch,expand the range of DWI-FLAIR mismatch,and allow venous thrombolysis in WUIS patients with DWI-FLAIR partial match.3.Coronary heart disease history,NIHSS score at admission,NIHSS score at discharge and m RS score at admission were independent predictors of the 3-month prognosis of patients with WUIS. |
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