Influence Of Serum Homocysteine Level On Efficacy And Prognosis Of Intravenous Thrombolytic Therapy In Patients With Acute Ischemic Stroke

Background and Objective:Acute ischemic stroke(AIS)is the second most common cause of death in the world and its morbidity and prognosis are affected by many factors.To the best of our knowledge,homocysteinemia(HHcy)is a well-known risk factor for ischemic stroke.However,whether HHcy can influence the treatment outcome of AIS patients has yet to be fully determined.In this study,we investigated the influence of serum homocysteine(Hcy)level on the efficacy and prognosis of intravenous thrombolytic therapy of recombinant tissue plasminogen activator(rt-PA)in patients with AIS.Methods:The clinical data of 386 antierior circulation AIS patients with rt-PA treated by intravenous thrombolytic therapy from January 2014 to July 2016 were retrospectively analyzed.The serum Hcy levels below 15 mol / l were non-high Hcy group,and those with higher serum Hcy level than 15 mmol / l were high Hcy group.The National Institute of Health Stroke Scale(NHISS)score,the modified Rankin Scale(m RS)score at 90 days after treatment were recorded before treatment,24 h after treatment and 14 d after treatment respectively.To analyze the relationship between Hcy and rt-PA intravenous thrombolytic effect and prognosis in patients with AIS.Receiver operating characteristic curve(ROC)was employed to assess whether serum Hcy levelcan be used as an index to predict the outcome after rt-PA treatment.Results:According to the serum Hcy level at admission,386 patients were divided into two groups: There were 252 cases in non-high Hcy group and cases134 in high Hcy group. (1)The baseline data showed that there was no significant difference in sex,history of hypertension,history of diabetes,history of coronary heart disease and history of atrial fibrillation between non-high Hcy group and high Hcy group.analysis of baseline data shows,HHcy group of patients with non HHcy in age(63.96±10.87,61.96±10.61,P = 0.034),NIHSS score on admission(11.59±8.29,8.53±7.19,P < 0.001),discharge the NIHSS score(8.77±9.31,5.02±7.27,P < 0.001),s ICH(10,2,P = 0.026),the 90 {DMRS score 3(1,5),1(0,3),P < 0.001}.(2)The single factor analysis results show that good prognosis and bad prognosis groups in age(64.91±10.46,61.37±10.73,P = 0.034),the history of atrial fibrillation(75,31,P < 0.001),NIHSS on admission(14.75±8.11,6.50±5.53,P < 0.001),TOAST classification,Hcy levels,discharge the NIHSS(14.16±8.78,1.96±3.10,P < 0.001),s ICH(12,0,P < 0.001),and other factors on the difference was statistically significant(P < 0.05),the poor prognosis group compared with the group of patients with good prognosis,average age is on the high side,there are a history of atrial fibrillation,nerve function defect severity on admission is on the high side,a higher percentage of HHcy,discharge when the nerve function defect severity on the high side,are more likely to appear after thrombolysis s ICH,prone to deterioration of neurological function after thrombolysis.But in prognosis of thrombolysis and sex,smoking history,addicted to wine history history,history of hypertension,diabetes mellitus,history of coronary heart disease,systolic blood pressure,thrombolysis time window,blood lipids and biochemical indexes such as risk factors,there was no statistically significant difference(P > 0.05).(3)the single factor analysis results in the difference was statistically significant(P < 0.05)of the indicators as independent variable,with poor prognosis in patients with(m RS > 2)as the dependent variable multiariable logistic regression analysis(table 5),the results show that the history of atrial fibrillation(OR 2.831,95% CI 2.831 1.223)at discharge NIHSS score(OR 1.481,95% CI 1.481 1.349),Hcy levels(OR 2.102,95% CI 2.102 1.114)is the AIS patients vein thrombolysis is an independent predictor of poor prognosis.Among them,the higher the Hcy level,the higher the risk of poor prognosis.(4)ROC indicates that Hcy level is a moderately sensitive index,and the analysis results show that the ROC analysis shows that AUC=0.646,S.E=0.025,P < 0.001,95%CI: 0.597-0.696.The recent critical value was 17.435,the sensitivity was 49.3%,and the specificity was 80.2%.Conclusion:High serum Hcy level is related to the poor prognosis of rt-PA in antierior circulation AIS patients,and Hcy level can be used as one of the predictors of poor prognosis of AIS patients after rt-PA thrombolytic therapy.