| Background and Objective:The therapeutic efficacy and safety of alteplase intravenous thrombolysis in patients with acute cerebral infarction within 4.5 hours has been widely confirmed,and it is the most commonly used treatment for the early opening of blood vessels in acute cerebral infarction.Statins have been widely used in clinical trials and secondary prevention of acute ischemic stroke in some randomized controlled trials[1].In the acute phase of ischemic stroke,the neurological improvement of statins is still controversial,and studies of neurological improvement and prognosis in patients with acute intravenous thrombolysis are rare.Therefore,the aim of this study was to investigate the effect of intensive statin therapy on 90-day prognosis in patients with acute cerebral infarction treated with intravenous alteplase thrombolysis within 4.5hours of onset.Methods:Retrospective analysis of 495 patients with acute cerebral infarction treated with intravenous alteplase intravenous thrombolysis in our hospital from January 2014to July 2016.All patients'demographic data,biochemical indicators and clinical data were collected.Standard doses of statin or booster statin were given within 24 hours of admission.The primary endpoint was to observe a good prognosis 90 days after onset in both groups?modified RanKin Scale,mRS?1?;secondary endpoint:safety of statin therapy in patients with acute cerebral infarction with intravenous thrombolysis?intracranial hemorrhage?ICH??.Results:A total of 495 patients were enrolled,including 374?75.6%?in the intensive statins treatment group and 121?24.4%?in the standard dose statins treatment group.?1?The baseline data showed that there was no significant difference in age,sex,history of hypertension,stroke,coronary heart disease and atrial fibrillation,Infarct location,TOAST classification,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,and Hypersensitive C-reactive protein between the intensive statins treatment group and the standard dose statins treatment group.In the patients of intensive statins treatment group with the standard dose statins group in diabetes?36?29.8%?,76?20.3%?,P=0.034?,TG?mmol/l,sd??1.497±0.888,1.758±1.579,P=0.021?,baseline NIHSS score?12,8,P=0.034?,24-hour NHISS score?12,7,P=0.002?,14-day NIHSS score?9,6,P=0.009?were statistically significant?P<0.05?.Univariate analysis showed that there are statistically significant between the favorable functional outcome group and the poor outcome group were in atrial fibrillation?23?9.0%?,75?31.45?,P<0.001?,infarct location?anterior circulation??165?64.5%?,193?80.8%?,P<0.001?,statin therapy?intensive statin??215?84.0%?,159?66.5%?,P<0.001?,TG?mmol/l,sd??1.886±1.591,1.488±1.241,P=0.002?,HDL-C?mmol/l,sd??1.034±0.245,1.117±0.262,P<0.001?,hsCRP?mg/l,sd??6.339±11.724,12.478±23.878,P<0.001?,baseline NIHSS score?6,13,P<0.001?,24-hour NISS score?3,13,P<0.001?,14-day NIHSS score?1,13,P<0.001?,intracranial hemorrhage?ICH??15?5.9%?,49?20.5%?,P<0.001?,symptomatic intracranial hemorrhage?SICH??0?0.0%?,10?4.2%?,0.001?;in other words,the patients of favorable functional outcome often with a history of atrial fibrillation,anterior circulation infarction,more severe the neurological deficit,intracranial hemorrhage or high level sCRP.On adjusted multivariate analysis,intensive statins use in the acute phase who received intravenous thrombolysis was associated with favorable functional outcome?OR 2.017,95%CI 1.066-3.816?.Conclusion:In patients with acute cerebral infarction who received intravenous thrombolysis within 4.5 hours of onset,early administration of intensive statin was safe and helped to improve the clinical outcome of 90 days. |
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