Value Of Serum Biological Markers In Predicting Prognosis Of Patients With Super Early Cerebral Infarction After Intravenous Thrombolysis Of Recombinant Tissue Plasminogen Activator

Objective:To investigate the value of serum cystatin C,fibrinogen and homocysteine in predicting prognosis of patients with super early cerebral infarction(AMCI)after intravenous thrombolysis of recombinant tissue plasminogen activator(rt-PA).Methods : We screened 102 patients admitted to Department of Neurology of Guangxi Zhuang Autonomous Region People's Hospital,the onset time was within 4.5h in patients with super early cerebral infarction,complied with the requirements for intravenous thrombolysis therapy and accepted rt-PA intravenous thrombolysis.Their clinic data and laboratory parameters were recorded on admission.Outcome index was the prognosis at the 90 d after intravenous thrombolysis,according to the modified Rankin Scale(m RS)score,the eligible patients were divide two group: favorable prognosis group and poor prognosis group.The risk factors for poor prognosis of patients accepted rt-PA intravenous thrombolysis were analyzed by univariate and multivariatelogistic regression analysis.ROC curve was used to analyze the predictive value of serum cystatin C,fibrinogen and homocysteine for poor prognosis of rt-PA intravenous thrombolysis.Result: According to the m RS score of rt-PA intravenous thrombolysis at 90 d,102 patients were divided into two groups: 57 patients in favorable prognosis group(55.9%)and 45 patients in poor prognosis group(44.1%).1.Analysis of baseline data and laboratory tests showed that the prognosis of the group with favorable prognosis and the poor at age(60.31±10.84,67.57 ± 10.62,P= 0.001),atrial fibrillation(6,16,P=0.020),admission NIHSS score(6,15,P < 0.001),serum cystatin C(0.77 ±0.21,1.14±0.47,P < 0.001),and fibrinogen(2.87 ±0.84,4.16 ±1.53).P < 0.001)and homocysteine(11.64 ±4.43,13.57 ±4.99,P=0.041)were statistically significant(P < 0.05).2.Multivariate logistic regression analysis showed that NIHSS score,serum cystatin C,fibrinogen and homocysteine were independent risk factors for poor prognosis after rt-PA intravenous thrombolysis(OR=1.419,95%CI 1.160-1.736,P=0.001;OR=11.916,95%CI 1.601-88.699,P=0.016;OR=2.610,95%CI 1.125-6.057,P=0.026;OR=1.201,95%CI 1.029-1.402,P=0.020).3.The diagnostic cut-off value of serum cystatin C level for poor prognosis of rt-PA intravenous thrombolysis was 1.05mg/L with a sensitivity of 53.3% and a specificity of 91.2%.The diagnostic cut-off value of serum fibrinogen level for poor prognosis of rt-PA intravenous thrombolysis was 3.33g/L with a sensitivity of 73.3% and a specificity of 77.2%.The diagnostic cut-off value of serum homocysteine level for poor prognosis of rt-PA intravenous thrombolysis was 11.89 umol/L with a sensitivity of 66.2% and a specificity of 59.6%.