| Objective:Glucose can provide energy for the use of various tissues and orga ns of the body.Only when blood sugar remains within the normal rang e,it can maintain the normal operation of the body.Hyperglycemia or hypoglycemia will bring adverse effects to the body,even very serious or irreversible harm.Chinese guidelines for the diagnosis and treatment of acute ischemic stroke mention that 40% of patients with acute ische mic stroke are accompanied by hyperglycemia.Hyperglycemia is not onl y an independent risk factor for the occurrence of acute ischemic stroke,but also has an impact on the prognosis of ischemic stroke.Recombin ant tissue plasminogen activator(rt-pa)is the first choice of ultra-early i ntravenous thrombolysis therapy drugs,which can effectively improve th e neurological defects of patients with ischemic stroke by accelerating t hrombolysis and inhibiting thrombosis,opening occluded blood vessels,r estoring blood flow,and being recommended by domestic and foreign g uidelines.However,although patients with acute ischemic stroke accomp anied by elevated blood glucose received super-early thrombolytic therap y,the results were unsatisfactory.The progressive deterioration of neurol ogical deficits often occurred,which aggravated the symptoms of ischem ic stroke.Therefore,the purpose of this study was to explore the correl ation between blood glucose level and the prognosis of emergency intra venous thrombolysis in patients with acute ischemic stroke.Methods:222 patients with acute ischemic stroke treated by intravenous thro mbolysis with ateplase were enrolled in Chengde Central Hospital from November 2015 to September 2017,According to the NIHSS score 24 h ours after emergency intravenous thrombolysis,the patients were divided into two groups,184 cases in non-early neurological deterioration grou p and 38 cases in early neurological deterioration group.The clinical da ta were collected retrospectively: age,sex,time from onset to thromboly sis(OTT),systolic and diastolic blood pressure,medcial history(hyperten sion,diabetes,coronary heart disease,dyslipidemia,atrial fibrillation,hy perhomocysteinemia)smoking history,Random blood glucose,fasting bloo d glucose the next day,NIHSS score before thrombolysis,WBC,NEU.Head CT was performed 24 hours before and after rt-PA emergency intr avenous thrombolysis or 24 hours after clinical observation of ischemic stroke symptoms deterioration.Carotid artery ultrasound,transcranial Do ppler and cardiac ultrasound were performed after stable condition.The above data were retrospectively analyzed.The degree of neurological im pairment was evaluated according to the NIHSS score 24 hours after e mergency intravenous thrombolysis.The early neurological deterioration group was defined as the increase of NIHSS score(> 4)24 hours after emergency intravenous thrombolysis.The improvement or increase of N IHSS score within 24 hours after emergency intravenous thrombolysis w as defined as non-early neurological deterioration group.The factors affe cting neurological function were analyzed by single factor and multi-fact or analysis.The ROC curve was established to evaluate the diagnostic e fficacy and determine the optimal diagnostic threshold.Pearson correlatio n analysis was used to compare the correlation.Results:1 Comparison of clinical data between early neurological deteriorati on group and non-early neurological deterioration groupThere were significant differences in age,hyperhomocysteinemia,ty pe 2 diabetes mellitus,coronary heart disease,NIHSS score before thrombolysis,admission random blood glucose,fasting blood glucose the ne xt day,WBC and NEU between the two groups(P<0.05).2 Multivariate logistic regression analysis was used to analyze the early prognosis of rt-PA intravenous thrombolysis.Statistically significant univariate factors were included in multivaria te logistic regression equation.The results showed that random blood gl ucose at admission and fasting blood glucose at the next day were signi ficantly different between the two groups.3 Diagnostic value of admission random blood glucose and fasting blood glucose on the next day for early prognosis of acute ischemic str oke patients undergoing emergency intravenous thrombolysis.The area under ROC curve(AUG)of admission random blood gluc ose was 0.701(95% CI: 0.577-0.825;P was 0.005),the sensitivity was 63.2%,and the specificity was 73.2%.The area under the ROC curve(AUG)of fasting blood glucose was 0.797(95% CI: 0.692-0.903;P < 0.001),the sensitivity was 63.2%,and the specificity was 90.2%.4 The correlation analysis of admission random blood glucose,fasti ng blood glucose the next day and early prognosis of acute ischemic str oke patients after emergency intravenous thrombolysis.Pearson correlation coefficient of admission random blood glucose was-0.216,which indicated that random blood glucose was negatively c orrelated with early prognosis.Pearson correlation coefficient of fasting blood glucose on the next day was-0.340,indicating that fasting blood glucose on the next day was negatively correlated with early prognosis.Conclusions:1 Age,hyperhomocysteinemia,type 2 diabetes,coronary heart disea se,NIHSS score before thrombolysis,random blood glucose upon admis sion,next-day fasting blood glucose,WBC and NEU are the influencing factors for early prognosis of emergency intravenous thrombolysis in pa tients with acute ischemic stroke.2 Admission random blood sugar and fasting blood glucose the next day are independent risk factors for early prognosis of patients with a cute ischemic stroke after emergency intravenous thrombolysis.3 Both random blood glucose on admission and next-day fasting bl ood glucose have predictive value for the early prognosis of emergency venous thrombolysis in patients with acute ischemic stroke,among whic h next-day fasting blood glucose has a higher predictive value.4 The early prognosis of patients with acute ischemic stroke after e mergency intravenous thrombolysis was negatively correlated with admiss ion random blood glucose and the next day fasting blood glucose,espec ially the next day fasting blood glucose. |
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