Clinical Analysis Of Acute Ischemic Stroke With Increased Troponin

Objective:Observing the factors related to the increase of cardiac troponin(cTn)in patients with acute ischemic stroke(AIS)and explore its clinical significance,so as to provide a basis for the clinical diagnosis and treatment process.Methods:Patients with AIS who were hospitalized in the Department of Neurology of the Second Hospital of Jilin University from August 2018 to August 2019 were enrolled in this study.Patients’ medical history was collected,including age,gender,height,weight,Body Mass Index(BMI),blood pressure,highest Body temperature during hospitalization,and scores of the National Institutes of Health’s Stroke Scale(NIHSS)on admission and discharge,hypertension,diabetes,smoking,drinking,heart disease,stroke,cancer,kidney dysfunction,lower limb vein thrombosis history,laboratory data(myocardial marker,myocardial enzymes,renal function,liver function and blood coagulation routine,blood routine,blood lipid,blood sugar),MRI(Magnetic Resonance Imaging),CT(Computed tomography),Electrocardiogram and other medical history data.According to whether cTn was above the critical value,the patients were divided into two groups: the increased cTn group and the normal cTn group,and the data of the two groups were compared and analyzed.According to the increased level of CTN,they were divided into three groups: mild increase,moderate increase and severe increase,and the data of the three groups were compared and analyzed.SPSS21.0 software was used for statistical analysis,and KolmogorovSmirnov was used to test the data normality.Measurement data following normal distribution were expressed as ± standard deviation(x±s).Comparison between two groups was performed by two independent sample t,one-way analysis of variance used for comparison between three groups.Measurement data that did not follow the normal distribution were represented by(M [P25,P75]),and Kolmogorov-Smirnov Z test was used between the two groups.Kruskal-Wallis test was used between the three groups.Counting data were expressed by frequency(%)and tested by chi-square test.The test results showed that P < 0.05 was considered statistically significant,and P<0.01 means the difference is statistically significant.Result:1.A total of 2290 ACI patients were included,96 patients with incomplete medical history were excluded,and 2194 patients were included in the clinical analysis.144 of the 2194 patients had an increase in cTn,the ratio was 6.6%.Among144 cases,88(61%)were males and 56(39%)were females.There were 2050 cases in the normal cTn group,including 1353 males(66%)and 697 females(34%),with an average age of 61[55,68] years.There were no significant differences in gender,body weight,height,BMI and admission blood pressure between the two groups(P > 0.05).NIHSS scores were significantly different between departure and admission(0.01<P<0.05).There were significant statistical differences in age,level of consciousness and the highest body temperature(P < 0.01).2.There was no statistical difference between the two groups of patients with hypertension,diabetes,smoking history,drinking history and stroke history(P>0.05).There were statistical differences between the two groups of patients with heart disease and renal insufficiency history(P<0.05).There were statistically significant differences in the history of myocardial infarction,unstable angina pectoris,atrial fibrillation and cardiac dysfunction between the two groups(P < 0.01),while there was no statistically significant difference in the history of cardiac stent implantation between the two groups(P > 0.05).3.There were significant statistical differences in pulmonary infection,renal function abnormality,liver function abnormality and pleural effusion between two groups(P < 0.01).4.There were statistically significant differences in infarction size and large volume between the two groups(P < 0.01),while there were no statistically significant differences between small,medium,single lesion,multiple lesion and left and right cerebral hemispheres(P > 0.05).There was no significant difference between the two groups in cerebral lobe,basal ganglia,brainstem,cerebellum,thalamus,corona radiata and center of semiovale(P > 0.05).There was no statistical difference in frontal lobe,temporal lobe,parietal lobe and occipital lobe between two groups(P > 0.05),while there was statistical difference in insula lobe between two groups(P < 0.05).5.There were significant differences in normal electrocardiogram,sinus tachycardia,left anterior branch block,and ST-T changes between the two groups(P<0.01);T wave abnormalities,ST segment changes,q wave/Q wave,QRS wave no Statistical difference(P>0.05).6.There were significant statistical differences in myoglobin,creatine kinase,creatine kinase isoenzyme,lactate dehydrogenase,α-hydroxybutyrate dehydrogenase,super-sensitive C-reactive protein,BNP,prothrombin time,fibrinogen degradation products,glutamic oxalacetic transaminase and white blood cell count between the two groups(P < 0.01).The levels of creatinine,urea nitrogen and uric acid were significantly different(0.01 < P < 0.05).There were no significant differences in the levels of D-dimer,antithrombin,blood homocysteine,glutamic pyruverine transaminase,triglycerides,total cholesterol,low density lipoprotein,high density lipoprotein,fasting blood glucose,2 hours postprandial blood glucose,glycated hemoglobin,red blood cell count,platelet count and hemoglobin(P > 0.05).7.There were statistically significant differences in the number of aggravation and death between the two groups(P < 0.01),while there were statistically significant differences in the number of improvement(0.01 < P < 0.05).8.There were no statistically significant differences in gender,age,height,weight,BMI,consciousness level,blood pressure at admission,NHISS score,previous history and heart history among the three groups(P > 0.05).9.After excluding the patients with previous history of heart disease,renal insufficiency and cancer,there were statistically significant differences between the three groups in creatine kinase isoenzyme and lactate dehydrogenase(P < 0.01),and there were statistically significant differences between the three groups in glutamic-oxalacetic transaminase and glutamic-pyruvic transaminase(P < 0.05).There was no statistical difference between other cases(P > 0.05).Conclusion:1.Patients with increased troponin in acute cerebral infarction have high age,large infarct area,serious neurological defect,many complications,serious condition and poor recovery.2.Increased troponin in acute cerebral infarction is closely related to heart disease,commonly seen in ischemic heart disease,atrial fibrillation,and cardiac insufficiency.3.The higher the level of troponin in patients with acute cerebral infarction,the higher the risk of death.