The Effect Of Bilirubin On The Clinical And Hs-CRP Level Of Rt-PA In The Treatment Of Acute Cerebral Infarction

Objectives To explore the effect of different serum total bilirubin levels on the short-term clinical efficacy and long-term prognosis of alteplase（rt-PA）in the treatment of acute cerebral infarction（ACI）,and on the level of high-sensitivity C-reactive protein（hs-CRP）during treatment.Methods From October 2018 to October 2020,a total of 192 patients with acute cerebral infarction were selected as the research subjects,who were all treated with rt-PA thrombolysis in the Neurology Department of North China University of Science and Technology Affiliated Hospital.The patients were divided into groups according to the quartile level of total bilirubin in the initial measurement:49 cases in the Q1 group（≤8.7μmol/L）,55 cases in the Q2 group（>8.7μmol/L,≤11.5μmol/L）,and 42 cases in the Q3group（>11.5μmol/L,≤14.8μmol/L）,46 cases in Q4 group（>14.8μmol/L）.The four groups of patients were given rt-PA intravenous thrombolysis（0.9mg/kg）and conventional drug treatment,and the comprehensive treatment time was 14 days.Statistical analysis was performed by SPSS 22.0 software.The severity of stroke was evaluated by the National Institutes of Health Stroke Scale（NIHSS）of the four groups of patients before treatment and 24 hours,7 days,and 14 days after treatment.And analyze the improvement of nerve function of the four groups of patients after 14 days of treatment,and compare the differences in total effective rate.The neurological recovery of patients was evaluated by the modified Rankin scale（m RS）,and their Self-care ability was evaluated by modified Barthel Index scoring scale（MBI）when followed up for 3 months.At the same time,the changes in serum hs-CRP levels during the treatment period were used to assess the patient’s inflammatory response.Results 1 The NIHSS scores of the four groups of patients decreased after treatment.Repeated measures analysis of variance showed that the differences between time and between-group effects were statistically significant(P_time<0.001;P_{between-group}=0.025);the interaction effect was not statistically significant.Pairwise comparisons between groups and comparisons between groups at the same time indicated that the NIHSS scores of patients in the Q3 and Q4 groups were lower than those in the Q1 group at 7 days and 14days after treatment（P<0.05）.2 At 14 days of treatment,the total effective rates of the four groups were not all equal（P=0.003）.The analysis and comparison of the chi-square method showed that the total effective rate of the Q3 group and the Q4 group was higher than the Q1 group（P<0.05）,and the Q3 group had the highest effective rate.3 After 3months of treatment,the difference in m RS scores of the four groups of patients was statistically significant（P<0.05）.Comparing the Value difference m RS scores before and after treatment among the four groups showed that the nerve function recovery of the Q3group and the Q4 group was better than that of the Q1 group（P=0.029）.Through the analysis of the MBI scores of the four groups of patients,it is shown that the difference in effects within and between groups is statistically significant(P_time<0.001,P_{between-group}=0.012),but the interaction effect is not statistically significant(P_interaction=0.134).Pairwise comparison indicated that the Q3 group and Q4 group were better than the Q1group in the ability of daily living at 3 months after treatment,and the difference was statistically significant（P<0.05）.4 After 3 months of treatment,the good prognosis rates of the four groups of patients were not all equal（P=0.003）.Chi-square analysis and comparison showed that the prognosis of the Q3 group and the Q4 group was better than that of the Q1 group,and the difference was statistically significant（P<0.05）.5 The analysis of serum hs-CRP levels during treatment of the four groups of patients showed that the differences in the time and interaction effects were statistically significant(P_time<0.001;P_interaction=0.001).The results of the pairwise comparison showed that the hs-CRP levels of the Q2,Q3,and Q4 groups were lower than those of the Q1 group at 7 days after treatment（P<0.01）,and the difference between the Q2 group and the Q4 group was statistically significant（P<0.05）.On the 14th day of treatment,the Q3 group and Q4 group were compared with the Q1 group and Q2 group respectively,the difference was statistically significant（P<0.05）,and the difference between the Q4 group and the Q1group was the most significant（P<0.001）.Conclusions This study analyzed the effects of different serum total bilirubin levels on the short-term efficacy,long-term prognosis,and inflammatory response levels of ACI patients treated with rt-PA intravenous thrombolysis.It was found that the short-term clinical symptoms and prognosis of ACI patients with higher levels of serum total bilirubin improved significantly after 3 months,and the total clinical effective rate increased significantly after 14 days of treatment.In the course of treatment,the hs-CRP level of patients with higher levels of serum total bilirubin was significantly reduced,suggesting that serum total bilirubin can alleviate the inflammatory response and play a neuroprotective effect.Figure 3;Table 7;Reference 120...