| PurposeThrough the analysis of the factors affecting the short-term clinical efficacy and prognosis of patients with acute cerebral infarction after intravenous thrombolysis with alteplase,the purpose of this study is to find a reliable index that can evaluate the benefits of patients after IVT as early as possible,so as to provide a reliable theoretical basis for clinical individualized treatment and improving the improvement rate of patients.MethodA retrospective analysis was made on 104 ACI patients who received IVT by rt-p A in the emergency department of Nanchang University from 2019 to 2021.The diagnosis accorded with the standard of Chinese guidelines for diagnosis and treatment of Acute Ischemic Stroke 2014.The short-term clinical efficacy and 90-day prognosis were evaluated respectively.According to the improvement of neurological function at 24 hours after IVT,the short-term clinical efficacy was divided into short-term improvement group and short-term non-improvement group,and they were divided into good prognosis group and poor prognosis group according to90-day modified rankin scale.The general demographic data,hematology and imaging examination of all patients,baseline National Institute of Health stroke scale,NIHSS score,90 dm RS score and other conditions after 24 hours of thrombolysis were collected.Result1.A total of 104 patients with ACI were enrolled in this study.There were 70 males and 34 females,aged from 41 to 91 years old,with an average of(68.2 ±11.53)years.2.According to the reduction rate of NIHSS score 24 hours after IVT,66 patients in the improvement group(63.5%)and 38 patients in the non-improvement group(36.5%)were divided into two groups.Univariate analysis showed that compared with the non-improvement group,the improvement group had lower homocysteine level(P=0.030),fewer risk factors for cerebrovascular disease(P <0.001)and higher level of free triiodothyronine(P < 0.001).There are differences among different age groups(P=0.002).Binary Logistic multivariate regression analysis showed that low level FT3(OR=6.768,95%CI:2.004-22.854,P=0.002)was an independent risk factor for the improvement of neurological function in patients with ACI 24 hours after IVT.3.According to 90 dm RS score,there were 20 cases(19%)with good prognosis after 90 days and 84 cases(81%)with poor prognosis after 90 days.Univariate analysis showed that there were differences in age(P < 0.001),different age groups(P =0.012),pre-thrombolysis prothrombin time(P = 0.003)and atrial fibrillation(P=0.014).The lower the baseline NIHSS score(P < 0.001),the lower the urea level(P= 0.010),the lower the α-HBDH level(P =0.022)and the lower the B-type brain natriuretic peptide level(P=0.036),the better the clinical prognosis 90 days after IVT.Binary Logistic multivariate regression analysis showed that baseline NIHSS score(OR=1.262,95%CI:1.068-1.492,P=0.006),α-HBDH(OR=1.025,95%CI:1.005-1.046,P=0.013)and PT before thrombolysis(OR=0.006,95%CI:0.251-0.796,P=0.006)were independent factors affecting clinical prognosis 90 days after IVT.Conclusion1.FT3 is an independent factor affecting the improvement of neurological function in patients with ACI after IVT,and high level of FT3 is a protective factor of neurological function.2.Baseline NIHSS score,α-HBDH and pre-thrombolytic PT level were independent prognostic factors of ACI patients 90 days after IVT,and high baseline NIHSS score and α-HBDH were independent prognostic factors of poor prognosis.3.Age,atrial fibrillation,CRF,B-type brain natriuretic peptide and urea are not independent influencing factors,but they are related to the improvement of neurological function and prognosis in the near future.4.Strict control of the indications before thrombolysis,evaluation and reasonable control of relevant risk factors,such as stable reduction of blood pressure,blood glucose before thrombolysis,dynamic monitoring of patients’ blood coagulation function,etc.,can improve the effective rate of IVT. |
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