87例大血管闭塞急性缺血性卒中患者阿替普酶静脉溶栓后疾病转归的影响因素分析

Influencing factors of disease outcome after intravenous alteplase thrombolysis in 87 patients with acute ischemic stroke due to large vessel occlusion

目的分析87例大血管闭塞急性缺血性卒中(AIS⁃LVO)患者阿替普酶(rt⁃PA)静脉溶栓后疾病转归的影响因素。方法选取2019年2月至2021年10月本院收治的87例AIS⁃LVO患者为研究对象,根据出院或rt⁃PA静脉溶栓后14d采用改良Rankin量表(mRS)评价患者临床转归,≤2分作为转归良好组(50例),>2分作为转归不良组(37例)。收集两组临床资料,比较两组基线临床特征、生化常规[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL⁃C)、脂蛋白a、C⁃反应蛋白(CRP)、降钙素原(PCT)、肌酐、血红蛋白]、吞咽功能障碍、美国国立卫生研究院卒中量表(NIHSS)评分。Logistic多因素回归分析相关影响因素,受试者工作特征(ROC)曲线分析Logistic回归模型对溶栓后转归不良的预测价值。结果转归不良组心房颤动、饮酒、TG、TC、LDL⁃C、脂蛋白a、肌酐、白细胞、中性粒细胞、CRP、NIHSS评分、卒中严重程度、吞咽功能障碍、PCT、嗜酸性粒细胞与转归良好组比较差异有统计学意义(P<0.05);中性粒细胞、白细胞、嗜酸性粒细胞、NIHSS评分、卒中严重程度、脂蛋白a、CRP、PCT、TG、TC、LDL⁃C水平是溶栓后转归不良的独立危险因素(P<0.05);ROC曲线分析显示曲线下面积(AUC)为0.888,敏感度为83.78%,特异度为84.00%。结论中性粒细胞、白细胞、嗜酸性粒细胞、NIHSS评分、卒中严重程度、脂蛋白a、CRP、PCT、TG、TC、LDL⁃C水平是AIS⁃LVO患者rt⁃PA静脉溶栓后转归不良的影响因素,临床应针对影响因素积极干预、制定相关措施,以降低溶栓后转归不良发生率。

Objective To analyze the influencing factors of disease outcome after alteplase(rt⁃PA)intravenous throm⁃bolysis in 87 patients with acute ischemic stroke with large vessel occlusion(AIS⁃LVO).Methods A total of 87 patients with AIS⁃LVO who were admitted to our hospital from February 2019 to October 2021 were selected as the research objects,and the clinical outcomes of the patients were evaluated by modified Rankin Scale(mRS)according to discharge or 14 days after intravenous thrombolysis with rt⁃PA.,≤2 points as a good outcome group(50 cases),>2 points as a poor outcome group(37 cases).The clinical data of the two groups were collected,and the baseline clinical characteristics,biochemical routines(triglyceride(TG),total cholesterol(TC),low⁃density lipoprotein(LDL⁃C),lipoprotein a,C⁃reactive protein(CRP))were compared between the two groups.,procalcitonin(PCT),creatinine,hemoglobin,swallowing dysfunction,Na⁃tional Institutes of Health Stroke Scale(NIHSS)score.Logistic multivariate regression analysis of relevant influencing fac⁃tors,receiver operating characteristic(ROC)curve analysis of the predictive value of Logistic regression model for poor out⁃come after thrombolysis.Results Atrial fibrillation,drinking,TG,TC,LDL⁃C,lipoprotein a,creatinine,white blood cells,neutrophils,CRP,NIHSS score,stroke severity,swallowing dysfunction,PCT,eosinophils in the poor outcome group Com⁃pared with the good outcome group,the difference was statistically significant(P<0.05);neutrophils,white blood cells,eo⁃sinophils,NIHSS score,stroke severity,lipoprotein a,CRP,PCT,TG,TC,LDL⁃C level was an independent risk factor for poor outcome after thrombolysis(P<0.05);ROC curve analysis showed that the area under the curve(AUC)was 0.888,the sensitivity was 83.78%,and the specificity was 84.00%.Conclusion The levels of neutrophils,leukocytes,eosinophils,NIHSS score,stroke severity,lipoprotein a,CRP,PCT,TG,TC,and LDL⁃C are the outcomes of patients with AIS⁃LVO after intravenous thrombolysis with rt⁃PA.Adverse influencing factors should be actively intervened in clinical practice and rele⁃vant measures should be formulated to reduce the incidence of adverse outcomes after thrombolysis.