目的 调查急性缺血性脑卒中(cerebral ischemic stroke,CIS)接受阿替普酶(alteplase,rt-PA)静脉溶栓治疗的早期疗效及预后不佳驱动因素.方法 选取2020年9月—2023年5月南京市栖霞区医院收治的168例CIS患者进行回顾性研究,CIS患者均接受rt-PA溶栓治疗,根据其治疗后90 d预后情况纳入良好组(n=89)、不良组(n=79).比较两组临床资料,调查早期疗效,并分析CIS患者接受rt-PA治疗后预后不佳的驱动因素.结果 经多因素Logistic回归模型显示,高龄、发病至溶栓时间长、溶栓前美国国立卫生研究院卒中量表(Na-tional Institute of Health stroke scale,NIHSS)评分、血糖水平、C反应蛋白(C-reactive protein,CRP)水平、合并高血压均为影响rt-PA静脉溶栓治疗CIS预后不佳的独立危险因素(OR=1.062、1.012、1.093、1.076、1.097、2.392,P<0.05).结论 高龄、发病至溶栓时间长、溶栓前NIHSS评分、高血糖水平、高CRP水平、合并高血压均为影响rt-PA静脉溶栓治疗CIS预后不佳的独立危险因素,因此在对CIS患者进行rt-PA静脉溶栓治疗时,医师可针对以上各个因素进行专业的处理,以改善预后质量.
Objective To investigate the early efficacy and the driving factors of poor prognosis in acute cerebral isch-emic stroke(CIS)treated with alteplase(rt-PA)intravenous thrombolytic therapy.Methods A total of 168 CIS pa-tients admitted to Nanjing Qixia District Hospital from September 2020 to May 2023 were selected for retrospective study.CIS patients received rt-PA thrombolytic therapy,and were divided into good group(n=89)and poor group(n=79)according to their prognosis at 90 days after treatment.The clinical data of the two groups were compared,the early ef-ficacy was investigated,and the driving factors of poor prognosis in CIS patients treated with rt-PA were analyzed.Re-sults Multivariate Logistic regression model showed that advanced age,long time from onset to thrombolysis,National Institute of Health stroke scale(NIHSS)score before thrombolysis,blood glucose level,C-reactive protein(CRP)level and hypertension were independent risk factors affecting the poor prognosis of CIS patients treated with rt-PA intrave-nous thrombolysis(OR=1.062,1.012,1.093,1.076,1.097,2.392,P<0.05).Conclusion Advanced age,long duration from onset to thrombolysis,pre-thrombolysis NIHSS score,high blood glucose level,high CRP level,and combined hypertension are all independent risk factors for poor prognosis of CIS after intravenous thrombolytic therapy with rt-PA.Therefore,physicians can conduct professional treatment for these factors when performing intravenous thrombo-lytic therapy with rt-PA for CIS patients to improve the quality of prognosis.