Objective To investigate the predictive factors of no early improvement and their impact on outcomes after alteplase intravenous thrombolysis in patients with acute ischemic stroke.Methods Between March 2015 and March 2016,the clinical data of the patients with acute ischemic stroke admitted to the Department of Neurology,Fengcheng People's Hospital and treated with intravenous thrombolysis were analyzed retrospectively.The National Institutes of Health Stroke Scale score declined ＜4 within 24 h after admission was defined as no early improvement,and the modified Rankin Scale score ＞ 2 at 3 months was defined as poor outcome.Multivariate logistic regression analysis was used to determine predictors of no early improvement and their impact on outcomes.Results A total of 85 patients were enrolled,aged 63.88 ± 11.12 years,63 (74.1％) were males;45 (52.9％) had no early improvement,40 (47.1％) had early improvement;48 (56.5％) had good outcome at 3 months,and 37 (43.5％) had poor outcome.The proportion of hypertension (73.3％ vs.45.0％;x2 =7.083,P =0.008) and diabetes mellitus (33.3％ vs.15.0％;x2 =3.826,P =0.051),as well as the baseline fasting blood glucose (8.74 ± 4.28 mmol/L vs.6.87 ±2.57 mmol/L;t=2.471,P=0.016) in the no early improvement group were significantly higher than those in the early improvement group.Multivariate logistic regression analysis showed that hypertension alone was an independent risk factor for no early improvement after intravenous thrombolysis with ateplase (odds ratio 2.896,95％ confidence interval 1.108-7.570;P =0.030).The proportion of early improvement in the good outcome group was significantly higher than that in the poor outcome group (58.3％ vs.32.4％;x2=5.626,P=0.018).Multivariate logistic regression analysis showed that early improvement might be a independent predictor of good outcome (odds ratio 3.187,95％ confidence interval 1.099-9.242;P =0.033).Conclusion In patients treated with alteplase thrombolytic therapy,hypertension was an independent risk factor for no early improvement,and no early improvement was independently associated with poor outcome.%目的 探讨阿替普酶静脉溶栓早期无改善的预测因素及对其转归的影响.方法 回顾性分析2015年3月至2016年3月期间丰城市人民医院神经内科住院并接受阿替普酶静脉溶栓治疗的急性缺血性卒中患者的临床资料,入院24h内美国国立卫生研究院卒中量表评分较基线下降＜4分定义为早期无改善,3个月时改良Rankin量表评分＞2分定义为转归不良.应用多变量logistic分析确定早期无改善的预测因素及其对转归的影响.结果 共纳入85例患者,年龄(63.88±11.12)岁,男性63例(74.1％);早期无改善45例(52.9％),早期改善40例(47.1％);3个月时转归良好48例(56.5％),转归不良37例(43.5％).早期无改善组高血压(73.3％对45.0％;x2 =7.083,P=0.008)和糖尿病(33.3％对15.0％;x2 =3.826,P=0.051)患者的构成比以及基线空腹血糖[(8.74±4.28) mmol/L对(6.87±2.57) mmol/L;t =2.471,P=0.016)显著高于早期改善组.多变量logistic回归分析显示,仅高血压是阿替普酶静脉溶栓早期无改善的独立危险因素(优势比2.896,95％可信区间1.108～7.570;P=0.030).转归良好组早期改善的患者比例显著高于转归不良组(58.3％对32.4％;x2 =5.626,P=0.018);多变量logistic回归分析显示,早期无改善是转归不良的独立预测因素(优势比3.187,95％可信区间1.099～9.242;P=0.033).结论 高血压为阿替普酶溶栓治疗患者早期无改善的独立危险因素,早期无改善与转归不良独立相关.
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