房颤、血清CysC、Hcy水平对rt-PA静脉溶栓治疗急性脑梗死患者预后结局的影响  

Effects of atrial fibrillation, serum CysC and Hcy levels on the prognosis of patients with acute cerebral infarction treated with rt-PA intravenous thrombolysis

作　　者：王联军 李世芳 WANG Lianjun;LI Shifang(Neurology Department,Third Hospital of Baoji City,Baoji 721004,China)

机构地区：[1]宝鸡第三医院神经内科,陕西宝鸡721004

出　　处：《临床医学研究与实践》2022年第4期17-20,共4页Clinical Research and Practice

摘　　要：目的探讨房颤、血清胱抑素C(CysC)、同型半胱氨酸(Hcy)水平对阿替普酶(rt-PA)静脉溶栓治疗急性脑梗死(ACI)患者预后结局的影响。方法回顾性分析我院2017年5月至2020年2月收治的100例采用rt-PA静脉溶栓治疗的ACI患者的临床资料,根据治疗后90 d的预后情况将患者分为预后良好组(67例)和预后不良组(33例)。比较两组的一般资料及实验室指标。分析影响ACI患者rt-PA静脉溶栓治疗预后的危险因素。结果预后不良组的合并冠心病率、房颤率、美国国立卫生研究院神经功能缺损量表(NIHSS)评分高于预后良好组,格拉斯哥昏迷量表(GCS)评分低于预后良好组,差异具有统计学意义(P<0.05)。两组的白细胞计数(WBC)、中性粒细胞计数、血小板计数(PLT)及血肌酐(Scr)、尿素氮(BUN)、纤维蛋白原(Fib)、血糖(GLU)水平比较,差异无统计学意义(P>0.05);预后不良组的CysC、Hcy、D-二聚体(D-D)水平及糖化血红蛋白(HbA1c)高于预后良好组,差异具有统计学意义(P<0.05)。Logistic回归分析结果显示,房颤、NIHSS和GCS评分、CysC和Hcy水平是ACI患者rt-PA静脉溶栓治疗预后不良的独立危险因素(P<0.05)。结论伴有房颤及CysC、Hcy水平增高是ACI患者rt-PA静脉溶栓治疗预后恢复不良的独立危险因素,临床治疗过程中应对上述指标进行监测,以及时调整治疗方案,进而提高患者的预后效果。Objective To investigate the effects of atrial fibrillation, serum cystatin C(CysC) and homocysteine(Hcy)levels on the prognosis of patients with acute cerebral infarction(ACI) treated with alteplase(rt-PA) intravenous thrombolysis. Methods The clinical data of 100 patients with ACI treated with rt-PA intravenous thrombolysis admitted in our hospital from May 2017 to February 2020 were analyzed retrospectively, and the patients were divided into good prognosis group(67 cases) and poor prognosis group(33 cases) according to the prognosis at 90 d after treatment. The general data and laboratory indexes of the two groups were compared. The risk factors affecting the prognosis of rt-PA intravenous thrombolysis therapy in patients with ACI were analyzed. Results The combined coronary heart disease rate atrial fibrillation rate, and the national institutes of health neurological impairment scale(NIHSS) score in the poor prognosis group were higher than those in the good prognosis group, and the Glasgow coma scale(GCS) score was lower than that in the good prognosis group, and the differences were statistically significant(P<0.05). There were no significant differences in the white blood cell count(WBC), neutrophil count, platelet count(PLT) and serum creatinine(Scr), urea nitrogen(BUN), fibrinogen(Fib) and blood glucose(GLU) levels between the two groups(P >0.05);the levels of CysC,Hcy, D-dimer(D-D) and glycosylated hemoglobin(HbA1 c) in the poor prognosis group were higher than those in the good prognosis group, and the differences were statistically significant(P<0.05). Logistic regression analysis result showed that atrial fibrillation, NIHSS and GCS scores, CysC and Hcy levels were independent risk factors for poor prognosis of ACI patients treated with rt-PA intravenous thrombolysis(P <0.05). Conclusion Accompanied by atrial fibrillation,increased CysC and Hcy levels are independent risk factors for poor prognosis of ACI patients treated with rt-PA intravenous thrombolysis. The above indexes should be monitored du

关 键 词：阿替普酶 静脉溶栓 急性脑梗死 神经功能 房颤 胱抑素C 同型半胱氨酸 

分 类 号：R743[医药卫生—神经病学与精神病学]