White matter hyperintensities and prognosis of patients with acute cerebral infarction treated by intravenous thrombolysis with alteplasejan analysis of influencing factors / 中国脑血管病杂志

ABSTRACT

Objective To investigate the influencing factors of intravenous thrombolysis with altepla.se on acute cerebral infarction patients with different degrees of white matter hyperintensity( WMH). Methods From September 2016 to January 2019,consecutive 326 acute cerebral infarction patients who had WMH and were treated with alteplase for intravenous thrombolysis at Department of Neurology,Xuzhou Central Hospital were retrospectively recruited. All patients completed cranial MRI examination after onset. Fazekas scale was used to evaluate WMH. National Institute of Health stroke scale ( N1HSS) score was used to evaluate the pre-thromkolytic neurological deficiency of the patients. The modified Rankin scale (MRS) was used to evaluate the prognosis at 90 days. According to the niRS score, patients were divided into the good prognosis group ( MRS 2,79 cases). Age,gender, previous risk factors related with cerebrovascular diseases, the pathogenesis of cerebral infarction, related biochemical indexes and NIHSS score before thrombolysis were compared between the two groups. Through the binary Logistic regression analysis, risk factors for poor prognosis of rt-PA intravenous thrombolysis in patients with acute cerebral infarction were identified. Results There was significant difference in age ([ 65 ± 12[ years old vs. [70 ± 12[ years old, t-2. 984, P = 0. 003), history of atrial fibrillation ( 10. 1% [25/247] w.21.5% [ 17/79]= 6. 928, P = 0. 008), history of coronary atherosclerotic disease ( 8. 1 % [ 20/247[ vs. 21.5% [ 17/79[ = 10. 717 , P-0. 001 ) , pre-thrombolylic N1HSS score ( median score 6 [4,10] r$. 12 [8,19],/=-7. 183.Pc0.01) and WMH (no WMH, mild WMH, moderate WMH, severe WMH5.3% [ 13/247[, 55. 9% [ 138/247], 24. 3% [60/247], 14. 6% [36/247] vs. 0,36.7% [29/79] ,34. 2% [ 27/79[, 29. 1 % [23/79],∗' = 17. 631 ,P <0. 01 ).The binary Logistic regression analysis shoved that moderate and severe WMH (OR, 2. 145,95% CI 1. 17-3.49,/' = 0.014) and pre-thrombolytic NIHSS score 9 (OR, I. 131 ,95% CI 1.08-1. 18,/' <0. 01 ) were the independent risk factors for poor prognosis in patients with acute cerebral infarction with alteplase intravenous thrombolysis. Conclusion Moderate and severe WMH and pre-thrombolytic NIHSS score were independent risk factors for poor prognosis in acute cerebral infarction patients treated with intravenous alteplase.