Abstract：Objective To investigate the risk factors for early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction.Methods Patients with acute cerebral infarction were selected, who were treated with alteplase thrombolytic therapy within 4.5 h of the onset in our hospital between January 2014 and January 2019. These patients were divided into the early neurological deterioration group and the non-deterioration group according to the occurrence of early neurological deterioration. Demographics, clinical data, and laboratory test indicators were compared between the two groups. The risks factors for early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction were analyzed by using multivariate logistic regression analysis.Results A total of 108 patients with acute cerebral infarction were included in the study, 19 of whom were in the early neurological deterioration group. The age, body weight, proportion of atrial fibrillation, baseline NIHSS score, proportion of major vessel narrow or occlusion, white blood cell counts, and levels of fibrinogen in the early neurological deterioration group were significantly above those in the non-deterioration group. Multivariate logistic regression analysis showed that age(OR=3.285; 95%CI:2.023-5.682; P=0.028),body weight(OR=2.679; 95%CI:1.690-6.287; P=0.039), atrial fibrillation(OR=2.551; 95%CI:1.980-4.235; P=0.027), baseline NIHSS score(OR=3.627; 95%CI:6.267-13.331; P=0.018), and levels of fibrinogen(OR=2.016; 95%CI:4.650-7.823; P=0.031) were significantly correlated with early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction.Conclusions The incidence of early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction is relatively high. Age, body weight, atrial fibrillation, baseline NIHSS scores, and levels of fibrinogen are risk factors for early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction.
Seners P, Turc G, Oppenheim C, et al. Incidence causes and predictors of neurological deterioration occurring within 24h following acute ischaemic stroke: a systematic review with pathophysiological implications[J]. J Neurol Neurosurg Ps, 2015, 86(1):87-94.
[4]
Seet R C, Rabinstein A A. Symptomatic intracranial hemorrhage following intravenous thrombolysis for acute ischemic stroke: a critical review of case definitions [J]. Cerebrovasc Dis, 2012, 34(2):106-114.
[5]
Siegler J E, Boehme A K, Kumar A D, et al. Identification of modifiable and nonmodifiable risk factors for neurologic deterioration after acute ischemic stroke[J]. J Stroke Cerebrovasc Dis, 2013,22(7):E207-E213.
Hill M D, Bucham A M. Thrombolysis for acute ischemic stroke: results of the Canadian alteplase for stroke effectiveness study [J]. CMAJ, 2015, 172(10):1307-1312.
[8]
Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase 3-4.5 h after acute ischeamic stroke(SITS-ISTR):an observational study[J]. Lancet, 2008, 372(9646): 1303-1309.
[9]
Tisserand M, Seners P, Turc G, et al. Mechanisms of unexplained neurological deterioration after intravenous thrombolysis[J]. Stroke, 2014, 45(12):3527-3534.
[10]
Leigh R, Zaidat O O, Suri M F, et al. Predictors of hyperaute clinical worsening in ischemic stroke patients receiving thrombolytic therapy[J]. Stroke, 2004, 35(8):1903-1907.
Siegler J E, Samai A, Semmes E, et al. Early neurological deterioration after stroke depends on vascular territory and stroke etiology [J]. J Stroke, 2016, 18(2): 203-210.
[13]
Kim J M, Moon J, Ahn S W, et al. The etiologies of early neurological deteriroration after thrombolysis and risk factors of ischemia progression[J]. J Stroke Cerebrovasc Dis, 2016, 25(2):383-388.
Lou M, Selin M. Does body weight influence the response to intravenous tissue plasminogen activator in stroke patients[J]. Cerebrovasc Dis, 2009,27:84-90.
[16]
Wang X G, Zhang L Q, Liao X L, et al. Unfavorable outcome of thrombolysis in Chinese patients with cardioembolic stroke: a prospective cohort study[J]. CNS Neurosci Ther, 2015, 21(8): 657-661.
[17]
Sato Y, Ishibashi-Ueda H, Iwakiri T, et al. Thrombus components in cardioembolic and atherothronbotic stokes [J]. Thromb Res, 2012, 130(2): 278-280.
[18]
Whiteley W N, Slot K B, Eernandes P, et al. Risk factors for intracranial hemorrhage in actue ischemic stroke patients treated with recombinant tissue plasminogen activator: a systematic review and meta-analysis of 55 studies [J]. Stroke, 2012, 43(11): 2904-2909.
[19]
Strbian D, Meretoja A, Putaala J, et al. Cerebral edema in acute ischemic stroke patients treated with intravenous thrombolysis[J]. Int J Stroke, 2013, 8(7):529-534.
2020, Vol. 31 
