| Objective To investigate the risk factors of early neurological deterioration (END) in patients with acute cerebral infarc?tion treated with alteplase, and to construct joint predictors and verify the predictive efficacy.Methods The clinical data of 208 pa?tients with acute cerebral infarction treated with alteplase thrombolysis in Huainan First People's Hospital from January 2017 to May 2020 (modeling group) were retrospectively analyzed. According to whether END occurred within 72 hours after treatment, patients were divided into 54 cases of deterioration group and 154 cases of non-deteriorating group. The joint predictive factors were constructed based on the regression coefficients of the risk factors in the modeling group, and the cutoff point was calculated. The predictive effica?cy was verified in 50 patients from June 2020 to August 2020 (validation group).Results The proportion of NIHSS >7 score in the de?terioration group was significantly higher than that in the non-deterioration group (79.6% vs. 46.8%,P<0.05); the incidence of END was the highest within 24 hours after thrombolysis (17.3%). According to univariate analysis, patients' blood glucose, systolic blood pres?sure, body mass index (BMI), white blood cell count, lipoprotein (a), creatinine level, proportion of responsible great vessel occlusion,admission NIHSS score, and TOAST classification and other indicators were related with END occurrence (P<0.05); Multivariate analy?sis found that hyperglycemia, high BMI, high white blood cell count, high lipoprotein (a), high creatinine, occlusion of the responsible great vessels, high NIHSS score at admission were the independent risk factors for END; a joint predictive factor was constructed based on regression coefficients L= 1 × blood glucose + 0.327 × BMI+0.742 × white blood cell count + 0.026 × lipoprotein (a) + 0.143 × creat?inine?2.104 × responsible great vessel occlusion+ 0.225 × NIHSS score at admission, the cut-off point was 38.9846. When the com?bined predictor was applied to 50 patients in the verification group, the prediction accuracy rate was 78.0%, the sensitivity was 75.0%, the specificity was 81.6%, and AUC=0.921.Conclusions The higher the NIHSS score at admission, the greater the risk of END after thrombolysis, and the high incidence period is within 24 hours. The combined predictor has a good predictive effect on the occurrence of END in patients with acute cerebral infarction by alteplase thrombolysis, and can provide reliable help for the clinic. |
