Factors Influencing the Prognosis of Alteplase Thrombolysis in Acute Ischemic Stroke Patients
LI Qiang
GUO Zhenzhen
Abstract：Objective To investigate the factors influencing the prognosis of alteplase(rt-PA)thrombolysis in patients with acute ischemic stroke(AIS).Methods This retrospective study included 187 consecutive AIS patients treated at Xuchang Municipal Hospital from July 2022 to February 2025 who underwent rt-PA thrombolysis.Patients were grouped based on the occurrence of poor prognosis within 3 months post-treatment:poor prognosis group and favorable prognosis group.Clinical data between the favorable and unfavorable prognosis groups were compared.Variable selection was performed using LASSO regression.Multivariate logistic regression models analyzed factors influencing rt-PA thrombolysis outcomes in AIS patients.Additionally,receiver operating characteristic(ROC)curves were constructed to assess the predictive value for adverse outcomes at 3 months post-treatment.Results This study included clinical data from 187 AIS patients.Statistical analysis revealed that 62 patients had an mRS score ≥3,with a poor prognosis rate of 33.16％,who were assigned to the poor prognosis group.The remaining 125 patients with an mRS score＜3 were assigned to the good prognosis group.Comparison of clinical data between the poor prognosis and favorable prognosis groups revealed significant differences in infarct size,National Institutes of health stroke scale(NIHSS)score at admission,time from onset to thrombolysis,trial of ORG 10172 in acute stroke treatment(TOAST)classification,and length of hospitalization(P＜0.05).C-reactive protein(CRP),brain natriuretic peptide(BNP),and homocysteine(Hey)levels were higher in the poor prognosis group than in the favorable prognosis group(P＜0.05).The incidence of qi deficiency with blood stasis syndrome was higher in the poor prognosis group(54.84％)than in the favorable prognosis group(10.40％)(P＜0.05).LASSO regression identified six characteristic variables for model construction:admission NIHSS score,time from onset to thrombolysis,CRP,BNP,Hey,and qi deficiency with blood stasis syndrome.Multivariate logistic regression revealed that NIHSS score at admission,CRP,BNP,and qi deficiency with blood stasis syndrome were independent predictors of poor prognosis at 3 months post-treatment in AIS patients(P＜0.05).ROC curve analysis revealed the following area under the curve(AUC)values for predicting poor prognosis at 3 months post-treatment:0.850(95％CI:0.791-0.909),0.632(95％CI:0.544-0.721),0.722(95％CI:0.641-0.803),and 0.746(95％CI:0.681-0.812),respectively,indicating their predictive value in assessing the prognosis of AIS patients undergoing rt-PA thrombolysis.Conclusion Patients with acute ischemic stroke may experience poor outcomes following rt-PA thrombolysis.This study identified admission NIHSS score,CRP,BNP,and qi deficiency with blood stasis syndrome as significant prognostic factors.Therefore,constructing a risk prediction model for rt-PA thrombolysis outcomes in AIS patients is feasible and may provide evidence for optimizing subsequent clinical treatment.
Keywords：acute ischemic strokealteplasethrombolysisprognosisinfluencing factortraditional Chinese medicine syndrome
Publication Date：2026-08-28
Online Publishing Date：2026-09-12(First online date of this platform, not the publication date of the document)
Pages：6( 3029-3034 )