Therapeutic effect of alteplase for injection on acute cerebral infarction patients with different serum asymmetric dimethylarginine levels

Sun Yan; Wang Gang; Liu Hongna; Liang Panpan

doi:10.3760/j.issn.1673-4777.2024.04.009

Abstract：Objective To analyze the therapeutic effect of alteplase for injection on acute cerebral infarction patients with different serum asymmetric dimethylarginine(ADMA)levels.Methods A total of 106 patients with acute cerebral infarction admitted to the First Affiliated Hospital of Hebei North University from May 2021 to May 2023 were selected.With the ADMA level of 0.883 μmol/L as the critical value,and 52 patients with ADMA＞0.883 μmol/L were selected as the high expression group,and 54 patients with ADMA ≤0.883 μmol/L were selected as the low expression group.Both groups were given basic treatment such as reducing intracranial pressure,protecting nerves,improving circulation and regulating pressure,and at the same time,0.9 mg/kg alteplase for injection was given.The therapeutic effect was evaluated after 2 weeks of treatment in both groups.The neurological factors,inflammatory factors,fibrinolysis function,vascular endothelial function index,hemorheology index,modified Rankin scale score,National Institutes of Health Stroke Scale score and clinical efficacy were detected and compared between the two groups.Results After treatment,the levels of myelin basic protein,central nervous system specific protein,neuron-specific enolase,high-sensitivity C-reactive protein,interleukin-1 β,tumor necrosis factor-α,type Ⅰ plasmin activation inhibitor,P-selectin,tubulohemophilia factor,endothelin-1,low-cut whole blood viscosity,high-cut whole blood viscosity,plasma viscosity and the scores of modified Rankin scale and National Institutes of Health Stroke Scale score in the two groups were lower than those before treatment,and those in the high expression group were higher than those in the low expression group(all P＜0.05).After treatment,the levels of tissue plasminogen activator and nitric oxide in the two groups were higher than those before treatment,and those in the high expression group were lower than those in the low expression group(all P＜0.05).The total effective rate of high expression group was lower than that of low expression group[78.8％(41/52)vs 92.6％(50/54)],and the difference was statistically significant(x2=4.121,P=0.042).The results of multivariate Logistic regression analysis showed that myelin basic protein,central nervous system specific protein,neuron-specific enolase,type Ⅰ plasmin activation inhibitor,P-selectin,tubulohemophilia factor,low-cut whole blood viscosity,high-cut whole blood viscosity,plasma viscosity,nitric oxide and endothelin-1 were the main risk factors of treatment effect in patients with acute cerebral infarction with different ADM A levels(all P=0.001).Conclusion The treatment of acute cerebral infarction with alteplase for injection has a good effect,and the improvement of neurological function,fibrinolytic function and hemorheology is more obvious in patients with acute cerebral infarction with low expression of ADMA,and the inflammatory reaction and vascular endothelial damage are less.