Abstract: Objective To investigate the relationship between serum homocysteine ( Hcy),cystatin C (CysC) and D-dimer ( D-D) levels and the condition and short-term prognosis of patients with acute ischemic stroke ( AIS) after intravenous thrombolysis. Methods A total of 100AIS patients who received intravenous thrombolytic therapy in Shunyi District Hospital from October2019 to June 2023 were selected. According to the National Institutes of Health Stroke Scale (NIHSS) score, the patients were divided into 3 groups: mild defect group (1-4 points, 44 cases), moderate defect group (5-15 points, 29 cases) and severe defect group (16-42 points, 27 cases). According to the volume of cerebral infarction, the patients were divided into 3 groups: small infarction group ( < 5 cm³, 40 cases), moderate infarction group (5 ~ 15 cm3, 37 cases), and large infarction group ( > 15 cm3, 23 cases). Three months after intravenous thrombolysis, the patients were divided into 2 groups: good prognosis group (≤2 points, 75 cases) and poor prognosis group ( > 2 points, 25 cases), according to the modified Rankin scale score. Baseline data of patients were collected, and serum Hcy, CysC and D-D levels were detected. The changes of serum Hcy, CysC and D-D levels in AIS patients with different degrees of neurological deficit, cerebral infarction volume and short-term prognosis were compared. Pearson correlation coefficient was used to analyze the correlation between serum Hcy, CysC and D-D levels and AIS condition. Multivariate logistic regression was used to analyze the independent influencing factors of short-term prognosis of AIS. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum Hcy, CysC and D-D levels for short-term prognosis after AIS intravenous thrombolysis. Results The levels of serum Hcy, CysC and D-D in the mild defect group were the lowest, followed by the moderate defect group, and the severe defect group was the highest, with statisticallysignificant (P< 0. 05). The levels of serum Hcy, CysC and D-D in the small infarction group werethe lowest, followed by the moderate infarction group, and the large infarction group was the highest, the difference between the groups was statistically significant (P < 0. 05). Pearson correlationcoefficient analysis showed that serum Hcy, CysC and D-D levels were positively correlated withNHISS score (r = 0. 424, 0. 573, 0. 716, all P < 0. 001) and cerebral infarction volume ( r =0. 633, 0. 479, 0. 548, all P< 0. 001). Univariate analysis showed that the levels of serum Hcy,CysC and D-D in the good prognosis group were lower than those in the poor prognosis group (all P< 0. 05). Multivariate logistic regression analysis showed that Hcy, CysC and D-D (OR = 1. 093,1. 343, 1. 146) were independent predictors of short-term prognosis of AIS (P< 0. 05). ROC curveanalysis showed that the area under the curve of serum Hcy, CysC, D-D and the combination of thethree in predicting the short-term prognosis of AIS was 0. 853, 0. 873, 0. 792 and 0. 946, respectively, and the combination of the three had the highest predictive value. Conclusion The levels ofserum Hcy, CysC and D-D are positively correlated with the severity of AIS patients, which can beused as predictors of short-term prognosis after intravenous thrombolysis in AIS patients.

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