Objective To explore the prognostic value of serum gap connexin 43(Cx43)and galectin-9(Gal-9)levels in elderly patients with acute cerebral infarction(ACI)after ultra-early intravenous thrombo-lytic therapy.Methods A total of 106 elderly patients with ACI who received ultra-early intravenous throm-bolytic therapy in the hospital from September 2020 to September 2022 were selected as the study group,and 100 healthy subjects who came to the hospital for physical examination during the same period were selected as the health group.The levels of Cx43 and Gal-9 in serum of all subjects were detected by enzyme-linked im-munosorbent assay(ELISA).After 2 weeks of treatment,106 elderly ACI patients were divided into good prognosis group(81 cases)and poor prognosis group(25 cases)according to the National Institutes of Health Stroke Scale(NIHSS)score.Receiver operating characteristic(ROC)curve was used to analyze the evaluation value of serum Cx43 and Gal-9 in the prognosis of ultra-early intravenous thrombolytic therapy in elderly ACI patients.Multivariate Logistic regression analysis was used to explore the influencing factors of poor prognosis of ultra-early intravenous thrombolytic therapy in elderly ACI patients.Results The levels of Cx43 and Gal-9 in the study group were higher than those in the health group(P＜0.05).The levels of Cx43 and Gal-9 in the poor prognosis group were higher than those in the good prognosis group(P＜0.05).The area under the curve(AUC)of serum Cx43 and Gal-9 for predicting the poor prognosis in elderly ACI patients was 0.721(95％CI:0.673-0.758)and 0.837(95％CI:0.787-0.886),respectively,and the AUC of combined detection of CX43 and GAL-9 was 0.901(95％CI:0.857-0.946).The proportion of hypertension in the poor progno-sis group was higher than that in the good prognosis group(P＜0.05).Hypertension(OR=3.487,95％CI:1.564-7.773),serum Cx43≥106.53 pg/mL(OR=4.586,95％CI:1.982-10.611),serum Gal-9≥11.84 ng/mL(OR=4.345,95％CI:1.957-9.648)were risk factors for poor prognosis in elderly patients with ACI after ultra-early intravenous thrombolysis(P＜0.05).Conclusion Serum Cx43 and Gal-9 are highly expressed in elderly ACI patients,which could be used to evaluate the prognosis of elderly ACI patients after ultra-early intravenous thrombolysis therapy,and their combined detection has higher evaluation value.