替罗非班序贯双联抗血小板治疗非心源性进展性缺血性脑卒中的临床分析

Clinical Analysis of Tirofiban Sequential Dual Antiplatelet Therapy for Non-cardiogenic Progressive Ischemic Stroke

目的:探讨替罗非班对非心源性进展性缺血性脑卒中(PIS)的临床疗效。方法:回顾性分析2020年6月—2022年6月于本院神经内科住院治疗的非心源性PIS患者80例,按抗栓方案不同分为研究组(n=40)和对照组(n=40),研究组先接受替罗非班治疗3 d后序贯双联抗血小板治疗(DAPT),对照组仅接受DAPT,比较两组NIHSS评分、90 d mRS评分、90 d良好预后率、不良事件发生率及不同病因亚型治疗90d良好预后率。结果:两组进展时NIHSS评分比较,差异无统计学意义(P>0.05);研究组治疗14 d后NIHSS评分、90 d mRS评分低于对照组,且90 d良好预后率高于对照组(P<0.05)。两组治疗期间出血事件及血小板减少发生率比较,差异无统计学意义(P>0.05)。研究组中LAA亚组、其他/不明病因亚组90 d良好预后率与对照组比较,差异无统计学意义(P>0.05);研究组中SAO亚组良好预后率高于对照组(P<0.05)。结论:相比单独DAPT,替罗非班序贯DAPT治疗非心源性PIS具有良好的临床预后,尤其在SOA亚组中疗效更好,且不会增加不良事件发生概率。

Objective: To investigate the clinical efficacy of tirofiban on non-cardiac progressive ischemic stroke(PIS).Methods: A retrospective analysis of 80 patients with non-cardiogenic PIS who were hospitalized in the Department of Neurology of our hospital from June 2020 to June 2022 was divided into study group(n=40) and control group(n=40)according to different antithrombotic regimens. The study group received sequential dual antiplatelet therapy(DAPT)after 3 days of tirofiban treatment, while the control group only received DAPT. The NIHSS score, 90-day mRS score, 90-day good prognosis rate, incidence of adverse events and 90-day good prognosis rate of different etiological subtypes were compared between the two groups. Results: There was no significant difference in NIHSS score between the two groups(P>0.05). After 14 days of treatment, the NIHSS score and mRS score at 90 days in the study group were lower than those in the control group, and the good prognosis rate at 90 days was higher than that in the control group(P<0.05). There was no significant difference in the incidence of bleeding events and thrombocytopenia between the two groups(P>0.05).There was no significant difference in the 90-day good prognosis rate of LAA subgroup, other/unknown etiology subgroup between the study group and the control group(P>0.05). The good prognosis rate of SAO subgroup in study group was higher than that in control group(P<0.05). Conclusion: Compared with DAPT alone, tirofiban sequential DAPT can have better clinical prognosis in the treatment of non-cardiogenic PIS, especially in the SAO subgroup, without increasing adverse reactions.