急性缺血性卒中患者血管内治疗后应用替罗非班的安全性及预后分析

Safety of tirofiban in patients with acute cerebral infarct receiving endovascular therapy

目的:探讨急性缺血性卒中患者血管内治疗后使用替罗非班的安全性及预后分析。方法:回顾性分析2013年10月至2017年4月在浙江大学医学院附属第二医院接受静脉溶栓桥接动脉取栓或直接动脉取栓的急性缺血性卒中患者115例的临床资料。根据患者术后24 h内是否使用替罗非班治疗分为替罗非班组(30例)和对照组(85例)。参照欧洲协作性急性卒中研究(ECASS)Ⅱ标准评估24 h内的出血转化,治疗后3个月时改良Rankin量表(mRS)超过2分定义为预后不优。采用二元logistic回归分析治疗后使用替罗非班是否独立影响患者出血转化和3个月临床预后。结果:二元logistic回归分析提示,替罗非班治疗不增加出血转化的风险(OR=0.437,95%CI:0.168~1.132,P>0.05);患者基线美国国立卫生研究院卒中量表(NIHSS)评分(OR=1.136,95%CI:1.014~1.273,P<0.05)、血管再通(OR=0.060,95%CI:0.010~0.365,P<0.01)、高血压(OR=4.233,95%CI:1.320~13.570,P<0.05)和起病至治疗时间(OR=1 006,95%CI:1.001~1.011,P<0.05)与临床预后不优独立相关,而替罗非班治疗与临床预后不优无独立相关性(OR=1.923,95%CI:0.536~6.568,P>0.05)。结论:急性缺血性卒中患者血管内治疗后使用替罗非班不会增加出血转化的风险。

Objective： To investigate the effect of tirofiban on hemorrhagic transformation and neurological outcome in patients with acute cerebral infarct treated with endovascular therapy. Methods： One hundred and fifteen patients with acute cerebral infarct who received endovascular stent mechanical thrombectomy in the Second Affiliated Hospital, Zhejiang University School of Medicine during October 2013 and April 2017 were included in the study. Among 115 patients, 30 received tirofiban treatment. Hemorrhagic transformation and neurological outcomes were assessed using the ECASS I1 criteria and modified Rankin scale （mRS）, respectively. Unfavorable outcome was defined as mRS 〉 2. Binary logistic regression model was used to analyze the independent predictors of hemorrhagic transformation and neurological outcome. Results： Binary logistic regression analysis showed that tirofiban treatment did not increase the risk of hemorrhagic transformation （ OR = 0. 437, 95% CI： O. 168 - 1. 132, P 〉 0.05 ） ; baseline NIHSS （ OR = 1. 136, 95% CI： 1. 014 - 1. 273, P 〈 0.05 ）, recanalization （OR=0.060, 95% CI： 0.010-0.365, P〈0.01）, hypertension （OR =4.233, 95% CI： 1. 320 - 13. 570, P 〈 0.05） and onset to treatment time （ OR = 1. 006, 95% CI： 1. 001 -1. 011, P 〈 0.05 ） were independently associated with unfavorable outcome, while such association was not observed in tirofiban treatment （ OR = 1. 923, 95% CI： 0.536 - 6.568, P 〉 0.05 ）. Conclusion： Tirofiban appears to be safe for patients with acute cerebral infarct receiving endovascular therapy.