替罗非班联合静脉溶栓治疗老年急性缺血性卒中的有效性和安全性

Effectiveness and safety of tirofiban combined with intravenous thrombolysis in the treatment of elderly patients with acute ischemic stroke

目的:探讨阿替普酶静脉溶栓后早期联合替罗非班治疗老年急性缺血性卒中患者的有效性和安全性。方法:前瞻性纳入2018年1月至2020年5月期间在青岛市黄岛区中医医院神经内科接受阿替普酶静脉溶栓的老年(60~75岁)急性缺血性卒中患者,按是否联合替罗非班分为替罗非班组和非替罗非班组。替罗非班组在静脉溶栓后2 h启用静脉泵入替罗非班,首先0.4μg/(kg·min)持续30 min,然后0.1μg/(kg·min)持续24 h。有效性终点包括治疗后7 d时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分和发病后90 d时改良Rankin量表(modified Rankin Scale,mRS)评分,0~2分定义为转归良好,>2分定义为转归不良。安全性终点包括出血性转化发生率、有症状颅内出血发生率以及发病后90 d内病死率。结果:共纳入124例急性缺血性卒中患者,中位年龄68岁(范围60~75岁),男性73例(58.9%),女性51例(41.1%)。替罗非班组62例(50%),非替罗非班组62例(50%)。中位基线NIHSS评分14分,共7例发生出血性转化(5.6%),其中2例为有症状颅内出血(1.6%)。发病后90 d随访显示,68例(54.8%)转归良好,56例(45.2%)转归不良,其中4例(3.2%)死亡。替罗非班组治疗后7 d时NIHSS评分[(5.52±4.79)分对(7.35±3.80)分;t=2.357,P=0.020]、90 d时转归良好率(64.5%对45.2%;χ^(2)=4.689,P=0.030)均显著优于非替罗非班组,而出血性转化发生率(4.8%对6.5%;P=1.000)、有症状颅内出血发生率(1.6%对1.6%;P=1.000)以及90 d病死率(3.2%对3.2%;P=1.000)均差异无统计学意义。结论:老年急性缺血性卒中患者阿替普酶静脉溶栓后早期联合替罗非班治疗能够显著提高疗效和改善转归,而且不会增高出血性转化、有症状颅内出血以及死亡风险。

Objective To investigate the effectiveness and safety of early combined with tirofiban in the treatment of elderly patients with acute ischemic stroke after intravenous thrombolysis with alteplase.Methods Elderly(60-75 years old)patients with acute ischemic stroke received intravenous alteplase thrombolysis in the Department of Neurology,Traditional Chinese Medicine Hospital of Huangdao District,Qingdao from January 2018 to May 2020 were enrolled prospectively.According to whether tirofiban is combined or not,they were divided into tirofiban group and non-tirofiban group.Tirofiban was pumped intravenously 2 h after intravenous thrombolysis,first 0.4μg/(kg·min)for 30 min,then 0.1μg/(kg·min)for 24 h.The efficacy endpoints included National Institutes of Health Stroke Scale(NIHSS)score at 7 d after treatment and modified Rankin Scale(mRS)score at 90 d after onset.0-2 was defined as good outcome,and>2 was defined as poor outcome.The safety endpoints included the incidence of hemorrhagic transformation,symptomatic intracranial hemorrhage(sICH)and mortality within 90 days after onset.Results A total of 124 patients with acute ischemic stroke were enrolled.The median age was 68 years(range,60-75 years).There were 73 males(58.9%)and 51 females(41.1%).There were 62 patients(50%)in the tirofiban group and 62(50%)in the non-tirofiban group.The median baseline NIHSS score was 14.Hemorrhagic transformation occurred in 7 patients(5.6%),of which 2 were sICH(1.6%).The follow-up at 90 d after onset showed that 68 patients(54.8%)had a good outcome,56(45.2%)had a poor outcome,of which 4(3.2%)died.The NIHSS score at 7 d after treatment(5.52±4.79 vs.7.35±3.80;t=2.357,P=0.020)and the rate of good outcome at 90 d after onset(64.5%vs.45.2%;χ^(2)=4.689,P=0.030)in the tirofiban group were significantly better than those of the non-tirofiban group,and there were no significant differences among the incidence of hemorrhagic transformation(4.8%vs.6.5%;P=1.000),sICH(1.6%vs.1.6%;P=1.000),and 90 d mortality(3.2%vs.3.2%;P=1.000).Conclusion After intravenous thrombolysis with alteplase,the early combined treatment with tirofiban in elderly patients with acute ischemic stroke can significantly improve the efficacy and outcome,and will not increase the risk of hemorrhagic transformation,sICH and death.