替罗非班联合替格瑞洛对急性进展性脑梗死患者神经功能及复发的影响

Effect of Tirofiban Combined with Ticagrelor on Neurological Function and Recurrence in Patients with Acute Progressive Cerebral Infarction

目的探讨替罗非班联合替格瑞洛对急性进展性脑梗死患者神经功能及复发的影响。方法选取2021年3月至2023年3月医院收治的108例急性进展性脑梗死患者,依据随机数字法分为替格瑞洛组(54例,接受常规治疗和替格瑞洛治疗)和联合组(54例,接受常规治疗联合替罗非班联合替格瑞洛治疗)。比较两组神经功能[改良Rankin评分量表(mRS)及美国国立卫生研究院卒中量表(NIHSS)]、生活能力[日常生活能力评定量表(ADL)]、颅底血流动力学水平、神经损伤标志物[中枢神经特异性蛋白(S100-β)、泛素c端水解酶-L1(UCH-L1)、神经元特异性烯醇化酶(NSE)]水平、血清氧化应激指标[活性氧簇(ROS)、丙二醛(MDA)、谷胱甘肽(GSH)]水平、药物不良反应发生率和疾病复发率。结果治疗后,两组mRS评分、NIHSS评分均降低(P<0.05),且联合组低于替格瑞洛组(P<0.05)。出院时,两组患者躯体生活自理和工具性日常生活活动评分均提高(P<0.05),且联合组高于替格瑞洛组(P<0.05)。治疗后,两组中动脉、前动脉及椎动脉血流速度均提高(P<0.05),且联合组高于替格瑞洛组(P<0.05);两组S100-β、UCH-L1、NSE、ROS、MDA、GSH水平均降低(P<0.05),且联合组低于替格瑞洛组(P<0.05)。两组不良反应发生率及复发率差异无统计学意义(P>0.05)。结论替罗非班联合替格瑞洛可改善急性进展性脑梗死患者神经功能,提升日常生活能力,缓解神经损伤,提升脑内血流,且不良反应较少,复发率较低。

Objective To explore the effect of tirofiban combined with ticagrelor on neurological function and recurrence in patients with acute progressive cerebral infarction.Methods A total of 108 patients with acute progressive cerebral infarction were selected from March 2021 to March 2023 and were divided into ticagrelor group(54 cases,conventional treatment combined with ticagrelor)and combined group(54 cases,conventional treatment combined with tirofiban and ticagrelor)according to the random number method.The neurological function[modified Rankin scale(mRS)and National Institutes of Health stroke scale(NIHSS)],living ability[activities of daily living(ADL)],cranial base hemodynamics[middle cerebral artery,anterior artery and vertebral artery],nerve injury markers[central nerve specific protein(S100-β),ubiquitin C-terminal hydrolase-L1(UCH-L1),neuron-specific enolase(NSE)],serum oxidative stress markers[reactive oxygen species(ROS),malondialdehyde(MDA),glutathione(GSH)],adverse drug reactions and recurrence rate were compared between the two groups.Results After treatment,mRS score and NIHSS score in the two groups were decreased(P<0.05),and the scores in combined group were lower than those in ticagrelor group(P<0.05).At discharge,the scores of physical life self-care and instrumental activities of daily living were increased in both groups(P<0.05),and the scores in combined group were higher than those in ticagrelor group(P<0.05).The blood flow velocities of middle artery,anterior artery and vertebral artery were risen in both groups after treatment(P<0.05),and the velocities in combined group were faster than those in ticagrelor group(P<0.05).After treatment,the levels of S100-β,UCH-L1,NSE,ROS,MDA and GSH were decreased in both groups(P<0.05),and the levels in combined group were lower(P<0.05).There was no statistically difference in the incidence and recurrence rates of adverse reactions between the two groups(P>0.05).Conclusion Tirofiban combined with ticagrelor can improve neurological function,enhance daily living ability,alleviate cerebral nerve injury,and enhance cerebral blood flow in patients with acute progressive cerebral infarction,with few adverse reactions and low recurrence rate.