替罗非班对IVT桥接EVT治疗急性前循环大血管闭塞性脑梗死患者预后的影响

Effect of Tirofiban on Prognosis of Patients with Acute Large Vessel Occlusion Stroke Treated with IVT Bridging EVT

目的:观察替罗非班对急性前循环大血管闭塞性脑梗死(acute large vessel occlusion stroke,ALVOS)静脉溶栓(intravenous thrombolysis,IVT)桥接血管内治疗(endovascular therapy,EVT)患者预后的影响。方法:选取2021年1月—2023年1月宜都市人民医院收治的73例ALVOS患者作为研究对象,根据随机数表法将患者分为对照组36例和研究组37例。对照组采用IVT桥接EVT治疗,研究组在此基础上加用替罗非班治疗,比较两组取栓次数及血管再通率、美国国立卫生院卒中量表(National Institutes of Health stroke scale,NIHSS)评分、改良Rankin量表(modified Rankin scale,mRS)评分、神经功能血清学指标[神经生长因子(nerve growth factor,NGF)、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、中枢神经特异性蛋白(central nervous system specific protein β,S100β)]、凝血功能[凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、D-二聚体(D-dimer,D-D)]及安全性。结果:研究组取栓次数少于对照组,差异有统计学意义(P<0.05);两组血管再通率比较,差异无统计学意义(P>0.05)。研究组治疗后NIHSS评分、mRS评分及S100β、D-D水平低于对照组,NGF、BDNF水平高于对照组,PT、APTT长于对照组,差异有统计学意义(P<0.05);两组症状性颅内出血率、各种类型出血率、复发率、病死率比较,差异无统计学意义(P>0.05)。结论:在IVT桥接EVT治疗过程中加用替罗非班可改善ALVOS患者的神经功能状态及凝血功能水平,短期预后较好。

Objective:To observe the effect of Tirofiban on the prognosis of patients with acute large vessel occlusion stroke(ALVOS)treated with intravenous thrombolysis(IVT)bridging endovascular therapy(EVT).Method:A total of 73 patients with ALVOS who admitted to Yidu People's Hospital from January 2021 to January 2023 were selected as the research objects,the patients were divided into the control group(36 cases)and the study group(37 cases)according to the random number table method.The control group was treated with IVT bridging EVT,and the study group was treated with Tirofiban on this basis,the number of thrombectomy and vascular recanalization rate,National Institutes of Health stroke scale(NIHSS)score,modified Rankin scale(mRS)score,neurological serological indicators[nerve growth factor(NGF),brain-derived neurotrophic factor(BDNF),central nervous system specific proteinβ(S100β)],coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer(D-D)]and safety were compared between two groups.Result:The number of thrombectomy in the study group was less than that in the control group,and the difference was statistically significant(P<0.05);there was no significant difference in the vascular recanalization rate between two groups(P>0.05).The NIHSS score,mRS score,S100βand D-D levels in the study group after treatment were lower than those in the control group,NGF and BDNF levels were higher than those in the control group,PT and APTT were longer than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the symptomatic intracranial hemorrhage rate,various types of bleeding rate,recurrence rate and mortality between two groups(P>0.05).Conclusion:The addition of Tirofiban during IVT bridging EVT treatment can improve the neurological and coagulation function levels of ALVOS patients,with a good short-term prognosis.