替罗非班治疗急性脑梗死阿替普酶溶栓后再闭塞患者预后及其影响因素分析

Prognosis of Acute Cerebral Infarction Patients with Re-Occlusion After Alteplase Thrombolysis Therapy Treated by Tirofiban and Its Influencing Factors

目的 探讨替罗非班治疗急性脑梗死(ACI)阿替普酶溶栓后再闭塞患者的预后情况,并分析其不良预后的影响因素。方法 前瞻性选取安徽省涡阳县中医院2021年2月至2022年3月收治的住院期间予阿替普酶溶栓治疗且出现再闭塞的ACI患者154例,均予替罗非班治疗。随访1年,统计随访期间患者颅内出血、症状性颅内出血、血小板减少、发热乏力、死亡等不良预后的发生情况。对影响替罗非班治疗ACI阿替普酶溶栓后再闭塞患者预后的因素进行单因素分析,采用多因素Logisitic回归分析筛选独立危险因素,构建风险预测模型,采用受试者工作特征(ROC)曲线分析危险因素对预后的评估价值。结果 154例患者不良预后发生率为31.17%。单因素分析结果显示,年龄、饮酒史、梗死部位、再闭塞到治疗时间、再闭塞后梗死体积、脑梗死溶栓(TICI)分级、美国国立卫生研究院卒中量表(NIHSS)评分、合并冠状动脉粥样硬化性心脏病(简称冠心病)、合并高血压均与发生不良预后存在明显关联(P <0.05);多因素Logistic回归分析结果显示,年龄(β=0.192,OR=1.212,P=0.005),饮酒史(β=1.938,OR=6.946,P=0.007),NIHSS评分(β=0.383,OR=1.467,P <0.001),再闭塞到治疗时间(β=0.026,OR=1.026,P=0.010),再闭塞后梗死体积(β=0.618,OR=1.855,P=0.003),TICI分级(β=1.852,OR=6.371,P=0.012),合并冠心病(β=2.226,OR=9.267,P=0.002),合并高血压(β=1.448,OR=4.255,P=0.041)均是替罗非班治疗ACI阿替普酶溶栓后再闭塞患者发生不良预后的独立危险因素。ROC曲线分析结果显示,模型的曲线下面积(AUC)为0.923[95%CI(0.880,0.965),P <0.001],最佳截断值0.351对应的灵敏度、特异度分别为0.938,0.849。结论 替罗非班治疗ACI阿替普酶溶栓后再闭塞患者预后不良受多种因素影响,所建立的风险预测模型具有较好的预后预测效能。

Objective To investigate the prognosis of acute cerebral infarction(ACI) patients with re-occlusion after alteplasethrombolysis therapy treated by tirofiban,and to analyze the influencing factors of adverse prognosis.Methods A total of 154 ACIpatients who received alteplase thrombolytic therapy and developed re-occlusion in the Guoyang County Hospital of TraditionalChinese Medicine from February 2021 to March 2022 were prospectively selected.All patients were treated with tirofiban.After oneyear of follow-up,the incidence of adverse prognosis such as intracranial hemorrhage,symptomatic intracranial hemorrhage,thrombocytopenia,fever,fatigue,and death during the follow-up period was recorded.Univariate analysis was conducted on thefactors affecting the prognosis of ACI patients with re-occlusion after alteplase thrombolysis therapy treated by tirofiban.Multivariate Logistic regression analysis was used to screen for independent risk factors,in order to construct the risk predictionmodel.Receiver operating characteristic(ROC) curve was used to analyze the evaluation value of risk factors on prognosis.Results The incidence of adverse prognosis in 154 patients was 31.17%.The results of the univariate analysis showed that age,alcohol consumption history,infarct site,time from re-occlusion to treatment,infarct volume after re-occlusion,thrombolysis incerebral infarction(TICI) grading,National Institute of Health Stroke Scale(NIHSS) score,combined coronary heart disease(CHD),and combined hypertension were significantly associated with adverse prognosis(P < 0.05).The results of the multipleLogistic regression analysis showed that age(β = 0.192,OR = 1.212,P = 0.005),alcohol consumption history(β = 1.938,OR =6.946,P = 0.007),NIHSS score(β = 0.383,OR = 1.467,P < 0.001),time from re-occlusion to treatment(β = 0.026,OR =1.026,P = 0.010),infarct volume after re-occlusion(β = 0.618,OR = 1.855,P = 0.003) and TICI grading(β = 1.852,OR = 6.371,P = 0.012),combined CHD(β = 2.226,OR = 9.267,P = 0.002),and combined hypertension(β = 1.448,OR =4.255,P = 0.041) were independent risk factors for adverse prognosis in ACI patients with re-occlusion after alteplase thrombolysis therapy.The results of ROC curve analysis showed that the area under the plasma concentration-time curve(AUC)was 0.923 [95% CI(0.880,0.965),P < 0.001],and the sensitivity and specificity corresponding to the optimal cut-off valueof 0.351 were 0.938 and 0.849,respectively.Conclusion The adverse prognosis of ACI patients with re-occlusion afteralteplase thrombolysis therapy treated by tirofiban is affected by many factors,and the established risk prediction model has goodprognostic efficacy.