阿替普酶静脉溶栓序贯联合替罗非班对急性脑梗死进展的预防作用及影响因素

Preventive effect of intravenous thrombolysis with alteplase combined with tirofiban in the progression of acute cerebral infarction and related factors

目的分析阿替普酶静脉溶栓序贯联合替罗非班对急性脑梗死进展的预防作用及影响因素。方法选取丽水市人民医院2019年7月至2022年7月收治的急性脑梗死患者72例(连续入组)为研究对象,将其按治疗方法分对照组、观察组,每组36例,对照组接受阿替普酶静脉溶栓干预,观察组接受阿替普酶静脉溶栓+替罗非班治疗。比较2组患者美国国立卫生研究院脑卒中量表(NIHSS)评分、不良反应发生率。根据观察组患者治疗后病情变化将其分为未进展组、进展组,比较2组患者临床资料,采用二元Logistic回归分析影响阿替普酶静脉溶栓序贯联合替罗非班预防进展性脑梗死转变的因素。结果观察组16例患者治疗后转变为进展性脑梗死,对照组25例患者治疗后转变为进展性脑梗死,对照组转变率更高(χ^(2)=4.589,P=0.032)。2组治疗后凝血指标较治疗前均增高,NIHSS评分均下降,且观察组治疗后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)均高于对照组[(14.4±0.6)s与(13.0±0.8)s、(32.6±1.8)s与(30.4±1.1)s、(19.4±1.1)s与(18.0±1.2)s],观察组治疗后NIHSS评分低于对照组[(6.1±1.3)分与(8.9±1.6)分],(t=8.384、6.234、5.408、-7.921,P<0.05)。观察组中,未转变患者糖尿病、高血压、高血脂、血小板异常、纤维蛋白原异常比例更少,入院时NIHSS评分更低(11±3)与(14±3)(P<0.05)。Logistic回归分析显示糖尿病、高血压、高血脂、血小板、纤维蛋白原、入院时NIHSS评分是影响进展性脑梗死转变的因素(P<0.05)。评估模型Y=-1.897×糖尿病-1.609×高血压-1.986×高血脂+2.833血小板+1.897×纤维蛋白原-0.261×入院时NIHSS评分+3.530。模型评估受试者工作特征曲线下面积为0.925,特异度为0.812,敏感度为0.950,约登指数为0.762,界值为0.491。结论阿替普酶静脉溶栓序贯联合替罗非班预防急性脑梗死进展有一定成效,可改善急性脑梗死患者神经功能与凝血功能,糖尿病、高血压、高血脂、血小板、纤维蛋白原、入院时NIHSS评分是影响预防效果的主要因素。

Objective To analyze the preventive effect of sequential intravenous thrombolysis with al-teplase combined with tirofiban on the progression of acute cerebral infarction and related factors.Methods A total of 72 patients with cerebral infarction from Lishui People′s Hospital from July 2019 to July 2022 were ran-domly divided into a control group and a observation group,with 36 cases in each group.The control group re-ceived intravenous thrombolytic intervention with alteplase,and the observation group added tirofiban on this ba-sis.The clinical efficacy,NIHSS score of the two groups were compared.According to the curative effect of the pa-tients in the observation group,they were divided into two groups:the obvious group and the other group.The clinical data of the patients in the two groups were compared,and the factors affecting the curative effect of the se-quential intravenous thrombolysis of ateplase combined with tirofiban in the treatment of acute progressive cerebral infarction were analyzed by binary logistic regression.Results A total of 16 patients in the observation group and 25 patients in the control group had progressive cerebral infarction after treatment,and the conversion rate in the control group was significantly higher(χ^(2)=4.589,P=0.032).After treatment,coagulation indexes increased and NIHSS scores decreased in both groups[(14.4±0.6)s vs(13.0±0.8)s,(32.6±1.8)s vs(30.4±1.1)s,(19.4±1.1)s vs(18.0±1.2)s].The PT,APTT and TT were higher in the observation group then in the control group after treatment[(6.1±1.3)score vs(8.9±1.6)]score,(t=8.384,6.234,5.408,-7.921,P<0.05).In the observation group,the inci-dence of diabetes,hypertension,hyperlipidemia,platelet abnormality and fibrinogen abnormality were less in the unconverted patients,and the NIHSS score was lower on admission(11±3 vs 14±3)(P<0.05).Logistic regression analysis showed that diabetes,hypertension,hyperlipidemia,platelet,fibrinogen and NIHSS score at admission were the factors affecting the transformation of progressive cerebral infarction(P<0.05).Evaluation model Y=-1.897×diabetes-1.609×hypertension-1.986×hyperlipidemia+2.833×platelets+1.897×fibrinogen-0.261×NIHSS score at admission+3.530.The area under ROC curve evaluated by the model was 0.925,the specificity was 0.812,the sensitivity was 0.950,the Jorden index was 0.762,and the cut-off value was 0.491.Conclusion The sequential combination of ateplase intravenous thrombolysis and tirofiban has a certain effect on preventing the progression of acute cerebral infarction,which can improve neurological and coagulation functions in patients with acute cerebral infarction;Diabetes,hypertension,hyperlipidemia,platelets,fibrinogen,NIHSS score at admis-sion are the main factors affecting the prevention effect.