替罗非班对急性缺血性脑卒中患者新发脑微出血的影响  

Effect of tirofiban on new cerebral microbleeds in patients with acute ischemic stroke

作　　者：钮佳丽 丁云龙[3] 刘艳[3] 魏灿[3] 张艳荣[3] 刘丽[4] 陆云峰[4] 陈芸[1] NIU Jiali;DING Yunlong;LIU Yah;WEI Can;ZHANG Yanrong;LIU Li;LU Yunfeng;CHEN Yun(School of Pharmacy,Nanfing Medical University,Nanfing 210000,China;Department of Clinical Pharmacy;Department of Neurology,4 MRI Room,Jingjiang People＇ s Hospital,Jingjiang 214500,China)

机构地区：[1]南京医科大学药学院,南京210000 [2]江苏省靖江市人民医院临床药学科,靖江214500 [3]江苏省靖江市人民医院神经内科,靖江214500 [4]江苏省靖江市人民医院磁共振室,靖江214500

出　　处：《中国临床药学杂志》2018年第4期215-220,共6页Chinese Journal of Clinical Pharmacy

基　　金：国家自然科学基金面上项目(编号21675089);2016年泰州市科技支撑社会发展计划(指导性)项目(编号ssf20160141)

摘　　要：目的探讨替罗非班对急性缺血性脑卒中患者的新发脑微出血(CMBs)风险的影响。方法前瞻性纳入我院2014年3月至2017年7月急性缺血性脑卒中患者118例,进入临床路径,根据是否使用替罗非班分为观察组36例与对照组82例。发病48 h内及发病10～14 d时完善头颅磁敏感加权成像(SWI)检查以观察有无新发CMBs,分析观察组与对照组新发CMBs之间差异。结果观察组与对照组人口统计学、血管危险因素、实验室检查等指标经比较,差异均无统计学意义。观察组心房颤动、心源性栓塞、单抗(阿司匹林/氯吡格雷)、抗凝(低分子肝素/华法林)、NIHSS评分及新发CMBs均低于对照组,差异均有统计学意义,而小血管闭塞、双抗(阿司匹林联合氯吡格雷)和大脑中动脉梗死患者的DWI-ASPECTS高于对照组。2组大脑中动脉梗死,DWI-ASPECTS≥6分的患者以及新发CMBs差异均无统计学意义。观察组的口服抗血小板强度大于对照组(P <0. 01),而抗凝比例低于对照组(P <0. 05)。结论替罗非班不会增加急性缺血性脑卒中患者的新发CMBs。AIM To explore the possibility of tirof＇than increasing risks of emerging cerebral mierobleeds （CMBs） in patients with acute ischemic stroke （AIS）. METHODS Patients with AIS admitted from March 2014 to July 2017 were enrolled prospectively and allocated into tirofiban group and control group respectively according to the clinical pathway. A total of 118 patients with AIS were enrolled, including 36 cases of intervention （tirofi- ban） group and 82 cases of control group. Susceptibility weighted imaging （SWI） were completed within 48 h after admission and performed again in 10 to 14 d after onset to detect CMBs. New CMBs were compared between 2 groups. RESULTS Compared with control group, significantly fewer atrial fibrillation （P 〈 0.05 ） , less cardio- genic cerebral embolism （ P 〈 0.05 ）, lower proportion of antiplatelet （P 〈 0.01 ） and anticoagulant （ P 〈 0.01 ） ther- apy, lower NIHSS scores （P 〈 0.05） and less new CMBs （ P 〈 0. 05 ） were observed in intervention group. However, higher DWI-ASPECTS in middle cerebral infarction patients and more small-artery occlusion lacunar （ P 〈 0.05） and antiplatelet therapy （ P 〈 0.01 ） were documented in intervention group. In addition, of all the patients with acute middle cerebral artery infarction as well as DWI-ASPECTS ≥6, there were no difference in DWI-ASPECTS or new CMBs. Oral antiplatelet intensity was greater （P 〈 0.01 ）, while the antieoagulation ratio was lower （ P 〈 0.05 ） in in- tervention group. CONCLUSION Tirofiban would not significantly increase the risk of new CMBs in AIS patients.

关 键 词：替罗非班 急性缺血性脑卒中 脑微出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]