替罗非班对急性颅内外大动脉闭塞型脑梗死患者取栓后纤溶系统及临床预后的影响  

Effect of Tirofiban on fibrinolytic system and clinical prognosis in acute cerebral infarction with intracranial and extracranial arterial occlusion after thrombectomy

作　　者：杨牧[1] 鹿滨麒 程相杰[1] YANG Mu;LU Binqi;CHENG Xiangjie(Department of Neurology,The Second People's Hospital of Nanyang City,Nanyang,Henan473000,China)

机构地区：[1]南阳市第二人民医院神经内科,河南南阳473000

出　　处：《社区医学杂志》2023年第22期1163-1168,共6页Journal Of Community Medicine

摘　　要：目的探讨替罗非班应用于急性颅内外大动脉闭塞脑梗死血栓抽吸后的效果及对纤溶系统、神经炎症的影响,为临床应用提供参考。方法选取2020-02-10-2021-10-20南阳市第二人民医院神经内科收治的130例急性颅内外大动脉闭塞脑梗死患者,均经血栓抽吸治疗,经简单随机化分组,分为观察组(n=65)和对照组(n=65)。对照组给予常规抗血小板药物(阿司匹林100mg/次,1次/d、阿托伐他汀钙片20mg/次,1次/d、硫酸氢氯吡格雷75mg/次,1次/d),观察组给予替罗非班〔静脉推注10μg/kg,再进行静脉滴注36h,0.15μg/(kg·min),而后改为常规抗血小板药物,用法用量同对照组〕,连续治疗3个月,比较2组治疗效果、纤溶系统〔血浆组织型纤溶酶原激活物(t-PA)、纤维酶原激活抑制物-1(PAI-1)、纤维蛋白原降解产物(FDP)、血浆纤溶酶原(PLG)〕、血管内皮功能〔内皮素-1(ET-1)、血浆血管性假血友病因子(vWF)〕、血小板最大聚集率(MPAR)、神经功能〔神经元特异性烯醇化酶(NsE)、缺血修饰蛋白(IMA)、神经胶质纤维酸性蛋白(GFAP)〕及炎症因子〔巨噬细胞移动抑制因子(MIF)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、脂蛋白相关磷脂酶A2(LP-PLA2)〕;计量资料以x-±s表示,差异行单因素协方差分析,计数资料以n(%)表示,差异行χ^(2)检验,检验水准α=0.05(双尾)。结果观察组总有效率95.38%(62/65)高于对照组83.08%(54/65),差异有统计学意义,χ^(2)=5.123,P=0.024;治疗3个月后,观察组血清FDP(19.86±3.50)mg/L、t-PA(1.83±0.82)U/mL水平,高于对照组(13.06±2.57)mg/L、(1.56±0.27)U/mL,PAI-1(5.18±1.79)IU/mL、PLG(37.51±3.54)%水平,低于对照组(9.37±2.23)IU/mL、(48.41±3.88)%,差异有统计学意义,F值分别为12.626、11.813、2.522、16.732,均P<0.001;治疗3个月后,观察组血清ET-1(64.63±4.33)ng/L、vWF(101.92±8.57)%、MPAR(40.56±11.38)%、NSE(9.70±2.24)μg/L、IMA(76.18±9.72)U/L、GFAP(16.12±5.26)pg/mL水平,低�Objective To investigate the effects of Tirofiban on thrombus aspiration in acute intracranial and extracranial large artery occlusion cerebral infarction and its effects on fibrinolysis system and neuroinflammation,so as to provide a reference for clinical application.Methods A total of 130patients with acute intracranial and extracranial arterial occlusion with cerebral infarction admitted to the Department of Neurology,Nanyang Second People's Hospital from February 10,2020to October 20,2021were selected.All patients were treated with thrombus aspiration and divided into observation group(n=65)and control group(n=65)by simple randomization.The control group was given conventional antiplatelet drugs(aspirin 100 mg/time,once/d,atorvastatin calcium tablet 20 mg/time,once/d,clopidogrel bisulfate 75mg/time,once/d),the observation group was given Tirofiban intravenous injection 10μg/kg,then intravenous infusion for 36h.0.15μg/(kg·min),and then conventional antiplatelet drugs(the usage and dosage are the same as those of the control group).Three months of continuous treatment,the therapeutic effect,fibrinolytic system[plasma tissue type plasminogen activator(t-PA),fibrinogen activator inhibitor-1(PAI-1),fibrinogen degradation product(FDP),plasma plasminogen(PLG)],vascular endothelial function[endothelin-1(ET-1),plasma vWF factor]and platelet Maximum aggregation rate(MPAR),neural function[neuron-specific enolase(NsE),ischemia modification protein(IMA),glial fibrillary acidic protein(GFAP)]and inflammatory factors[macrophage migration inhibitory factor(MIF),tumor necrosis faction-α(TNF-α),hypersensitive C-reactive protein(hs-CRP),lipoprotein phase]Phospholipase A2(LPPLA2)were compared between the two groups;The measurement data were expressed as x-±s,the difference was analyzed by one-way covariance analysis,the count data was expressed as n(%),and the difference was measured byχ^(2)test,the test levelα=0.05(double-tailed).Results The total effective rate of the observation group was 95.38%(62/65)higher than tha

关 键 词：脑梗死 替罗非班 颅内外大动脉闭塞 血栓 纤溶系统 炎症 

分 类 号：R743.3[医药卫生—神经病学与精神病学]