重组组织型纤维蛋白溶酶原激活剂静脉溶栓后不同时间加用替罗非班对急性缺血性脑卒中患者神经血管功能的影响  

Effect of recombinant tissue-type fibrinolytic plasminogen activator intravenous thrombolysis followed by the addition of tirofiban at different times on neurovascular function in patients with acute ischemic stroke

作　　者：付彦[1] 张志勇 张艳丽[1] 李亚伟[1] FU Yan;ZHANG Zhiyong;ZHANG Yanli;LI Yawei(Department of Neurology,Beijing Geriatric Hospital,Beijing 100095,China)

机构地区：[1]北京老年医院神经内科,北京100095

出　　处：《新乡医学院学报》2024年第7期663-667,共5页Journal of Xinxiang Medical University

摘　　要：目的探讨重组组织型纤维蛋白溶酶原激活剂(rt-PA)静脉溶栓后不同时间加用替罗非班对急性缺血性脑卒中(AIS)患者神经血管功能的影响。方法选择2020年3月至2023年3月北京老年医院神经内科收治的120例AIS患者为研究对象,患者均经rt-PA静脉溶栓治疗。根据静脉溶栓治疗后加用替罗非班的时间将患者分为早期组(溶栓后6 h内,n=52)、中期组(溶栓后6~12 h,n=38)和晚期组(溶栓后12~24 h,n=30)。比较治疗前、治疗后3组患者神经功能[美国国立卫生院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分]、血管功能[血管性假血友病因子(vWF)、血管内皮细胞钙黏蛋白(VE-cadherin)、血栓调节蛋白(TM)]、炎症因子[高敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)、白细胞介素-1β(IL-1β)]水平,记录治疗期间不良事件发生率。结果治疗前,3组患者NIHSS、mRS评分比较差异无统计学意义(P>0.05);3组患者治疗后NIHSS、mRS评分显著低于治疗前(P<0.05);治疗后,早期组患者NIHSS、mRS评分显著低于中期组、晚期组,中期组患者NIHSS、mRS评分显著低于晚期组(P<0.05)。治疗前,3组患者vWF、VE-cadherin、TM水平比较差异无统计学意义(P>0.05);3组患者治疗后vWF、VE-cadherin、TM水平显著低于治疗前(P<0.05);治疗后,早期组患者vWF、VE-cadherin、TM水平显著低于中期组、晚期组(P<0.05);治疗后,晚期组患者vWF水平显著高于中期组(P<0.05),中期组与晚期组患者VE-cadherin、TM水平差比较异无统计学意义(P>0.05)。治疗前,3组患者hs-CRP、Hcy、IL-1β水平比较差异无统计学意义(P>0.05),3组患者治疗后hs-CRP、Hcy、IL-1β水平显著低于治疗前(P<0.05);治疗后,早期组患者hs-CRP、Hcy、IL-1β水平显著低于中期组和晚期组,中期组患者hs-CRP、Hcy、IL-1β水平显著低于晚期组(P<0.05)。治疗期间,3组患者症状性脑出血发生率比较差异无统计学意义(P>0.05);早期组患者再闭塞、心肺并发症�Objective To investigate the effect of recombinant tissue-type fibrinolytic plasminogen activator(rt-PA)intravenous thrombolysis followed by the addition of tirofiban at different times on neurovascular function in patients with acute ischemic stroke(AIS).Methods A total of 120 patients with AIS admitted to the Neurology Department of Beijing Geriatric Hospital from March 2020 to March 2023 were selected as the research subjects,and all patients received intravenous thrombolysis with rt-PA.According to the different times of adding tirofiban after intravenous thrombolysis treatment,the patients were divided into the early group(within 6 hours after thrombolysis,n=52),intermediate group(6-12 hours after thrombolysis,n=38)and late group(12-24 hours after thrombolysis,n=30).The neurological function[National Institutes of Health Stroke Scale(NIHSS)score,modified Rankin scale(mRS)score],vascular function[von Willebrand factor(vWF),vascular endothelial cell-calcineurin(VE-cadherin),thrombomodulin(TM)],inflammatory factors[high-sensitivity C-reactive protein(hs-CRP),homocysteine(Hcy),interleukin-1β(IL-1β)]levels were compared among the three groups before and after treatment.The incidence of adverse events during treatment was recorded.Results Before treatment,there was no significant difference in NIHSS and mRS scores of patients among the three groups(P>0.05);NIHSS and mRS scores of patients in the three groups after treatment were significantly lower than those before treatment(P<0.05);after treatment,NIHSS and mRS scores of patients in the early group were significantly lower than those in the intermediate and late groups,and those in the intermediate group were significantly lower than those in the late group(P<0.05).Before treatment,there was no statistically significant difference in vWF,VE-cadherin,and TM levels of patients among the three groups(P>0.05);the levels of vWF,VE-cadherin and TM of patients in the three groups after treatment were significantly lower than those before treatment(P<0.05);after treat

关 键 词：急性缺血性脑卒中 重组组织型纤维蛋白溶酶原激活剂 静脉溶栓 替罗非班 神经血管功能 

分 类 号：R743[医药卫生—神经病学与精神病学]