替罗非班联合双抗疗法治疗急性进展性前循环脑梗死的疗效  

Efficacy of tirofiban combined dual antiplatelet therapy in the treatment of acute progressive anterior circulation stroke

作　　者：吴亚平 王万华 张炎 梁达 刘其锋 刘媛媛 缪桂华 WU Yaping;WANG Wanhua;ZHANG Yan;LIANG Da;LIU Qifeng;LIU Yuanyuan;MIAO Guihua(Department of Neurology,the First People′s Hospital of Kunshan,Jiangsu Province,Kunshan 215300,China)

机构地区：[1]江苏省昆山市第一人民医院神经内科,215300

出　　处：《临床合理用药》2025年第2期27-30,34,共5页Chinese Journal of Clinical Rational Drug Use

基　　金：江苏省卫生健康委2022年度医学科研项目(Z2022044)。

摘　　要：目的观察急性进展性前循环脑梗死患者通过替罗非班联合双抗疗法治疗的疗效。方法回顾性选取2020年1月—2022年12月于昆山市第一人民医院神经内科住院的149例急性进展性前循环脑梗死患者,根据治疗方法不同分为替罗非班联合双抗组(n=75)和常规双抗组(n=74)。替罗非班联合双抗组采用替罗非班联合阿司匹林和氯吡格雷治疗,常规双抗组采用阿司匹林和氯吡格雷治疗。比较2组治疗前、治疗7 d后、治疗2周后美国国立卫生研究院卒中量表(NIHSS)评分、人血浆脂蛋白相关磷脂酶A2(Lp-PLA2)水平,治疗3个月后改良Rankin量表(mRS)评分情况,治疗前、治疗2 d后血小板计数(PLT),治疗前、治疗2周后凝血功能指标[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)],治疗2周内不良反应发生情况。结果治疗7 d、2周后,2组NIHSS评分及Lp-PLA2水平均低于治疗前,且替罗非班联合双抗组低于常规双抗组(P<0.05或P<0.01)。治疗3个月后,替罗非班联合双抗组mRS评分为≤2分的比例高于常规双抗组(χ^(2)=18.935,P<0.001)。治疗2 d后,2组PLT均低于治疗前,且替罗非班联合双抗组低于常规双抗组(P<0.01)。治疗2周后,2组PT均较治疗前延长,且替罗非班联合双抗组长于常规双抗组(P<0.01),2组TT及APTT与治疗前比较及组间比较差异均无统计学意义(P>0.05)。替罗非班联合双抗组与常规双抗组不良反应总发生率比较差异无统计学意义(48.00%vs.54.05%,χ^(2)=0.546,P=0.460)。结论急性进展性前循环脑梗死患者在临床通过替罗非班联合双抗疗法治疗,可改善患者神经功能缺损症状及预后,降低Lp-PLA2水平。Objective To observe the effect of tirofiban combined dual antiplatelet therapy on acute progressive anterior circulation stroke.Methods A total of 149 patients with acute progressive anterior circulation stroke admitted to the Department of Neurology,the First People′s Hospital of Kunshan from January 2020 to December 2022 were retrospectively selected,and divided into tirofiban combined DAT group(n=75)and conventional DAT group(n=74)according to different treatment methods.Tirofiban combined DAT group was treated with tirofiban injection followed by aspirin and clopidogrel,and conventional DAT group was treated with aspirin and clopidogrel.A comparison was made of NIHSS scores and Lp-PLA2 levels at baseline,7 days,and 2 weeks after treatment,mRS scores at 3 months after treatment,platelet count at baseline and 2 days after treatment,and coagulation function indicators(PT,TT,APTT)at baseline and 2 weeks after treatment,as well as the occurrence of adverse events within 2 weeks of treatment.Results After 7 days and 2 weeks,NIHSS score and Lp-PLA2 level in two groups were lower than before treatment,and tirofiban combined DAT group was lower than conventional DAT group(P<0.05 or P<0.01).After 3 months of treatment,the proportion of mRS Scores≤2 points in tirofiban combined DAT group was higher than that in conventional DAT group(χ^(2)=18.935,P<0.001).After 2 days of treatment,PLT in two groups was lower t han before treatment,and that in tirofiban combined DAT group was lower than that in conventional DAT group(P<0.01).After 2 weeks of treatment,PT in two groups was longer than before treatment,and the tirofiban combined DAT group was longer than that of conventional DAT group(P<0.01).There were no statistically significant differences in TT and APTT between two groups compared with before treatment or between groups(P>0.05).There was no significant difference in the overall incidence of adverse reactions between the tirofiban combined DAT group and the conventional DAT group(48.00%vs.54.05%,χ^(2)=0.546,P=0.

关 键 词：急性进展性前循环脑梗死 替罗非班注射液 双抗疗法 治疗效果 

分 类 号：R743.33[医药卫生—神经病学与精神病学]