小动脉闭塞型进展性脑梗死的相关危险因素分析及替罗非班疗效评价

Analysis of Risk Factors Related to Progressive Cerebral Infarction with Small Artery Occlusion and Evaluation of the Efficacy of Tirofiban

摘要: 目的：探讨小动脉闭塞型进展性脑梗死(PCI)的相关危险因素，以及应用替罗非班后的疗效。方法：回顾性分析青岛大学附属医院神经内科病房自2020年1月至2024年1月收治的明确诊断为小动脉闭塞型脑梗死患者的临床资料，分成进展组(93例)和非进展组(63例)，对两组患者的一般临床指标、实验室检查、影像学亚型进行分析，比较统计学上的差异。进展组给予替罗非班治疗，在应用替罗非班后，比较治疗前后NIHSS评分有无统计学差异。结果：两组患者在性别、年龄、高血压史、2型糖尿病史、冠心病史、高脂血症、吸烟、饮酒、收缩压数值、舒张压数值、FBG、TC、TG、HDL、LDL、HCY、FIB、UA方面比较差异无统计学意义(P > 0.05)。进展性脑梗死与梗死神经解剖定位有关(χ² = 15.702, P < 0.05)。单因素分析提示脑梗死部位与进展性脑梗死相关(P < 0.05)，进一步经多因素二元Logistic回归分析，以脑干背侧脑梗死作为参照，发现脑干腹侧(P < 0.05)基底节区(P < 0.05)与对照组比较均有明显差异，放射冠、内囊后肢、丘脑、脑干背侧与对照组比较差异无统计学意义(P > 0.05)。小动脉闭塞型进展性脑梗死应用替罗非班治疗前与治疗后NIHSS评分存在着统计学差异(Z = −7.834, P < 0.05)。结论：小动脉闭塞型进展性脑梗死与脑梗死部位有关。累及基底节区和脑干腹侧区域的梗死患者在住院期间更容易进展和恶化，其预后也较差。小动脉闭塞型脑梗死进展后应用替罗非班治疗显著优于双抗治疗。

Abstract: Objective: To investigate the risk factors associated with Progressive Cerebral Infarction (PCI) of Small Artery Occlusion (SAO) type and evaluate the therapeutic efficacy of tirofiban in its management. Methods: A retrospective analysis was conducted on clinical data of patients diagnosed with small artery occlusive cerebral infarction admitted to the Department of Neurology of Qingdao University Affiliated Hospital between January 2020 and January 2024. Patients were categorized into two groups: a progressive group (93 cases) and a non-progressive group (63 cases). General clinical indicators, laboratory tests, and imaging subtypes were analyzed between the two groups to compare the statistical differences. The progressive group was treated with tirofiban, and changes in NIHSS scores before and after treatment were analyzed. Results: There were no statistically significant differences between the two groups in terms of gender, age, history of hypertension, history of type 2 diabetes, history of coronary heart disease, hyperlipidemia, smoking, alcohol consumption, systolic blood pressure, diastolic blood pressure, FBG, TC, TG, HDL, LDL, HCY, FIB, and UA (P > 0.05). Progressive cerebral infarction was associated with the neuroanatomical location of the infarction (χ² = 15.702, P < 0.05). Univariate analysis indicated that the location of the cerebral infarction was associated with progressive cerebral infarction (P < 0.05). Further multivariate binary Logistic regression analysis, with brainstem dorsal cerebral infarction as the reference, revealed significant differences between the brainstem ventral (P < 0.05) and basal ganglia regions (P < 0.05) compared with the control group, while no statistically significant differences were observed between the corona radiata, posterior limb of the internal capsule, thalamus, and brainstem dorsal regions compared with the control group (P > 0.05). There was a statistically significant difference in NIHSS scores before and after treatment with tirofiban in patients with small artery occlusion-type progressive cerebral infarction (Z = −7.834, P < 0.05). Conclusion: Progressive cerebral infarction with small artery occlusion is closely related to the location of the infarction. Patients with infarctions involving the basal ganglia and ventral brainstem are more prone to progression and worsening during hospitalization, with poorer early prognosis. Tirofiban treatment demonstrates superior efficacy compared to dual antiplatelet therapy in managing progressive small artery occlusion-type cerebral infarction.