阿替普酶联合替罗非班治疗穿支动脉闭塞性脑梗死的疗效及安全性

Efficacy and Safety of Alteplase Combined with Tirofiban in the Treatment of Perforating Artery Occlusive Cerebral Infarction

摘要: 目的：探讨穿支动脉性脑梗死患者在应用阿替普酶(alteplase, rt-PA)静脉溶栓后无效或再闭塞，应用替罗非班(Tirofiban)治疗的疗效、安全性及治疗前后体内尿酸(Uricacid, UA)水平变化。方法：选取2020年1月至2020年12月我院神经内科收治的急性穿支动脉闭塞性脑梗死(Acute perforator artery occlusive cerebral infarction, APCI)患者30例，作为观察组，本组患者在rt-PA静脉溶栓后无效或症状进行性加重，于溶栓后24小时内给予替罗非班治疗。年龄与性别相匹配的同期入院的另30例APCI患者，作为对照组，此组患者只给予rt-PA静脉溶栓治疗。比较两组患者治疗前后NIHSS评分、mRs评分、不良事件发生率(卒中后抑郁、再梗死、脑出血、死亡)等指标及治疗前后两组患者体内尿酸水平。结果：两组患者NIHSS评分在溶栓前[(4.07 ± 3.10) vs (4.33 ± 3.39), P > 0.05]、加重时[(7.80 ± 3.22) vs (7.83 ± 3.36), P > 0.05]、溶栓后24小时[(3.73 ± 3.60) vs (5.43 ± 3.81), P > 0.05]差异无统计学意义；溶栓后7天[(2.73 ± 2.64) vs (4.33 ± 2.76), P < 0.05]、溶栓后14天[(2.13 ± 2.26) vs (3.53 ± 2.24), P < 0.05]差异有统计学意义。两组患者mRs评分在溶栓前[(1.93 ± 1.17) vs (2.13 ± 1.22), P > 0.05]、加重时[(3.37 ± 1.30) vs (3.87 ± 1.25), P > 0.05]、溶栓后24小时[(2.17 ± 1.37) vs (2.90 ± 1.52), P > 0.05]差异无统计学意义，溶栓后14天[(1.63 ± 1.03) vs (2.40 ± 1.25), P < 0.05]、溶栓后90天[(0.87 ± 1.01) vs (1.63 ± 0.93), P < 0.05]差异有统计学意义。两组患者不良事件发生率，观察组，卒中后抑郁[3.3% vs 26.6%, P < 0.05]、再梗死[6.6% vs 36.6%, P < 0.05]显著低于对照组。脑出血[10% vs 3.0%, P > 0.05]、死亡[3.3% vs 10%, P > 0.05]，差异无统计学意义。治疗前两组尿酸水平对比[(252.37 ± 96.06) vs (263.73 ± 85.97), P > 0.05]，差异无统计学意义，治疗后两组尿酸水平对比[(195.04 ± 72.75) vs (239.90 ± 74.75), P < 0.05]，差异有统计学意义。结论：对于穿支动脉闭塞性脑梗死，静脉溶栓后无效或24小时内进行性加重，早期给予替罗非班泵入治疗可以改善预后、不增加出血风险，降低体内尿酸水平。

Abstract: Objective: To investigate the efficacy and safety of Tirofiban and the changes of uric acid levels in patients with perforating artery cerebral infarction after intravenous thrombolysis with alteplase (rt-PA). Methods: Thirty patients with Acute perforator artery occlusive cerebral infarction (APCI) admitted to the Department of Neurosurgery in our hospital from January 2020 to December 2020 were selected as the observation group. Patients in this group were treated with tirofiban within 24 hours after intravenous thrombolysis for ineffective rt-PA or progressive exacerbation of symptoms. Another 30 patients with APCI who matched their age and gender during the same period were admitted as the control group, and only rt-PA intravenous thrombolytic therapy was given in this group. NIHSS score, mRs score, incidence of adverse events (post-stroke depression, reinfarction, cerebral hemorrhage, death) and the level of uric acid in two groups before and after treatment were compared. Results: NIHSS score in the two groups was significantly higher than that in patients before thrombolysis [(4.07 ± 3.10) vs (4.33 ± 3.39), P > 0.05] and in patients with exacerbation [(7.80 ± 3.22) vs (7.83 ± 3.36), P > 0.05], 24 hours after thrombolysis [(3.73 ± 3.60) vs (5.43 ± 3.81), P > 0.05], there was no statistical significance. 7 days after thrombolysis [(2.73 ± 2.64) vs (4.33 ± 2.76), P < 0.05]; the difference was statistically significant 14 days after thrombolysis [(2.13 ± 2.26) vs (3.53 ± 2.24), P < 0.05]. The mRs scores of the two groups were [(1.93 ± 1.17) vs (2.13 ± 1.22), P > 0.05] before thrombolysis, [(3.37 ± 1.30) vs (3.87 ± 1.25), P > 0.05] when aggravating, [(2.17 ± 1.37) vs (2.90 ± 1.52), P > 0.05] 24 hours after thrombolysis, which had no statistical significance. The difference was statistically significant 14 days after thrombolysis [(1.63 ± 1.03) vs (2.40 ± 1.25), P < 0.05] and 90 days after thrombolysis [(0.87 ± 1.01) vs (1.63 ± 0.93), P < 0.05]. The incidence of adverse events, observation group, post-stroke depression [3.3% vs 26.6%, P < 0.05] and reinfarction [6.6% vs 36.6%, P < 0.05] in 2 groups were significantly lower than those in control group. Intracerebral hemorrhage [10% vs 3.0%, P > 0.05] and death [3.3% vs 10%, P > 0.05] were not statistically significant. Before treatment, there was no statistically significant difference in uric acid levels between the two groups [(252.37 ± 96.06) vs (263.73 ± 85.97), P > 0.05]. After treatment, there was statistically significant difference in uric acid levels between the two groups [(195.04 ± 72.75) vs (239.90 ± 74.75), P < 0.05]. Conclusion: For perforating artery occlusive cerebral infarction, it is progressively worse within 24 hours after intravenous thrombolysis. Early administration of tirofiban pump therapy can improve the prognosis without increasing the risk of bleeding, and reduce in vivo uric acid level.