摘要
目的 探讨替罗非班辅助血管内介入治疗术对急性缺血性脑卒中(acute ischemic stroke,AIS)患者神经功能的影响.方法 采用前瞻性研究,研究对象为2020年1月至2023年10月在宝鸡市人民医院介入科接受治疗的86例AIS患者.按照随机数字表法分为两组,对照组43例,男25例,女18例,年龄(60.33±6.13)岁,接受血管内介入治疗术;观察组43例,男26例,女17例,年龄(59.48±5.29)岁,在对照组的基础上配合替罗非班治疗(治疗2周).比较疗效,治疗前、治疗2周后的神经功能评分[美国国立卫生研究院脑卒中量表(NIHSS)和Rankin量表(mRS)]、神经功能指标[脑源性神经营养因子(BDNF)、神经生长因子(NGF)和中枢神经特异性蛋白(S100β)]、血小板功能指标(血小板聚集率、血小板黏附率和最大聚集时间)和氧化及炎症指标[谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)、丙二醛(MDA)和C反应蛋白(CRP)],记录随访3个月的复发、死亡及治疗过程中各类出血情况.组间比较采用独立样本t检验、x2检验.结果 治疗2周后,观察组总有效率为81.40％(35/43),高于对照组的60.47％(26/43),差异有统计学意义(x2=4.568,P＜0.05);观察组NIHSS和mRS评分低于对照组[(7.48±1.35)分比(9.68±1.89)分、(1.69±0.24)分比(2.06±0.23)分],差异均有统计学意义(t=6.211、7.299,均P＜0.05);观察组S100β水平低于对照组[(0.37±0.06)µg/L比(0.46±0.09)μg/L],血清 BDNF 和 NGF 水平高于对照组[(43.97±7.92)µg/L 比(37.14±6.87)µg/L、(99.38±12.73)ng/L 比(86.47±9.56)ng/L],差异均有统计学意义(t=5.456、4.272、5.318,均 P＜0.05);观察组血小板聚集率、血小板黏附率和最大聚集时间均低于或短于对照组[(26.74±4.93)％比(32.64±5.26)％、(32.35±4.86)％比(38.26±5.38)％、(147.35±21.83)s 比(163.67±22.67)s],差异均有统计学意义(t=5.367、5.345、3.400,均P＜0.05);观察组GSH-Px和SOD水平均高于对照组[(168.97±24.73)U/L 比(140.68±20.59)U/L、(86.36±12.79)U/mL 比(75.21±11.47)U/mL],MDA和 CRP水平均低于对照组[(4.89±1.35)μmol/L 比(6.82±1.63)µmol/L、(9.36±3.25)mg/L 比(12.18±4.75)mg/L],差异均有统计学意义(t=5.765、4.256、5.980、3.213,均P＜0.05).随访3个月,两组所有出血、症状性颅内出血、复发和病死率比较,差异均无统计学意义(均P＞0.05).结论 替罗非班辅助血管内介入治疗能显著提高AIS患者的治疗总有效率,改善其神经功能评分,有效促进患者神经功能恢复,且安全性良好.
Abstract
Objective To investigate the effect of tirofiban-assisted endovascular intervention on neurological function in patients with acute ischemic stroke(AIS).Methods Eighty-six patients with AIS treated at Department of Intervention,Baoji City People's Hospital from January 2020 to October 2023 were selected for the randomized controlled trial.The patients were randomly divided into a control group and an observation group by the random number table method,with 43 cases in each group.There were 25 males and 18 females in the control group;they were(60.33±6.13)years old.There were 26 males and 17 females in the observation group;they were(59.48±5.29)years old.The control group took endovascular intervention;in addition,the observation group took tirofiban(treated for 2 weeks).The treatment efficacies,neurological function scores[National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS)],neurotrophic indicators[brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),and serum CNS-specific protein(S100β)],platelet function markers(platelet aggregation,adhesion rates,and maximum aggregation time),and oxidative and inflammatory markers[glutathione peroxidase(GSH-Px),superoxide dismutase(SOD),malondialdehyde(MDA),and C-reactive protein(CRP)]were compared between the two groups by the independent sample t test and x2 test.Results After two weeks'treatment,the total effictive rate in the observation group higher than that in the control group[81.40％(35/43)vs.60.47％(26/43)],with a statistical difference between the two groups(x2=4.568,P＜0.05).The scores of NIHSS and mRS in the observation group were lower than those in the control group[(7.48±1.35)vs.(9.68±1.89)and(1.69±0.24)vs.(2.06±0.23)],with statistical differences(t=6.211 and 7.299;both P＜0.05).The levels of S100β,BDNF,and NGF in the observation group were better than those in the control group[(0.37±0.06)μg/L vs.(0.46±0.09)μg/L,(43.97±7.92)μg/L vs.(37.14±6.87)μg/L,and(99.38±12.73)ng/L vs.(86.47±9.56)ng/L],with statistical differences(t=5.456,4.272,and 5.318;all P＜0.05).The platelet aggregation rate,adhesion rate,and maximum aggregation time in the observation group were lower than those in the control group[(26.74±4.93)％vs.(32.64±5.26)％,(32.35±4.86)％vs.(38.26±5.38)％,and(147.35±21.83)s vs.(163.67±22.67)s],with statistical differences(t=5.367,5.345,and 3.400;all P＜0.05).The levels of GSH-Px,SOD,MDA,and CRP in the observation group were better than those in the control group[(168.97±24.73)U/L vs.(140.68±20.59)U/L,(86.36±12.79)U/mL vs.(75.21±11.47)U/mL,(4.89±1.35)μmol/Lvs.(6.82±1.63)μmol/L,and(9.36±3.25)mg/L vs.(12.18±4.75)mg/L],with statistical differences(t=5.765,4.256,5.980,and 3.213;all P＜0.05).There were no statistical differences in bleeding,symptomatic intracerebral hemorrhage,recurrence,and mortality between the two groups(all P＞0.05).Conclusion Tirofiban-assisted endovascular intervention for patients with AIS can significantly increase the overall treatment efficacy,their neurological function scores,and promote their neurological function recovery,and is safe.
维普
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