2025 年第 12 期 第 20 卷

替罗非班在动脉粥样硬化性急性脑梗死血管内治疗中的应用时机选择及与预后的关系研究

Study on the timing selection of tirofiban application in endovascular treatment of atherosclerotic acute cerebral infarction and its relationship with prognosis

作者：武钟毅闫彩萍孙玉琴孔玉娟

英文作者：Wu Zhongyi Yan Caiping Sun Yuqin Kong Yujuan

单位：山西省汾阳医院神经内科,汾阳032200

英文单位：Department of Neurology Shanxi Province Fenyang Hospital Fenyang 032200 China

关键词：急性脑梗死；血管内治疗；替罗非班；应用时机；预后

英文关键词：Acutecerebralinfarction;Endovasculartreatment;Tirofiban;Timingofapplication;Prognosis

• 摘要：

• 目的 探究替罗非班在动脉粥样硬化性急性脑梗死（AIS）血管内治疗中不同应用时机的疗效及与预后的关系。方法 选取2024年6月至2025年5月于山西省汾阳医院就诊的需行血管内治疗的动脉粥样硬化性AIS患者98例为研究对象。采用随机数字表法将其分为观察组［49例，术前先静脉滴注替罗非班0.4 μg/（kg·min）0.5 h再以0.1 μg/（kg·min）静脉滴注24 h+血管内治疗］和对照组［49例，术中使用替罗非班0.2～1 mg及术后以0.1 μg/（kg·min）静脉滴注24 h+血管内治疗］。比较2组患者入院时、治疗后24 h、治疗后7、14 d的血小板聚集率、血小板黏附率、血小板体积分布宽度（PDW）、高敏C反应蛋白（hs-CRP）、白细胞介素6（IL-6）以及美国国立卫生研究院卒中量表（NIHSS）评分。比较2组患者并发症及预后良好率，采用Cox回归分析替罗非班应用时机对患者预后不良的影响。结果 入院时，2组患者血小板聚集率、血小板黏附率、PDW、hs-CRP、IL-6、NIHSS评分差异均无统计学意义（均P＞0.05）；治疗后，2组患者的血小板聚集率、血小板黏附率、PDW、hs-CRP、IL-6、NIHSS评分均明显降低，其中在治疗后7、14 d观察组下降更为明显（均P＜0.05）。观察组再闭塞发生率及总不良反应发生率明显低于对照组（均P＜0.05），预后良好率高于对照组［73.5%(36/49)比51.0%(25/49)］（P＜0.05）。观察组替罗非班应用时机是患者预后不良的保护因素（风险比=0.782，95%置信区间：0.289～0.897，P=0.008），且在不同亚组人群中的结果一致。结论 血管内治疗前应用替罗非班可降低患者预后不良发生风险，有助于患者神经功能、血小板功能的改善及炎症状态的减轻。

• Objective To investigate the efficacy of tirofiban at different time points in the endovascular treatment of atherosclerotic acute cerebral infarction (AIS) and its relationship with prognosis. Methods A total of 98 patients with atherosclerotic AIS who needed endovascular treatment in Shanxi Province Fenyang Hospital from June 2024 to May 2025 were selected as the research objects. All of the patients were divided into observation group ［49 cases, tirofiban 0.4 μg/(kg·min) intravenous infusion for 0.5 h followed by 0.1 μg/(kg·min) intravenous infusion for 24 h+ endovascular treatment］ and control group ［49 cases, tirofiban 0.2-1 mg during operation and 0.1 μg/(kg·min) intravenous infusion for 24 h after operation plus endovascular treatment］ by random number table method. The platelet aggregation rate, platelet adhesion rate, platelet volume distribution width (PDW), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and National Institutes of Health Stroke Scale (NIHSS) scores were compared between the two groups at admission, 24 h, 7 d and 14 d after treatment. The rate of complications and good prognosis were compared between the two groups. Cox regression analysis was used to analyze the effect of tirofiban application time on the poor prognosis of patients. Results On admission, there were no significant differences in platelet aggregation rate, platelet adhesion rate, PDW, hs-CRP, IL-6, and NIHSS score between the two groups (all P＞0.05). After treatment, the platelet aggregation rate, platelet adhesion rate, PDW, hs-CRP, IL-6 and NIHSS score of the two groups were significantly decreased, and the observation group decreased more significantly at 7 d and 14 d after treatment  (all P＜0.05). The incidence of reocclusion and the total incidence of adverse reactions in the observation group were significantly lower than those in the control group (all P＜0.05), and the rate of good prognosis was higher than that in the control group ［73.5%(36/49) vs 51.0%(25/49)］(P＜0.05). The timing of tirofiban administration in the observation group was a protective factor for the poor prognosis (hazard ratio =0.782, 95% confidence interval: 0.289-0.897, P=0.008), and the results were consistent in different subgroups. Conclusion The application of tirofiban before endovascular treatment can reduce the risk of poor prognosis of patients, and help to improve the neurological function, platelet function and inflammatory state of patients.