替罗非班治疗进展性穿支动脉梗死临床疗效的相关因素

doi:10.3969/j.issn.1004-583X.2023.12.006

摘要/Abstract

摘要：

目的探讨替罗非班对进展性穿支动脉梗死临床疗效的相关因素。方法回顾性分析替罗非班治疗进展性穿支动脉梗死186例,根据90d改良Rankin 量表(mRS)评分分为结局良好组122例(mRS评分0~2分)及结局欠佳组64例(mRS评分3~5分)。比较两组临床资料,采用Logistic回归分析影响临床疗效的相关因素。结果两组发病年龄、低密度脂蛋白胆固醇、同型半胱氨酸、入院时美国国立卫生研究院卒中量表(national institute of health stroke scale, NIHSS)基线评分、溶栓治疗、开始应用替罗非班的时间比较,差异有统计学意义( $P$ <0.05)。Logistic分析结果显示,年龄、低密度脂蛋白胆固醇、入院时基线NIHSS评分及替罗非班应用时间是影响临床疗效的相关因素( $P$ <0.05)。结论对于进展性穿支动脉梗死患者,年龄越轻、低密度脂蛋白胆固醇水平越低、入院时基线NIHSS评分越低,以及应用替罗非班越早,临床预后可能越好。

关键词: 脑梗死, 穿支动脉梗死, 替罗非班, 影响因素分析

Abstract:

Objective To analyze the factors affecting the clinical efficacy of Tirofiban in the treatment of branch atheromatous disease (BAD). Methods The clinical data of 186 BAD patients treated with Tirofiban were retrospectively analyzed. According to the 90-day modified Rankin Scale (mRS) score, they were assigned into the good outcome group ( $n$ =122, mRS Score 0-2) and the poor outcome group ( $n$ =64, mRS Score 3-5). The general clinical data and clinical indicators of patients between groups were compared, and the risk factors affecting the clinical efficacy were analyzed by logistic regression model. Results There were significant differences in age of onset(AOO), low-density lipoprotein cholesterol (LDL-C), homocysteine, baseline the national institute of health stroke scale (NIHSS) score at admission, thrombolytic therapy (TT), and time to application of tirofiban between the two groups ( $P$ <0.05). Multivariate logistic analysis showed that younger AOO, lower LDL-C, lower baseline NIHSS score on admission, and earlier application of Tirofiban were factors affecting the clinical efficacy ( $P$ <0.05). Conclusion For BAD patients, their clinical prognosis might be better when the younger AOO, the lower LDL-C, the lower the baseline NIHSS score at admission, and the earlier the application of tirofiban.

Key words: acute cerebral infarction, branch atheromatous disease, tirofiban, risk factors

中图分类号:

R743.33

梁炳松, 李育英, 张岐平, 陈英道, 李健. 替罗非班治疗进展性穿支动脉梗死临床疗效的相关因素[J]. 临床荟萃, 2023, 38(12): 1091-1094.

Liang Bingsong, Li Yuying, Zhang Qiping, Chen Yingdao, Li jian. Analysis of factors affecting clinical efficacy of Tirofiban in treating branch atheromatous disease[J]. Clinical Focus, 2023, 38(12): 1091-1094.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.12.006

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I12/1091

图/表 2

表1 两组临床资料比较

Tab. 1 Comparison of clinical data between groups

组别	例数 (男/女)	年龄 (岁)		吸烟史 [例(%)]		高血压病病史[例(%)]		2型糖尿病 [例(%)]		冠心病 [例(%)]		TIA/卒中病史[例(%)]		入院时血糖 (mmol/L)		低密度脂蛋白胆固醇 (mmol/L)
结局良好组	122(56/66)	64.26±7.23		41(33.61)		62(50.82)		36(29.51)		15(12.30)		12(9.84)		7.71±3.21		3.25±0.63
结局欠佳组	64(34/30)	67.96±6.06		26(40.63)		27(42.19)		19(29.69)		8(12.50)		5(7.81)		8.49±3.77		3.88±0.48
$t$ /χ²值	0.697	-29.978		0.897		0.870		0.001		0.002		0.207		-1.761		-13.353
$P$ 值	0.404	0.000		0.344		0.351		0.980		0.968		0.649		0.080		0.000
组别	同型半胱氨酸 (μmol/L)		入院ASPECTS评分[例(%)]				溶栓治疗[例(%)]				应用替罗非班时间[例(%)]
组别	同型半胱氨酸 (μmol/L)		1~3分		3~15分		是		否		<12 h		12~24 h		≥24 h
结局良好组	13.31±4.32		81(66.39)		41(33.61)		70(57.38)		52(42.62)		84(68.85)		35(28.69)		3(2.46)
结局欠佳组	14.63±4.63		22(34.38)		42(65.62)		25(39.06)		39(60.94)		35(54.69)		20(31.25)		9(14.06)
$t$ 值/χ²值	-6.765		17.416				5.635				10.170
$P$ 值	0.000		0.000				0.018				0.006

表1 两组临床资料比较

Tab. 1 Comparison of clinical data between groups

组别	例数 (男/女)	年龄 (岁)		吸烟史 [例(%)]		高血压病病史[例(%)]		2型糖尿病 [例(%)]		冠心病 [例(%)]		TIA/卒中病史[例(%)]		入院时血糖 (mmol/L)		低密度脂蛋白胆固醇 (mmol/L)
结局良好组	122(56/66)	64.26±7.23		41(33.61)		62(50.82)		36(29.51)		15(12.30)		12(9.84)		7.71±3.21		3.25±0.63
结局欠佳组	64(34/30)	67.96±6.06		26(40.63)		27(42.19)		19(29.69)		8(12.50)		5(7.81)		8.49±3.77		3.88±0.48
$t$ /χ²值	0.697	-29.978		0.897		0.870		0.001		0.002		0.207		-1.761		-13.353
$P$ 值	0.404	0.000		0.344		0.351		0.980		0.968		0.649		0.080		0.000
组别	同型半胱氨酸 (μmol/L)		入院ASPECTS评分[例(%)]				溶栓治疗[例(%)]				应用替罗非班时间[例(%)]
组别	同型半胱氨酸 (μmol/L)		1~3分		3~15分		是		否		<12 h		12~24 h		≥24 h
结局良好组	13.31±4.32		81(66.39)		41(33.61)		70(57.38)		52(42.62)		84(68.85)		35(28.69)		3(2.46)
结局欠佳组	14.63±4.63		22(34.38)		42(65.62)		25(39.06)		39(60.94)		35(54.69)		20(31.25)		9(14.06)
$t$ 值/χ²值	-6.765		17.416				5.635				10.170
$P$ 值	0.000		0.000				0.018				0.006

表2 Logistic分析影响替罗非班治疗效果的相关因素

Tab. 2 Logistic analysis of factors affecting the clinical efficacy of Tirofiban on BAD

变量	β	标准误	Wald χ²值	$O R$ 值	$P$ 值	95% $C I$
年龄	0.114	0.036	10.255	1.121	0.001	1.045~1.202
低密度脂蛋白	2.237	0.411	29.67	9.369	0.000	4.189~20.958
同型半胱氨酸	0.074	0.066	1.258	1.077	0.262	0.946~1.225
入院基线NIHSS	2.578	0.512	25.385	13.169	0.000	4.831~35.899
是否溶栓治疗	-0.399	0.49	0.695	0.671	0.404	0.262~1.715
应用替罗非班时间	0.902	0.337	7.172	2.464	0.007	1.274~4.768

表2 Logistic分析影响替罗非班治疗效果的相关因素

Tab. 2 Logistic analysis of factors affecting the clinical efficacy of Tirofiban on BAD

变量	β	标准误	Wald χ²值	$O R$ 值	$P$ 值	95% $C I$
年龄	0.114	0.036	10.255	1.121	0.001	1.045~1.202
低密度脂蛋白	2.237	0.411	29.67	9.369	0.000	4.189~20.958
同型半胱氨酸	0.074	0.066	1.258	1.077	0.262	0.946~1.225
入院基线NIHSS	2.578	0.512	25.385	13.169	0.000	4.831~35.899
是否溶栓治疗	-0.399	0.49	0.695	0.671	0.404	0.262~1.715
应用替罗非班时间	0.902	0.337	7.172	2.464	0.007	1.274~4.768

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