【摘要】 目的 探讨尿激酶溶栓后早期使用替罗非班治疗急性脑梗死的安全性和有效性。方法 纳入2019年3月～2023年6月哈尔滨二四二医院神经内科收治的急性脑梗死患者178例，应用尿激酶序贯替罗非班治疗77例，应用尿激酶序贯氯吡格雷和阿司匹林治疗101例。通过倾向性评分的方法匹配50对患者，分为替罗非班组和双抗组，各50例。比较治疗方法的有效性和安全性，分析应用替罗非班时间长短对14 d美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale, NIHSS)评分影响，通过线性回归的方法分析影响患者14 d NIHSS评分的因素。结果 替罗非班组治疗14 d后的NIHSS评分明显低于双抗组(1.44±1.72 vs. 3.10±2.17),差异有统计学意义(P<0.001);90 d的mRS评分差异无统计学意义；7 d内致命性出血、180 d内的卒中复发及全病因死亡差异无统计学意义。应用尿激酶序贯替罗非班治疗的77例患者，使用替罗非班1 d与2、3 d均有差异(P=0.016;P=0.025,LSD法),而2 d和3 d无差异(P=0.763,LSD法)。多元线性回归分析显示，未使用替罗非班(β=-1.660,P<0.001)、纤维蛋白原升高(β=0.354,P=0.007)、入院时NIHSS值大(β=0.357,P<0.001)是影响治疗14 d NIHSS评分的因素。结论 尿激酶溶栓序贯替罗非班治疗比直接序贯双抗治疗的患者疗效更好并且安全性方面未见差异，使用替罗非班2～3 d比使用1 d的效果更好。纤维蛋白原升高是不良预后的影响因素。更多还原

【Abstract】 Objective To evaluate the safety and efficacy of early tirofiban following urokinase thrombolysis in patients with acute cerebral infarction. Methods A total of 178 patients with acute cerebral infarction admitted to the Department of Neurology from March 2019 to June 2023 in Harbin 242 Hospital were enrolled. A sequential therapy of urokinase followed by tirofiban was administered to 77 patients, and a sequential therapy of urokinase followed by clopidogrel and aspirin was administered to 101 patients. By using the propensity score method, 50 pairs of patients were successfully matched and divided into the tirofiban group and dual antiplatelet therapy(50 cases in each group). Efficacy and safety were compared firstly; then the impact of tirofiban duration on 14-day National Institute of Health Stroke Scale(NIHSS) score was analyzed; finally, factors influencing 14-day NIHSS score were identified using linear regression. Results After propensity score matching, baseline characteristics between the tirofiban group and dual antiplatelet therapy showed no significant difference. The NIHSS score in tirofiban group was significantly lower than that in dual antiplatelet therapy after 14 days of treatment(1.44±1.72 vs. 3.10±2.17, P<0.001). There was no significant difference in mRS Score at 90 days. There was no difference in fatal bleeding within 7 days, recurrent stroke within 180 days, or death from any cause. The analysis of 77 patients with urokinase sequential tirofiban showed that there was a difference in tirofiban use between 1 day and 2 or 3 days(P=0.016; P=0.025, LSD method), but no difference between 2 days and 3 days(P=0.763, LSD method). Multiple linear regression analysis showed that no use of tirofiban(β=-1.660, P<0.001), elevated fibrinogen(β=0.354, P=0.007), and high NIHSS value at admission(β=0.357, P<0.001) were the factors affecting NIHSS score at 14 days of treatment. Conclusion Urokinase sequentially followed by tirofiban is more effective than urokinase sequentially followed by clopidogrel and aspirin with same safety. Efficacy of tirofiban used for 2～3 days is better than that of tirofiban used for 1 day. Elevated fibrinogen is an independent risk factor for poor prognosis.更多还原