替罗非班治疗进展性缺血性脑卒中的疗效观察
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摘要
目的探讨替罗非班治疗进展性脑卒中(progressive ischemic stroke,PIS)的有效性和安全性。方法收集解放军第371中心医院神经内科2016-01—2017-12确诊的PIS并应用盐酸替罗非班氯化钠注射液治疗的5例患者,记录其人口学特征,发病时间,替罗非班应用的持续时间,不同时间点的美国国立卫生研究院卒中量表(NIHSS)评分以及并发症。结果 5例患者应用替罗非班后NIHSS评分下降4～13分,平均7.2分。在应用替罗非班注射液后血凝系列出现变化的3例,血栓弹力图均未见明显变化;5例患者在应用替罗非班前、后和应用替罗非班过程中均未出现出血并发症。结论替罗非班作为一种新型、高效、可逆的抗血小板聚集药物,通过阻断糖蛋白ⅡbⅢa受体与纤维蛋白原结合这一血小板聚集的最后、唯一途径,发挥高效的抗血小板聚集作用,其治疗PIS的价值值得进一步研究。
Objective To investigate the efficacy and safety of tirofiban in the treatment of progressive ischemic stroke(PIS).Methods Five patients who were diagnosed with PIS and treated with tirofiban hydrochloride sodium chloride injection from Department of Neurology,the 371 st Central Hospital of PLA form January 2016 to December 2017,recorded demographic characteristics,onset time,and application,the duration of the National Institute of Health Stroke Scale(NIHSS)scores and complications at different time points.Results In 5patients,the NIHSS score decreased by 4to 13 points after an application of tirofiban,with an average of 7.2points.In the 3cases of hemagglutination series after the application of tirofiban injection,no significant changes were observed in the thromboelastogram;5patients did not appear the application of tirofiban before and after treatment,no bleeding complications occurred.Conclusion As a new,highly effective and reversible anti-platelet aggregation drug,tirofiban exerts an effective anti-platelet aggregation effect by blocking the final and only pathway of platelet aggregation in which glycoprotein IIbIIIa receptor binds to fibrinogen,its value is worth further research for the treatment of PIS.
Objective To investigate the efficacy and safety of tirofiban in the treatment of progressive ischemic stroke(PIS).Methods Five patients who were diagnosed with PIS and treated with tirofiban hydrochloride sodium chloride injection from Department of Neurology,the 371 st Central Hospital of PLA form January 2016 to December 2017,recorded demographic characteristics,onset time,and application,the duration of the National Institute of Health Stroke Scale(NIHSS)scores and complications at different time points.Results In 5patients,the NIHSS score decreased by 4to 13 points after an application of tirofiban,with an average of 7.2points.In the 3cases of hemagglutination series after the application of tirofiban injection,no significant changes were observed in the thromboelastogram;5patients did not appear the application of tirofiban before and after treatment,no bleeding complications occurred.Conclusion As a new,highly effective and reversible anti-platelet aggregation drug,tirofiban exerts an effective anti-platelet aggregation effect by blocking the final and only pathway of platelet aggregation in which glycoprotein IIbIIIa receptor binds to fibrinogen,its value is worth further research for the treatment of PIS.
引文
[1]包萨如拉,孟云清.银杏叶注射液联合丁苯酞注射液高压氧治疗进展性脑梗死临床分析[J].中国实用神经疾病杂志,2016,19(8):116-117.
[2]TANABE N,HIRAOKA E,HOSHINO M,et al.Progressive Ischemic Stroke due to Thyroid Storm-Associated Cerebral Venous Thrombosis[J].Am J Case Rep,2017,18:194-197.
[3]LI Z,WANG Y,ZHAO X,et al.Treatment Effect of Clopidogrel Plus Aspirin Within 12 Hours of Acute Minor Stroke or Transient Ischemic Attack[J].J Am Heart Assoc,2016,5(3):e003038.
[4]ZHANG F L,GUO Z N,LIU Y,et al.Dissection extending from extra-to intracranial arteries:A case report of progressive ischemic stroke[J].Medicine(Baltimore),2017,96(21):e6980.
[5]FEIGIN V L,NORRVING B,MENSAH G A.Global burden of stroke[J].Circ Res,2017,120(3):439-448.
[6]ZHOU M,WANG H,ZHU J,et al.Cause-specific mortality for 240causes in China during 1990/2013:a systematic subnational analysis for the Global Burden of Disease Study 2013[J].Lancet,2016,387(10 015):251-272.
[7]LI J,WANG L,CHAO B,et al.Prevalence of stroke in China:an epidemiological study based on the National Stroke Screening Survey[J].Lancet,2015,386:S49.
[8]MATHIAS E,SETHURAMAN U.Ischemic Stroke of the Spinal Cord:A Pediatric Emergency in an Otherwise Healthy Child[J].J Emerg Med,2016,51(1):73-76.
[9]冯远,郑自龙.进展性脑梗死的病因、危险因素及临床特点分析[J].中国实用神经疾病杂志,2009,12(4):39-40.
[10]BARBER M,STOTT D J,LANGHOENE P.An internationally agreed definition of progressing stroke[J].Cerebrovasc Dis,2004,18(3):255-256.
[11]李春,赵高峰,何谦益,等.中性粒细胞-淋巴细胞比值与急性脑梗死的相关性分析[J].中国实用神经疾病杂志,2018,21(1):21-25.
[12]HERISSON F,GODARD S,VOLTEAU C,et al.Early Sitting in Ischemic Stroke Patients(SEVEL):A Randomized Controlled Trial[J].PLoS One,2016,11(3):e0149466.
[13]MA J,MA Y,DONG B,et al.Prevention of the collapse of pial collaterals by remote ischemic perconditioning during acute ischemic stroke[J].J Cereb Blood Flow Metab,2017,37(8):3 001-3 014.
[14]MAJERSIK J J.Inherited and Uncommon Causes of Stroke[J].Continuum(Minneap Minn),2017,23(1,Cerebrovascular Disease):211-237.
[15]PEREZ-DE-PUIG I,MIR?MUR F,FERRER-FERRER M,et al.Neutrophil recruitment to the brain in mouse and human ischemic stroke[J].Acta Neuropathol,2015,129(2):239-57.
[16]郝静,赵娜,田成林.替罗非班治疗PIS的疗效和安全性观察[J].解放军医学院学报,2017,38(5):409-413.
[17]SUWANWELA N C,CHUTINET A,MAYOTARNS,et al.A randomized controlled study of intravenous fluid in acute ischemic stroke[J].Clin Neurol Neurosurg,2017,161:98-103.
[18]CANDELARESI P,LATTUADA P,UGGETTI C,et al.A high-urgency stroke code reduces in-hospital delays in acute ischemic stroke:a single-centre experience[J].Neurol Sci,2017,38(9):1 671-1 676.
[19]DA SILVA-CANDAL A,ARGIBAY B,IGLESIAS-REY R,et al.Vectorized nanodelivery systems for ischemic stroke:a concept and a need[J].J Nanobiotechnology,2017,15(1):30.
[20]PHAM M,BENDSZUS M.Facing Time in Ischemic Stroke:An Alternative Hypothesis for Collateral Failure[J].Clin Neuroradiol,2016,26(2):141-151.
[21]RIZOS T,BARTSCH A J,JOHNSON T D,et al.Voxelwise distribution of acute ischemic stroke lesions in patients with newly diagnosed atrial fibrillation:Trigger of arrhythmia or only target of embolism?[J].PLoS One,2017,12(5):e0177474.
[22]GONZALES S,MULLEN M T,SKOLARUS L,et al.Progressive rural-urban disparity in acute stroke care[J].Neurology,2017,88(5):441-448.
[23]BAERTS L,BROUNS R,KEHOE K,et al.Acute Ischemic Stroke Severity,Progression,and Outcome Relate to Changes in Dipeptidyl Peptidase IV and Fibroblast Activation Protein Activity[J].Transl Stroke Res,2017,8(2):157-164.
[24]FULLERTON H J,DEVEBER G A,HILLS N K,et al.Inflammatory Biomarkers in Childhood Arterial Ischemic Stroke:Correlates of Stroke Cause and Recurrence.Stroke,2016,47(9):2 221-2 228.
[25]SIEGLER J E,MARTIN-SCHILD S.Intravenous Thrombolysis Attenuates Neurologic Deterioration After Ischemic Stroke[J].South Med J,2016,109(10):661-667.
[26]CICCONE A,MOTTO C,ABRAHA I,et al.GlycoproteinⅡb?Ⅲa inhibitors for acute ischaemic stroke[D].Cochrane Database Syst Rev,2014,8(3):CD005208.
[27]LI W,LIN L,ZHANG M,et al.Safety and Preliminary Efficacy of Early Tirofiban Treatment After Alteplase in Acute Ischemic Stroke Patients[J].Stroke,2016,47(10):2 649-2 651.
[28]COHEN-INBAR O,AMSALEM Y.Cerebral Nitinol Stenting in Progressive Stroke and in Crescendo TIAs[J].J Neurol Surg A Cent Eur Neurosurg,2015,76(6):499-507.
[29]FENG L,LIU J,LIU Y,et al.Tirofiban combined with urokinase selective intra-arterial thrombolysis for the treatment of middle cerebral artery occlusion[J].Exp Ther Med,2016,11(3):1 011-1 016.
[30]DOBRIVOJEVIC M,PIRANEC K,SINDIC A.Involvement of bradykinin in brain edema development after ischemic stroke[J].Pflugers Arch,2015,467(2):201-212.
[31]SEO J H,JEONG H W,KIM S T,et al.Adjuvant tirofiban injection through deployed solitaire stent as a rescue technique after failed mechanical thrombectomy in acute troke[J].Neurointervention,2015,10(1):22-27.
[32]ZHOU X,PENG H,YIN Y,et al.Diffused alveolar hemorrhage:a rare and severe complication of tirofibaninduced thrombocytopenia[J].Int J Cardiol,2016,206:93-94.
[33]KELLERT L,HAMETNER C,ROHDE S,et al.Endovascular stroke therapy:tirofiban is associated with risk of fatal intracerebral hemorrhage and poor outcome[J].Stroke,2013,44(5):1 453-1 455.
[34]JUNGHANS U,SEITZ R J,AULICH A,et al.Bleeding risk of tirofiban,a nonpeptide GPIIb/IIIa platelet receptor antagonist in progressive stroke:an open pilot study[J].Cerebrovasc Dis,2001,12(4):308-312.
[2]TANABE N,HIRAOKA E,HOSHINO M,et al.Progressive Ischemic Stroke due to Thyroid Storm-Associated Cerebral Venous Thrombosis[J].Am J Case Rep,2017,18:194-197.
[3]LI Z,WANG Y,ZHAO X,et al.Treatment Effect of Clopidogrel Plus Aspirin Within 12 Hours of Acute Minor Stroke or Transient Ischemic Attack[J].J Am Heart Assoc,2016,5(3):e003038.
[4]ZHANG F L,GUO Z N,LIU Y,et al.Dissection extending from extra-to intracranial arteries:A case report of progressive ischemic stroke[J].Medicine(Baltimore),2017,96(21):e6980.
[5]FEIGIN V L,NORRVING B,MENSAH G A.Global burden of stroke[J].Circ Res,2017,120(3):439-448.
[6]ZHOU M,WANG H,ZHU J,et al.Cause-specific mortality for 240causes in China during 1990/2013:a systematic subnational analysis for the Global Burden of Disease Study 2013[J].Lancet,2016,387(10 015):251-272.
[7]LI J,WANG L,CHAO B,et al.Prevalence of stroke in China:an epidemiological study based on the National Stroke Screening Survey[J].Lancet,2015,386:S49.
[8]MATHIAS E,SETHURAMAN U.Ischemic Stroke of the Spinal Cord:A Pediatric Emergency in an Otherwise Healthy Child[J].J Emerg Med,2016,51(1):73-76.
[9]冯远,郑自龙.进展性脑梗死的病因、危险因素及临床特点分析[J].中国实用神经疾病杂志,2009,12(4):39-40.
[10]BARBER M,STOTT D J,LANGHOENE P.An internationally agreed definition of progressing stroke[J].Cerebrovasc Dis,2004,18(3):255-256.
[11]李春,赵高峰,何谦益,等.中性粒细胞-淋巴细胞比值与急性脑梗死的相关性分析[J].中国实用神经疾病杂志,2018,21(1):21-25.
[12]HERISSON F,GODARD S,VOLTEAU C,et al.Early Sitting in Ischemic Stroke Patients(SEVEL):A Randomized Controlled Trial[J].PLoS One,2016,11(3):e0149466.
[13]MA J,MA Y,DONG B,et al.Prevention of the collapse of pial collaterals by remote ischemic perconditioning during acute ischemic stroke[J].J Cereb Blood Flow Metab,2017,37(8):3 001-3 014.
[14]MAJERSIK J J.Inherited and Uncommon Causes of Stroke[J].Continuum(Minneap Minn),2017,23(1,Cerebrovascular Disease):211-237.
[15]PEREZ-DE-PUIG I,MIR?MUR F,FERRER-FERRER M,et al.Neutrophil recruitment to the brain in mouse and human ischemic stroke[J].Acta Neuropathol,2015,129(2):239-57.
[16]郝静,赵娜,田成林.替罗非班治疗PIS的疗效和安全性观察[J].解放军医学院学报,2017,38(5):409-413.
[17]SUWANWELA N C,CHUTINET A,MAYOTARNS,et al.A randomized controlled study of intravenous fluid in acute ischemic stroke[J].Clin Neurol Neurosurg,2017,161:98-103.
[18]CANDELARESI P,LATTUADA P,UGGETTI C,et al.A high-urgency stroke code reduces in-hospital delays in acute ischemic stroke:a single-centre experience[J].Neurol Sci,2017,38(9):1 671-1 676.
[19]DA SILVA-CANDAL A,ARGIBAY B,IGLESIAS-REY R,et al.Vectorized nanodelivery systems for ischemic stroke:a concept and a need[J].J Nanobiotechnology,2017,15(1):30.
[20]PHAM M,BENDSZUS M.Facing Time in Ischemic Stroke:An Alternative Hypothesis for Collateral Failure[J].Clin Neuroradiol,2016,26(2):141-151.
[21]RIZOS T,BARTSCH A J,JOHNSON T D,et al.Voxelwise distribution of acute ischemic stroke lesions in patients with newly diagnosed atrial fibrillation:Trigger of arrhythmia or only target of embolism?[J].PLoS One,2017,12(5):e0177474.
[22]GONZALES S,MULLEN M T,SKOLARUS L,et al.Progressive rural-urban disparity in acute stroke care[J].Neurology,2017,88(5):441-448.
[23]BAERTS L,BROUNS R,KEHOE K,et al.Acute Ischemic Stroke Severity,Progression,and Outcome Relate to Changes in Dipeptidyl Peptidase IV and Fibroblast Activation Protein Activity[J].Transl Stroke Res,2017,8(2):157-164.
[24]FULLERTON H J,DEVEBER G A,HILLS N K,et al.Inflammatory Biomarkers in Childhood Arterial Ischemic Stroke:Correlates of Stroke Cause and Recurrence.Stroke,2016,47(9):2 221-2 228.
[25]SIEGLER J E,MARTIN-SCHILD S.Intravenous Thrombolysis Attenuates Neurologic Deterioration After Ischemic Stroke[J].South Med J,2016,109(10):661-667.
[26]CICCONE A,MOTTO C,ABRAHA I,et al.GlycoproteinⅡb?Ⅲa inhibitors for acute ischaemic stroke[D].Cochrane Database Syst Rev,2014,8(3):CD005208.
[27]LI W,LIN L,ZHANG M,et al.Safety and Preliminary Efficacy of Early Tirofiban Treatment After Alteplase in Acute Ischemic Stroke Patients[J].Stroke,2016,47(10):2 649-2 651.
[28]COHEN-INBAR O,AMSALEM Y.Cerebral Nitinol Stenting in Progressive Stroke and in Crescendo TIAs[J].J Neurol Surg A Cent Eur Neurosurg,2015,76(6):499-507.
[29]FENG L,LIU J,LIU Y,et al.Tirofiban combined with urokinase selective intra-arterial thrombolysis for the treatment of middle cerebral artery occlusion[J].Exp Ther Med,2016,11(3):1 011-1 016.
[30]DOBRIVOJEVIC M,PIRANEC K,SINDIC A.Involvement of bradykinin in brain edema development after ischemic stroke[J].Pflugers Arch,2015,467(2):201-212.
[31]SEO J H,JEONG H W,KIM S T,et al.Adjuvant tirofiban injection through deployed solitaire stent as a rescue technique after failed mechanical thrombectomy in acute troke[J].Neurointervention,2015,10(1):22-27.
[32]ZHOU X,PENG H,YIN Y,et al.Diffused alveolar hemorrhage:a rare and severe complication of tirofibaninduced thrombocytopenia[J].Int J Cardiol,2016,206:93-94.
[33]KELLERT L,HAMETNER C,ROHDE S,et al.Endovascular stroke therapy:tirofiban is associated with risk of fatal intracerebral hemorrhage and poor outcome[J].Stroke,2013,44(5):1 453-1 455.
[34]JUNGHANS U,SEITZ R J,AULICH A,et al.Bleeding risk of tirofiban,a nonpeptide GPIIb/IIIa platelet receptor antagonist in progressive stroke:an open pilot study[J].Cerebrovasc Dis,2001,12(4):308-312.