治疗中风的蒂罗菲班,没有大或中型血管阻塞
Wenjie Zi1, Jiaxing Song1, Weilin Kong1
1From the Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University) (W.Z., J.S., W.K., J.H., C.G., Z.Q., C.Y., L.L., Yan Tian, Dahong Yang, J.Y., J.H., F.L., Q.Y.), Guangyang Bay Laboratory, Chongqing Institute for Brain and Intelligence (W.Z., F.L., Q.Y.), the Department of Neurology, People's Hospital of Chongqing Banan District (M.T.), the Department of Neurology, Chongqing University Fuling Hospital (De Yang), No. 2 Department of Internal Medicine, Chongqing Sanbo Chang'an Hospital (J.Z.), the Department of Neurology, Youyang County People's Hospital (S.X., T.C.), and the Department of Neurology, Second Affiliated Hospital of Chongqing Medical University (C.L.), Chongqing, the Department of Neurology, Guiping People's Hospital, Guiping (W.H.), the Department of Neurology, Bazhong Hospital of Traditional Chinese Medicine (Y.Y.), the Department of Neurology, Bazhong Central Hospital (B.L.), the Department of Neurology, People's Hospital of Pingchang (J.L.), and the Department of Neurology, Nanjiang Hospital of Traditional Chinese Medicine (J.M.), Bazhong, the Department of Neurology, Suining First People's Hospital, Suining (B.Z), the Department of Neurology, Taihe County People's Hospital (W.G.), and the Department of Neurology, Taihe County Hospital of Traditional Chinese Medicine (Z.L.), Fuyang, the Department of Neurology, Meishan Second People's Hospital, Meishan (X.T.), the Department of Neurology, Qian Xi Nan People's Hospital, Qian Xi Nan (Yaoyu Tian), the Department of Neurology, Jingdezhen No. 1 People's Hospital, Jingdezhen (M.C.), the Department of Neurology, Xingyi People's Hospital, Xingyi (D.C.), the Department of Encephalopathy, Maoming Hospital of Traditional Chinese Medicine, Maoming (W.H.), the Department of Neurology, Weihai Municipal Hospital, Weihai (P.W.), the Department of Neurology, Liangshan First People's Hospital, Xichang (Z.Y.), the Department of Neurology, People's Hospital of Luyi, Zhoukou (H.L.), the Department of Neurology, People's Hospital of Zunyi City Bo Zhou District, Zunyi (S.Y.), the Department of Neurology, Wuhan Hospital of Traditional Chinese and Western Medicine (W.L.), and the Department of Neurology, Third People's Hospital of Hubei Province, (Y.W.), Wuhan, the Department of Neurology, First Affiliated Hospital of Wannan Medical College, Wuhu (X.H.), the Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan (S.L), the Department of Neurology, Mianyang Central Hospital (Y. Tang), the Department of Cerebrovascular Diseases, Sichuan Mianyang 404 Hospital (J.L.), the Department of Neurology, People's Hospital of Zitong County (M.W.), and the Department of Neurology, Sichuan Science City Hospital (Y.P.), Mianyang, the Department of Neurology, Chongzhou People's Hospital, Chengdu (Y.W.), the Department of Neurology, Xian XD Group Hospital, Xi'an (L.Y.), the Department of Neurology, Southern Medical University-affiliated Dongguan People's Hospital, Dongguan (Z.S.), the Department of Neurology, People's Hospital of Nanbu County (P.H.), and the Department of Neurology, Affiliated Hospital of North Sichuan Medical College (Z.L.), Nanchong, the Department of Neurology, Second People's Hospital of Mengjin District, Luoyang (H.Z.), the Department of Neurology, Mianzhu People's Hospital, Deyang (Z.C.), the Department of Neurology, Zigong First People's Hospital, Zigong (Q.S.), the Department of Neurology, Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan (X.C.), the Department of Cerebrovascular Diseases, People's Hospital of Yuxi City, Yuxi (F.H.), the Department of Neurology, First People's Hospital of Yibin, Yibin (H.L.), the Department of Neurology, People's Hospital of Mengzi, Hani-Yi Autonomous Prefecture of Honghe, Mengzi (W.X.); and the Department of Neurology, Xianyang Hospital of Yan'an University, Xianyang (J.M.) - all in China; University of Pittsburgh Medical Center Stroke Institute, Departments of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.); the Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (D.W.); and the Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles (J.L.S.).
在没有大血管封闭的急性缺血性中风患者中,tirofiban改善了结果,与阿司匹林相比,显示出更高的良好恢复率. 虽然整体上是安全的,但tirofiban对内出血的风险略有增加.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 临床试验 临床试验
背景情况:
- 糖蛋白IIb/IIIa受体抑制剂,如蒂罗菲班,在没有大或中型血管封闭的急性缺血性中风患者中尚未得到广泛研究.
- 急性缺血性中风管理往往侧重于再输疗法,在了解非闭塞病例的治疗方法方面存在差距.
研究的目的:
- 在急性缺血性中风患者中与低剂量阿司匹林相比,评估静脉注射蒂罗菲班的疗效和安全性,并且没有大或中型血管封闭.
- 为了确定蒂罗菲班是否能在这种特定的中风患者群体中改善功能结果和生活质量.
主要方法:
- 在中国的一项多中心试验中,纳入了患有缺血性中风的患者,NIH中风评分≥5,肢体软弱,没有大血管封闭.
- 患者接受了静脉注射的蒂罗菲班或口服阿司匹林2天,随后服用阿司匹林90天.
- 主要疗效终点是90天的优秀结果 (修改的兰金度数0-1分);安全终点包括死亡和症状性内出血.
主要成果:
- 与阿司匹林 (22.2%) 相比,显著更高的患者百分比获得了提洛菲班 (29.1%) 的优秀结果 (调整后风险比,1.26;P=0.02).
- 大多数患者有小的,可能是动脉样硬化性心脏病发作.
- 死亡率在各组之间是相似的,但症状性内出血发生在铁奥菲班组的1.0%与阿司匹林组的0%之间.
结论:
- 与低剂量阿司匹林相比,静脉静脉罗非班与最近发作或进展中风和非遮脑血管的患者的优秀结局的可能性更大.
- 虽然有效,但tirofiban的使用与内出血的发病率略高有关,因此需要仔细考虑风险和益处.
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