盐酸替罗非班对急性进展性脑梗死脑灌注及MMP-9影响的系列研究ⅡOACSTPCD

Objective To investigate the effect of tirofiban hydrochloride on cerebral perfusion and serum matrix metalloproteinase-9(MMP-9)in patients with acute progressive cerebral infarction(APCI)and provide reference for the treatment of APCI.Methods A total of 132 APCI patients admitted to Xinzheng Public People's Hospital from January 2019 to May 2023 were included as the study subjects and were randomly divided into Group A(61 cases)and Group B(61 cases).Group B received conventional treatment including enteric-coated aspirin 100 mg/d,clopidogrel 75 mg/d,and atorvastatin calcium 40 mg/d.After admission,group A received tirofiban hydrochloride by means of intravenous infusion continuously instead of enteric-coated aspirin and clopidogrel treatment at the rate of 0.4 μg·kg-1·min-1 for 30 minutes,and then at rate of 0.1 μg·kg-1·min-1 for 48 hours,and then added enteric-coated aspirin and clopidogrel at 44 hours after excluding cerebral hemorrhage by CT,with the remaining treatment the same as Group B.Both groups underwent 3.0T high-field magnetic resonance perfusion imaging of the brain at admission and 48 hours after exacerbation to evaluate the cerebral perfusion effects,including regional cerebral blood volume(rCBV),regional cerebral blood flow(rCBF),mean transit time(MTT),and time to peak(TTP).Peripheral venous blood samples were collected to measure MMP-9 concentration.Results Group A:before treatment,MTT was(4.45±1.03)s,TTP was(11.52±2.19)s,after treatment for 48 hours,MTT was(2.06±1.41)s,TTP was(8.17±2.01)s,both are shorter than those before treatment obviously(P<0.05).Before treatment,rCBV was(18.15±8.14)mL,rCBF was(3.86±0.77)mL/min,after treatment for 48 hours,rCBV was(37.42±6.17)mL,rCBF was(8.18±0.51)mL,both increased than those before treatment obviously(P<0.05).Before treatment,serum MMP-9 was(205.04±41.15)μg/L,after treatment for 48 hours,serum MMP-9 was(158.22±62.07)μg/L,which decreased obviously compared with those before treatment(P<0.05).Group B:before treatment,MTT was(4.84±1.73)s,TTP was(12.06±2.33)s,after treatment for 48 hours,MTT was(3.74±1.25)s,TTP was(10.93±1.62)s,both are shorter than those before treatment obviously.Before treatment,rCBV was(18.04±7.25)mL,rCBF was(3.91±0.63)mL/min,after treatment for 48 hours,rCBV was(25.81±6.09)mL,rCBF was(5.76±0.82)mL,both increased than those before treatment obviously(P<0.05).Before treatment,serum MMP-9 was(198.82±40.95)μg/L,after treatment for 48 hours,serum MMP-9 was(176.35±51.79)μg/L,which decreased obviously compared with those before treatment(P<0.05).After 48 hours of treatment,Group A showed significantly shorter of MTT and TTP compared to Group B(P<0.05),while CBV and CBF in Group A were significantly higher than those in Group B(P<0.05).After 48 hours of treatment,the serum MMP-9 levels in group A decreased significantly compared to Group B(t=15.07,P<0.05).Conclusion Tirofiban hydrochloride can improve cerebral perfusion and reduce serum MMP-9 levels significantly in APCI patients,thereby reducing brain tissue damage in APCI patients,and its efficacy is superior to conventional therapy.