氯吡格雷联合阿司匹林治疗非心源性急性期脑梗死的临床观察
|
摘要
目的探究氯吡格雷联合阿司匹林对非心源性急性期脑梗死治疗的临床效果及安全性评估。方法回顾性分析2015年9月—2017年3月间在滁州市第一人民医院住院接受治疗,发病时间在72 h以内且未进行溶栓治疗的比例非心源性急性期脑梗死患者(包括发病在6 h以内拒绝溶栓治疗的患者)。从使用氯吡格雷联合阿司匹林双抗治疗患者中简单随机抽样30例患者作为研究组,从使用阿司匹林单抗治疗患者中简单随机抽样30例患者作为对照组。2组患者在急诊科就诊时均已给予咀嚼服用阿司匹林100 mg,入院后(包括入院当天)开始,研究组每天口服氯吡格雷75 mg联合阿司匹林100 mg,对照组每天口服阿司匹林100 mg。治疗3周后,对比2组患者治疗后与入院时的NIHSS评分、总有效率、血浆纤维蛋白原与同型半胱氨酸水平变化以及对比2组患者在出院后随访1年中脑梗死的再发率和药物不良反应发生率。结果治疗3周后,2组患者治疗后的NIHSS评分、血浆纤维蛋白原水平、同型半胱氨酸水平均较入院时明显降低(均P<0.05),且研究组显著低于对照组(均P<0.05);研究组总有效率(93.33%)高于对照组(70.00%,P<0.05);在患者出院后1年随访中,研究组脑梗死再发率(6.67%)明显低于对照组(30.00%,P<0.05),2组不良反应发生率差异无统计学意义(P>0.05),2组患者均无脑出血事件的发生。结论对于非心源性急性期脑梗死患者的治疗,氯吡格雷联合阿司匹林双抗治疗比单一使用阿司匹林更能提高急性脑梗死患者的治疗效果,更能有效地降低患者血浆纤维蛋白原与同型半胱氨酸的水平,同时能有效降低脑梗死的再发率,且药物不良反应无明显增加。
Objective To study the efficacy of clopidogrel plus aspirin in treatment of non-cardiogenic acute cerebral infarction and safety assessment.Methods A retrospective analysis was carried on for the patients with non-cardiogenic acute cerebral infarction who are unable or refusing to undergo thrombolytic therapy in the first people's hospital of Chuzhou from September 2015 to March 2017.Thirty patients were randomly selected from the patients treated with clopidogrel plus aspirin as the observation group.Thirty patients were randomly selected from the patients treated with aspirin as the control group.All of them had been given chewing aspirin 100 mg at the emergency department.The observation group oral clopidogrel 75 mg combined with aspirin 100 mg daily and the control group oral aspirin 100 mg daily from the day of admission.After 3 weeks treatment,the NIHSS score,total effective rate,the levels of plasma fibrinogen and homocysteine were compared between the two groups.The recurrence rate of cerebral infarction and the incidence of adverse drug reactions in 1-year follow-up visits between the two groups were compared.Results After 3 weeks treatment,the NIHSS score,total effective rate,the levels of plasma fibrinogen and homocysteine decrease effectively compared to the time of the admission(P < 0.05).The total effective rate of observation group(93.33%) was significantly higher than that in control group(70.00%,P < 0.05).During 1 year follow-up,the recurrence rate of cerebral infarction in observation group was 6.67%,significantly lower than that in control group(30.00%,P < 0.05).The incidence of adverse reactions between the two groups had no significant(P > 0.05) and no cerebral hemorrhage occurred in both groups.Conclusion For the treatment of non-cardiogenic acute cerebral infarction patients,comparing with aspirin alone,clopidogrel combined with aspirin can significantly improve the treatment effect of patients with acute cerebral infarction,and effectively reduce the levels of plasma fibrinogen and homocysteine in patients.It can also effectively reduce the recurrence rate of cerebral infarction,and there is no significant increase in adverse drug reactions.
Objective To study the efficacy of clopidogrel plus aspirin in treatment of non-cardiogenic acute cerebral infarction and safety assessment.Methods A retrospective analysis was carried on for the patients with non-cardiogenic acute cerebral infarction who are unable or refusing to undergo thrombolytic therapy in the first people's hospital of Chuzhou from September 2015 to March 2017.Thirty patients were randomly selected from the patients treated with clopidogrel plus aspirin as the observation group.Thirty patients were randomly selected from the patients treated with aspirin as the control group.All of them had been given chewing aspirin 100 mg at the emergency department.The observation group oral clopidogrel 75 mg combined with aspirin 100 mg daily and the control group oral aspirin 100 mg daily from the day of admission.After 3 weeks treatment,the NIHSS score,total effective rate,the levels of plasma fibrinogen and homocysteine were compared between the two groups.The recurrence rate of cerebral infarction and the incidence of adverse drug reactions in 1-year follow-up visits between the two groups were compared.Results After 3 weeks treatment,the NIHSS score,total effective rate,the levels of plasma fibrinogen and homocysteine decrease effectively compared to the time of the admission(P < 0.05).The total effective rate of observation group(93.33%) was significantly higher than that in control group(70.00%,P < 0.05).During 1 year follow-up,the recurrence rate of cerebral infarction in observation group was 6.67%,significantly lower than that in control group(30.00%,P < 0.05).The incidence of adverse reactions between the two groups had no significant(P > 0.05) and no cerebral hemorrhage occurred in both groups.Conclusion For the treatment of non-cardiogenic acute cerebral infarction patients,comparing with aspirin alone,clopidogrel combined with aspirin can significantly improve the treatment effect of patients with acute cerebral infarction,and effectively reduce the levels of plasma fibrinogen and homocysteine in patients.It can also effectively reduce the recurrence rate of cerebral infarction,and there is no significant increase in adverse drug reactions.
引文
[1]JABBARLI R,REINHARD M,NIESEN W D,et al.Predictors and impact of early cerebral infarction after aneurysmal subarachnoid hemorrhage[J].Eur J Neurol,2015,22(6):941-947.
[2]吉廷鑫.阿替普酶溶栓治疗急性脑梗死的临床效果及对神经功能缺损改善状况分析[J].中国实用医药,2018,13(13):105-106.
[3]陈奥.急性脑梗死合并脑微出血患者进行静脉溶栓治疗的效果分析[J].中国现代药物应用,2018,12(6):13-15.
[4]杨静,阿布都沙拉木·阿布都热衣木,张磊.血清ox-LDL、LpPLA2水平与缺血性脑卒中患者动脉粥样硬化及神经功能缺损的相关性研究[J].国际检验医学杂志,2017,38(23):3283-3285.
[5]PFAFF J,HERWEH C,PHAM M,et al.Mechanical thrombectomy in patients with acute ischemic stroke and lower NIHSS scores:recanalization rates,periprocedural complications,and clinical outcome[J].AJNR Am J Neuroradiol,2016,37(11):2066-2071.
[6]LORIGOOINI Z,AYATOLLAHI S A,AMIDI S,et al.Evaluation of anti-platelet aggregation effect of some allium species[J].Iran J Pharm Res,2015,14(4):1225-1231.
[7]张映红.进展性脑卒中中医辨证与血脂及血浆纤维蛋白原的关系[J].哈尔滨医药,2016,36(1):74-75.
[8]谈毅,郑云华.血浆纤维蛋白原和D-二聚体与急性缺血性脑卒中病情进展及出院结局的关系研究[J].中国预防医学杂志,2017,18(4):281-285.
[9]SKLIROU E,LICHTERKONECKI U.Inborn errors of metabolism with cognitive impairment:metabolism defects of phenylalanine,homocysteine and methionine,purine and pyrimidine,and creatine[J].Pediatr Clin North Am,2018,65(2):267-277.
[10]王璐,赵美芸,张敏,等.血清超氧化物歧化酶与同型半胱氨酸水平与心血管疾病的相关性研究[J].检验医学与临床,2015,12(6):752-753.
[11]MCCULLY K S.Homocysteine and the pathogenesis of atherosclerosis[J].Expert Rev Clin Pharmacol,2015,8(2):1-9.
[12]张江蓉,袁惠敏,诸培佳,等.老年2型糖尿病患者血清维生素D水平与同型半胱氨酸及胰岛素敏感性的相关性研究[J].中华高血压杂志,2018,26(2):200.
[13]林瑞声,付铖,周强,等.细胞色素P450 3A5基因多态性与氯吡格雷抵抗的相关性研究[J].中国临床药理学杂志,2018,34(7):815-817.
[14]梁友云.阿司匹林联合氯吡格雷治疗大脑中动脉狭窄脑梗死的临床研究[J].河北医学,2015,21(4):627-629.
[15]王维化.进展性缺血性脑卒中相关因素与阿司匹林抵抗的临床分析[J].中国实用神经疾病杂志,2016,19(21):81-82.
[16]HACEIN-BEY L,MUKUNDAN G,SHAHI K,et al.Hyperintense ipsilateral cortical sulci on FLAIR imaging in carotid stenosis:ivy sign equivalent from enlarged leptomeningeal collaterals[J].Clin Imaging,2015,38(3):314-317.
[17]吕清林.脑血栓患者应用阿托伐他汀与抗血小板药联合治疗的效果及血小板参数影响观察[J].中华肿瘤防治杂志,2016,23(S2):63-64.
[18]陈灏.不同剂量氯吡格雷和阿司匹林在急性脑梗死防治中的作用对比[J].中国实用神经疾病杂志,2016,19(20):5-7.
[19]SAVER J L,CARROLL J D,SMALLING R,et al.Letter by Saver et al regarding article,“Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association”[J].Stroke,2015,46(4):e85.
[20]马辉,吕慧怡,于晓杰,等.细胞色素P450 2C19基因多态性对氯吡格雷抗血小板作用的影响[J].中国临床药理学杂志,2017,33(19):1909-1911.
[21]LIN Y,WANG A,LI J,et al.Impact of glycemic control on efficacy of clopidogrel in transient ischemic attack or minor stroke patients with CYP2C19 genetic variants[J].Stroke,2017,48(4):998-1004.
[22]曾春艳,纪征,孙淑贤,等.不同程度冠状动脉病变ST段抬高型急性心肌梗死患者抗栓效果比较研究[J].中国全科医学,2018,21(12):1428-1431,1436.
[23]WANG Y,PAN Y,ZHAO X,et al.Clopidogrel with aspirin in acute minor stroke or transient ischemic attack[J].N Engl J Med,2013,369(1):11-19.
[2]吉廷鑫.阿替普酶溶栓治疗急性脑梗死的临床效果及对神经功能缺损改善状况分析[J].中国实用医药,2018,13(13):105-106.
[3]陈奥.急性脑梗死合并脑微出血患者进行静脉溶栓治疗的效果分析[J].中国现代药物应用,2018,12(6):13-15.
[4]杨静,阿布都沙拉木·阿布都热衣木,张磊.血清ox-LDL、LpPLA2水平与缺血性脑卒中患者动脉粥样硬化及神经功能缺损的相关性研究[J].国际检验医学杂志,2017,38(23):3283-3285.
[5]PFAFF J,HERWEH C,PHAM M,et al.Mechanical thrombectomy in patients with acute ischemic stroke and lower NIHSS scores:recanalization rates,periprocedural complications,and clinical outcome[J].AJNR Am J Neuroradiol,2016,37(11):2066-2071.
[6]LORIGOOINI Z,AYATOLLAHI S A,AMIDI S,et al.Evaluation of anti-platelet aggregation effect of some allium species[J].Iran J Pharm Res,2015,14(4):1225-1231.
[7]张映红.进展性脑卒中中医辨证与血脂及血浆纤维蛋白原的关系[J].哈尔滨医药,2016,36(1):74-75.
[8]谈毅,郑云华.血浆纤维蛋白原和D-二聚体与急性缺血性脑卒中病情进展及出院结局的关系研究[J].中国预防医学杂志,2017,18(4):281-285.
[9]SKLIROU E,LICHTERKONECKI U.Inborn errors of metabolism with cognitive impairment:metabolism defects of phenylalanine,homocysteine and methionine,purine and pyrimidine,and creatine[J].Pediatr Clin North Am,2018,65(2):267-277.
[10]王璐,赵美芸,张敏,等.血清超氧化物歧化酶与同型半胱氨酸水平与心血管疾病的相关性研究[J].检验医学与临床,2015,12(6):752-753.
[11]MCCULLY K S.Homocysteine and the pathogenesis of atherosclerosis[J].Expert Rev Clin Pharmacol,2015,8(2):1-9.
[12]张江蓉,袁惠敏,诸培佳,等.老年2型糖尿病患者血清维生素D水平与同型半胱氨酸及胰岛素敏感性的相关性研究[J].中华高血压杂志,2018,26(2):200.
[13]林瑞声,付铖,周强,等.细胞色素P450 3A5基因多态性与氯吡格雷抵抗的相关性研究[J].中国临床药理学杂志,2018,34(7):815-817.
[14]梁友云.阿司匹林联合氯吡格雷治疗大脑中动脉狭窄脑梗死的临床研究[J].河北医学,2015,21(4):627-629.
[15]王维化.进展性缺血性脑卒中相关因素与阿司匹林抵抗的临床分析[J].中国实用神经疾病杂志,2016,19(21):81-82.
[16]HACEIN-BEY L,MUKUNDAN G,SHAHI K,et al.Hyperintense ipsilateral cortical sulci on FLAIR imaging in carotid stenosis:ivy sign equivalent from enlarged leptomeningeal collaterals[J].Clin Imaging,2015,38(3):314-317.
[17]吕清林.脑血栓患者应用阿托伐他汀与抗血小板药联合治疗的效果及血小板参数影响观察[J].中华肿瘤防治杂志,2016,23(S2):63-64.
[18]陈灏.不同剂量氯吡格雷和阿司匹林在急性脑梗死防治中的作用对比[J].中国实用神经疾病杂志,2016,19(20):5-7.
[19]SAVER J L,CARROLL J D,SMALLING R,et al.Letter by Saver et al regarding article,“Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association”[J].Stroke,2015,46(4):e85.
[20]马辉,吕慧怡,于晓杰,等.细胞色素P450 2C19基因多态性对氯吡格雷抗血小板作用的影响[J].中国临床药理学杂志,2017,33(19):1909-1911.
[21]LIN Y,WANG A,LI J,et al.Impact of glycemic control on efficacy of clopidogrel in transient ischemic attack or minor stroke patients with CYP2C19 genetic variants[J].Stroke,2017,48(4):998-1004.
[22]曾春艳,纪征,孙淑贤,等.不同程度冠状动脉病变ST段抬高型急性心肌梗死患者抗栓效果比较研究[J].中国全科医学,2018,21(12):1428-1431,1436.
[23]WANG Y,PAN Y,ZHAO X,et al.Clopidogrel with aspirin in acute minor stroke or transient ischemic attack[J].N Engl J Med,2013,369(1):11-19.