两种药物单独和联合使用对急性脑梗死患者血小板抑制率及超敏C反应蛋白水平的影响
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摘要
目的研究急性脑梗死患者应用阿司匹林及氯吡格雷抗血小板的临床治疗效果及对血清相关炎症因子水平的影响,为临床抗血小板药物个体化治疗提供参考。方法选取山东省立第三医院2015年1月至2016年12月收治的300例急性脑梗死患者分为阿司匹林组、氯吡格雷组及联合组,每组各100例。治疗前、治疗后2周应用血栓弹力图(TEG)测定花生四烯酸(AA)水平及二磷酸腺苷(ADP)途径诱导的血小板抑制率,采用免疫比浊法测定3组患者血清超敏C反应蛋白(hs-CRP)水平。比较3组患者血小板抑制率、hs-CRP水平、患者神经功能评分及卒中复发率。结果 3组患者治疗后AA水平、ADP途径诱导的血小板抑制率均高于治疗前,差异均有统计学意义(P<0.05)。3组之间AA水平及ADP途径诱导的血小板抑制率差异均有统计学意义(P<0.05)。3组患者治疗后血清hs-CRP水平较治疗前明显降低,联合组治疗后血清hs-CRP水平明显低于其余两组,差异均有统计学意义(P<0.05)。联合组神经功能恢复更佳,卒中复发率更低。结论阿司匹林及氯吡格雷均具有抗血小板作用,但两种药物联合应用可从2个途径有效抑制血小板聚集,起到更强的抗血小板作用,降低血小板聚集活性,减少血管炎性反应,减少血栓复发的风险。
Objective To study the clinical therapeutic effect of aspirin and clopidogrel and their effect on the level of serum related inflammatory factors in patients with acute cerebral infarction,and to provide a reference for the individualized treatment of antiplatelet drugs.Methods A total of 300 patients with acute cerebral infarction admitted in Shandong Provincial Third Hospital from January 2015 to December 2016,were divided into aspirin group(n=100),clopidogrel group(n=100)and the combination group(n=100).Before and two weeks after treatment,thromboela-stogram(TEG)was used to determine the platelet inhibition rate of arachidonic acid(AA)level and adenosine diphosphate(ADP)pathway.Immunoturbidimetry was used to determine the level of serum hypersensitivity C reactive protein(hs-CRP)in the three groups of patients.Platelet inhibition rate,hs-CRP level,neurological function score and recurrence rate of stroke were compared between the three groups.Results The platelet inhibition rate induced by AA and ADP pathway after treatment in three groups were higher than those before treatment,and the difference was statistically significant(P<0.05).The difference of platelet inhibition rate induced by AA level and ADP pathway between the 3 groups was statistically significant(P<0.05).The level of serum hs-CRP in the 3 groups after treatment was significantly lower than before the treatment,the difference was statistically significant(P<0.05).The serum hs-CRP level in the combined group was significantly lower than those in the other two groups(P<0.05).The combined group had better neurological function recovery and lower stroke recurrence rate.ConclusionBoth aspirin and clopidogrel have antiplatelet effect,but the combined use of two drugs can effectively inhibit platelet aggregation from two ways.It can play a stronger antiplatelet function,reduce platelet aggregation activity,reduce vasculitis reaction,and reduce the risk of thrombus recurrence.
Objective To study the clinical therapeutic effect of aspirin and clopidogrel and their effect on the level of serum related inflammatory factors in patients with acute cerebral infarction,and to provide a reference for the individualized treatment of antiplatelet drugs.Methods A total of 300 patients with acute cerebral infarction admitted in Shandong Provincial Third Hospital from January 2015 to December 2016,were divided into aspirin group(n=100),clopidogrel group(n=100)and the combination group(n=100).Before and two weeks after treatment,thromboela-stogram(TEG)was used to determine the platelet inhibition rate of arachidonic acid(AA)level and adenosine diphosphate(ADP)pathway.Immunoturbidimetry was used to determine the level of serum hypersensitivity C reactive protein(hs-CRP)in the three groups of patients.Platelet inhibition rate,hs-CRP level,neurological function score and recurrence rate of stroke were compared between the three groups.Results The platelet inhibition rate induced by AA and ADP pathway after treatment in three groups were higher than those before treatment,and the difference was statistically significant(P<0.05).The difference of platelet inhibition rate induced by AA level and ADP pathway between the 3 groups was statistically significant(P<0.05).The level of serum hs-CRP in the 3 groups after treatment was significantly lower than before the treatment,the difference was statistically significant(P<0.05).The serum hs-CRP level in the combined group was significantly lower than those in the other two groups(P<0.05).The combined group had better neurological function recovery and lower stroke recurrence rate.ConclusionBoth aspirin and clopidogrel have antiplatelet effect,but the combined use of two drugs can effectively inhibit platelet aggregation from two ways.It can play a stronger antiplatelet function,reduce platelet aggregation activity,reduce vasculitis reaction,and reduce the risk of thrombus recurrence.
引文
[1]王艳海.血栓弹力图在急性脑梗死患者凝血监测中的临床应用[J].检验医学与临床,2015,12(22):3312-3313.
[2]黄媛,陈水平,宋世平,等.血栓弹力图法与光学比浊法监测冠心病患者阿司匹林抵抗的效果比较[J].检验医学与临床,2014,11(23):3277-3279.
[3]NAKAGAWA I,WADA T,PARK H S,et al.Platelet inhibition by adjunctive cilostazol suppresses the frequency of cerebral ischemic lesions after carotid artery stenting in patients with carotid artery stenosis[J].J Vasc Surg,2014,59(3):761-767.
[4]CHOI S W,CHOI D H,KIM H W,et al.Clinical outcome prediction from mean platelet volume in patients undergoing percutaneous coronary intervention in Korean cohort:implications of more simple and useful test than platelet function testing[J].Platelets,2013,12(4):863-865.
[5]ERLINGE D,GURBEL P A,JAMES S,et al.Prasugrel 5mg in the very elderly attenuates platelet inhibition but maintains noninferiority to prasugrel 10mg in nonelderly patients:the GENERATIONS trial,apharmacodynamic and pharmacokinetic study in stable coronary artery disease patients[J].J Am Coll Cardiol,2015,62(7):577-583.
[6]刘莅欣,胡桃红,丁力平,等.PCI术后口服三联抗血小板治疗的有效性和安全性研究[J].中国心血管病研究,2013,11(7):493-496.
[7]PANOVA-NOEVA M,MARCHETTI M,RUSSO L,et al.ADP-induced platelet aggregation and thrombin Generation are increased in essential thrombocythemia and polycythemia vera[J].Thromb Res,2013,132(1):88-93.
[8]LI R Z,FRIES S,LI X W,et al.Microfluidic assay of platelet deposition on collagen by perfusion of whole blood from healthy individuals taking aspirin[J].Clin Chem,2013,59(8):1195-1204.
[9]刘玲,杨防,李敏,等.血栓弹力图评价患者颅内外动脉狭窄支架置入术后抗血小板聚集药物的疗效[J].中国脑血管病杂志,2012,9(2):67-71.
[10]MANNACIO V A,DI TOMMASO L,ANTIGNAN A,et al.Aspirin plus clopidogrel for optimal platelet inhibition following off-pump coronary artery bypass surgery:results from the CRYSSA(prevention of Coronary arteRY bypaSS occlusion After off-pump procedures)randomised study[J].Heart,2012,98(23):1710-1715.
[11]李健,曹剑,王成彬,等.阿司匹林或氯吡格雷作用下血小板不同活化途径的反应特点[J].中国心血管杂志,2012,17(4):272-275.
[12]PATAL R,JONAS-KAMAHI T,MARGALIT N,et al.The effect of platelet transfusion on traumatic intracranial hemorrhage among patients treated with aspirin[J].Harefuah,2013,151(1):29-33.
[13]许强,张玉霄,卢才义,等.氯吡格雷抵抗对老年冠心病合并糖尿病患者介入治疗预后的影响及其危险因素[J].中华老年多器官疾病杂志,2013,12(5):354-357.
[14]LABARTHE B,BABIN J,BRYCKAERT M,et al.Effects of P2Y1receptor antagonism on the reactivity of platelets from patients with stable coronary artery disease using aspirin and clopidogrel[J].Br J Pharmacol,2012,166(1):221-231.
[15]王凡.C反应蛋白的检测与临床应用进展[J].检验医学与临床,2011,8(14):1761-1763.
[16]唐小勇,钟万芬,尚芙蓉.降钙素原和C反应蛋白与急性脑梗死患者短期预后的相关性研究[J].检验医学与临床,2016,13(13):1803-1806.
[2]黄媛,陈水平,宋世平,等.血栓弹力图法与光学比浊法监测冠心病患者阿司匹林抵抗的效果比较[J].检验医学与临床,2014,11(23):3277-3279.
[3]NAKAGAWA I,WADA T,PARK H S,et al.Platelet inhibition by adjunctive cilostazol suppresses the frequency of cerebral ischemic lesions after carotid artery stenting in patients with carotid artery stenosis[J].J Vasc Surg,2014,59(3):761-767.
[4]CHOI S W,CHOI D H,KIM H W,et al.Clinical outcome prediction from mean platelet volume in patients undergoing percutaneous coronary intervention in Korean cohort:implications of more simple and useful test than platelet function testing[J].Platelets,2013,12(4):863-865.
[5]ERLINGE D,GURBEL P A,JAMES S,et al.Prasugrel 5mg in the very elderly attenuates platelet inhibition but maintains noninferiority to prasugrel 10mg in nonelderly patients:the GENERATIONS trial,apharmacodynamic and pharmacokinetic study in stable coronary artery disease patients[J].J Am Coll Cardiol,2015,62(7):577-583.
[6]刘莅欣,胡桃红,丁力平,等.PCI术后口服三联抗血小板治疗的有效性和安全性研究[J].中国心血管病研究,2013,11(7):493-496.
[7]PANOVA-NOEVA M,MARCHETTI M,RUSSO L,et al.ADP-induced platelet aggregation and thrombin Generation are increased in essential thrombocythemia and polycythemia vera[J].Thromb Res,2013,132(1):88-93.
[8]LI R Z,FRIES S,LI X W,et al.Microfluidic assay of platelet deposition on collagen by perfusion of whole blood from healthy individuals taking aspirin[J].Clin Chem,2013,59(8):1195-1204.
[9]刘玲,杨防,李敏,等.血栓弹力图评价患者颅内外动脉狭窄支架置入术后抗血小板聚集药物的疗效[J].中国脑血管病杂志,2012,9(2):67-71.
[10]MANNACIO V A,DI TOMMASO L,ANTIGNAN A,et al.Aspirin plus clopidogrel for optimal platelet inhibition following off-pump coronary artery bypass surgery:results from the CRYSSA(prevention of Coronary arteRY bypaSS occlusion After off-pump procedures)randomised study[J].Heart,2012,98(23):1710-1715.
[11]李健,曹剑,王成彬,等.阿司匹林或氯吡格雷作用下血小板不同活化途径的反应特点[J].中国心血管杂志,2012,17(4):272-275.
[12]PATAL R,JONAS-KAMAHI T,MARGALIT N,et al.The effect of platelet transfusion on traumatic intracranial hemorrhage among patients treated with aspirin[J].Harefuah,2013,151(1):29-33.
[13]许强,张玉霄,卢才义,等.氯吡格雷抵抗对老年冠心病合并糖尿病患者介入治疗预后的影响及其危险因素[J].中华老年多器官疾病杂志,2013,12(5):354-357.
[14]LABARTHE B,BABIN J,BRYCKAERT M,et al.Effects of P2Y1receptor antagonism on the reactivity of platelets from patients with stable coronary artery disease using aspirin and clopidogrel[J].Br J Pharmacol,2012,166(1):221-231.
[15]王凡.C反应蛋白的检测与临床应用进展[J].检验医学与临床,2011,8(14):1761-1763.
[16]唐小勇,钟万芬,尚芙蓉.降钙素原和C反应蛋白与急性脑梗死患者短期预后的相关性研究[J].检验医学与临床,2016,13(13):1803-1806.