拜阿司匹林联合氯吡格雷在急性脑梗塞中的应用对CD-63、CD62P和PAC-1以及炎性因子、血小板聚集功能的影响
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摘要
目的探讨拜阿司匹林联合氯吡格雷治疗急性脑梗塞对患者CD-63、CD62P和PAC-1以及炎性因子、血小板聚集功能的影响。方法选取本院2014年3月-2016年11月急性脑梗塞患者190例,按入院顺序分为对照组,每组95例,观察组予以拜阿司匹林联合氯吡格雷治疗,对照组仅予以拜阿司匹林治疗,比较2组治疗前和治疗2周后CD-63、CD62P和PAC-1以及炎性因子、血液流变学、血小板活性指标。结果观察组治疗后CD63、CD62P、PAC-1、hs-CRP、IL-6和IL-8均低于对照组,全血黏度、血浆黏度和血小板聚集率均低于对照组,血小板抑制率高于对照组,血小板黏附率、红细胞沉降率和D-二聚体低于对照组,以上差异均有统计学意义(P<0.05)。结论拜阿司匹林联合氯吡格雷治疗急性脑梗塞可有效抑制血小板聚集,降低血液黏度,减轻炎性反应,提高临床疗效,推荐广泛应用。
Objective To investigate the effects of aspirin combined with clopidogrel on CD-63,CD62 P and PAC-1,inflammatory cytokines and platelet aggregation dysfunction in patients with acute cerebral infarction. Methods 190 patients with acute cerebral infarction in our hospital were collected from March 2014 to November 2016 and divided into the control group( n = 95) and the observation group according to the order of admission. The observation group was given combined therapy of aspirin and clopidogrel,but the control group was treated with aspirin only. The index of CD-63,CD62 P,PAC-1 and inflammatory factors,blood rheology and platelet activity were compared before and after 2 weeks of treatment. Results After treatment,the levels of CD63,CD62 P,PAC-1,HS-CRP,IL-6 and IL-8 of the observation group were all lower than those of the control group,whole blood viscosity,plasma viscosity and platelet aggregation rate were lower than the control group,and the platelet inhibition rate was higher than that of the control group. The platelet adhesion rate,erythrocyte sedimentation rate and D-dimer were lower than those of the control group,with the differences statistically significant( P < 0. 05).Conclusion A combination therapy of aspirin and clopidogre is effective in inhibiting platelet aggregation,reducing blood viscosity,alleviating inflammatory response and improving the clinical efficacy in patients with acute cerebral infarction. It is recommended to be widely applied.
Objective To investigate the effects of aspirin combined with clopidogrel on CD-63,CD62 P and PAC-1,inflammatory cytokines and platelet aggregation dysfunction in patients with acute cerebral infarction. Methods 190 patients with acute cerebral infarction in our hospital were collected from March 2014 to November 2016 and divided into the control group( n = 95) and the observation group according to the order of admission. The observation group was given combined therapy of aspirin and clopidogrel,but the control group was treated with aspirin only. The index of CD-63,CD62 P,PAC-1 and inflammatory factors,blood rheology and platelet activity were compared before and after 2 weeks of treatment. Results After treatment,the levels of CD63,CD62 P,PAC-1,HS-CRP,IL-6 and IL-8 of the observation group were all lower than those of the control group,whole blood viscosity,plasma viscosity and platelet aggregation rate were lower than the control group,and the platelet inhibition rate was higher than that of the control group. The platelet adhesion rate,erythrocyte sedimentation rate and D-dimer were lower than those of the control group,with the differences statistically significant( P < 0. 05).Conclusion A combination therapy of aspirin and clopidogre is effective in inhibiting platelet aggregation,reducing blood viscosity,alleviating inflammatory response and improving the clinical efficacy in patients with acute cerebral infarction. It is recommended to be widely applied.
引文
[1]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J].中华神经科杂志,2015,48(4):258-273.
[2]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):376-381.
[3]沈景红,何海燕,戴鸣萱.阿司匹林联合奥扎格雷钠对急性脑梗死的治疗作用观察[J].海南医学院学报,2017,23(1):38-40.
[4]倪贵华,梁晨,赵卫东,等.血栓弹力图评价大动脉粥样硬化性脑梗死患者氯吡格雷抗栓效果和预测血管事件的价值[J].中华老年心脑血管病杂志,2017,19(5):513-514.
[5]Mehta GU,Heiss JD,Park JK,et al.Neurological surgery at the National Institutes of Health[J].World Neurosurg,2010,74(1):49-59.
[6]赵晓玲.瑞舒伐他汀联合氯吡格雷对脑梗死急性期患者血小板活化及聚集状态的影响[J].中国实用神经疾病杂志,2017,20(8):28-30.
[7]Okabe T,Aida N,Niwa T,et al.Early magnetic resonance detection of cortical necrosis and acute network injury associated with neonatal and infantile cerebral infarction[J].Pediatric Radiol,2014,44(5):597-604.
[8]Mastenbroek TG,van Geffen JP,Heemskerk JW,et al.Acute and persistent platelet and coagulant activities in atherothrombosis[J].J Thromb Haemost,2015,13(1):272-280.
[9]申伟,金香兰,陈宝鑫.中医药治疗脑梗死后认知障碍的研究进展[J].北京中医药,2016,35(7):638-639.
[10]Pan Y,Wang A,Liu G,et al.Cost-effectiveness of clopidogrelaspirin versus aspirin alone for acute transient ischemic attack and minor stroke[J].J Am Heart Assoc,2014,3(3):96-98.
[11]赵孟娟.氯吡格雷联合阿司匹林治疗脑梗死患者的疗效及对其血小板活性及动脉硬化的影响[J].中国实用神经疾病杂志,2017,20(5):102-104.
[12]沈小静,龚昌富.早期干预对老年脑梗死患者负性情绪和康复依从性的影响[J].实用老年医学,2016,30(9):784-785.
[13]Gross L,Aradi D,Sibbing D.Platelet function testing in patients on antiplatelet medications[J].Semin Thromb Hemost,2016,42(3):306-320.
[14]高志强,柏燕燕,孔玉,等.氯吡格雷联合蚓激酶治疗对急性脑梗死患者血浆D-二聚体、血小板聚集和纤维蛋白原的影响[J].江苏医药,2014,40(14):1707-1709.
[15]Leunissen TC,Janssen PW,Ten BJM,et al.The use of platelet reactivity testing in patients on antiplatelet therapy for prediction of bleeding events after cardiac surgery[J].Vascul Pharmacol,2016,77(16):19-27.
[16]Huang Y,Li M,Li JY,et al.The efficacy and adverse reaction of bleeding of clopidogrel plus aspirin as compared to aspirin alone after stroke or TIA:a systematic review[J].PLo S ONE,2013,8(6):65754-65756.
[17]卢丽敏,武一平,林杰,等.氢氯吡格雷联合拜阿司匹林治疗脑梗死的疗效及安全性评价[J].中国实用神经疾病杂志,2015,18(7):32-33.
[18]Zhou Y,Huang J,He W,et al.N2 ameliorates neural injury during experimental ischemic stroke via the regulation of thromboxane A2 production[J].Pharmacol Biochem Behav,2014,124(11):458-465.
[19]Mastenbroek TG,van Geffen JP,Heemskerk JW,et al.Acute and persistent platelet and coagulant activities in atherothrombosis[J].Thromb Haemost,2015,13(1):272-280.
[20]Kernan WN,Ovbiagele B,Black HR,et al.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,2014,45(7):2160-2236.
[21]饶子龙,郑华光,王菲,等.血栓弹力图凝血酶原通道检测指标在评价急性缺血性脑血管病患者高血小板反应性以及预测复发缺血事件中的价值[J].中国卒中杂志,2016,11(3):207-214.
[22]Osawa A,Maeshima S,Tanahashi N.Efficacy of cilostazol in preventing aspiration pneumonia in acute cerebral infarction[J].J Stroke Cerebrovasc Dis,2013,22(6):857-861.
[23]倪贵华,赵卫东,田向阳,等.CYP2C19和ABCB1基因多态性对脑梗死患者的氯吡格雷反应性和血管性事件的影响[J].中华神经科杂志,2016,49(7):526-530.
[24]卢丽敏.氢氯吡格雷联合拜阿司匹林治疗急性脑梗死患者100例临床分析[J].陕西医学杂志,2016,45(12):1670-1672.
[25]韩玉庆,董力庆,赵理乐.静脉溶栓联合介入治疗急性脑梗死的疗效[J].临床神经外科杂志,2015,12(6):459-461.
[26]戴杰,周永,李新玲,等.影响后循环脑梗死急性期阿司匹林和氯吡格雷联合抗血小板治疗预后的相关因素[J].临床神经病学杂志,2014,27(1):22-25.
[2]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):376-381.
[3]沈景红,何海燕,戴鸣萱.阿司匹林联合奥扎格雷钠对急性脑梗死的治疗作用观察[J].海南医学院学报,2017,23(1):38-40.
[4]倪贵华,梁晨,赵卫东,等.血栓弹力图评价大动脉粥样硬化性脑梗死患者氯吡格雷抗栓效果和预测血管事件的价值[J].中华老年心脑血管病杂志,2017,19(5):513-514.
[5]Mehta GU,Heiss JD,Park JK,et al.Neurological surgery at the National Institutes of Health[J].World Neurosurg,2010,74(1):49-59.
[6]赵晓玲.瑞舒伐他汀联合氯吡格雷对脑梗死急性期患者血小板活化及聚集状态的影响[J].中国实用神经疾病杂志,2017,20(8):28-30.
[7]Okabe T,Aida N,Niwa T,et al.Early magnetic resonance detection of cortical necrosis and acute network injury associated with neonatal and infantile cerebral infarction[J].Pediatric Radiol,2014,44(5):597-604.
[8]Mastenbroek TG,van Geffen JP,Heemskerk JW,et al.Acute and persistent platelet and coagulant activities in atherothrombosis[J].J Thromb Haemost,2015,13(1):272-280.
[9]申伟,金香兰,陈宝鑫.中医药治疗脑梗死后认知障碍的研究进展[J].北京中医药,2016,35(7):638-639.
[10]Pan Y,Wang A,Liu G,et al.Cost-effectiveness of clopidogrelaspirin versus aspirin alone for acute transient ischemic attack and minor stroke[J].J Am Heart Assoc,2014,3(3):96-98.
[11]赵孟娟.氯吡格雷联合阿司匹林治疗脑梗死患者的疗效及对其血小板活性及动脉硬化的影响[J].中国实用神经疾病杂志,2017,20(5):102-104.
[12]沈小静,龚昌富.早期干预对老年脑梗死患者负性情绪和康复依从性的影响[J].实用老年医学,2016,30(9):784-785.
[13]Gross L,Aradi D,Sibbing D.Platelet function testing in patients on antiplatelet medications[J].Semin Thromb Hemost,2016,42(3):306-320.
[14]高志强,柏燕燕,孔玉,等.氯吡格雷联合蚓激酶治疗对急性脑梗死患者血浆D-二聚体、血小板聚集和纤维蛋白原的影响[J].江苏医药,2014,40(14):1707-1709.
[15]Leunissen TC,Janssen PW,Ten BJM,et al.The use of platelet reactivity testing in patients on antiplatelet therapy for prediction of bleeding events after cardiac surgery[J].Vascul Pharmacol,2016,77(16):19-27.
[16]Huang Y,Li M,Li JY,et al.The efficacy and adverse reaction of bleeding of clopidogrel plus aspirin as compared to aspirin alone after stroke or TIA:a systematic review[J].PLo S ONE,2013,8(6):65754-65756.
[17]卢丽敏,武一平,林杰,等.氢氯吡格雷联合拜阿司匹林治疗脑梗死的疗效及安全性评价[J].中国实用神经疾病杂志,2015,18(7):32-33.
[18]Zhou Y,Huang J,He W,et al.N2 ameliorates neural injury during experimental ischemic stroke via the regulation of thromboxane A2 production[J].Pharmacol Biochem Behav,2014,124(11):458-465.
[19]Mastenbroek TG,van Geffen JP,Heemskerk JW,et al.Acute and persistent platelet and coagulant activities in atherothrombosis[J].Thromb Haemost,2015,13(1):272-280.
[20]Kernan WN,Ovbiagele B,Black HR,et al.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,2014,45(7):2160-2236.
[21]饶子龙,郑华光,王菲,等.血栓弹力图凝血酶原通道检测指标在评价急性缺血性脑血管病患者高血小板反应性以及预测复发缺血事件中的价值[J].中国卒中杂志,2016,11(3):207-214.
[22]Osawa A,Maeshima S,Tanahashi N.Efficacy of cilostazol in preventing aspiration pneumonia in acute cerebral infarction[J].J Stroke Cerebrovasc Dis,2013,22(6):857-861.
[23]倪贵华,赵卫东,田向阳,等.CYP2C19和ABCB1基因多态性对脑梗死患者的氯吡格雷反应性和血管性事件的影响[J].中华神经科杂志,2016,49(7):526-530.
[24]卢丽敏.氢氯吡格雷联合拜阿司匹林治疗急性脑梗死患者100例临床分析[J].陕西医学杂志,2016,45(12):1670-1672.
[25]韩玉庆,董力庆,赵理乐.静脉溶栓联合介入治疗急性脑梗死的疗效[J].临床神经外科杂志,2015,12(6):459-461.
[26]戴杰,周永,李新玲,等.影响后循环脑梗死急性期阿司匹林和氯吡格雷联合抗血小板治疗预后的相关因素[J].临床神经病学杂志,2014,27(1):22-25.