血栓前状态指标在缺血性脑血管病二级预防中的作用

Prethrombotic state index in the secondary prevention of ischemic cerebrovascular diseases

目的:通过观察血栓前状态的实验室指标,探讨其对缺血性脑血管病二级预防的指导作用并评估小剂量肠溶阿司匹林等药物的干预效果。方法:选择2001-03/2004-08在甘肃省人民医院神经内科住院治疗的首次发病的急性脑梗死患者中筛选出存在血栓前状态的患者192例,随机分为干预组和对照组两组,每组96例。对照组给予常规治疗,干预组在对照组基础上每日早餐前(至少30min)口服肠溶阿司匹林50mg,同时给予维生素E、双嘧达莫、华法林等药物治疗。随访3年,每6个月复查1次血栓前状态的实验室指标(血浆血管性假血友病因子、P-选择素、D-二聚体、血浆纤维蛋白肽A、组织型纤溶酶原激活物极其抑制物),同时记录两组脑梗死患者复发及脑出血发生的例数。结果:按实际处理分析,进入结果分析170例,对照组87例,干预组83例。①观察3年中,对照组脑血栓形成复发率明显高于干预组[29%(28/96),10%(10/96),χ2=11.138,P<0.01];干预组的脑出血发生率与对照组比较无差异[4%(4/96),3%(3/96),χ2=0.148,P>0.05]。②血栓前状态的实验室指标结果:干预组经干预治疗后,血管性假血友病因子、P-选择素、D-二聚体、血浆纤维蛋白肽A水平减低,组织型纤溶酶原激活物活性增强,组织型纤溶酶原激活物抑制物活性减低,并且与对照组相比差异有显著性意义(P<0.01)。结论:血浆血管性假血友病因子、P-选择素、D-二聚体、血浆纤维蛋白肽A、组织型纤溶酶原激活物及其抑制物可作为诊断和监测血栓前状态的实验室指标;小剂量肠溶阿司匹林等药物能有效降低脑梗死的复发、同时不增加脑出血的发生率。

AIM:To study the instructing role of prethrombotic state index in the secondary prevention of ischemic cerebrovascular diseases and the preventing contribution of lowdose aspirin and other drugs to ischemic cerebrovascular diseases. METHODS:A total of 192 patients with acute cerebral infarction of the first time were selected from the Department of Neurology,People's Hospital of Gansu Province from March 2001 to August 2004.All patients were assigned to receive routine treatment(control group,n=96),or daily 50 mg aspirin, vitamin E,dipyridamole,warfarin,ect.30 minutes before breakfast besides routine treatment(treatment group,n=96).They were followed for 3 years,the laboratory indexes of prethrombotic state(vascular pseudohemophilia factors in plasm,Pselectin,Ddimer,fibrous protein A in plasm, tissuetype plasminogen activator and plasminogen activator inhibitor1) were detected every 6 months,and meanwhile,the cases of secondary cerebral infarction or cerebral hemorrhage were recorded.RESULTS:According to intentiontotreat analysis,87 cases in control group and 83 in treatment group were involved in the result analysis.①During the 3 years of followup,relapse rate of cerebral infarction in control group was significantly higher than that in treatment group[29%(28/96),10%(10/96), χ2= 11.138, P< 0.01],but there was no significantly difference in the incidence of cerebral hemorrhage between the two groups[4%(4/96), 3%(3/96), χ2=0.148,P >0.05].②The level of vascular pseudohemophilia factors in plasm,Pselectin,Ddimer and fibrous protein A in plasm,and the activity of plasminogen activator inhibitor1 decreased,and the activity of tissuetype plasminogen activator increased in treatment group,and there was significant difference between the two groups(P< 0.01). CONCLUSION:Vascular pseudohemophilia factors in plasm,Pselectin, Ddimer,fibrous protein A in plasm,tissuetype plasminogen activator and plasminogen activator inhibitor1 can be considered as laboratory indexes for diagnosing and monitoring prethrombotic state.Lowdose aspirin,vitamin E, dipyridamole and warfarin can decrease the recurrence of cerebral infarction, and no severe complication occurs such as cerebral hemorrhage.