氯吡格雷对脑梗死患者血管内皮功能的影响

The Influence of Clopidogrel on Vascular Endothelial Function in Patients with Cerebral Infarction

目的:研究氯吡格雷对脑梗死患者血管内皮功能的影响,探讨氯吡格雷预防和治疗脑梗死的药理学作用。方法:将48例临床和影像学确诊的脑梗死患者随机分为治疗组(28例)和对照组(20例),治疗组服用氯吡格雷(75mg/d),对照组服用阿司匹林(100mg/d)。治疗前和用药2个月后分别进行超声检查观察肱动脉血流介导性扩张,同时测定血清内皮素(ET)、一氧化氮(NO)、前列环素(PGI2)和vonWillebrand因子(vWF)水平。结果:用药前后治疗组和对照组血流介导的肱动脉内径变化率有显著差异(P<0.01);治疗组用药后ET和vWF水平明显下降(P<0.01),而NO和PGI2水平显著升高(P<0.01,P<0.05)。与对照组相比,治疗组ET和vWF水平下降、PGI2水平增高更为显著(P<0.05)。结论:与阿司匹林100mg/d相比,氯吡格雷75mg/d能更有效地改善血管内皮功能和预防脑梗死。

Objective： To study the influence of clopidogrel on vascular endothelial function in patients with cerebral infarction and to explore the pharmacological action in the prevention and treatment of cerebral infarction with clopidogrel. Methods： Forty-eight patients who were clinically diagnosed as having cerebral infarction by imaging were randomly divided into the treatment group （n=28） and the control group （n =20）. The treatment group took clopidogrel （75 mg/d） and the control group took aspirin （100 mg/d）. Ultrasound examinations were performed to observe the change of brachial artery flow-mediated dilation （FMD） and the levels of serum endothelin （ET）, nitric oxide （NO）, prostaglandin I2 （PGI2） and yon Willebrand factor （vWF） before the treatment and 2 months after it, respectively. Results：There were significant differences between the 2 groups （P 〈 0. 01 ） for the changes of FMD before and after the administration of the drugs, The levels of serum ET and vWF in the treatment group decreased significantly （P 〈 0. 01 ） after the administration, while the levels of serum NO and PGI2 increased significantly （P 〈 0.01, P 〈 0.05）.The levels of serum ET/vWF and PGI2 in the treatment group decreased and increased more significantly compared with the control group （P〈0.05）. Conclusion： In comparison with aspirin （100 mg/d）, clopidogrel （75 mg/d） can improve the function of vascular endothelium and prevent cerebral infarction more effective.