巴曲酶联合抗血小板聚集药治疗急性脑梗死的疗效观察

Efficacy of treating acute cerebral infarction by Batroxobin combined with Aspirin

目的探讨巴曲酶与阿司匹林联合治疗急性脑梗死的疗效和安全性。方法将102例急性脑梗死患者分成单用阿司匹林组(ASA组)23例、单用巴曲酶组(巴曲酶组)35例及两者联合治疗组(联合治疗组)44例,观察治疗前后血小板计数、血小板聚集率、纤维蛋白原、高切应力、红细胞压积、凝血功能、血栓烷B2(TXB2)、影像学、卒中量表评分(NIHSS)及生活自理能力(MBI)的变化,并比较出血(包括颅内出血及其他脏器出血)的发生率。结果3组治疗后血小板聚集率(60s、180s及最大聚集率)差异均有显著性(均P<0.05),联合治疗组作用最明显(P<0.05);ASA组及联合治疗组TXB2水平明显降低(均P<0.05);巴曲酶组及联合治疗组血纤维蛋白原水平、血高切应力均降低(P<0.005,P<0.01)。生活自理能力恢复联合治疗组(70.45%)优于巴曲酶组(45.71%)和ASA组(17.39%)。出血发生率3组之间比较差异无显著性(P>0.05)。3个月时3组NIHSS、MBI比较显示联合治疗组神经功能恢复明显优于其他两组(均P<0.001)。结论巴曲酶联合阿司匹林治疗急性脑梗死疗效优于单药治疗,且安全性好。

Objective To investigate the effect and safety of Batroxobin （DF-521） combined with Aspirin （ASA） in the treatment of acute cerebral infarction, Methods 102 patients with acute cerebral infarction were enrolled in the study and all the patients were divided into three groups： ASA group （n = 23）, Batroxobin group （n = 35） and ASA combined with Batroxobin group （n =44）. Platelet count, blood viscosity, platelet aggregation test （PAgT）, fibrinogen, coagulation studies （PT, APTT, INR）, TXB2, imaging, National Institutes of Health Stroke SCale （NIHSS） and Modified Barthel Index （MBI） were measured or assessed before and after treatment, respectively. Hemorrhage rate （including brain and other organs） as one of complication was also investigated. Results After treatments, ASA combined with Batroxobin group showed the strongest inhibition of platelet aggregation among the three groups （ all P 〈 0. 05 ）. TXB2 level in ASA group and ASA combined with Batroxobin group was significantly lower than in Batroxobin group （ all P 〈 0. 05 ）. Plasma fibrinogen levers and high sheer rate decreased significantly in Batroxobin group and ASA combined with Batroxobin group compared with ASA group （ P 〈 0. 05 ,P 〈0. 01 ）. Functional recovery in ASA combined with Batroxobin group （70. 45% ） was superior to ASA group （ 17. 39% ） and Batroxobin group （45. 71% ）. There was no significant difference in systemic hemorrhage among the three groups （P 〉 0. 05）. A follow up of 3 months showed that the scores of NIHSS and MBI in ASA combined with Batroxobin group were better than those in the other two groups （ all P 〈 0. 001 ）. Conclusion ASA combined with Batroxobin shows better clinic effect and no more hemorrhagic risk than ASA or Batroxobin in the therapy of acute cerebral infarction.