氯吡格雷联合阿司匹林治疗青年人血管狭窄性脑梗死及对血浆P-选择素的影响

The influence of Clopidogrel combined with Aspirin in treatment of young people with cerebral artery stenosis and blood plasma P-selectin

目的 探讨氯吡格雷联合阿司匹林治疗青年人血管狭窄性脑梗死及对血浆P-选择素的影响.方法 将142例18～45岁经证实为血管狭窄性脑梗死患者随机分为治疗组（70例）和对照组（72例）.两组均给予口服或鼻饲（吞咽障碍者）阿司匹林,同时合并用他汀类药物、血塞通、丹参注射液等常规治疗.治疗组加用氯吡格雷.两组均于用药前、用药24 h后、用药7 d后抽取静脉血,检测血小板聚集率、P-选择素（CD62p）及经颅多普勒、颈动脉血管超声检查血流速度.结果 两组治疗后的血小板聚集率、P-选择素均较治疗前降低（均P〈0.05）,且治疗组比对照组降低更显著（P〈0.01）.治疗后两组梗死灶体积差异有统计学意义（P〈0.01）.对照组治疗7 d后经颅多普勒及颈动脉血管超声检查血流速度明显改善（P〈0.05）,但治疗组更显著（P〈0.01）.结论 氯吡格雷联合阿司匹林治疗能有效改善血液流变学及血流动力学参数,可减轻脑梗死灶的体积,改善患者的预后.

Objective To study the influence of Clopidogrel combined Aspirin to treat cerebral artery stenosis of young people and P-selectin in blood plasma. Methods 142 cases were randomly divided into therapy group （70 cases）and control group（72 cases）. The two groups were given Aspirin（0. 1/d,Bayer company） by peroral administration or nasal feeding（ deglutation disturbance） and simultaneously given tatin drug, Venoruton injection, Citicoline and Salvia Miltiorrhiza injection. The therapy group were added clopidogrel（75mg/d, Shenzhen Salubris Pharmaceuticals Co, Ltd）. Venous blood was taken suction to detect platelet packing fraction,P-selectin and Doppler ultrasound and carotid artery blood flow velocity before medication ,24 hours after medication ,7 days after medication. Results Platelet packing fraction,P-selectin were significantiy decreased in the two groups than before treatment （P 〈 0. 05） and therapy group were sigrificantly lower than control group （ P 〈 0. 01 ）. The control group after 7 days of treatment, transcranial Doppler ultrasound and carotid artery blood flow velocity significantly improved（ P 〈 0. 05 ）, but the treatment group more significantly （P 〈 0. 01 ）. Conclusion Blood plate was activated in patients of cerebral artery stenosis of young people, Clopidogrel combined with Aspirin could improve the blood theology and hemodynamies, reduce the volume of cerebral lesions and improve the prognosis of patients.