间断性低分子肝素治疗对缺血性卒中患者经颅多普勒监测的微栓子的影响

Effect of intermittent use of low molecular heparin on microemboli detected by transcranial Doppler monitoring in patients with ischemic stroke

目的探讨在抗血小板聚集、他汀类药物治疗基础上，间断使用低分子肝素（lowmolecularheparin，LMWH）对缺血性卒中患者微栓子信号（microembolicsigaal，MES）的影响。方法90例经颅多普勒监测MES阳性的急性缺血性卒中患者被随机分为非LMWH组（n=44）和LMWH组（n=46）。非LMWH组给予肠溶阿司匹林、阿托伐他汀等常规治疗；LMWH治疗组在常规治疗基础上给予LMWH，每3个月皮下注射低分子肝素钙4100AXalU，2次／d，持续1周为1个疗程，共3个疗程。比较两组患者3个月和6个月时MES数量、MES阳性率以及缺血性脑血管事件发生率。结果治疗3个月时非LMWH组MES阳性率与LMWH组并无显著差异（70．45％对61．36％；x2=1．357，P=0．244），但非LMWH组MES数量显著多于LMWH组[（12．07±10．16）个对（8．09±8．13）个；t=1．470，P=0．043]；治疗6个月时啡LMWH组MES阳性率显著高于LMWH组（36．96％对19．57％；x2=3．982，P=0．046），非LMWH组MES数量也显著多于LMWH组[（10．32±9．93）个对（1．46±3．27）个；t=5．450，P=0．000]。3个月时的缺血性脑血管事件发生率无显著性差异（2．17％对9．09％，P=0．198），但LMWH组6个月时缺血性脑血管事件发生率显著低于非LMWH组（4．35％对20．45％，P=0．025）。结论在抗血小板聚集和他汀类药物治疗基础上，间断使用LMWH可降低MES阳性缺血性卒中患者6个月时MES阳性率和缺血性脑血管事件发生率。

Objective To investigate the effect of intermittent use of low molecular heparin （LMWH） on microembolic signal （MES） in patients with ischemic Stroke on the basis of anti-platelet asgregation and statin therapy. Methods Ninety MES-positive patients with acute ischemic stroke detected by transeranial Doppler were randomly divided into a non-LMWH group （n =44） and a LMWH group （n=46）. The non-LMWH group was treated conventionally with enteric-coated aspirin and atorvastatin. On the basis of conventional therapy, the LMWH group was treated with LMWH, subcutaneous injection of LMWH calcium 4 100 AXalU every 3 months, twice a day, and one week as a courseof treatment （a total of 3 courses）. The number of MES, MES-positive rate and incidence of ischemic cerebrovascular events at 3 and 6 month were compared in both groups. Results There was no si^aificant difference in the MES-positive rates at 3 month after treatment between the non-LMWH group and the LMWH group （70. 45% vs. 61.36% ;X2 = 1. 357, P =0. 244）, but the number of MES in the non-LMWH group was higher than that in the LMWH group （12. 07 ± 10. 16 vs. 8. 09 ± 8. 13; t = 1. 470,P =0. 043）; the MES-positive rate at 6 month after treatment in the non-LMWH group wassignificantly higher than that in the LMWH goup （36. 96% vs. 19. 57% ; X2 = 3. 982, P = 0. 046）, and the number of MES in the non-LMWH group was also sigfificantly higher than that in the LMWH group （10. 32 ±9. 93 vs. 1.46±3.27; t = 5.450, P = 0. 000）. There was no significant difference in incidence of ischemic cerebrovascular events at 3 month （2. 17% vs. 9. 09%, P = 0. 198 ）, but the incdence of ischemic cerebrovascular events at 6 month in the LMWH group was sigaificantly lower than that in the non-LMWH group （4. 35% vs. 20. 45%, P= 0. 025）. Conclusions On the basis of anti-platelet aggregation and statin therapy, the intermittent use of LMWH may decrease the MES-positive rate and the incidence of ischemic cerebrovascular events in the MES-positive patients with ischernic stroke at 6 month.