负荷剂量氯吡格雷对急性脑梗死患者临床疗效和血液流变学的影响

Clinical Observation onHemorheological Change of Clopidogrel of Loading Dosage in the Treatment of Acute Ischemic Stroke

目的探讨负荷剂量氯吡格雷治疗急性脑梗死的疗效。方法前瞻性随机单盲对照设计，起病12h内入院的非心源性急性脑梗死患者，按照随机数字表法随机分为负荷剂量氯吡格雷组（首剂1300mg，之后75mg／d）和标准剂量氯吡格雷组（75mg／d），连用14d。主要疗效观察指标包括美国国立卫生研究院卒中量表（NHISS）评分及血液流变学指标，并观察出血、白细胞减少等安全及药物副作用。结果共纳入242例患者，标准剂量组122例、负荷剂量组120例。经过14d治疗，两组NHISS评分较治疗前均明显下降（P〈0．05），病情好转；与标准剂量组相比，负荷剂量氯吡格雷组〈14dNHISS评分下降更为明显，差异有统计学意义（P〈0．05）；经过14d治疗，两组血液流变学参数较治疗前均明显好转（P〈0．05）；两组间治疗前、后血液流变学参数差异无统计学意义（P〉0．05），两组均未发生危及生命的中枢神经系统出血及严重的皮肤黏膜出血（P〉0．05）。结论负荷剂量氯吡格雷治疗非心源性急性脑梗死优于常规剂量氯吡格雷的趋势，无明显并发症，值得临床进一步推广。

Objective To explore the feasibility and safety of loading dose of clopidogrel in the treatment of patients with non-eardioembolic acute ischemic stroke. Methods A prospective, randomized, single blind, controlled parallel clinical trial was conducted. Patients with non-cardioembolic ischemic stroke, which were within 12 hours from the onset, were randomly divided into load dose group （300 mg of clopidogel followed by 75 mg daily） and standard dose group （75 mg daily）. The treatment continued for 14 days. The NIHSS score and change of hemarheology were evaluated after the 14-day treatment. Results 242 patients were included in this study. The NHISS score and the hemorheological parameter were significantly decreased after the treatment in both group （P〈0.05）. The NHISS score in the load dose group decreased more obviously at the 14th day （P〈0.05）, and the change of the hemorheological parameter had no significant difference between the two groups （P〉0.05）. No life-threatening bleeding and significant change of blood routine test were found. The safety of clopidogel was confirmed （P 〉 0.05）. Conclusion The load dose of clopidogrel is safe and effective in the treatment of patients with non cardioembolic acute ischemic stroke.