探讨低分子肝素联合氯吡格雷对急性脑梗死患者早期神经功能恶化的治疗作用

Low-molecular-weight Heparin with Clopidogrel Prevents Early Neurological Deterioration in Patients with Acute Ischemic Stroke

目的:探讨低分子肝素联合氯吡格雷对急性脑梗死患者早期神经功能恶化(END)的治疗作用。方法:161例发病48 h内入院的急性脑梗死END患者随机分为联合治疗组和对照组。对照组口服氯吡格雷75 mg·d-1,联合治疗组在服用氯吡格雷75 mg·d-1基础上加用低分子肝素4250 IU皮下注射,bid。分别于治疗前和14 d后进行NIHSS评分以及第30 d时改良Rankin量表(mRS)评分,同时进行肝肾功能、血常规和凝血功能等检查,并观察治疗期间可能出现的不良反应。结果:联合治疗组第14 d时NIHSS评分明显低于对照组(P=0.002),第30 d时联合治疗组预后良好者(mRS≤2分)比例明显高于对照组(P=0.039)。两组患者治疗前后肝肾功能、血常规和凝血功能等各项指标无明显改变,两组均无明显不良出血反应。结论:低分子肝素联合氯吡格雷治疗能更有效地控制急性脑梗死早期神经功能恶化,防止病情进展,改善患者预后,具有较高安全性。

Objective： To investigate the efficacy of low-molecular-weight heparin （LMWH） plus clopidogrel in the treatment of acute ischemic stroke patients with early neurological deterioration. Methods： A total of 161 patients with acute ischemic stroke and progression of /〉3 points on the National Institute of Health Stroke Scale （NIHSS） in the first 48 h ＇after stroke onset were randomly assigned to combination therapy group （LMWH 4250 IU, subcutaneously twice daily plus clopidogrel 75 rag, once daily） or monotherapy group （clopidogrel 75 mg, once daily）. NIH Stroke Scale （NIHSS） and modified Rankin Scale （mRS） scores were checked before and after 14 days and 1 months of drug administration. Laboratory index and adverse events were also observed. Results： The NIHSS scores after 14 days were lower （P= 0.002） while the frequency of the favorable functional status of mRS 0-1 at month 1 was significantly higher （P=0.039） in the combination therapy group than in the monotherapy group. Laboratory index had no obvious change after the treatment. No severe bleeding complications occurred during treatment in the two groups. Conclusion： Patients treated with LMWH plus clopidogrel during the acute phase of ischemic stroke had less neurological deterioration and more favorable functional status than those treated with clopidogrel alone. Combination therapy with LMWH and clopidogrel does not increase incidence of side effects comparing to therapy with clopidogrel alone.