氯吡格雷联合阿托伐他汀钙在预防TIA后脑梗死中的临床应用

Application of clopidogrel combined with atorvastatin calcium in the prevention of cerebral infarction after TIA

目的观察氯吡格雷联合阿托伐他汀钙在预防短暂性脑缺血发作(TIA)患者脑梗死中的应用。方法选取60例TIA患者,采用信封法随机分为2组,每组30例。对照组患者在发病后口服氯吡格雷50 mg,1次/d。观察组患者在对照组基础上加服20 mg阿托伐他汀钙,1次/d。随访两组患者1年。在两组患者治疗前及随访结束时,采用全自动生化分析仪测定血脂四项,测定凝血酶原时间(PT)、活化部分凝血酶原时间(APTT),检查PLT(血小板)计数。治疗前后,应用彩色多普勒超声诊断仪检查颈动脉血管斑块,观察斑块数量及性质改变。观察两组患者随访期间脑梗死发生率、脑出血发生率及其他不良反应事件。结果治疗后,观察组TC、TG、LDLC降低(P<0.05),两组比较差异有统计学意义(P<0.05)。两组患者治疗前后及组间PT、APTT、PLT比较差异均无统计学意义(P>0.05)。治疗后,观察组患者颈动脉平均斑块发生率及平均低回声斑块发生率均明显低于对照组(P<0.05),两组平均强回声斑块比较差异无统计学意义(P>0.05)。观察组在随访1年期间仅1例(3.33%)发生脑梗死或脑出血,对照组6例(20.00%)发生脑梗死或脑出血,两组患者随访期间脑血管不良事件发生率比较差异有统计学意义(P<0.05)。两组患者治疗期间均无皮肤粘膜、内脏等部位出血。结论氯吡格雷联合阿托伐他汀钙应用于TIA患者,通过调节血脂及抗血小板治疗,可明显降低脑梗死的发生率,效果明显优于单用氯吡格雷组。

Objective To observe the effect of clopidogrel combined with atorvastatin calcium in the preven-tion of cerebral infarction after transient ischemic attack （ TIA） . Methods 60 patients with TIA were randomly divid-ed into two groups. Patients in control group （n=30） were given clopidogrel 50 mg once daily after onset. Patients in observation group （n=30） were added atorvastatin calcium 20 mg once daily. All the patients were followed up for one year,The four indexes of blood lipid was detected using automatic biochemical analyzer before treatment and at the end of the follow-up,and the prothrombin time （PT）,activated partial thromboplastin original time （APTT） and the PLT （ platelet） count were recorded. The carotid artery plaque of all the patients was examined by color Doppler ultra-sonography,and the quantity and quality of plaque was observed. The incidence of cerebral infarction,cerebral hemor-rhage and other adverse events were recorded during the follow-up period. Results After treatment,TC,TG,LDL-C of the observation group decreased （P＆lt;0. 05）,there were significant differences between the two groups （P＆lt;0. 05）. No significant difference was found in PT, APTT, PLT between the two groups （ P ＆gt;0. 05 ） . The incidence of carotid plaque and the mean average keyed block plaque of observation group were significantly lower than those of control group （P＆lt;0. 05）,there was no significant difference in the average echogenic plaques between the two groups （P＆gt;0. 05）. There were 1 case （3. 33%） and 6 cases （20. 00%） of cerebral infarction or cerebral hemorrhage in observa-tion group and control group,there were significant differences between the two groups （P＆lt;0. 05）. No bleeding was observed at the site of skin and mucous membranes and viscera,etc. Conclusion Clopidogrel combined with atorvasta-tin calcium in patients with TIA,can significantly reduce the incidence of cerebral infarction by regulating lipid and an-tiplatelet therapy,and the effect is better than clopidogrel alone.