氯吡格雷联合阿司匹林治疗进展性缺血性脑卒中的临床疗效和安全性

Efficacy and safety of short-term use of clopidogrel in combination with aspirin in treatment of progressive ischemic stroke

目的:探讨短期氯吡格雷联合阿司匹林在治疗进展性缺血性脑卒中的临床疗效和安全性。方法:分析本院收治的90例进展性缺血性脑卒中患者的临床资料,根据治疗方法不同分为治疗组和对照组各45例,治疗组采用氯吡格雷联合阿司匹林治疗,对照组仅给予阿司匹林治疗,观察30d治疗变化,分别于治疗前及治疗后7、14、30d对患者进行美国国立卫生研究院卒中量表评分(NIHSS)、日常生活能力评分(ADL),以及治疗14、30dNIHSS和ADL绝对分值变化作为主要临床疗效判断标准,同时检测治疗前后血清高敏C反应蛋白(hs-CRP),动态复查颅脑CT和(或)MRI,观察有无颅内出血及消化系统不良反应。结果:治疗后7、14d治疗组NIHSS评分较对照组明显降低,治疗后30d时较对照组有更明显降低,差异具有统计学意义(P<0.05);治疗后30d时治疗组较对照组ADL评分有更明显降低,差异具有统计学意义(P<0.01);治疗后14、30d时,治疗组血清c-反应蛋白与对照组比较,差异具有统计学意义(P<0.05);两组均未出现明显药物不良反应,未发生致死性出血现象,差异无统计学意义(P>0.05)。结论:短期氯吡格雷联合阿司匹林治疗进展性缺血性脑卒中安全有效,能改善临床症状,降低血清hs-CRP水平,临床疗效氯吡格雷联合阿司匹林组比单用阿司匹林组显著。

Objective： To analyze clinical efficacy and safety of short-term use of clopidogrel in combination with aspirin in the treatment of progressive ischemic stroke. Methods.. A retrospective analysis was conducted in 90 patients hospitalized for progressive ischemie stroke. Ninety cases were divided into the treatment group （45 cases） which were given the treatment of clopidogrel in combination with aspirin and the control group （45 cases） was treated with aspirin only. The treatments lasted 30-days in both groups. They were evaluated by NIHSS and ADL before the treatment, and at the 7th day, the 14th day, the 30th day after the beginning of treatments. The changes of absolute scores of the NIHSS and ADL were regarded as the meas- urement of clinical efficacy. The hs-CRP and CT or MRI of the brain were checked. Results： The decrease of the NIHSS score and the level of hs-CRP and the increase of the ADL score of both groups were significant at the 7th day, the 14th day, and the 30th day after the treatments. The differences of the NIHSS and ADL scores of the 7th day and the 14th day between the two groups have statistical significance （P〈0.05）, the difference in ADL scores of the 30th day was even more significant （P〈0.01）. Symptomatic intracranial hemorrhage and gastrointestinal adverse reaction didn＇t happen in neither of the two groups. The adverse event rates were similar between the two groups （P〉0.05）. Conclusion： Short-term use of clopidogrel in combi nation with aspirin in the treatment of progressive ischemic stroke is safe and can improve the clinical outcome and decrease the level of hs-CRP. The clinical efficacy is better than that of aspirin alone.