不同抗血小板药物联合低分子肝素对糖尿病合并脑梗死的疗效

Comparison of therapeutic effects of different anti-platelet drugs combined low molecular weight heparin on patients with diabetes mellitus complicated cerebral infarction

目的:比较糖尿病(T2DM)合并脑梗死(CI)患者应用不同抗血小板药物联合低分子肝素的临床疗效。方法:选择150例T2DM合并CI患者,分为:阿司匹林组,氯吡格雷组,奥扎格雷组,各50例,均同时给予低分子肝素治疗,疗程3个月。比较三组治疗后的临床疗效、神经功能缺损评分(NDS评分)、血小板计数(PLT)、凝血功能(PT、APTT、Fb)、各种不良反应发生率,以及随访1年的缺血性脑卒中再发率的差异。结果:奥扎格雷组总有效率明显低于阿司匹林组和氯吡格雷组(20.0%比62.0%、60.0%,P均<0.01),阿司匹林组和氯吡格雷组间无显著差异(P>0.05)。氯吡格雷组的NDS评分明显低于阿司匹林组和奥扎格雷组[(8.1±2.0)分比(16.2±3.4)分、(15.4±2.9)分,P均<0.05],阿司匹林组和奥扎格雷组无显著差异(P均>0.05)。三组的血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)及纤维蛋白原(Fg)指标无显著差异(P均>0.05)。三组的不良反应发生率以及缺血性脑卒中再发率均无显著差异(P>0.05)。结论:与阿司匹林和奥扎格雷比较,氯吡格雷联合低分子肝素对于2型糖尿病合并脑梗死患者的临床疗效和神经功能改善最佳。

Objective：To compare the clinical therapeutic effects of different anti-platelet drugs combined low molec-ular weight heparin （LMWH ） on patients with type 2 diabetes mellitus （T2DM ） complicated cerebral infarction （CI） .Methods ：A total of 150 patients with T2DM complicated CI were randomly and equally divided into aspirin group （received aspirin） ,clopidogrel group （received clopidogrel） and ozagrel group （received ozagrel） .All groups received LMWH simultaneously ,and were treated for three months .Therapeutic effects ,neurologic deficit score （NDS score） ,platelet count （PLT） ,coagulant function [prothrombin time （PT） ,activated partial thromboplastin time （APTT） ,fibrinogen （Fg）] ,incidence rates of adverse reactions and recurrence rates of ischemic cerebral stroke within one-year follow up were compared among three groups .Results：Total effective rate of ozagrel group was significantly lower than those of aspirin group and clopidogrel group （20.0% vs .62.0% ,60.0% , P〈 0.01 all） ,and there was no significant difference between aspirin group and clopidogrel group （P〉0.05） .NDS score of clopidogrel group was significant lower than those of aspirin group and ozagrel group [ （8.1 ± 2.0） scores vs .（16.2 ± 3.4） scores ,（15.4 ± 2.9） scores ,P〈0.05 all] ,and there was no significant difference between aspirin group and ozagrel group （ P〉0.05） .There were no significant difference in incidence rates of adverse reactions and recurrence rate of ischemic cerebral stroke and PLT ,PT ,APTT and Fg levels among three groups （ P〉0.05 all） .Conclusion：Compared with aspirin and ozagrel ,the clinical effect and neurologic function improvement of clopidogrel plus low molecular weight heparin is best in patients with type 2 diabetes mellitus complicated cerebral infarction .