氯吡格雷联合阿司匹林对短暂性脑缺血发作的疗效分析

Efficacy and mechanism of clopidogrel combined with aspirin in the treatment of transient ischemic attack

目的 研究氯吡格雷联合阿司匹林对短暂性脑缺血发作治疗的疗效.方法 选取150例短暂性脑缺血发作患者作为研究对象,按照随机数字表法分为氯吡格雷组、阿司匹林组和联合组.氯吡格雷组口服75 mg氯吡格雷进行治疗,每天1次;阿司匹林组口服50 mg阿司匹林进行治疗,每天2次;联合组第1天给予300 mg氯吡格雷＋300 mg阿司匹林,第2天开始给予75 mg氯吡格雷＋100 mg阿司匹林.三组患者均进行为期15 d的治疗.治疗15 d后,比较分析三组患者的纤维蛋白原（FIB）、D-二聚体（D-D）、活化部分凝血酶原时间（APTT）及凝血酶原时间（PT）水平,并对疗效、不良反应及复发率进行分析.结果 治疗后三组患者凝血功能四项指标比较,联合组FIB、D-D、APTT及PT分别为（3.14±0.24）g/L、（0.61±0.26）mg/L、（33.58±2.77）s、（15.67±0.72）s,氯吡格雷组分别为（3.32±0.25）g/L、（0.91±0.32）mg/L、（30.19±2.19）s、（15.64±0.78）s,阿司匹林组分别为（3.40±0.22）g/L、（1.02±0.39）mg/L、（29.71±2.21）s、（13.21±0.80）s,均较治疗前联合组[（3.59±0.26）g/L、（2.50±0.35）mg/L、（27.53±2.41）s、（11.23±0.69）s]、氯吡格雷组[（3.58±0.28）g/L、（2.51±0.40）mg/L、（27.19±2.53）s、（11.73±0.82）s]、阿司匹林组[（3.61±0.27）g/L、（2.46±0.32）mg/L、（27.61±2.13）s、（11.68±0.77）s]显著改变,且联合组变化较氯吡格雷组、阿司匹林组明显,差异均有统计学意义（均P〈0.05）.联合组的总有效率（96.00%）明显高于氯吡格雷组（84.00%）和阿司匹林组（76.00%）,差异均有统计学意义（x2联合组vs氯吡格雷组=4.00,x2联合组vs阿司匹林组=8.31,均P〈0.05）.三组不良反应发生率差异均无统计学意义,但联合组的复发率（8.00%）明显低于氯吡格雷组（24.00%）和阿司匹林组（28.00%）,差异均有统计学意义（x2联合组vs氯吡格雷组=4.76,x2联合组vs阿司匹林组=6.78,均P〈0.05）.结论 氯吡格雷联合阿司匹林治疗短暂性脑缺血发作,疗效显著,复发率低,值得临床推广.

Objective To study the efficacy and mechanism of sequential therapy of clopidogrel combined with aspirin in the treatment of transient ischemic attack.Methods 150 cases with transient ischemic attack were set as the research subjects.According to the random number table method,they were divided into aspirin group,clopidogrel group and combination group.The clopidogrel group was treated with 75mg clopidogrel,once daily.The aspirin group was treated with 50mg aspirin,twice a day.The combined group was treated with 300mg clopidogrel ＋300mg aspirin at the first day,75mg clopidogrel ＋100mg aspirin at the second day.Three groups were treated for a period of 15 days.After 15d treatment,the raw fiber protein （FIB）,two D dimer （D-D）,activated partial thromboplastin time （APTT） and prothrombin time （PT） of three groups and adverse reactions,curative effect and recurrence rate were analyzed.Results After treatment,the FIB,D-D,APTT and PT of the combined group were （3.14±0.24）g/L,（0.61±0.26）mg/L,（33.58±2.77）s,（15.67±0.72）s,which of the clopidogrel group were （3.32±0.25）g/L,（0.91±0.32）mg/L,（30.19±2.19）s,（15.64±0.78）s,which of the aspirin group were （3.40±0.22）g/L,（1.02±0.39）mg/L,（29.71±2.21）s,（13.21±0.80）s,which were significantly improved than before treatment[the combination group （3.59±0.26）g/L,（2.50±0.35）mg/L,（27.53±2.41）s,（11.23±0.69）s;the clopidogrel group （3.58±0.28）g/L,（2.51±0.40）mg/L,（27.19±2.53）s,（11.73±0.82）s;the aspirin group （3.61±0.27）g/L,（2.46±0.32）mg/L,（27.61±2.13）s,（11.68±0.77）s,the effect of the combined group was better than that of the clopidogrel group and aspirin group （F=8.12,P〈0.05）.The total effective rate of the combination group （96.00%） was significantly higher than that of clopidogrel group （84.00%） and aspirin group （76.00%）,the differences were statistically significant （x2 combination group vs.clopidogrel group=4.00,x2combination group vs.aspirin group=8.31,all P〈0.05）.The adverse reactions in the three groups had no difference,but the recurrence rate of the combination group （8.00%） was significantly lower than that of the clopidogrel group （24.00%） and the aspirin group （28.00%）,the differences were statistically significant （x2combination group vs.clopidogrel group=4.76,x2combination group vs.aspirin group=6.78,all P〈0.05）.Conclusion The combination of clopidogrel and aspirin in the treatment of transient ischemic attack has significant effect and low recurrence rate,which is worthy of popularizing widely.