不同方案治疗进展性分支动脉粥样硬化病的临床疗效

Clinical efficacy of different treatment on progressive branch atherosclerosis disease

目的:探讨不同方案治疗分支动脉粥样硬化病(branch atherosclerotic disease,BAD)早期神经功能恶化的临床效果。方法:选取住院治疗的95例BAD进展性卒中患者,按治疗方案不同分为两组:双抗组(49例),给予拜阿司匹林和氯吡格雷治疗;单抗+抗凝组(46例),给予拜阿司匹林加依诺肝素钠治疗。两组给予其他临床常规治疗脑梗死药物,如他汀类、依达拉奉、丁苯酞等。评估所有患者进展时、出院时的NIHSS评分及Barthel指数(Barthel index,BI)评分,比较两组患者的神经功能改善程度以及日常生活活动(activities of daily living,ADL)能力。测定患者病情进展时及出院时的血浆CRP浓度,比较两种治疗方案对患者血生化指标的影响程度。结果:两组患者出院时的NIHSS评分均显著降低(P<0.05),BI评分均显著升高(P<0.05)。单抗+抗凝组患者出院时的神经功能改善程度以及ADL能力显著高于双抗组(P<0.05)。两组患者出院时的血浆CRP浓度均显著低于BAD进展时(P<0.05),单抗+抗凝组患者的血浆CRP差值显著高于双抗组(P<0.05)。结论:双联抗血小板治疗和阿司匹林联合依诺肝素钠抗凝治疗均可改善BAD进展性卒中患者的早期神经功能,单抗联合抗凝治疗的临床效果优于双抗治疗。

Objective： To explore the clinical efficacy of different methods in the treatment of early neurological deterioration（END） of branch atherosclerotic disease（BAD）. Methods： According to the different treatment methods, 95 consecutive patients with progressive stroke in BAD were classified into two groups： a dual antiplatelet therapy group（49 cases） and an antiplatelet combined anticoagulation group（46 cases）. The dual antiplatelet therapy group was treated by aspirin and clopidogrel, the antiplatelet combined anticoagulation group was managed with aspirin plus enoxaparin sodium. Both groups accepted other clinical routines for the treatment of cerebral infarction such as statins, edaravone, dl-3-n-butylphthalide were same. The NIHSS score and Barthel index（BI） of the patients when progression and discharge were assessed respectively. The improvement of neurological function and activities of daily living（ADL） ability was compared in both groups. The plasma CRP concentration was measured at the time of progression and discharge, the effect of both treatments on CRP was compared. Results： NIHSS scores decreased significantly in both groups at discharge（P0.05）, and BI scores increased significantly（P0.05）. The degree of improvement of neurological function and the ability of ADL in antiplatelet combined anticoagulation group were significantly higher than those in the dual antiplatelet therapy group（P0.05）. Plasma CRP level in each group was significantly lower than that in BAD progression（P0.05）. Plasma CRP in antiplatelet combined anticoagulation group was significantly higher than that of the dual antiplatelet therapy group（P0.05）. Conclusion： Both dual antiplatelet therapy and aspirin combined with enoxaparin anticoagulation can improve END in patients with BAD progressive stroke. Furthermore, the clinical efficacy of aspirin combined with enoxaparin therapy is better than aspirin and clopidogrel antiplatelet therapy.