不同剂量氯吡格雷对脑梗死患者神经功能的影响

Clinical observation of different dose of clopidogrel on the neural function in patients with ischemic stroke

目的观察不同剂量氯吡格雷对脑梗死患者神经功能的影响。方法将120例脑梗死患者随机分为低剂量组和高剂量组,两组均进行常规治疗,低剂量组予氯吡格雷75mg,1次/d,连续3个月。高剂量组予氯吡格雷150mg,1次/d,连续3个月。观察并比较两组患者入组时、用药1个月及3个月时的美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、血小板计数及血小板聚集率、神经功能恶化率、再发脑梗死率及颅内外出血率。结果治疗1个月时,两组患者NIHSS评分均较入组时下降,但高剂量组下降幅度更大,差异均有统计学意义(P<0.05)。当治疗3个月时,低剂量组NIHSS评分与1个月时比较,差异无统计学意义(P<0.05),高剂量组NIHSS评分进一步下降,差异有统计学意义(P<0.05)。治疗3个月后,高剂量组患者血小板计数及血小板聚集程度较入组时均显著下降,差异有统计学意义(P<0.05);而低剂量组未见明显变化(P>0.05)。低剂量组神经功能恶化率、再发脑梗死率分别为11.7%、10.0%,显著高于高剂量组(5.0%、5.0%),差异有统计学意义(P<0.05)。但是,两组患者颅内出血率分别为5.0%及6.7%,差异无统计学意义(P>0.05)。结论氯吡格雷高剂量组比低剂量组更能促进脑梗死患者神经功能的恢复,且能降低再发脑梗死及动脉粥样硬化相关心血管事件的发生率,值得临床进一步研究。

Objective To explore the clinical effects of different dose of clopidogrel on the neural functions in patients with ischemic stroke.Methods 120 patients with ischemic stroke were randomly divided into low dose group （clopidogrel 75 mg daily） or high dose group （clopidogrel 150 mg daily）.All the patients received the same basic treatment plus clopidogrel for 3 month.Both groups were evaluated and compared for their NIHSS scores, platelet count, platelet aggregation rate, neurologic deterioration rate, recurrence rate of cerebral infarction and intracranial bleeding rate at the time of admission, one month and three month.Results Compared to the scores at the time of admission, NIHSS scores decreased in both groups after one month treatment with statistical significance （P＆lt;0.05）.The high dose group dropped more obviously.The NIHSS scores at 3 month in the low dose group had no difference statistically compared to 1 month （P＆gt;0.05）, while high dose group declined significantly （P＆lt;0.05）.The platelet count and platelet aggregation were decreased significantly in high dose group at 3 month（P＆lt;0.05）, while there was no significant change in the low dose group（P＆gt;0.05）.The neurologic deterioration rate, recurrence rate of cerebral infarction in the low dose group were 11.7%, 10.0% respectively, significantly higher than that of high dose group （5.0%, 5.0%, respectively）, which was statistically significant （P＆lt;0.05）.However, there was no statistically significant difference （P＆gt;0.05） between two groups in intracranial bleeding rate （5.0% and 6.7% respectively）.Conclusion Patients on clopidogrel 150 mg exhibited much better recovery of neural functions and greater reduction in the recurrence of cerebral infarction and atherosclerosis related cardiovascular events.