单抗联合抗凝治疗不同亚型进展性分支动脉粥样硬化病的临床效果

Efficacy of an antiplatelet combined anticoagulation therapy on progressive branch atheromatous disease in different subtypes

目的:比较拜阿司匹林联合依诺肝素钠治疗不同亚型进展性分支动脉粥样硬化病(branch atheromatous disease,BAD)的临床疗效。方法:选取104例入院1周内出现脑卒中进展的BAD患者,按梗死灶部位不同分为两组:脑桥旁正中动脉(pontine paremedian artery,PPA)BAD组(PPABAD组)(n=58)和豆纹动脉(lenticulostriate artery,LSA)BAD组(LSA-BAD组)(n=46)。两组患者治疗方案相同:入院后予拜阿司匹林联合氯吡格雷抗血小板治疗,治疗期间出现病情进展则换用拜阿司匹林联合依诺肝素钠治疗,其他常规辅助治疗脑梗死的药物相同。记录两组患者卒中进展时和出院时的美国国立卫生研究院卒中量表(NIH Stroke Scale,NIHSS)评分、Barthel指数(Barthel index,BI)评分、血浆纤维蛋白原(fibrinogen,FIB)和CRP浓度,比较两组临床疗效。结果:出院时,两组NIHSS评分均减少、BI评分均增加,FIB浓度和CRP浓度明显降低,与病情进展时比较差异均有统计学意义(P<0.05)。PPA-BAD组出院时与病情进展时的NIHSS评分差值以及BI评分差值均显著高于LSA-BAD组(P<0.05);两组出院时与病情进展时的FIB浓度差值和CRP浓度差值的差异均无统计学意义(P>0.05)。结论:早期抗血小板联合抗凝治疗PPA-BAD的临床疗效优于LSA-BAD。

Objective： To compare the clinical efficacy of aspirin combined with enoxaparin in the treatment of different subtypes of progressive branch atheromatous disease （BAD）. Methods： According to the different of infarct site, 104 consecutive BAD patients with progressive stroke within 1-week admission were classified into two groups： a pontine paramedian artery BAD group （PPA-BAD, n=58） and a lenticulostriate artery BAD group （LSA-BAD, n=46）. All patients administrated with the same treatment programs, the anti-platelet therapy with aspirin and clopidogrel was applied after enrollment, while replaced by the aspirin combined with enoxaparin treatment when the patient’s condition aggravated, other clinical routines treatment of cerebral infarction were same. The patients NIHSS score and Barthel index （BI） when progression and discharge were assessed respectively. The plasma levels of fibrinogen （FIB） and CRP were measured at the time of progression and discharge and the effect of both treatments was compared. Results： There were significant differences in NIHSS score, BI score, FIB concentration and CRP concentration between the two groups at the time of stroke progression and at discharge （P〈0.05）. When both group patients were discharged, The NIHSS scores were reduced and the BI scores were increased, FIB concentration and CRP concentration were significantly decreased. In the PPA-BAD group, the differences of NIHSS score, BI score between progression and discharge were significantly higher than those in the LSA-BAD group （P〈0.05）. However, there was no significant difference in FIB or CRP concentrations difference between discharge and progression of the two groups （P〉0.05）. Conclusion： The clinical efficacy of anti-platelet combined with anticoagulation in the early treatment of PPA-BAD is better than that of LSA-BAD.