血栓弹力图评价脑梗死患者阿司匹林、氯吡格雷及其联合应用抗血小板治疗的作用研究

Study on the effects of aspirin,clopidogrel and their combination antiplatelet therapy in cerebral infarction patients by thrombelastogram evaluation

目的探讨采用血栓弹力图测定血小板抑制率评价脑梗死患者口服阿司匹林、氯吡格雷单药及其合用双联抗血小板治疗的作用。方法 98例住院的急性脑梗死患者按口服抗血小板药物分为阿司匹林组(39例)、氯吡格雷组(37例)及氯吡格雷+阿司匹林组(22例)。在患者服药21 d时,采用血栓弹力图仪(TEG-5000)检测花生四烯酸(AA)途径和二磷酸腺苷(ADP)途径诱导的血小板抑制率值,并与正常对照组(52人)进行比较。结果阿司匹林组和阿司匹林+氯吡格雷组AA途径诱导的血小板抑制率均显著高于正常对照组及氯吡格雷组(均P <0. 05)。氯吡格雷组和阿司匹林+氯吡格雷组ADP途径诱导的抑制率均明显高于正常对照组(均P <0. 05)。结论血栓弹力图可用于评价临床抗血小板药物的效果。服用阿司匹林能起到很好的抗血小板作用,氯吡格雷的效果稍差;而阿司匹林联合氯吡格雷的抗血小板作用更强。

Objective To explore the effects of aspirin, clopidogrel monotherapy and their combination dual antiplatelet therapy in cerebral infarction patients by platelet inhibition rate evaluation with thrombelastogram. Methods The 98 hospitalized patients with acute cerebral infarction were divided into aspirin group （39 cases ） , clopidogrel group （37 cases） and clopidogrel plus aspirin group （22 cases）, according to their oral antiplatelet drugs. At 21 d taking drugs, the value of platelet inhibition rate induced by arachidonic acid （AA） and adenosine diphosphate （ADP） pathway were measured with thrombelastogram （TEG-5000） in the patients, and those were compared with normal control group （52 cases）. Results The inhibition rate induced by AA pathway in the aspirin group and aspirin plus clopidogreI group were significantly higher than those in the normal control group and clopidogrel group （all P 〈 0. 05 ）. The inhibition rate induced by ADP pathway in the clopidogrel group and aspirin plus clopidogrel group were significantly higher than those in the normal control group （all P 〈 0. 05）. Conclusions Thrombuselastograph can be used to evaluate the efficacy of antiplatelet drugs. Aspirin can play a good antiplatelet role, and clopidogrel is slightly worse. While aspirin combined with clopidogrel has a stronger antiplatelet effect.