阿司匹林与替格瑞洛对急性轻型缺血性卒中溶栓后再发心脑血管风险的预防效果比较

Effect comparison between aspirin and ticagrelor in the prevention of the recurrent risk of cardiovascular and cerebrovascular diseases after thrombolysis for acute mild ischemic stroke

目的探讨阿司匹林与替格瑞洛对急性轻型缺血性脑卒中溶栓后再发心脑血管风险的短期预防效果。方法2012年5月至2015年4月我院接受静脉溶栓治疗的80急性轻型缺血性脑卒中患者,按随机数字表法分为A、B组各40例,两组均配合应用抗血小板药物,A组采用阿司匹林,B组采用替格瑞洛,测定治疗前后两组肝肾指标的变化[血小板计数(PLT)、谷丙转氨酶(ALT)、血肌酐(Cr)血碱性磷酸酶(ALP)],采用改良Rankin(mRS)表评定患者神经功能恢复情况,应用Barthel指数表评定患者日常活动能力的改善情况,统计两组溶栓90 d内心脑血管不良事件发生率。结果治疗后两组改良Rankin评分、NIHSS评分均降低,B组低于A组(P<0.05);两组Barthel指数表评分均上升,B组高于A组(P<0.05);两组脑血管事件、心血管事件、出血事件及全因死亡率差异无统计学意义(P>0.05)。结论急性轻型缺血性脑卒中患者溶栓后加用替格瑞洛抗血小板处理,可改善患者神经功能,提升患者日常活动能力,改善患者短期预后,减少不良心脑血管事件发生率。

To investigate the short-term effect of aspirin and ticagrelor in prevention of the risk of cardiovascular and cerebrovascular diseases after thrombolysis for acute mild ischemic stroke.Eighty patients with acute mild ischemic stroke who received intravenous thrombolytic therapy in our hospital between May 2012 and April 2015 were divided into group A or B according to the random number table method,40 cases in each group.Both groups were treated with antiplatelet drugs.The group A was treated with aspirin while the group B was treated with ticagrelor.Changes of hepatic and renal indexes including platelet count(PLT),alanine aminotransferase(ALT),serum creatinine(Cr)and serum alkaline phosphatase(ALP)were determined.The modified Rankin scale(MRS)was used to evaluate the recovery of neurological function and Barthel index was used to evaluate the improvement of activity of daily living(ADL).The incidence of cardiovascular and cerebrovascular adverse events in 90 days of thrombolysis was statistically analyzed.After treatment,the scores of MRS and NIHSS were decreased and the Barthel index was increased in the both groups but the group B was lower or higher than the group A(all P<0.05).There was no statistically different in the incidence of cerebrovascular and cardiovascular events,bleeding events and all-cause mortality rates between the two groups(P>0.05).After thrombolysis,patients with acute mild ischemic stroke can be treated with ticagrelor antiplatelet treatment to improve the neurological function,enhance the activities of daily living,improve the short-term prognosis and reduce the incidence of adverse cardiovascular events.