阿司匹林抵抗病人应用普拉格雷预防脑缺血发作的临床研究

Clinical Research on Prasugrel in Preventing Transient Ischemic Attack in Patients with Aspirin Resistance

目的研究普拉格雷单药预防阿司匹林抵抗的短暂性脑缺血发作病人的临床进展疗效及安全性。方法筛选阿司匹林抵抗的短暂性脑缺血发作病人56例,将病人随机分为两组。试验组使用普拉格雷进行二级预防,对照组使用氯吡格雷联合阿司匹林进行二级预防,分别在病人治疗后的7 d、14 d、30 d、60 d、90 d进行花生四烯酸(AA)、二磷酸腺苷(ADP)诱导的血小板聚集率(PAG)、血栓素B 2(TXB 2)、白介素-6(IL-6)检测。统计90 d内短暂性脑缺血复发及进展为缺血性脑卒中的例数,并统计不良反应事件发生情况。结果两组病人在90 d内AA、ADP诱导的PAG以及TXB 2和IL-6的表达均呈下降趋势,与试验组相比对照组下降程度差异有统计学意义(P<0.05)。而试验组短暂性脑缺血再发病人例数以及进展为缺血性脑卒中的例数均少于对照组(P<0.05)。不良反应总发生率比较试验组低于对照组(P<0.05)。结论阿司匹林抵抗病人使用普拉格雷单药预防短暂性脑缺血发作的临床进展效果优于氯吡格雷联合阿司匹林,这对于急性脑卒中的二级预防具有一定的借鉴意义,尤其是针对阿司匹林抵抗的病人。

Objective To study the clinical efficacy and safety of prasugrel in preventing transient ischemic attack(TIA)in patients with aspirin resistante.Methods Fifty-six patients with TIA who were resistant to aspirin were screened and randomly divided into two groups.The patients in experimental group were treated with prasugrel for secondary prevention,and the patients in control group were treated with clopidogrel and aspirin for secondary prevention.The arachidonic acid(AA),adenosine diphosphate(ADP)-induced platelet aggregation(PAG),thromboxane B 2(TXB 2),and interleukin-6(IL-6)were detected after 7 d,14 d,30 d,60 d,and 90 d of treatment,respectively.Results The expressions of AA,ADP-induced PAG,and the expression of TXB 2 and IL-6 were decreasing in two groups within 90 days,which were lower in the experimental group than that in the control group(P<0.05).The number of patients with recurrent TIA and the number of patients with TIA in the experimental group were less than those in the control group(P<0.05).The total incidence of adverse reactions in the experimental group was lower than that in the control group(P<0.05).Conclusion Prasugrel in preventing TIA in patients with aspirin resistance is more effective than clopidogrel and aspirin.It has certain reference significance for the secondary prevention of acute stroke,especially for patients with aspirin resistance.