阿司匹林+氯吡格雷联合依那普利对TIA合并H型高血压患者脂代谢及血Hcy水平的影响

Effect of aspirin,clopidogrel and enalapril on lipid metabolism and Hcy level in patients with TIA and H-type hypertension

目的探究阿司匹林、氯吡格雷联合依那普利对短暂性脑缺血发作(TIA)合并H型高血压患者脂代谢及血同型半胱氨酸(Hcy)水平的影响。方法选取2017年6月~2018年12月收治的122例TIA合并H型高血压患者作为研究对象,依据随机数表分成研究组和对照组各61例。对照组给予阿司匹林和氯吡格雷治疗,研究组在对照组治疗基础上给予依那普利治疗。观察治疗6个月后两组血液流变学指标[血浆黏度(PV)、血细胞比容(HCT)、血小板聚集率(PAR)]、脂代谢指标[低密度脂蛋白(LDL)、甘油三酯(TG)]及Hcy变化,分析疗程中两组脑血管意外及药物不良反应差异。结果治疗6个月后,两组PV、HCT、PAR、LDL、TG及Hcy水平均较治疗前显著降低,且研究组明显低于同一时间对照组(均P<0.05或0.001)。疗程中,研究组脑血管意外总发生率显著低于对照组(P<0.05);研究组出现消化道出血3例,咳嗽1例,对照组出现咳嗽2例,头痛1例,两组药物不良反应比较差异无统计学意义(P>0.05)。结论阿司匹林、氯吡格雷联合依那普利治疗TIA合并H型高血压效果显著,可改善患者脂代谢,且药物安全性良好,有一定临床应用价值。

Objective To investigate the effects of aspirin,clopidogrel and enalapril on lipid metabolism and blood homocysteine(Hcy) level in patients with transient ischemic attack(TIA) and H-type hypertension.Methods 122 patients from June 2017 to December 2018 with TIA and H-type hypertension were randomized into experimental group and control group(61 cases each).The control group was treated with aspirin and clopidogrel,and the experimental group was treated with enalapril on the basis of the control group.6 months later,two groups were compared in the changes of Hemorheology indexes [plasma viscosity(PV),hematocrit(HCT) and platelet aggregation rate(PAR)],lipid metabolism indexes [low density lipoprotein(LDLC) and triglyceride(TG)] and Hcy,which helps to analyze the differences of cerebrovascular accidents and adverse reactions.Results After 6 months’ treatment,the levels of PV,HCT,par,LDLC,TG and Hcy in the two groups were significantly lower than those before treatment,and the experimental group was significantly lower than the control group(all P<0.05 or 0.001).During the course of treatment,the total incidence of cerebrovascular accidents in the experimental group was significantly lower than that in the control group(P<0.05);in the experimental group,3 cases had gastrointestinal hemorrhage and 1 case coughed,whereas 2 cases coughed and 1 case had headache in the control group,and no significant difference was observed in adverse reactions between the two groups(P>0.05).Conclusion Aspirin,clopidogrel and enalapril are effective in the treatment of TIA combined with H-type hypertension,which can improve the lipid metabolism of patients,and the drug regimen is safe and has certain clinical application value.