强化瑞舒伐他汀钙联合氯吡格雷及阿司匹林对高危短暂性脑缺血发作患者临床效果评价

Effect of intensive rosuvastatin calcium combined with clopidogrel and aspirin on patients with high risk of transient ischemic attack

目的探讨强化瑞舒伐他汀钙联合氯吡格雷及阿司匹林对高危短暂性脑缺血发作患者的临床效果及对颈动脉内中膜厚度、血脂及血小板参数的影响。方法入我科接受治疗的110例高危TIA患者随机分为试验组和对照组。试验组给予瑞舒伐他汀20 mg(14 d后减为10 mg)、氯吡格雷75 mg及阿司匹林100 mg(21 d后停服);对照组患者给予瑞舒伐他汀10 mg、氯吡格雷75 mg及阿司匹林100 mg(21 d后停服)治疗,对比治疗3 m后两组卒中发生率、颈动脉内中膜厚度、血脂、血小板参数及不良事件发生率。结果对照组脑梗死发病率11.5%,试验组脑梗死发病率5.2%,差异有统计学意义(P<0.05);试验组患者总胆固醇(TC)、甘油三酯(TG)及低密度脂蛋白-C(LDL-C)降低较对照组更明显(P<0.05)。治疗后试验组较对照组相比颈动脉内中膜厚度更低,差异有统计学意义(P<0.05);治疗后两组血小板计数(PLT)及血小板平均宽度(MPV)与治疗前相比均降低,差异有统计学意义(P<0.05);治疗后MPV两组组间相比差异有统计学意义(P<0.05)。结论早期强化瑞舒伐他汀钙联合氯吡格雷及阿司匹林对高危TIA患者能够显著减低卒中复发率,有效降低血脂水平,减轻颈动脉内中膜厚度,降低血小板计数及血小板平均体积。

Objective To explore the clinical efficacy of intensive rosuvastatin calcium combined with clopidogrel and aspirin on patients with high risk of transient ischemic attack(TIA),and the influence of treatment on carotid artery intima-media thickness,blood lipid and platelet parameter.Methods One hundred and ten patients with high risk of TIA were randomly divided into control group and treatment group.The control group was given rosuvastatin 10 mg/d combined with 100 mg/d aspirin(withdraw at day 21)and 75 mg/d clopidogrel,while the treatment group was initiated with a loading dose of 20 mg/d for 14 days followed by 10 mg/d combined with 100 mg/d aspirin(withdraw at day 21)and 75 mg/d clopidogrel.The primary efficacy end point is the percentage of patients with any stroke,the influence on carotid artery intima-media thickness,blood lipid and platelet parameter 3 months later.Results Stroke occurred in 5.2%of patients in the treatment group and 11.5%in the control group,the difference was statistically significantly(P<0.05).Total cholesterol(TC),triglyceride(TG),and low density lipoprotein-C(LDL-C)were significant lower in treatment group compared with those in control group,and the difference was statistically significantly(P<0.05).The carotid artery intima-media thickness was lower in the treatment group(P<0.05).Besides,the platelet(PLT)count and the mean platelet volume(MPV)was lower after treatment(P<0.05).Moreover,MPV were significantly lower in treatment group compared to that in control group 3 months later(P<0.05).Conclusion Intensive rosuvastatin calcium combined with clopidogrel and aspirin can reduce the blood lipid level and has a significant effect on the prevention of patients with high risk of TIA to cerebral infarction,reduce the carotid artery intima-media thickness,PLT and MPV.