阿加曲班注射液治疗卒中预警综合征的短期临床效果研究

Short-term Clinical Effect of Argatroban Injection in the Treatment of Patients with Stroke Warning Syndrome

背景卒中预警综合征(SWS)是一种特殊类型的缺血性脑卒中综合征,极易进展为脑梗死,故及时、有效治疗SWS具有重要临床意义。目的探讨阿加曲班注射液治疗SWS的短期临床效果。方法选取2017年6月—2020年12月在徐州医科大学附属医院神经内科注册研究的第一入院诊断为短暂性脑缺血发作(TIA)及脑梗死患者共10198例,其中符合SWS诊断标准的患者187例,最终纳入101例SWS患者,并根据入院后是否使用阿加曲班注射液分为治疗组(50例)和对照组(51例)。对照组患者采用双联抗血小板聚集治疗和对症治疗,治疗组患者在对照组基础上予以阿加曲班注射液治疗。比较两组患者一般资料、实验室检查指标、首次发作时与治疗7 d后美国国立卫生研究院卒中量表(NIHSS)评分差值及治疗7 d后临床效果,记录患者影像学检查结果及药物相关不良反应发生情况。结果101例SWS患者中42例存在脑梗死,其中对照组19例,治疗组23例;内囊梗死23例(54.8%)、丘脑梗死5例(11.9%)、纹状体梗死4例(9.5%)、脑桥梗死3例(7.1%)、放射冠梗死3例(7.1%)、胼胝体梗死2例(4.8%)、海马梗死1例(2.4%)、小脑梗死1例(2.4%)。101例SWS患者入院后5 d内均未见血管闭塞或夹层形成,其中10例出现脑动脉狭窄。治疗组患者NIHSS评分差值低于对照组,临床效果优于对照组(P<0.05)。治疗组脑梗死患者临床效果优于对照组脑梗死患者(P<0.05);两组非脑梗死患者临床效果比较,差异无统计学意义(P>0.05)。治疗期间两组患者均未观察到症状性颅内出血、消化道出血或其他部位出血等药物相关不良反应。结论阿加曲班注射液与抗血小板药物联用可更有效地减轻SWS患者神经功能缺损程度,提高患者短期临床效果,尤其是进展为脑梗死的SWS患者获益更好,且未增加出血风险。

Background Stroke warning syndrome(SWS)is a special type of ischemic stroke syndrome,which is very easy to develop into cerebral infarction.Therefore,timely and effective treatment is of great clinical significance for SWS.Objective To investigate the short-term clinical effect of argatroban injection in the treatment of SWS.Methods A total of 10198 patients with transient ischemic attack(TIA)and cerebral infarction who were first admitted to the Department of Neurology,the Affiliated Hospital of Xuzhou Medical University from June 2017 to December 2020 were selected,among whom 187 patients met the diagnostic criteria of SWS,and 101 patients with SWS were eventually included.The patients were divided into treatment group(50 cases)and control group(51 cases)according to the use of argatroban injection after admission.The control group was treated with dual antiplatelet aggregation therapy and symptomatic therapy,and the treatment group was additively treated with argatroban injection.The general information,laboratory examination indexes,the difference of National Institutes of Health Stroke Scale(NIHSS)score at the time of first attack and 7 days after treatment,and the clinical effect after 7 days of treatment were compared between the two groups.Imaging examination results and drug-related adverse reactions were recorded.Results Among 101 SWS patients,42 had cerebral infarction(19 in the control group and 23 in the treatment group).There were 23 cases located in the capsular(54.8%),5 cases in thalamus(11.9%),4 cases in corpus striatum(9.5%),3 cases in pons(7.1%),3 cases in corona radiata(7.1%),2 cases in callosum(4.8%),1 case in hippocampus(2.4%),and 1 case in cerebellum(2.4%).No vascular occlusion or dissection was observed in 101 SWS patients within 5 days after admission,and 10 of them had cerebral artery stenosis.The difference of NIHSS score in the treatment group was lower than that in the control group,and the clinical effect was better than that in the control group(P<0.05).The clinical effect of cerebral infarction in the treatment group was better than that in the control group(P<0.05).There was no significant difference in the clinical effect of non-cerebral infarction patients between the two groups(P>0.05).No drug-related adverse reactions,such as symptomatic intracranial hemorrhage,gastrointestinal hemorrhage or bleeding in other parts,were observed in both groups during treatment.Conclusion Argatroban injection combined with antiplatelet agents can more effectively reduce the neurological impairment in SWS patients,improve the short-term clinical effect,especially in SWS patients with cerebral infarction,and do not increase the risk of bleeding.