阿司匹林联合氯吡格雷治疗对短暂性脑缺血发作患者脑血流动力学及细胞因子的影响

Effects of Clopidogrel Combined With Aspirin on Cerebral Hemodynamics and Cytokines in Patients With Transient Ischemic Attack

目的观察氯吡格雷联合阿司匹林治疗对短暂性脑缺血发作(TIA)患者脑血流动力学及细胞因子的影响。方法采用随机数字表法将140例TIA患者分为观察组与对照组,每组70例,对照组在常规治疗的基础上予以阿司匹林治疗,观察组在对照组的基础上联合应用氯吡格雷。比较两组临床疗效,治疗前、治疗2周后大脑中动脉血流动力学指标(峰流速、平均流速、峰流速差值、流速差值),血清细胞因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、转化生长因子-β1(TGF-β1)]及治疗期间出血事件(脑出血、皮肤黏膜出血、牙龈出血、消化道出血)发生情况。结果治疗2周后,观察组总有效率高于对照组(P<0.05);两组峰流速、平均流速均较治疗前升高,且观察组高于对照组,峰流速差值、流速差值均较治疗前降低,且观察组低于对照组(P<0.05);两组血清hs-CRP、IL-6、TNF-α、TGF-β1水平均较治疗前降低,且观察组低于对照组(P<0.05);两组均未出现脑出血等严重出血事件,皮肤黏膜出血、牙龈出血、消化道出血发生率差异无统计学意义(P>0.05)。结论TIA患者采用阿司匹林联合氯吡格雷治疗,可有效地改善脑血流动力学状态,缓解炎症反应,同时不会增加出血风险,疗效确切且安全性高。

Objective To observe the effects of clopidogrel combined with aspirin on cerebral hemodynamics and cytokines in patients with transient ischemic attack(TIA).Methods 140 TIA patients were divided into observation group and control group according to the random number table method,with 70 cases in each group.Control group was treated with aspirin on the basis of conventional treatment,and observation group was combined with clopidogrel on the basis of control group.The clinical efficacy,and middle cerebral artery hemodynamic indicators(peak flow rate,average flow rate,peak flow rate difference,flow rate difference)and serum cytokines[hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor(TNF-α),transforming growth factor-β1(TGF-β1)]before treatment and after 2 weeks of treatment and occurrence of bleeding events during treatment(cerebral hemorrhage,mucocutaneous hemorrhage,gum bleeding,gastrointestinal bleeding)were compared between the two groups.Results After 2 weeks of treatment,the total effective rate in observation group was higher than that in control group(P<0.05).The peak flow rate and average flow rate of the two groups were higher than those before treatment,and the indexes in observation group were higher than those in control group,and the peak flow rate difference and flow rate difference were lower than those before treatment,and the indexes in observation group were lower than those in control group(P<0.05).The serum levels of hs-CRP,IL-6,TNF-αand TGF-β1 in the two groups were lower than those before treatment,and the levels in observation group were lower than those in control group(P<0.05).There were no serious bleeding events such as cerebral hemorrhage in both groups,and there was no statistically significant difference in the incidence rate of mucocutaneous hemorrhage,gum bleeding and gastrointestinal bleeding(P>0.05).Conclusion Clopidogrel combined with aspirin for patients with TIA can effectively improve cerebral hemodynamics and relieve inflammatory response without increasing the risk of bleeding.It has a definite efficacy and high safety.