替格瑞洛片联合阿司匹林片治疗颅内大动脉狭窄合并小血管病的临床研究

Clinical trial of ticagrelor tablets combined with aspirin tablets in the treatment of patients with intracranial arterial stenosis and small vessel disease

目的观察不同剂量的替格瑞洛片联合阿司匹林片治疗颅内大动脉狭窄合并小血管病的临床疗效,并对其预后进行分析。方法将200例急性缺血性脑卒中患者分为A、B、C、D组,每组50例。A组给予阿司匹林75 mg·d^(-1),替格瑞洛90 mg·d^(-1); B组给予阿司匹林75 mg·d^(-1),替格瑞洛75 mg·d^(-1); C组给予氯吡格雷75 mg·d^(-1),替格瑞洛75 mg·d^(-1); D组给予氯吡格雷75 mg·d^(-1)+替格瑞洛90 mg·d^(-1)。分别于治疗前、治疗后1,6个月和1年记录各组患者的改良Rankin量表(mRS)、日常生活能力量表(ADL)、美国国立卫生院卒中量表(NIHSS)评分、白细胞Homer1、Homer2表达水平,观察各组治疗后1年的新发血管事件的发生率。结果治疗后1个月、6个月和1年,A组mRS分别为(2. 0±0. 5),(1. 7±0. 2),(1. 5±0. 1)分,B组分别为(2. 2±0. 6),(2. 0±0. 4),(1. 8±0. 2)分,C组分别为(2. 4±0. 4),(2. 2±0. 5),(2. 0±0. 3)分,D组分别为(2. 4±0. 5),(2. 2±0. 6),(2. 0±0. 4)分; A组与B、C、D组比较,差异均有统计学意义(均P <0. 05)。治疗后1个月、6个月和1年,A组ADL评分分别为(81. 3±7. 5),(89. 7±8. 2),(92. 5±9. 1)分; B组分别为(78. 2±8. 1),(82. 3±8. 4),(88. 7±10. 2)分,C组分别为(75. 4±7. 9),(79. 2±9. 5),(82. 5±9. 3)分,D组分别为(75. 3±7. 7),(79. 8±8. 9),(82. 8±9. 4)分,A组显著高于B组(P <0. 05),且A、B组与C、D组比较,差异有统计学意义(P <0. 05)。治疗后1年,A、B、C、D组新发血管事件发生率分别为8. 0%,18. 0%,36. 0%,38. 0%,A组与B组比较,差异有统计学意义(P <0. 05),C、D组间差异无统计学意义(P> 0. 05)。结论在颅内大动脉狭窄合并小血管病患者中用阿司匹林75 mg+替格瑞洛90 mg治疗方案,可促进患者神经功能的恢复,提高生活质量,降低血管不良事件发生率。

Objective To evaluate the clincial efficacy of different doses of ticagrelor tablets combined with aspirin tablets in the treatment of patients with intracranial arterial stenosis and small vessel disease,and analyze its prognosis. Methods A total of 200 patients with acute ischemic stroke were divided into A,B,C,D groups,each group 50 cases.Group A was treated with aspirin 75 mg·d-1+ ticagrelor 90 mg·d-1,group B was treated with aspirin 75 mg·d-1+ ticagrelor 75 mg·d-1,group C was treated with clopidogrel 75 mg·d-1+ ticagrelor 75 mg·d-1,group D was treated with clopidogrel 75 mg·d-1+ ticagrelor90 mg·d-1. The modified Rankin scale( mRS),ability of daily livingscale( ADL),the National Institutes of Health Stroke Scale( NIHSS) scores were recorded before treatment and 1 month,6 months,1 year after treatment. The expression levels of leukocyte Homer1,Homer2 and the incidence of new vascular events( transient ischemic attack,recurrent cerebral infarction,cerebral hemorrhage,subarachnoid hemorrhage) 1 year after treatment were observed. Results The mRS at 1 month,6 months and 1 year after treatment in group A were 2. 0 ± 0. 5,1. 7 ± 0. 2,1. 5 ± 0. 1,group B were 2. 2 ± 0. 6,2. 0 ± 0. 4,1. 8 ± 0. 2,group C were2. 4 ± 0. 4,2. 2 ± 0. 5,2. 0 ± 0. 3,group D were 2. 4 ± 0. 5,2. 2 ± 0. 6,2. 0 ± 0. 4,there was significant difference between group A and group B,C,D( P < 0. 05). The ADL at 1 month,6 months and 1 year after treatment in group A were 81. 3 ± 7. 5,89. 7 ± 8. 2,92. 5 ± 9. 1,group B were 78. 2 ± 8. 1,82. 3 ± 8. 4,88. 7 ± 10. 2,group C were75. 4 ± 7. 9,79. 2 ± 9. 5,82. 5 ± 9. 3,group D were 75. 3 ± 7. 7,79. 8 ± 8. 9,82. 8 ± 9. 4,there was significnat difference between group A and group B( P < 0. 05),there was significant difference between group A,B and group C,D( P < 0. 05). The incidence of new vascular events in 1 year after treatment in group A,B,C,D were 8. 0%,18. 0%,36. 0%,38. 0%. There was significnat difference between group A and group B( P < 0. 05),there was no significant difference between group C and group D( P > 0. 05). Conclusion The use of ticagrelor 90 mg + 75 mg aspirin regimen in the treamtent of intracranial main artery stenosis and small vessel disease can promote the recovery of neurological function and improve quality of life and reduce the incidence of adverse vascular events,for clinical practice.