摘要
目的应用血栓弹力图(thromboelastography,TEG)指导急性非心源性卒中患者选择敏感抗血小板聚集药物,并评价临床治疗效果。方法连续选取首都医科大学附属北京朝阳医院西区神经内科2013年1月至2014年12月期间急性非心源性卒中住院患者162例,分为个体化治疗组54例(阿司匹林100 mg联合氯吡格雷75 mg应用14 d,后根据TEG结果选择阿司匹林或氯吡格雷单抗),阿司匹林组(n=54),氯吡格雷组(n=54)。三组患者均于住院第7天抽静脉血,应用TEG仪检测花生四烯酸(arachidonic acid,AA)途径诱导的血小板抑制率和二磷酸腺苷(adenosine diphosphate,ADP)受体途径诱导的血小板抑制率,并于入院时、第14天、3个月行美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分及日常生活能力量表(Activity of Daily Living Scale,ADL)评分。比较三组之间基线资料及AA途径、ADP途径诱导的血小板抑制率,并评估14 d及3个月NIHSS评分、ADL评分及再发缺血性卒中及脑出血发生事件。结果三组之间在年龄、性别、高血压、糖尿病、高血脂、吸烟、饮酒、既往卒中、冠状动脉粥样性心脏病以及入院时NIHSS评分、ADL评分方面比较差异无显著性(P>0.05)。个体化治疗组AA及ADP途径诱导的血小板抑制率中位数分别为93.2%(77.45%,98.35%)、50.4%(27.62%,67.25%),阿司匹林组AA途径及氯吡格雷组ADP诱导的血小板抑制率中位数分别为73.05%(40.8%,92.75%)、20.5%(5.1%,53.5%),个体化治疗组AA或ADP途径诱导血小板抑制率较阿司匹林组及氯吡格雷组相比差异有显著性(P<0.05)。个体化治疗组、阿司匹林组、氯吡格雷组三组患者入院第14天NIHSS评分中位数分别为3(2,4)、3.5(3,4)、4(3,4),ADL评分中位数分别为80(70,90)、75(70,85)、70(65,85);第3个月NIHSS评分中位数分别为2(2,3)、3(2,3)、3(2,3),ADL评分中位数分别为90(85,95)、87.5(80,90)、85(80,90),三组间两两比较个体化治疗组优于阿司匹林组及氯吡格雷组(P<0.05),阿司匹林组与氯吡格雷组比较差异无显著性(P>0.05)。随访3个月三组均无脑出血发生,个体化治疗组有1例再发缺血性事件,阿司匹林组有3例、氯吡格雷组有4例再发缺血性事件。结论急性非心源性卒中患者急性期给予双抗治疗后根据TEG结果选择敏感抗血小板聚集药物能提高患者临床预后,不增加出血风险。
Objective To choose sensitive anti-platelet aggregation drugs in acute non cardiogenic cerebral infarction patients with thromboelastography（TEG）, and evaluate the clinical results.Methods One hundred and sixty-two acute non cardiogenic cerebral infarction patients were collected in Beijing Chao Yang Hospital from Jan 2013 to Dec 2014. They were divided into individual therapy group（n =54 Aspirin 100 mg plus clopidogrel 75 mg for 14 days, then choose aspirin or clopidogrel according to the results of thromboelastography）, aspirin group（n =54） and clopidogrel group（n =54）. Venous blood samples were collected at day 7 after hospitalization. A TEG instrument was used to detect arachidonic acid（AA）-induced inhibition rate of platelet aggregation and adenosine diphosphate（ADP） receptor-induced inhibition rate of platelet aggregation. Experienced physicians determined baseline National Institutes of Health Stroke Scale（NIHSS） scores and Activity of Daily Living Scale（ADL） scores at the time of admission, and at day 14, day 90 respectively. Compared the baseline information and AA or ADP-induced inhibition rate of platelet aggregation, and assess the NIHSS score, ADL score at day 14 and day 90, and summary the number of recurrent ischemic stroke and cerebral hemorrhage events.Results There are no signifi cant difference among the three groups in age, gender, hypertension, diabetes, high cholesterol, smoking, drinking, previous stroke, coronary heart disease and the admission NIHSS score and ADL score（P〉0.05）. The median rate of AA and ADP induced platelet pathway inhibition in the individual therapy group was 93.2%（77.45%, 98.35%）, 50.4%（27.62%, 67.25%） respectively, while the AA-induced platelet pathway inhibition in aspirin group and the ADP-induced platelet pathway inhibition in clopidogrel group was 73.05%（40.8%, 92.75%）, 20.5%（5.1%, 53.5%） respectively, There was statistically signifi cant between individual therapy group and group aspirin and group clopidogrel（P〈0.05）. The median NIHSS score at day 14 in the individual therapy group, aspirin, clopidogrel group was 3（2, 4）, 3.5（3, 4）, 4（3, 4） respectively, and the median ADL score was 80（70, 90）, 75（70, 85）, 70（65, 85） respectively, while the median NIHSS score at day 90 was 2（2, 3）, 3（2, 3）, 3（2, 3） respectively, and the median ADL score was 90（85, 95）, 87.5（80, 90）, 85（80, 90） respectively. There are signifi cant differences on NIHSS and ADL score between individual therapy group and aspirin or clopidogrel group at day 14 and day 90（P〈0.05）; however, there was no statistic signifi cance between aspirin and clopidogrel group（P〉0.05）. During three months follow up, there was no cerebral hemorrhage cases in three groups, however there was one case of recurrent ischemic events in individual group, three in the aspirin group, and four in clopidogrel group respectively.Conclusion Given aspirin and clopidogrel during the acute non-cardiogenic acute cerebral infarction, then select sensitive antiplatelet drug according to TEG can improve the prognosis of acute non cardiogenic cerebral infarction patients, and does not increase the risk of hemorrhage.
出处
《中国卒中杂志》
2015年第12期1006-1011,共6页
Chinese Journal of Stroke
关键词
卒中
缺血性
抗血小板聚集
血栓弹力图
Cerebral infarction
Antiplatelet therapy
Thromboelastography
