| 姚科,李云燕.不同血小板浓度指导双联抗血小板治疗方案在轻型缺血性脑卒中/短暂性脑缺血发作患者中的应用价值[J].中国医药导报,2024,21(5):100-104 |
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| 不同血小板浓度指导双联抗血小板治疗方案在轻型缺血性脑卒中/短暂性脑缺血发作患者中的应用价值 |
| Application value of different platelet concentrations to guide dual antiplatelet therapy in patients with mild ischemic stroke/transient ischemic attack |
| 收稿日期： 修订日期：2023-05-29 |
| DOI：10.20047/j.issn1673-7210.2024.05.24 |
| 关键词: 缺血性脑卒中 短暂性脑缺血发作 抗血小板 血小板浓度 出血率 |
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| 基金项目:江苏省自然科学基金面上项目（BK20191173） |
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| 摘要:目的 探究不同血小板浓度指导双联抗血小板治疗方案在轻型缺血性脑卒中（MIS）/短暂性脑缺血发作（TIA）患者中的效果及安全性。 方法 选取江苏省常州市武进中医医院2020年9月至2022年5月收治的180例MIS/TIA患者作为研究对象，采用随机数字表法将其分为对照组和试验组，各90例。对照组常规使用阿司匹林+氯吡格雷；试验组按血小板浓度给药。治疗3个月后，比较两组复发率、症状性颅内出血发生率、死亡率；比较两组治疗前，治疗3周、3个月后美国国立卫生研究院卒中量表（NIHSS）评分；比较两组治疗前，治疗7 d、3个月后血小板计数；观察治疗期间不良反应发生情况。 结果 治疗期间，对照组7例患者因个人原因，自行退出研究，最终入组83例；研究组6例患者因个人原因，自行退出研究，最终入组84例。两组均无死亡患者；试验组复发率高于对照组，症状性颅内出血率低于对照组（P＜0.05）。整体分析：两组治疗前，治疗7 d、3个月后血小板计数时间比较，差异有统计学意义（P＜0.05）；两组治疗前，治疗7 d、3个月后血小板计数组间、交互作用比较，差异无统计学意义（P＞0.05）。组内比较：两组血小板计数不同时间点两两比较，差异有统计学意义（P＜0.05）。组间比较：两组治疗前，治疗7 d、3个月后血小板计数比较，差异无统计学意义（P＞0.05）。整体分析：两组治疗前，治疗3周、3个月后NIHSS评分时间比较，差异有统计学意义（P＜0.05）；两组治疗前，治疗3周、3个月后NIHSS评分组间、交互作用比较，差异无统计学意义（P＞0.05）。组内比较：两组NIHSS评分不同时间点两两比较，差异有统计学意义（P＜0.05）。组间比较：两组治疗前，治疗3周、3个月后NIHSS评分比较，差异无统计学意义（P＞0.05）。两组皮肤、黏膜瘀斑或牙龈、鼻腔出血，消化道反应发生率比较，差异无统计学意义（P＞0.05）。 结论 不同血小板浓度指导双联抗血小板治疗方案应用于MIS/TIA患者中，有助于降低颅内出血率，但复发风险随之增高。 |
| Abstract:Objective To explore the efficacy and safety of dual antiplatelet regimen guided by different platelet concentr- ations in the treatment of patients with mild ischemic stroke (MIS)/transient ischemic attack (TIA). Methods A total of 180 cases of MIS/TIA patients admitted to Wujin Hospital of Traditional Chinese Medicine of Changzhou, Jiangsu Province from September 2020 to May 2022 were selected as the research objects. They were divided into control group and experimental group, with 90 cases in each group. The control group received Aspirin+Clopidogrel; experimental group was adm- inistered according to platelet concentration. After three months of treatment, the recurrence rate, incidence of symptomatic intracranial hemorrhage, and mortality were compared between two groups; the National Institutes of Health stroke scale (NIHSS) scores of two groups were compared before treatment, three weeks and three months after treatment; the platelet count of two groups were compared before treatment, seven days, and three months after treatment; the occurrence of adverse reactions during treatment was observed. Results During the treatment period, seven patients in control group withdrew from the study due to personal reasons, resulting in a final enrollment of 83 cases; in study group, six patients withdrew from the study due to personal reasons, resulting in a final enrollment of 84 cases. No death occurred in both groups; the recurrence rate of experimental group was higher than that of control group, and the symptomatic intracranial hemorrhage rate was lower than that of control group (P＜0.05). Overall analysis: the platelet count time before treatment, seven days, and three months after treatment between two groups had statistical significances(P＜0.05); there were no significant difference in platelet count between two groups before treatment, seven days, and three months after treatment (P＞0.05). Intra-group comparison: pairwise comparison of platelet count at different time points between two groups showed statistically significant differences (P＜0.05). Comparison between the two groups: before treatment, seven days, and three months after treatment, there were no significant differences in platelet count between two groups (P＞0.05). Overall analysis: before treatment, three weeks, and three months after treatment, the differences in NIHSS score time between two groups were statistically significant (P＜0.05). There were no significant differences in NIHSS scores between two groups before treatment, three weeks, and three months after treatment (P＞0.05). Intra-group comparison: the NIHSS scores of two groups was pairwise compared at different time points, and the differences were statistically significant (P＜0.05). Comparison between groups: there were no significant differences in NIHSS scores between two groups before treatment, three weeks, and three months after treatment (P＞0.05). There were no significant differences in the incidence of skin, mucous ecchymosis, gingival and nasal bleeding and gastrointestinal reaction between two groups (P＞0.05). Conclusion Different platelet concentrations guide the application of dual antiplatelet regimen in MIS/TIA patients, which helps to reduce the rate of intracranial hemorrhage, but the risk of recurrence is increased. |
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