氯吡格雷与阿司匹林联合应用在急性脑梗死治疗中的疗效评定

Therapeutic effect of combined use of clopidogrel and aspirin in the treatment of acute cerebral infarction

摘要:

目的 观察急性脑梗死患者血小板上α颗粒膜糖蛋白（CD62p）及溶酶体颗粒膜糖蛋白（CD63）的表达，通过血小板活化的变化，探讨阿司匹林与氯吡格雷联合用药与阿司匹林单药治疗的疗效差异。方法 将60例脑梗死患者随机分为两个亚组：单药组（阿司匹林0.15 g/d）和联合用药组（阿司匹林0.10 g/d+氯吡格雷75 mg/d），30例健康体检者为对照组。使用流式细胞术检测所有病例CD62p、CD63阳性率，对单药组和联合用药组治疗前后的CD62p、CD63阳性率进行比较，同时进行NIHSS评分。结果 脑梗死组血小板CD62p、CD63阳性率显著高于对照组（P<0.01）。单药组和联合用药组在治疗一周和二周后CD62p、CD63阳性率和NIHSS评分均较治疗前显著下降（P<0.01）。联合用药组治疗二周后与单药组比较CD62p、CD63阳性率和NIHSS评分明显降低，差异有统计学意义（P<0.01）。结论 抗血小板治疗对脑梗死有效，阿司匹林+氯吡格雷联合治疗的总体疗效明显优于单用阿司匹林，CD62p、CD63可以衡量抗血小板治疗效果。

Abstract:

Objective To study the therapeutic effect of combined use of clopidogrel and aspirin in the treatment of acute cerebral infarction by measuring the expression of platelet membrane glycoprotein and lysosome membrane protein 53 in patients with cerebral infarction.Methods Sixty patients with cerebral infarction were randomly divided into two groups: aspirin alone (0.15 g/d) and aspirin (0.10 g/d)+clopidogrel (75 mg/d). Thirty healthy persons were used as control group. Flow cytometry was employed to detect CD62p and CD63 expression on circulating platelets. NIHSS scores were evaluated.Results The positive percentage of CD62p and CD63 on platelets significantly increased in patients with cerebral infarction than in controls. The positive percentages of CD62p and CD63 on platelets and NIHSS scores were significantly reduced in patients with cerebral infarction in both aspirin alone and aspirin+clopidogrel groups after 1 and 2 weeks of treatment. The group receiving a combined use of aspirin and clopidogrel showed a lower positive percentage of CD 62p and CD63 on platelets and a lower NIHSS score than the aspirin alone group 2 weeks after treatment(P<0.01).Conclusions Antiplatelet treatment is effective in patients with cerebral infarction. A combination of aspirin and clopidogre for treatment of cerebral infarction appears to be superior to aspirin alone. CD62p and CD63 expression on the surface of plateles can be used for the evaluation of the efficacy of antiblatelet agents.