不同剂量氯吡格雷对脑梗死患者神经功能的影响

胡乔乔; 何佳

doi:10.3969/j.issn.1006-0111.2017.05.016

不同剂量氯吡格雷对脑梗死患者神经功能的影响

doi: 10.3969/j.issn.1006-0111.2017.05.016

胡乔乔,
何佳

鄞州人民医院药剂科, 浙江宁波 315040

Clinical observation of different dose of clopidogrel on the neural function in patients with ischemic stroke

HU Qiaoqiao,
HE Jia

Department of Pharmacy, Yinzhou People's Hospital, Ningbo 315040, China

摘要: 目的观察不同剂量氯吡格雷对脑梗死患者神经功能的影响。方法将120例脑梗死患者随机分为低剂量组和高剂量组，两组均进行常规治疗，低剂量组予氯吡格雷75 mg，1次/d，连续3个月。高剂量组予氯吡格雷150 mg，1次/d，连续3个月。观察并比较两组患者入组时、用药1个月及3个月时的美国国立卫生研究院卒中量表（National Institute of Health stroke scale，NIHSS）评分、血小板计数及血小板聚集率、神经功能恶化率、再发脑梗死率及颅内外出血率。结果治疗1个月时，两组患者NIHSS评分均较入组时下降，但高剂量组下降幅度更大，差异均有统计学意义（P<0.05）。当治疗3个月时，低剂量组NIHSS评分与1个月时比较，差异无统计学意义（P<0.05），高剂量组NIHSS评分进一步下降，差异有统计学意义（P<0.05）。治疗3个月后，高剂量组患者血小板计数及血小板聚集程度较入组时均显著下降，差异有统计学意义（P<0.05）；而低剂量组未见明显变化（P>0.05）。低剂量组神经功能恶化率、再发脑梗死率分别为11.7%、10.0%，显著高于高剂量组（5.0%、5.0%），差异有统计学意义（P<0.05）。但是，两组患者颅内出血率分别为5.0%及6.7%，差异无统计学意义（P>0.05）。结论氯吡格雷高剂量组比低剂量组更能促进脑梗死患者神经功能的恢复，且能降低再发脑梗死及动脉粥样硬化相关心血管事件的发生率，值得临床进一步研究。
- 氯吡格雷 /
- 脑梗死 /
- 神经功能
Abstract: Objective To explore the clinical effects of different dose of clopidogrel on the neural functions in patients with ischemic stroke. Methods 120 patients with ischemic stroke were randomly divided into low dose group (clopidogrel 75 mg daily) or high dose group (clopidogrel 150 mg daily). All the patients received the same basic treatment plus clopidogrel for 3 month. Both groups were evaluated and compared for their NIHSS scores, platelet count, platelet aggregation rate, neurologic deterioration rate, recurrence rate of cerebral infarction and intracranial bleeding rate at the time of admission, one month and three month. Results Compared to the scores at the time of admission, NIHSS scores decreased in both groups after one month treatment with statistical significance (P<0.05). The high dose group dropped more obviously. The NIHSS scores at 3 month in the low dose group had no difference statistically compared to 1 month (P>0.05), while high dose group declined significantly (P<0.05). The platelet count and platelet aggregation were decreased significantly in high dose group at 3 month(P<0.05), while there was no significant change in the low dose group(P>0.05). The neurologic deterioration rate, recurrence rate of cerebral infarction in the low dose group were 11.7%, 10.0% respectively, significantly higher than that of high dose group (5.0%, 5.0%, respectively), which was statistically significant (P<0.05). However, there was no statistically significant difference (P>0.05) between two groups in intracranial bleeding rate (5.0% and 6.7% respectively). Conclusion Patients on clopidogrel 150 mg exhibited much better recovery of neural functions and greater reduction in the recurrence of cerebral infarction and atherosclerosis related cardiovascular events.
- lopidogrel /
- ischemic stroke /
- neural function

[1]	Wang Z, Li J, Wang C, et al. Gender differences in 1-year clinical characteristics and outcomes after stroke: results from the China National Stroke Registry［J］. PLoS ONE, 2013,8(2):e56459.
[2]	中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014［J］.中华神经科杂志, 2015,48(4):246-257.
[3]	Yi X, Zhou Q, Lin J, et al. Platelet response to aspirin in Chinese stroke patients is independent of genetic polymorphisms of COX-1 C50T and COX-2 G765C［J］. J Atheroscler Thromb, 2013, 20(1): 65-72.
[4]	Mehta SR, Bassand J P, Chrolavicius S, et al. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes［J］. N Engl J Med, 2010,363(10):930-942.
[5]	Yi X, Lin J, Wang C, et al. Low-molecular-weight heparin is more effective than aspirin in preventing early neurologic deterioration and improving six-month outcome［J］. J Stroke Cerebrovasc Dis, 2014, 23(6): 1537-1544.
[6]	王玥, 周瑜, 张建容,等. 进展性脑梗死患者血小板参数及血浆纤维蛋白原变化的研究［J］. 重庆医学, 2015, 44(26):3692-3694.
[7]	戴京涛, 李志贤, 孔伟丽,等. 氯吡格雷联合阿司匹林治疗脑梗死临床分析［J］. 中国实用神经疾病杂志, 2014, 17(11):72-73.
[8]	吴学永, 卢常盛, 李上华,等. 阿司匹林在不同年龄段脑梗死患者中二级预防的效果［J］. 临床荟萃, 2016, 31(2):201-203.
[9]	赵云清, 罗建华, 周其志, 等. 阿司匹林抵抗对大动脉粥样硬化性脑梗死复发的影响［J］. 卒中与神经疾病, 2015, 22(4):219-225.
[10]	Sacco RL, Diener HC, Yusuf S, et al. Aspirin and extended release dipyridamole versus clopidogrel for recurrent stroke［J］. N Engl J Med, 2008, 359(12):1238-1251.
[11]	乔伟. 氯吡格雷对急性缺血性脑卒中患者血清炎性标记物的影响［D］. 青岛:山东大学, 2012.
[12]	刘凡, 查泰, 刘雪娟,等. 不同剂量硫酸氯吡格雷治疗缺血性脑卒中的疗效与安全性比较［J］. 医药导报, 2014, 33(2):194-197.
[13]	倪金迪, 沈国锋, 李响,等. 抗血小板药预防脑卒中的应用进展［J］. 中国临床神经科学, 2014, 22(4):412-417.
[14]	肖明珠. 负荷剂量氯吡格雷治疗进展性脑卒中的安全性及临床效果［J］. 中国实用神经疾病杂志, 2015, 18(18):107-108.

[1]	王亚娟, 赵燕, 李维亮, 余爱荣. 缺血性脑卒中患者发生氯吡格雷抵抗的危险因素分析 . 药学实践与服务, 2024, 42(1): 32-37. doi: 10.12206/j.issn.2097-2024.202209054
[2]	徐熠, 何瑞华, 黄瑾. 中药复方参麻颈复颗粒治疗脑梗死的网络药理学研究 . 药学实践与服务, 2024, 42(2): 66-72. doi: 10.12206/j.issn.2097-2024.202303013
[3]	刘景雪, 何瑞华, 陶霞, 黄瑾. 参麻颈复方对脑缺血损伤小鼠的脑保护作用及其机制研究 . 药学实践与服务, 2023, 41(11): 666-671, 685. doi: 10.12206/j.issn.2097-2024.202208066
[4]	侯文洁, 张亮, 李翔宇, 王洁. CYP2C19基因多态性对PCI术后患者氯吡格雷血药浓度、血小板抑制率和安全性的影响 . 药学实践与服务, 2021, 39(5): 472-475. doi: 10.12206/j.issn.1006-0111.202008029
[5]	金飞虹, 陈婕, 杨文超. 银杏二萜内酯葡胺注射液治疗脑梗死的疗效及安全性的Meta分析 . 药学实践与服务, 2019, 37(1): 80-85. doi: 10.3969/j.issn.1006-0111.2019.01.019
[6]	黄莹, 孙力, 范瑞. 经皮冠状动脉介入治疗术后亚急性支架内血栓形成并发肝功能异常患者的药学服务 . 药学实践与服务, 2019, 37(2): 183-187. doi: 10.3969/j.issn.1006-0111.2019.02.017
[7]	杨世畅, 何荆贵, 周素月, 李雪梅. 盐酸美金刚改善缺血性脑卒中患者神经认知功能的回顾性研究 . 药学实践与服务, 2018, 36(5): 457-460. doi: 10.3969/j.issn.1006-0111.2018.05.017
[8]	李迪, 邵尉, 台宗光, 赵文军. 依达拉奉联合银杏二萜内酯葡胺注射液治疗急性脑梗死的临床疗效观察 . 药学实践与服务, 2018, 36(1): 80-82,87. doi: 10.3969/j.issn.1006-0111.2018.01.017
[9]	黄瑾, 李璐奕, 祁炜罡, 黄瑛, 曾颖, 唐帆. 血府逐瘀胶囊对重度血瘀证患者经皮冠状动脉介入治疗术后氯吡格雷抵抗的调节作用 . 药学实践与服务, 2018, 36(6): 533-535,546. doi: 10.3969/j.issn.1006-0111.2018.06.012
[10]	张红楠, 王强, 朱晓红, 郎轶咏. CYP2C19基因指导冠心病患者经皮冠状动脉介入术后抗血小板药合理应用 . 药学实践与服务, 2018, 36(6): 518-521. doi: 10.3969/j.issn.1006-0111.2018.06.009
[11]	邵腾飞, 葛卫红. 临床药师干预对脑梗死患者用药依从性的影响 . 药学实践与服务, 2017, 35(2): 178-181. doi: 10.3969/j.issn.1006-0111.2017.02.021
[12]	姜舒, 芮耀诚, 李铁军. 心肌梗死中涉及炎症和凋亡的机制 . 药学实践与服务, 2016, 34(2): 119-123. doi: 10.3969/j.issn.1006-0111.2016.02.007
[13]	黄瑾, 曾颖, 唐帆, 袁芳. 中药及其活性成分与氯吡格雷抗血小板聚集的相互作用 . 药学实践与服务, 2016, 34(5): 389-392,398. doi: 10.3969/j.issn.1006-0111.2016.05.002
[14]	彭净, 刘卫. CYP2C19基因多态性对药物代谢影响的研究进展 . 药学实践与服务, 2015, 33(6): 508-512. doi: 10.3969/j.issn.1006-0111.2015.06.008
[15]	黄健, 戴亦晖, 郭尧注. 氯吡格雷不良反应文献分析 . 药学实践与服务, 2014, 32(1): 74-75.
[16]	代黎, 姜志辉, 蔡瞻, 赵明珠, 李宴, 倪廷峻弘, 田淑娟, 张大志. 盐酸普拉格雷合成工艺的改进 . 药学实践与服务, 2013, 31(3): 195-197. doi: 10.3969/j.issn.1006-0111.2013.03.009
[17]	李蓉, 李明, 葛文俊. 五个厂家氯雷他定片或胶囊体外溶出度比较 . 药学实践与服务, 2008, (5): 350-352.
[18]	赵瑞祥. 蝮蛇抗栓酶对脑梗死患者脂质代谢紊乱的疗效观察 . 药学实践与服务, 2000, (3): 137-138.
[19]	钱文德, 任珠英, 张紫洞. 依那普利和氨氯吡脒及速尿 . 药学实践与服务, 1989, (4): 109-109.
[20]	魏文树, 苏开仲. 消炎痛与氨氯吡脒和双氢克尿塞 . 药学实践与服务, 1986, (3): 77-77.

点击查看大图

计量

文章访问数: 3224
HTML全文浏览量: 376
PDF下载量: 694
被引次数: 0

姓名
邮箱
手机号码
标题
留言内容
验证码

留言板

不同剂量氯吡格雷对脑梗死患者神经功能的影响

doi: 10.3969/j.issn.1006-0111.2017.05.016

Clinical observation of different dose of clopidogrel on the neural function in patients with ischemic stroke

计量

不同剂量氯吡格雷对脑梗死患者神经功能的影响

doi: 10.3969/j.issn.1006-0111.2017.05.016

鄞州人民医院药剂科, 浙江宁波 315040

English Abstract

Clinical observation of different dose of clopidogrel on the neural function in patients with ischemic stroke

Department of Pharmacy, Yinzhou People's Hospital, Ningbo 315040, China

全文HTML

目录

留言板

不同剂量氯吡格雷对脑梗死患者神经功能的影响

doi: 10.3969/j.issn.1006-0111.2017.05.016

Clinical observation of different dose of clopidogrel on the neural function in patients with ischemic stroke

计量

出版历程

不同剂量氯吡格雷对脑梗死患者神经功能的影响

doi: 10.3969/j.issn.1006-0111.2017.05.016

鄞州人民医院药剂科, 浙江 宁波 315040

English Abstract

Clinical observation of different dose of clopidogrel on the neural function in patients with ischemic stroke

Department of Pharmacy, Yinzhou People's Hospital, Ningbo 315040, China

全文HTML

目录

鄞州人民医院药剂科, 浙江宁波 315040