穿支动脉疾病性脑梗死合并糖尿病患者双联抗血小板治疗临床疗效观察

Effect of dual antiplatelet therapy on penetrating artery territory cerebral infarction in diabetic patients

关键词:  穿支动脉  脑梗死  糖尿病  双联抗血小板

Key words:  penetrating artery  cerebral infarction  diabetes  dual antiplatelet

摘要:

目的　观察穿支动脉疾病性脑梗死合并糖尿病患者应用双联抗血小板治疗的临床疗效及安全性。方法　选择2015年1月至2017年8月石家庄市第一医院神经内科收治的穿支动脉疾病性脑梗死合并糖尿病患者58例，依据抗血小板治疗方案的不同分为阿司匹林联合硫酸氢氯吡格雷治疗组30例及单用抗血小板聚集药物阿司匹林对照组28例，比较两组患者治疗3个月后NIHSS评分、BI指数、mRS评分、空腹血糖、糖化血红蛋白水平变化。随访1年并观察两组患者的复发率、出血率、全因死亡率。结果　双联抗血小板组临床疗效、NIHSS评分、mRS评分均优于对照组，复发率则低于对照组，随访3个月时分别为6.7%及13.3%，随访1年时分别为28.6%及39.3%），且两组之间具有统计学意义（P<0.05)。在出血并发症方面双联抗血小板组小出血高于对照组，但无明显统计学差异。结论　穿支动脉疾病性脑梗死合并患者双联抗血小板治疗可改善患者临床症状及预后，同时严重不良事件无明显增加。

Abstract:

Objective To investigate the effect of dual antiplatelet therapy on prognosis of penetrating artery territory cerebral infarction in diabetic patients. Methods Totally, 58 diabetic patients with penetrating artery territory cerebral infarction, who were admitted in our hospital from January 2015 to August 2017, were enrolled in the study. The patients were randomly divided into two groups according to the antiplatelet program at the time of admission. The dual antiplatelet therapy group（n=30）were treated with aspirin and clopidogrel. The control group（n=28） were treated with antiplatelet aggregation aspirin only. The changes of NISS score, mRS score, fasting blood glucose and glycosylated hemoglobin levels were compared between the two groups after 3 months of treatment. The rate of recurrence, hemorrhage and all-cause mortality rate in the two groups were analyzed after 12 months of follow up. Results The clinical efficacy, NISS score and mRS score in dual antiplatelet therapy group were better than control group, whereas the recurrence rate in dual antiplatelet therapy group was lower than control group (6.7% vs. 13.3% at 3-months of follow-up and 28.6% vs. 39.3% at 12-months of follow-up, P<0.05). In terms of bleeding complications, small hemorrhage occurred more often in duel antiplatelet group than control group, although the difference was not statistically significant. Conclusions Dual antiplatelet therapy can improve the clinical symptoms and prognosis of penetrating artery territory cerebral infarction in diabetic patients without significant increase in adverse events.