阿司匹林联合氯吡格雷治疗缺血性脑卒中疗效的TOAST分型评价

发布时间：2018-03-18 16:28

  本文选题：缺血性脑卒中　切入点：TOAST分型　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景及目的：缺血性脑卒中(IschemicStroke，IS)是由于供应大脑的动脉突然堵塞，导致其供应的脑组织灌注减低，缺血区神经血管单元坏死。可导致患者记忆力、计算力、语言表达等能力下降，严重影响患者的行为能力及生活质量。缺血性脑卒中以其高发病率和高致残率成为当前严重威胁人类健康的一大类重要疾病，是第二位致死性和第一位致残性疾病，在影响患者身心健康的同时，也给社会和家庭带来了巨大负担。现国内外对缺血性脑卒中患者急性期治疗方案已日渐成熟，但在抗血小板聚集口服药物的选择方面仍存争议，尤其针对不同病因的个体化抗血小板聚集药物治疗方案研究更是匮乏。本研究通过回顾我院同期治疗的缺血性脑卒中患者263例，利用头部CT或MRI扫描，头颅MRA或颅内、颈部血管彩超、心电图等临床检查结果及既往病史，完成病因学分型分组，观察不同亚型的疾病转归情况，并试探讨各亚型不同抗血小板聚集药物方案的获益及安全性。最终，使一线神经内科医生对于缺血性脑卒中分层诊断的认识得以加深，，同时为不同亚型的抗血小板聚集治疗方案选择方面提供借鉴。 研究方法：本研究回顾分析2011年6月至2012年6月间，就诊于吉林大学中日联谊医院神经内一科具有完备头部影像学检查、脑血管检查及脑血管病常见危险因素检查的缺血性脑卒中住院患者263例。依据单用阿司匹林、单用氯吡格雷及联合应用阿司匹林、氯吡格雷3种抗血小板聚集治疗方案进行分组，且3组均给予常规改善循环、营养神经药物静脉滴注及调整血压、血糖治疗，根据患者病情加用脱水剂等。于入院时、入院第7天、14天及随访6个月，进行美国国立卫生研究院卒中量表（NIHSS）评分和出血并发症评价。同时，按缺血性脑卒中病因学分型（TOAST分型）分为5种亚型，各亚型亦做如上治疗分组评估。最终，获得缺血性卒中总体及各个病因分型中应用不同抗血小板药物治疗方案的疗效差异及安全性。 结果：1、双抗组与各单抗组治疗前后神经功能评分比较，三组发病时NIHSS评分比较无显著差异（P＞0.05），分别比较各组间治疗后7天、14天及6个月的NIHSS评分，双抗组在治疗第14天和6个月时神经功能评分改善显著优于单用阿司匹林组（P＜0.05）；双抗组在治疗6个月后的终点时，NHISS评分优于单用氯吡格雷组（P＜0.05）；2、TOAST各亚型及各组抗血小板聚集药物治疗前后NIHSS评分比较。CE组发病时及治疗后7天、14天及6个月的NIHSS评分，各单抗组及双抗组均无显著性差异（P0.05）；LAA组发病时及治疗后7天、14天NIHSS评分，各单抗组及双抗组均无显著性差异、无统计学意义（P0.05）；LAA组治疗6个月后的NIHSS评分双抗组优于单用拜阿司匹林组（，P0.01），单用氯吡格雷组介于二者之间，均无显著统计学意义（P0.05）；SAA组发病时及治疗后7天NIHSS评分，各单抗组及双抗组均无显著性差异、无统计学意义（P0.05）；SAA组治疗14天及6个月后的NIHSS评分双抗组优于各个单抗组，（P0.01），各个单抗组之间无显著性差异（P0.05）。3、依据Gusto出血分级，各组均未出现严重出血事件。仅表现为牙龈出血，单用拜阿司匹林组4例（3.8%），单用氯吡格雷组2例（3.1%），双抗组4例（4.4%），各组比较出血倾向无显著统计学意义（P0.05）；4、通过脑血管病危险因素与双抗治疗治疗疗效的多元回归分析明确主要危险因素为糖尿病所致脑梗死的人群给予双抗治疗疗效较好，具有统计学意义。 综上：1、阿司匹林联合氯吡格雷在急性脑梗死的治疗中能有效改善神经功能，短期应用不增加出血等并发症。 2、终点治疗结束时对于改善神经功能障碍方面，LAA型患者阿司匹林联合氯吡格雷治疗优于单用阿司匹林，单独氯吡格雷组介于两者之间、且与二者差异不确定；SAA型患者联合用药优于单药，单药治疗间无差异；本次研究CE型患者单药及联合用药未见差异。 3.对于以2型糖尿病为危险因素脑卒中患者，阿司匹林联合氯吡格雷可明显改善神经功能缺损情况。
[Abstract]:Background and purpose: ischemic stroke (IschemicStroke, IS) is due to the supply of the arteries of the brain suddenly blocked, resulting in the supply of brain tissue perfusion defect, ischemic necrosis. The neurovascular unit can lead to patients with memory, calculation, decline such as language ability, seriously affect the capacity and quality of life in patients with ischemic stroke. Stroke with high incidence and high disability rate has become a serious threat to human health is a kind of important diseases, second fatal and disabling disease in the first place, affect the health of patients at the same time, also to the society and family brought a huge burden. The treatment of patients with acute ischemic stroke time has become more mature, but still controversial aspects in the choice of antiplatelet aggregation of oral drugs, especially individualized antiplatelet aggregation drug treatment for different causes. It is the case Lack. By reviewing 263 patients with ischemic stroke in our hospital during the same period for patients in this study, using CT or MRI scan head, head MRA or intracranial and neck vascular ultrasound, electrocardiogram and clinical findings and medical history, complete etiological typing group, observation of different subtypes of disease prognosis, and discuss the benefit and the safety of various subtypes of different antiplatelet drugs scheme. Finally, the first neurologist to deepen the understanding on the hierarchical diagnosis of ischemic stroke, and to provide reference for selection of aggregation treatment of different subtypes of platelet.
Methods: This study retrospectively from June 2011 to June 2012, visiting neurology in China Japan Union Hospital of Jilin University Department of internal medicine has a complete examination of imaging, ischemic cerebrovascular examination and common cerebrovascular disease risk factors examined 263 hospitalized patients. According to the single use of aspirin, clopidogrel and aspirin alone. 3 kinds of clopidogrel antiplatelet therapy program group, and the 3 groups were given conventional improve circulation, nerve nutrition drugs intravenously and adjust blood pressure, blood sugar treatment, according to the condition of patients with dehydration agent. At the time of admission, admission seventh days, 14 days and 6 months of follow-up, the National Institutes of Health Stroke Scale (NIHSS) score and bleeding complications were evaluated. At the same time, according to ischemic stroke subtypes (TOAST type) were divided into 5 subtypes, each subtype is above treatment group. Finally, the difference in efficacy and safety of different antiplatelet drugs for the overall and various etiological types of ischemic stroke were obtained.
缁撴灉锛

本文编号：1630380