[1]项广宇.氯吡格雷联合阿托伐他汀钙治疗短暂性脑缺血发作疗效观察[J].新乡医学院学报,2019,36(1):081-84.[doi:10.7683/xxyxyxb.2019.01.018]
　XIANG Guang-yu.Effect of clopidogrel combined with atorvastatin calcium in the treatment of transient ischemic attack[J].Journal of Xinxiang Medical University,2019,36(1):081-84.[doi:10.7683/xxyxyxb.2019.01.018]
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氯吡格雷联合阿托伐他汀钙治疗短暂性脑缺血发作疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年1
页码:
081-84
栏目:
临床研究
出版日期:
2019-01-05

文章信息/Info

Title:
Effect of clopidogrel combined with atorvastatin calcium in the treatment of transient ischemic attack
作者:
项广宇
（许昌市中心医院神经内科，河南　许昌　461000）
Author(s):
XIANG Guang-yu
（Department of Neurology，Xuchang Central Hospital，Xuchang 461000，Henan Province，China）
关键词:
短暂性脑缺血发作; 脑梗死; 氯吡格雷; 阿托伐他汀钙; 超氧化物歧化酶; 丙二醛; 白细胞介素-6; C反应蛋白
Keywords:
transient ischemic attack; cerebral infarction; clopidogrel; atorvastatin calcium; superoxide dismutase; malondialdehyde; interleukin-6; C-reactive protein
分类号:
R743
DOI:
10.7683/xxyxyxb.2019.01.018
文献标志码:
A
摘要:
目的　探讨氯吡格雷联合阿托伐他汀钙治疗短暂性脑缺血发作（TIA）的临床效果。方法　选择2012年9月至2015年9月许昌市中心医院收治的60例TIA患者为研究对象，按照治疗方法分为观察组和对照组，每组30例。对照组患者给予氯吡格雷治疗，观察组患者给予氯吡格雷和阿托伐他汀钙联合治疗。2组患者分别于治疗前及治疗后采用化学发光法检测血清中超氧化物歧化酶（SOD）活性，硫代巴比妥酸法检测血清中丙二醛（MDA）水平，酶联免疫吸附法检测血清中白细胞介素-6（IL-6）水平，免疫速率散射比浊法检测血清中高敏C反应蛋白（hs-CRP）水平；分别于治疗前及治疗后采用彩色多普勒超声诊断仪检查患者颈动脉斑块，记录斑块数量和性质改变；所有患者随访1 a，记录TIA发作次数及脑梗死发生率。结果　观察组和对照组患者治疗总有效率分别为93.33%（28/30）、66.67%（20/30），观察组患者治疗总有效率显著高于对照组（χ2=20.101，P<0.05）。治疗前2组患者血清SOD、MDA、IL-6及hs-CRP水平比较差异无统计学意义（P>0.05）。与治疗前比较，治疗后2组患者血清SOD水平显著升高，MDA、IL-6及hs-CRP水平显著降低（P<0.05）。治疗后，观察组患者血清SOD水平显著高于对照组，MDA、IL-6及hs-CRP水平显著低于对照组（P<0.05）。治疗前2组患者颈动脉斑块数、强回声斑块数及低回声斑块数比较差异无统计学意义（P>0.05）。对照组患者治疗前后颈动脉斑块数、强回声斑块数及低回声斑块数比较差异无统计学意义（P>0.05）。观察组患者治疗后颈动脉斑块数、低回声斑块数少于治疗前，强回声斑块数多于治疗前（P<0.05）。治疗后，观察组患者颈动脉斑块数少于对照组，强回声斑块数多于对照组（P<0.05）。治疗后2组患者低回声斑块数比较差异无统计学意义（P>0.05）。随访1 a内，观察组和对照组患者TIA发作次数分别为2.30±1.02、3.80±1.90，观察组患者TIA发作次数少于对照组（t=11.170，P<0.05）。随访1 a内，观察组和对照组患者脑梗死发生率分别为3.3%（1/30）、20.0%（6/30），观察组患者脑梗死发生率低于对照组（χ2=4.040，P<0.05）。结论　氯吡格雷联合阿托伐他汀钙可以有效改善TIA患者机体氧化应激状态，降低炎症反应水平，抑制颈动脉斑块，减少TIA发作次数，降低脑梗死发生率。
Abstract:
Objective　To study the effect of clopidogrel combined with atorvastatin calcium in the treatment of transient ischemic attack（TIA）.Methods　Sixty patients with TIA in Xuchang Central Hospital from September 2012 to September 2015 were selected as the subjects.The patients were divided into observation group and control group according to the treatment method，30 cases in each group.The patients in the control group were treated with clopidogrel，while the patients in the observation group were treated with clopidogrel and atorvastatin calcium.The activity of serum superoxide dismutase（SOD） was detected by chemiluminescence method，the level of serum malondialdehyde（MDA） was detected by thiobarbituric acid method，the level of serum interleukin-6（IL-6） was detected by enzyme-linked immunosorbent assay，and the level of serum high-sensitivity C-reactive protein（hs-CRP） was detected by immune rate nephelometry before and after treatment.The carotid atherosclerotic plaque was examined by color Doppler ultrasonography before and after treatment，and the number and nature of the atherosclerotic plaque were recorded.All patients were followed up for one year to record the number of TIA attacks and the incidence of cerebral infarction.Results　The total effective rate in the observation group and the control group was 93.33%（28/30） and 66.67%（20/30），respectively.The total effective rate in the observation group was significantly higher than that in the control group（χ2=20.101，P<0.05）.There was no significant difference in the levels of serum SOD，MDA，IL-6 and hs-CRP between the two groups before treatment（P>0.05）.Compared with before treatment，the serum SOD level in the two groups increased significantly after treatment，while the levels of serum MDA，IL-6 and hs-CRP decreased significantly（P<0.05）.After treatment，the serum SOD level in the observation group was significantly higher than that in the control group，and the levels of serum MDA，IL-6 and hs-CRP were significantly lower than those in the control group（P<0.05）.There was no significant difference in the number of carotid atherosclerotic plaques，hyperechoic plaques and hypoechoic plaques between the two groups before treatment（P>0.05）.There was no significant difference in the number of carotid atherosclerotic plaques，hyperechoic plaques and hypoechoic plaques before and after treatment in the control group（P>0.05）.Compared with before treatment，the number of carotid atherosclerotic plaques and hypoechoic plaques decreased，and the number of hyperechoic plaques increased after treatment in the observation group（P<0.05）.After treatment，the number of carotid atherosclerotic plaques in the observation group was less than that in the control group，and the number of hyperechoic plaques was more than that in the control group（P<0.05）.There was no significant difference in the number of hypoechoic plaques between the two groups after treatment（P>0.05）.The number of TIA attack in the observation group and the control group was 2.30±1.02 and 3.80±1.90，respectively during one-year follow-up.The number of TIA attack in the observation group was less than that in the control group（t=11.170，P<0.05）.The incidence of cerebral infarction in the observation group and the control group was 3.3%（1/30） and 20.0%（6/30），respectively during one-year follow-up.The incidence of cerebral infarction in the observation group was lower than that in the control group（χ2=4.040，P<0.05）.Conclusion　Clopidogrel combined with atorvastatin calcium can effectively improve the oxidative stress state，decrease the level of inflammatory reaction，inhibit carotid atherosclerotic plaque，reduce the number of TIA attack and the incidence of cerebral infarction in TIA patients.

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更新日期/Last Update: 2019-01-05