微栓子信号在评价抗血小板药治疗中的作用初步探讨  

Role of microembolic signals in the evaluation of antithrombotic agent therapy： a preliminary study

作　　者：王遐[1] 潘旭东[1] 马爱军[1] 张静静[1] 王琨[1] 

机构地区：[1]青岛大学医学院附属医院东区神经内科,266000

出　　处：《国际脑血管病杂志》2011年第3期204-208,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的初步探讨微栓子信号（microembolic signals，MES）监测在评价急性缺血性脑血管病患者抗血小板药或抗血小板药与他汀类药物联合应用中的价值。方法行MES监测的急性颈动脉系统缺血性脑血管病患者中，MES阳性者随机分为双联抗血小板组（阿司匹林100mg/d＋氯吡格雷75mg／d）和双联抗血小板与阿托伐他汀联用组（阿司匹林100mg／d＋氯吡格雷75mg/d＋阿托伐他汀20mg/d）。经颅多普勒超声监测MES。结果在60例急性颈动脉系统缺血性脑血管病患者中，有13例（21．7％）MEs阳性，其中分别有6例和7例随机分入双联抗血小板组和双联抗血小板与阿托伐他汀联用组。两组性别、高血压、糖尿病、冠心病、吸烟、饮酒、既件卒中史等构成比以及年龄、发病至微栓子监测时间、发病至药物干预时间等均无显著差异。双联抗血小板组与双联抗血小板与阿托伐他汀联用组治疗前微栓子数量分别为（8．83±1．17）和（9．00±1．83）个/h，无显著差异（P=0．851）；治疗第2天和第7天，双联抗血小板组微栓子数量分别为（4．17±1．47）和（2．17±0．75）个/h，分别显著多于双联抗血小板与阿托伐他汀联用组的（1．43±0．976）（P=0．002）和（0．71±0．488）个/h（P=0．003）。随访8d，两组均无缺血事件发生。结论双联抗血小板药或与他汀类药物联合应用均可减少MES，但后者MES数量减少更为显著。但由于例数较少，这一结论尚需大规模多中心随机对照试验进一步验证。MES监测在评价抗血小板药或抗血小板药与他汀类药物联用中有一定的价值。Objective To preliminarily study on the values of microembolic signal （MES） monitoring in the evaluation of anti-platelet agent or anti-platelet agent ＋ statins in patients with acute ischemic cerebrovascular disease. Methods Among the patients with acute ischemic cerebrovascular disease in the carotid system who performed MES monitoring, the MES-positive patients were ramdomly allocated into dual antiplatelet group （aspirin 100 mg/d ＋ clopidogrel 75 mg/d） and dual antiplatelet ＋ atorvastatin group （aspirin 100 mg/d ＋ clopidogrel 75 rng/d ＋ atorvastatin 20 mg/d）. MESs were monitored by transcranial Doppler ultrasound. Results Among the 60 patients with acute cerebrovascular disease in the carotid system, 13 （21.7%） were MES positive, in which, 6 and 7 were randomly divided into dual antiplatelet group and dual antiplatelet ＋ atorvastatin group respectively. There were no significant differences in the constituent ratios of sex, hypertension, diabetes, coronary heart disease, smoking, alcohol consumption, and history of previous stroke as well as the age, time from onset to microembolic monitoring, and time from onset to drug intervention between the 2 groups. There were no significant differences in the numbers of microemboli （8. 83 ± 1. 17/h vs. 9. 00 ± 1.83/h） before treatment between the dual antiplatelet group and dual antiplatelet ＋ atorvastatin group （P = 0. 851）; 2 and 7 days after treatment, the numbers of microemboli were 4. 17 ± 1.47 and 2. 17 ± 0. 75/h respevtively in the duural antiplatelet group, and they were significantly higher than 1.43 ± 0. 976 and 0. 71 ± 0. 488/h） respevtively in the dual antiplatelet ＋ atorvastatin group （P =0. 002 and P = 0. 003）. They were followed up for 8 days; and there were no ischemic events in both groups. Conclusions The dual antiplatelet agents or those in combination with statins might reduce the number of MES, but when they were used in combination with statins, the number of MES reduced more significant. However

关 键 词：栓塞 卒中 脑缺血 脑缺血发作 短暂性 超声检查 多普勒 经颅 羟甲基戊二酰基 COA还原酶抑制剂 阿托伐他汀 血小板聚集抑制药 阿司匹林 氯吡格雷 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]