影响后循环脑梗死急性期阿司匹林和氯吡格雷联合抗血小板治疗预后的相关因素  

Related factors of influence prognosis of aspirin combined with clopidogrel antiplatelet therapy in acute phase for posterior circulation cerebral infarction

作　　者：戴杰[1] 周永[1] 李新玲[1] 凌卓敏[1] 丁莉[1] 

机构地区：[1]南通大学第二附属医院神经内科,226001

出　　处：《临床神经病学杂志》2014年第1期22-25,共4页Journal of Clinical Neurology

摘　　要：目的 研究影响后循环脑梗死（PCCI）急性期阿司匹林和氯吡格雷联合抗血小板治疗预后的相关因素.方法 给83例急性PCCI患者阿司匹100 mg/d和氯吡格雷75 mg/d口服,连续7d,后改为单用阿司匹林或氯吡格雷.收集患者的临床资料及进行美国国立卫生研究院卒中量表（NIHSS）评分和血生化检测.统计14 d内发生颅内出血的例数.治疗90 d时,进行改良Rankin量表（mRS）评分,评定患者的预后；统计脑卒中复发、死亡的例数.结果 本组患者治疗90 d时,预后良好43例（51.8％）,预后不良40例（48.2％）,死亡11例（13.3％）；脑梗死复发1例（1.2％）；治疗14 d内发生颅内出血1例（1.2％）.预后良好组NIHSS评分、血糖水平、血压、开始治疗的时间显著低于或短于预后不良组（均P＜0.05）.多元Logistic回归分析显示,NIHSS评分低（OR=1.608,95％ CI：1.401～1.879;P＜0.01）、血糖水平低（OR=1.201,95％ CI：1.011 ～1.322;P ＜0.05）是PCCI患者联合抗血小板治疗预后良好的独立预测因素.结论 PCCI患者的NIHSS评分和血糖水平是影响其急性期阿司匹林和氯吡格雷联合抗血小板治疗预后的相关因素.Objective To investigate the related factors of influence prognosis of aspirin combined with clopidogrel antiplatelet therapy in acute phase for posterior circulation cerebral infarction （PCCI）.Methods Eightythree acute PCCI patients were treated with aspirin 100 mg/d and clopidogrel 75 mg/d orally,at least for 7 d.Then use aspirin or clopidogrel for maintenance therapy.All clinical datas included the national institutes of health stroke scale （NIHSS） and the blood biochemistry were collected.Intracerebral hemorrhage occured within 14 d was collected.At 90 d after treatment,the modified Rankin scale （mRS） was detected.And the prognosis was evaluated.The number of samples with recurrence and death was calculated.Results At 90 d after treatment,there were 43 cases （51.8%） with good outcome,40 cases （48.2%） with poor outcome,11 cases （13.3%） were died,and 1 case （1.2%） with recurrent stroke.One case （1.2%） occurred intracranial hemorrhage within 14 d.Either the NIHSS scores,blood glucose levels,blood pressure or the time of beginning antithrombotic therapy of the good outcome group was significantly lower or shorter than those of the poor outcome group （all P 〈 0.05）.Multivariate Logistic regression analysis indicated that the lower level of NIHSS scores （OR =1.608,95% CI：1.401-1.879,P 〈 0.01） and glucose （OR =1.201,95% CI：1.011-1.322,P 〈 0.05） were the independent predictive factors of good outcome of aspirin combined clopidogrel antiplatelet therapy in PCCI patients.Conclusion The NIHSS scores and blood glucose levels are the related factors of influence prognosis of aspirin with combined clopidogrel antiplatelet therapy in acute phase of PCCI patients.

关 键 词：后循环脑梗死 阿司匹林 氯吡格雷 抗血小板治疗 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]