氯吡格雷片联合阿司匹林肠溶片治疗急性缺血性脑卒中的临床研究  

Clinical trial of clopidogrel tablets combined with aspirin enteric-coated tablets in the treatment of acute ischemic stroke

作　　者：耿亚兰[1] 

机构地区：[1]贵州医科大学第二附属医院神经内科,贵州凯里556000

出　　处：《中国临床药理学杂志》2016年第24期2215-2217,2221,共4页The Chinese Journal of Clinical Pharmacology

基　　金：国家自然科学基金资助项目(81170181)

摘　　要：目的观察氯吡格雷片联合阿司匹林肠溶片治疗急性缺血性脑卒中的临床疗效和安全性,及其对细胞色素P450 2C19(CYP2C19)基因表达的影响。方法将64例急性缺血性脑卒中患者随机分为对照组32例与试验组32例。对照组在发病24 h内口服阿司匹林肠溶片100 mg qd;试验组在对照组治疗的基础上,予以口服硫酸氢氯吡格雷75 mg qd。2组患者均治疗14 d。比较2组患者的临床疗效、血流动力学、CYP2C19基因表达水平情况,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为93.75%(30/32例)和75.00%(24/32例),差异有统计学意义(P<0.05)。治疗后,试验组和对照组全血低切黏度分别为(17.08±1.90),(19.03±2.37)mPa·s;血浆黏度分别为(1.70±0.19),(2.01±0.22)mPa·s;血小板聚集率分别为(54.02±6.45)%,(61.98±6.53)%;CYP2C19基因表达水平分别为0.98±0.12,1.35±0.21,差异均有统计学意义(P<0.05)。治疗后,试验组和对照组的纤维蛋白分别为(3.43±0.41),(3.60±0.41)g·L^(-1),差异无统计学意义(P>0.05)。2组患者的药物不良反应主要有头痛和恶心,且试验组和对照组的药物不良反应发生率分别为9.38%和15.63%,差异无统计学意义(P>0.05)。结论与单用阿司匹林肠溶片相比,氯吡格雷片联合阿司匹林肠溶片治疗急性缺血性脑卒中的临床疗效显著提高,且不增加药物不良反应的发生率。Objective To observe the clinical efficacy and safety of clopidogrel tablets combined with aspirin enteric -coated tablets in the treatment of acute ischemic stroke, and its influence in the expression of cytochrome P450 2C19 （CYP2C19）. Methods A total of 64 patients with acute ischemic stroke were randomly divided into control group （n = 32 cases） and treatment group （ n = 32 cases）. Control group was orally given aspirin enteric - coated tablet 100 mg onset within 24 h, qd. Treatment group was treated with clopidogrel sulfate tablets 75 nag oral, qd, on the basis of control group. Two groups were treated for 14 d. The clinical efficacy, hemodynamics, expression levels of CYP2C19 gene and adverse drug reactions were compared between two groups. Results After treatment, the total effective rates in treatment and control groups were 93.75% （30/32 cases） and 75.00% （ 24/32 cases）, with significant difference （P 〈0. 05 ）. After treatment, the main indexes in treatment and control groups were compared, whole blood low shear viscosity were （ 17.08 ± 1.90）, （ 19. 03 ±2. 37） mPa·s; plasma viscosity were （ 1.70 ± 0. 19 ）, （ 2. 01 ± 0. 22 ） mPa·s; platelet aggregation rates were （ 54. 02 ± 6.45 ） %, （61.98 ± 6. 53 ）% ; expression levels of CYP2C19 gene were 0. 98 ± 0. 12,1.35 ± 0. 21, with statistically significant differences （P 〈 0. 05 ）. After treatment, fibrous protein in treatment and control groups were （3.43 ± 0. 41）,（3.60 ±0. 41 ）g·L^-1 without significant difference （P 〉0. 05 ）. The adverse drug reactions were based on headache and nausea in the two groups. In the treatment and control groups, the incidence of adverse drug reactions were 9.38% and 15.63% without significant difference （P 〉 0. 05 ）. Conclusion Clopidogrel tablets combine with aspirin enteric - coated tablets have a definitive clinical efficacy for the treatment of acute ischemic stroke - without increasing the incidence of adverse drug reactions which was bett

关 键 词：氯吡格雷 阿司匹林 急性缺血性脑卒中 细胞色素P450 2C19 

分 类 号：R973.2[医药卫生—药品]