阿司匹林联合氯吡格雷治疗房间隔缺损封堵术后新发偏头痛疗效评价  

Effects of Aspirin and Alopidogrel in the Treatment of New-onset Migraine after Transcatheter Atrial Septal Defect Closure

作　　者：卢静[1] 薛强[1] 光雪峰[1] 张伟华[1] 鲁一兵[1] 杨栋[1] LU Jing;XUE Qiang;GUANG Xue-feng;ZHANG Wei-hua;LU Yi-bing;YANG Dong(Dept. of Cardiology,The Affiliated Yan'an Hospital of Kunming Medical University,The Key Laboratory ofCardiovascular Diseases of Yunnan Province,Kunming Yunnan 650051,China)

机构地区：[1]昆明医科大学附属延安医院心内科云南省心血管病重点实验室

出　　处：《昆明医科大学学报》2019年第5期86-90,共5页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目[2017FE467(-097)]

摘　　要：目的评估阿司匹林联合氯吡格雷治疗房间隔缺损(ASD)封堵术后新发偏头痛疗效,分析治疗影响因素,探讨发病机制。方法 2013年1月至2017年10月昆明医科大学附属延安医院行房间隔缺损封堵手术后新发偏头痛的成年患者接受氯吡格雷(75 mg/d)治疗3月和阿司匹林(100 mg/d)治疗12月,偏头痛诊断、评估由神经科医师根据国际头痛协会标准独立进行。结果共纳入ASD封堵术患者1 006例,8.55%(86例)出现术后新发偏头痛,其中67.44%(58例)为先兆偏头痛,32.56%(28)为无先兆偏头痛,60.47%(53例)发生于封堵术后1周,68.60%(59例)为女性,平均年龄(39.76±12.94)岁(范围18~73岁),83例患者接受阿司匹林和氯吡格雷联合治疗。治疗1、3、6、12月随访发现偏头痛发作持续时间、发作频率、发作强度较基线显著改善(P<0.05),治疗应答最佳显效时间为治疗6月。治疗1、3、6、12月总有效率分别为59.04%、72.23%、86.75%及74.70%。双抗治疗的影响因素是偏头痛初次发作时间。结论阿司匹林和氯吡格雷联合治疗房间隔缺损封堵术后成年新发偏头痛安全有效,潜在机制需进一步研究阐明。Objective To evaluate the efficacy of aspirin plus clopidogrel in therapy for new-onset migraine attacks following atrial septal defect(ASD) closure,to analyze the factors affecting therapeutic outcome and to explore pathogenesis. Methods The adult patients with new-onset migraine who underwent transcatheter closure of ASD, accepted aspirin(100 mg/d) for 12 months and Clopidogrel(75 mg/d) for 3 month during the period from January 2013 to January 2017 in the Affiliated Yan’an Hospital of Kunming Medical University. The diagnosis and assessment of new-onset migraine were independently confirmed by neurologists,according to the criteria of the International Headache Society. Results 1006 patients were enrolled in the study. New-onset migraine occurred in 86(8.55%) patients with a mean age of(39.76±12.94) years, in which migraine with aura and migraine without aura were respectively 67.44%(58), 32.56%(28). 59(68.60%) patients were women. 53(67.44%) patients had the diagnosis of new-onset migraine attacks within 1 week after the procedure. 83 patients accepted the therapy of aspirin and clopidogrel. The duration,frequency and intensity of migraine attacks were significantly and gradually improved from baseline level to respective levels of 1,3,6,12 months after treatment(P<0.05). The total curative rates were 59.04%, 72.23%, 86.75% and 74.70% respectively after the treatment of 1, 3, 6 and 12 months. The factor associated with clinical outcomes was the time of initial migraine attack.Conclus ions The treatment of aspirin plus clopidogrel is safe and efficient for new-onset migraine in the adult patients who underwent transcatheter ASD closure, however the underlying mechanism needs to be further clarified.

关 键 词：阿司匹林 氯吡格雷 房间隔缺损 封堵术 偏头痛 

分 类 号：R741[医药卫生—神经病学与精神病学]