雷贝拉唑在进展性缺血性脑卒中治疗中的价值探讨  

The value of rabeprazole sodium in the treatment of progressive ischemic stroke

作　　者：罗叶婷 叶鹏 杨云珠 LUO Yeting;YE Peng;YANG Yunzhu(Department of Neurology,People’s Hospital of Ganzhou City,Ganzhou 341000,China)

机构地区：[1]赣州市人民医院(南昌大学附属赣州医院)神经内科

出　　处：《中风与神经疾病杂志》2019年第9期839-843,共5页Journal of Apoplexy and Nervous Diseases

基　　金：江西省赣州市科技局指导性科技计划课题项目(No.GZ2018ZSF231)

摘　　要：目的探讨雷贝拉唑在进展性缺血性脑卒中治疗中的应用价值。方法选取进展性缺血性脑卒中患者80例,随机分成观察组和对照组,观察组在对照组基础治疗上加用雷贝拉唑,对比两组的血小板最大聚集率、临床预后及上消化道出血事件发生率,并对患者的上消化道出血发生事件行多因素分析。结果对两组患者治疗后的血小板最大聚集率进行比较,差异无统计学意义(P>0.05);观察组治疗90 d后的mRS评分为(2.40±1.06)低于对照组的(2.90±1.11),差异有统计学意义(P<0.05),观察组的NIHSS评分为(5.85±4.13)低于对照组的(7.97±3.67),差异有统计学意义(P<0.05);两组上消化道出血事件发生对比,观察组的上消化道出血事件发生率为2.5%明显低于对照组的22.5%,差异具有统计学意义(P<0.01);Logistic回归分析显示,C 14尿素呼吸实验阳性、CYP2C19*1/*1型基因、高入院NIHSS评分是抗栓期间上消化道出血事件发生的独立危险因素(P<0.05)。结论雷贝拉唑对于氯吡格雷的抗血小板聚集治疗效果无明显影响;对于使用双联抗栓药物的进展性缺血性脑卒中患者,合用雷贝拉唑有利于预防上消化道出血事件发生、改善患者预后;特别是对于有幽门螺旋杆菌感染、CYP2C19*1/*1型基因、高入院NIHSS评分等多重危险因素的患者,预防性应用雷贝拉唑可能是必要的。Objective To explroe the application value of rabeprazole sodium in the treatment of progressive ischemic stroke.Methods 80 patients with progressive ischemic stroke were recruited and randomly divided into the study group and the control group.The study group was treated with rabeprazole sodium,on the basis of control group.The maximum aggregation rate of platelet、clinical outcomes and the incidence of upper gastrointestinal hemorrhage were compared between two groups.In addition the influencing factors of the patients with upper gastrointestinal hemorrhage were analyzed.Results The maximum platelet aggregation rate was compared between the two groups after treatment,and the difference was not statistically significant(P>0.05).After 90 days of treatment,the mRS score of study group and control group was(2.40±1.06)、(2.90±1.11),respectively.And the NIHSS score of study group and control group was(5.85±4.13)、(7.97±3.67),respectively.Study group is lower than coutrol group and the difference was statistically significant(P<0.05).A signicicant different was observed in incidence of upper gastrointestinal hemorrhage between the study group and control group[2.5%vs 22.5%,P<0.01].Logistic regression analysis showed that positive C 14 urea breath test,CYP2C19*1/*1 gene,and high NIHSS score were independent risk factors for upper upper gastrointestinal hemorrhage during antithrombotic therapy(P<0.05).Conclusion There are no significant impact of rabeprazole sodium on the antiplatelet aggregation of clopidogrel.For patients with progressive ischemic stroke treated with double antiplatelet therapy,the combination of rabeprazole sodium is beneficial to prevent upper gastrointestinal hemorrhage and improve clinical prognosis.Especially for patients with multiple risk factors such as helicobacter pylori infection,CYP2C19*1/*1 gene,and high NIHSS score,preventive use of rabeprazole sodium may be necessary.

关 键 词：雷贝拉唑 进展性缺血性脑卒中 阿司匹林 氯吡格雷 血小板最大聚集率 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R741.05[医药卫生—临床医学]