利伐沙班联合氯吡格雷对脑梗死合并房颤患者的治疗效果  

Therapeutic effect of rivaroxaban combined with clopidogrel on patients with cerebral infarction complicated with atrial fibrillation

作　　者：邢艳娜 刘俊柳 李华颖 刘文娟 方红双 XING Yanna;LIU Juniu;LI Huaying;LIU Wenjuan;FANG Hongshuang(Department of Neurology,the Sixth People’s Hospital of Hengshui City,Hengshui,Hebei,China,053200;Department of Cardiology,the Sixth People’s Hospital of Hengshui City,Hengshui,Hebei,China,053200;Brain Center of the Sixth People’s Hospital of Hengshui City,Hengshui,Hebei,China,053200;Operating Room of Hengshui Sixth PeopleHospital,Hengshui,Hebei,China,053200)

机构地区：[1]衡水市第六人民医院神经内科,河北衡水053200 [2]衡水市第六人民医院心内科,河北衡水053200 [3]衡水市第六人民医院脑科中心,河北衡水053200 [4]衡水市第六人民医院手术室,河北衡水053200

出　　处：《分子诊断与治疗杂志》2024年第7期1263-1267,共5页Journal of Molecular Diagnostics and Therapy

基　　金：河北省健康委员会计划项目(20221506)。

摘　　要：目的 研究利伐沙班联合氯吡格雷对脑梗死合并房颤患者的治疗效果。方法 选择2021年7月至2022年7月衡水市第六人民医院收治的脑梗死合并房颤96例患者随机分为华法林组(48例)和联合组(48例)。华法林组采用华法林钠片进行治疗,联合组采用利伐沙班片联合硫酸氢氯吡格雷片进行治疗,两组治疗6个月。统计两组临床疗效、安全性,比较两组血清细胞因子、炎症反应指标水平、外周血免疫指标水平及凝血功能、神经功能、生活能力。结果 治疗6个月后,联合组总有效率高于华法林组,差异有统计学意义(χ^(2)=4.098,P<0.05)。治疗6个月后,联合组外周血CD8+及血清内皮素-1(ET-1)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、D-二聚体(D-D)水平低于华法林组,差异有统计学意义(t=4.019、8.809、4.598、15.340、6.175、13.846、15.006);联合组美国国立卫生研究院卒中量表(NIHSS)、改良Rankin评分(mRS)评分低于华法林组,差异有统计学意义(t=5.304、8.660);外周血CD4+、血清血小板衍生生长因子(PDGFs)、血管内皮生长因子(VEGF)水平、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、Barthel指数(BI)评分高于华法林组,差异有统计学意义(t=4.265、5.914、18.960、13.204、4.578、8.762,P<0.05)。治疗期间,两组不良反应发生率比较,差异无统计学意义,差异有统计学意义(χ^(2)=0.000,P=1.000)。结论 与华法林钠片相比,利伐沙班片联合硫酸氢氯吡格雷片治疗脑梗死合并房颤患者的临床疗效更好,且安全性良好。Objective To study the therapeutic effect of rivaroxaban combined with clopidogrel on patients with cerebral infarction complicated with atrial fibrillation.Methods A total of 96 patients with cere-bral infarction complicated by atrial fibrillation were admitted from July 2021 to July 2022.They were randomly divided into two groups:the warfarin group(48 cases)and the combined group(48 cases)using a random num-ber table method.The warfarin group received treatment with warfarin sodium tablets,while the combined group received treatment with rivaroxaban tablets combined with clopidogrel bisulfate tablets.Both groups un-derwent treatment for 6 months.The clinical efficacy and safety of the two groups were assessed,and levels of serum cytokines,inflammatory response indicators,peripheral blood immune indicators,coagulation function,and nerve function and life ability were compared between the groups.Results After 6 months of treatment,the total effective rate of the combination group was higher than that of the warfarin group,and the difference was statistically significant(χ^(2)=4.098,P<0.05).Additionally,after 6 months of treatment,the levels of periph-eral blood CD8+and serum endothelin-1(ET-1),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α),pro-calcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),and D-dimer(D-D)in the combination group were lower than those in the warfarin group(t=4.019,8.809,4.598,15.340,6.175,13.846,15.006).Further-more,the National Institutes of Health Stroke Scale(NIHSS)and Modified Rankin Score(mRS)scores in the combination group were lower than those in the warfarin group(t=5.304,8.660).The levels of peripheral blood CD4+,serum platelet-derived growth factor(PDGFs)and vascular endothelial growth factor(VEGF),pro-thrombin time(PT),and partial thromboplastin time(APTT),and Barthel index(BI)score were higher in the combination group compared to the warfarin group(t=4.265,5.914,18.960,13.204,4.578,8.762,P<0.05).During the treatment period,there was no significant difference in t

关 键 词：脑梗死 房颤 利伐沙班 氯吡格雷 华法林钠片 

分 类 号：R541.75[医药卫生—心血管疾病] R743.33[医药卫生—内科学]