吉林大学学报(医学版) ›› 2021, Vol. 47 ›› Issue (6): 1531-1537.doi: 10.13481/j.1671-587X.20210625

• 临床医学 • 上一篇    下一篇

阿司匹林和氯吡格雷双重抗血小板治疗对急性缺血性脑卒中并发微出血患者出血转归及预后的影响

李嘉仪1,贾晓静2(),贾少杰3,马艳2,沈玉秀4,刘欣2,曲鸿雁2,白鸽2,程娜2   

  1. 1.北华大学临床医学院,吉林 吉林 132011
    2.北华大学附属医院神经二科,吉林 吉林 132011
    3.北华大学附属医院骨二科,吉林 吉林 132011
    4.北华大学附属医院药理部,吉林 吉林 132011
  • 收稿日期:2021-04-12 出版日期:2021-11-28 发布日期:2021-12-14
  • 通讯作者: 贾晓静 E-mail:jiaxiaojing888@sina.com
  • 作者简介:李嘉仪(1995-),女,吉林省吉林市人,在读硕士研究生,主要从事脑血管病、认知障碍、头晕和眩晕方面的研究。
  • 基金资助:
    吉林省科技厅科技发展计划项目(20200201597JC)

Effect of dual anti-platelet therapy with aspirin and clopidogrel on bleeding regression and prognosis of acute ischemic stroke patients complicated with cerebral microbleeds

Jiayi LI1,Xiaojing JIA2(),Shaojie JIA3,Yan MA2,Yuxiu SHEN4,Xin LIU2,Hongyan QU2,Ge BAI2,Na CHENG2   

  1. 1.School of Clinical Medical Sciences,Beihua University,Jilin 132011,China
    2.Department of Neurology,Affiliated Hospital,Beihua University,Jilin 132011,China
    3.Department of Orthopedics,Affiliated Hospital,Beihua University,Jilin 132011,China
    4.Department of Pharmacology,Affiliated Hospital,Beihua University,Jilin 132011,China
  • Received:2021-04-12 Online:2021-11-28 Published:2021-12-14
  • Contact: Xiaojing JIA E-mail:jiaxiaojing888@sina.com

摘要: 目的

观察并发不同程度脑微出血(CMBs)的急性缺血性脑卒中患者应用双重抗血小板(双抗)治疗后出血转归和预后情况。

方法

回顾性分析160例急性脑卒中患者的临床资料,根据头部磁敏感加权成像(SWI)检查结果分为对照组(无CMBs组,n=39)和CMBs(n=116)组,根据CMBs严重程度评分——NSL评分将116例CMBs患者分为低危组(最终入组39例)、中危组(最终入组39例)和高危组(最终入组38例),各组患者入院后均予以常规治疗,在此基础上按照《卒中指南2018》给予双抗治疗,阿司匹林100 mg,每日1次口服;氯吡格雷75 mg,每日 1次口服,连续口服21 d,此后改为阿司匹林100 mg每日1次或氯吡格雷75 mg 每日 1 次,且治疗期间未予以其他抗凝和抗血小板药物。入院时分别行头部CT和SWI 检查,根据美国国立卫生研究院卒中量表 (NIHSS)进行神经功能缺损评分,治疗21 d 时复查头部CT及NIHSS评分,统计出血转归例数。治疗21 d、3个月和6个月后采用改良Rankin量表(mRS)评分检测各组患者的神经功能恢复状况。

结果

对照组和CMBs组患者应用双抗治疗后脑出血转归率、NIHSS评分和mRS评分比较差异无统计学意义(P>0.05);CMBs组中低危组和中危组患者脑出血转归率、NIHSS评分和mRS评分与对照组比较差异无统计学意义(P>0.05),高危组患者脑出血转归率高于对照组(P<0.05),但高危组患者NIHSS评分及mRS评分与对照组比较差异无统计学意义(P>0.05)。

结论

急性缺血性脑卒中并发低危或中危CMBs患者应用双抗治疗不会增加颅内出血的风险,也不影响神经功能恢复及远期预后;急性缺血性脑卒中并发CMBs高危患者存在出血转归风险。

关键词: 急性缺血性脑卒中, 脑微出血, 出血转归, 头部磁敏感加权成像

Abstract: Objective

To observe the bleeding regression and prognosis of the acute ischemic stroke patients complicated with different degrees of cerebral microbleeds (CMBs )after the application of dual anti-platelet therapy.

Methods

The clinical data of 160 cases of acute ischemic stroke patients were analyzed retrospectively.The patients were divided into control group(non-CMBs group,n=39) and CMBs group(n=116) acording to the head checking results detected by magnetic sensitive weighted imaging (SWI).The patients in CMBs group were then divided into 3 subgroups: low-risk group, middle-risk group and high-risk group according to CMBs severity score—NSL score.The patients in various groups were given conventional treatment after admission, based on which they were given dual anti-platelet therapy, aspirin 100 mg orally once a day and clopidogrel 75 mg orally once a day for 21 d according to the Stroke Guidelines 2018, after which aspirin 100 mg once a day or clopidogrel 75 mg once a day was given as the monotherapy, and no other anticoagulant or antiplatelet drugs were given during the treatment period. CT and SWI examination of the head and the neurological deficit score according to the National Institute of Health Stroke Scale (NIHSS) were performed at admission. The CT of head and NIHSS scores were rechecked after 21 d of dual anti-treatment, and the number of bleeding regression cases was counted. The neurological recovery statuses of the patients in various groups were detected by modified Rankin Scale(mRS) score after 21 d, 3 months and 6 months of dual anti-treatment.

Results

There were no significant differences in the conversion rates of cerebral hemorrhage,NIHSS scores and mRS scores of the patients after dual anti-platelet therapy between control group and CMBs group (P>0.05); compared with control group, the conversion rates of cerebral hemorrhage, NIHSS scores and mRS scores of the patients in low-risk group and middle-risk group in CMBs group had no significant differences(P>0.05),the conversion rate of cerebral hemorrhage of the patients in high-risk group was increased(P<0.05),but there were no significant differences in the NIHSS scores and mRS scores of the patients between high-risk group and control group (P>0.05).

Conclusion

The application of dual anti-platelet therapy does not increase the risk of intracranial hemorrhage, nor does it affect the neurological recovery or long-term prognosis in the acute ischemic stroke patients complicated with low-risk and middle-risk CMBs; the acute ischemic stroke patients complicated with high-risk CMBs have the risk of bleeding regression.

Key words: acute ischemic stroke, cerebral microbleeds, bleeding regression, sensitive weighted imaging

中图分类号: 

  • R743.33