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阿司匹林联合氯吡格雷对缺血性轻度颈动脉狭窄患者脑卒中二级预防的作用

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Keywords: 脑卒中,抗血小板聚集,颈动脉狭窄

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Abstract:

目的对比阿司匹林联合氯吡格雷与单用阿司匹林或氯吡格雷对症状性轻度颈动脉狭窄患者脑卒中二级预防的疗效及安全性。方法纳入本科2009年1月至2013年8月诊断为症状性轻度颈动脉狭窄的患者,所有患者行全脑血管造影术(DSA)检查确诊狭窄率≤50%,给所有患者服用他汀类药物,联合服用抗血小板聚集药物阿司匹林和氯吡格雷的患者归为双联抗血小板药物组(双抗组),单用阿司匹林或氯吡格雷的患者归为单联抗血小板药物组(单抗组)。搜集入院时改良Rankin评分(mRS评分)、美国国立卫生研究院卒中神经功能残损量评分(NIHSS评分)及电话随访患者出院后1年内mRS评分情况、卒中复发及不良血管事件发生情况。结果共搜集151例症状性轻度颈动脉狭窄患者,其中单抗组及双抗组分别为52、99例,排除10例失访患者,最终分别纳入48、93例患者进入分析。通过比较发现单抗组与双抗组同侧卒中复发率(分别为8.3%、2.1%)、非同侧卒中复发率(分别是2.1%、1.1%)、病死率(分别为4.1%、2.1%)无明显差异(P>0.05),出血发生率(分别为0%、11.8%)有统计学差异(P<0.05);同侧卒中复发组与卒中未复发组颈动脉狭窄率分别为(46.70±5.16)%、(34.70±9.31)%,斑块面积分别为(86.15±17.15)%、(44.88±52.59)%,两组间比较均有统计学差异(P<0.05),而两组在最大颈动脉内膜中层厚度(IMT)值、不稳定斑块上无明显差异(P>0.05)。?结论?对颈动脉狭窄≤50%的症状性轻度颈动脉狭窄患者单用阿司匹林或氯吡格雷进行脑卒中二级预防可能更安全。

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