基于西洛他唑双重抗血小板方案对氯吡格雷抵抗老年急性脑梗死病人的疗效及预后评价

doi:10.3969/j.issn.1003-9198.2023.08.021

摘要/Abstract

摘要： 目的比较西洛他唑+阿司匹林与西洛他唑+替格瑞洛两种双重抗血小板方案对氯吡格雷抵抗老年急性脑梗死病人的临床疗效及预后价值。方法选择我院就诊的90例氯吡格雷抵抗老年急性脑梗死病人作为研究对象,随机分为阿司匹林组(西洛他唑联合阿司匹林双重抗血小板)和替格瑞洛组(西洛他唑联合替格瑞洛双重抗血小板)。比较2组治疗前后血清丙二醛(MDA)及超氧化物歧化酶(SOD)水平,血浆黏度、高切全血黏度、低切全血黏度、纤维蛋白原及血小板聚集率(PAR)等血液流变学指标,凝血酶原时间(PT)、国际标准化比值(INR)、血小板Ⅱb/Ⅲa复合物(CD61)、血小板纤维蛋白原受体(PAC-1)水平等凝血相关指标及2组的不良反应发生率。随访2年,比较2组病人Barthel指数(BI)、改良Rankin量表(mRS)、NIHSS评分以及终点事件发生率。结果与阿司匹林组相比,治疗后替格瑞洛组血清MDA、血液流变学各指标以及CD61、PAC-1水平均显著降低(P<0.05),SOD水平显著升高(P<0.05)。替格瑞洛组头痛症状发生率高于阿司匹林组(P<0.05)。随访2年,与阿司匹林组相比,替格瑞洛组的主要和次要终点事件发生率显著较低(分别为2.2%比13.3%,6.7%比24.4%,P<0.05)。2组治疗后BI、mRS、NIHSS评分差异均无统计学意义(P >0.05)。结论西洛他唑+替格瑞洛双重抗血小板能更加有效地改善氯吡格雷抵抗老年急性脑梗死病人的疗效及预后。

关键词: 西洛他唑, 替格瑞洛, 阿司匹林, 急性脑梗死, 氯吡格雷抵抗, 预后

Abstract: Objective To compare the clinical effect and the prognosis of dual anti-platelet therapies between cilostazol plus aspirin and cilostazol plus ticagrelor in the elderly patients with acute cerebral infarction(ACI) combined with clopidogrel resistance. Methods A total of 90 elderly patients with ACI combined with clopidogrel resistance were enrolled and randomly divided into the aspirin group(dual anti-platelet therapy with cilostazol plus aspirin) and the ticagrelor group(dual anti-plaelet therapy with cilostazol plus ticagrelor). The serum levels of malondialdehyde(MDA) and superoxidase dismutase(SOD), the hemorheological indexes of plasma viscosity, whole blood viscosity at high shear rate, whole blood viscosity at low shear rate, fibrinogen(Fbg) and platelet aggregation rate(PAR), the coagulation indexes of prothrombin time(PT), international normalized ratio(INR), plateletⅡb/Ⅲa complex(CD61), platelet fibrinogen receptor(PAC-1) were compared between the two groups. The adverse reactions in both groups were recorded and compared as well. After 2 years of followed-up, the scores of Barthel indexes(BI), modified Rankin scale(mRS) and National Institute of Health Stroke Scale (NIHSS) and the incidence rate of end-point events were compared between the two groups. Results Compared to the aspirin group, the serum levels of MDA, the hemorheology indexes, CD61 and PAC-1 after therapy were lower and the level of SOD was higher in the ticagrelor group. The incidence rate of headache in the ticagrelor group was significantly higher than that in the aspirin group(P<0.05). After 2 years of followed-up, compared to the aspirin group, the incidence rate of the main and secondary end-point events were lower in the ticagrelor group(P<0.05). There were no significant differences in the scores of BI, mRS and NIHSS between the two groups(P>0.05). Conclusions The dual anti-platelet therapy with cilostazol plus ticagrelor can improve the effect and prognosis in the elderly patients with ACI combined with clopidogrel resistance.

Key words: cilostazol, ticagrelor, aspirin, acute cerebral infarction, clopidogrel resistance, prognosis

中图分类号:

R 743.33

虞冬晴, 车路. 基于西洛他唑双重抗血小板方案对氯吡格雷抵抗老年急性脑梗死病人的疗效及预后评价[J]. 实用老年医学, 2023, 37(8): 843-847.

YU Dong-qing, CHE-Lu. Effect and prognosis of dual anti-platelet therapy based on cilostazol in elderly patients with acute cerebral infarction combined with clopidogrel resistance[J]. Practical Geriatrics, 2023, 37(8): 843-847.

参考文献

[1] PIRLOG B O, GROTTA J C. The applicability of thromboelastography in acute ischemic stroke: a literature review [J]. Semin Thromb Hemost, 2022, 48(7):842-849.
[2] DEL GIOVANE C, BONCORAGLIO G B, BERTU L, et al. Antiplatelet drugs for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis [J]. BMC Neurol, 2021, 21(1):319.
[3] KAMAROVA M, BAIG S, PATEL H, et al. Antiplatelet use in ischemic stroke [J]. Ann Pharmacother, 2022, 56(10):1159-1173.
[4] MEDRANDA G A, ZHANG C, DOROS G, et al. Meta-analysis of usefulness of antiplatelet therapy in ischemic stroke or transient ischemic attack [J]. Am J Cardiol, 2021, 153:129-134.
[5] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[6] 詹青.缺血性脑血管病[M].北京:科学技术文献出版社,2014:107-108.
[7] TAN C H, WU A G, SIA C H, et al. Cilostazol for secondary stroke prevention: systematic review and meta-analysis [J]. Stroke Vasc Neurol, 2021, 6(3):410-423.
[8] CHEN X, XU J, CHEN S, et al. Dual antiplatelet therapy with ticagrelor may increase the risk of all bleeding events in patients with minor strokes or high risk TIAs: a meta-analysis [J]. Stroke Vasc Neurol, 2022, 7(4):271-275.
[9] JUNG S J, SHIM S R, KIM B J, et al. Cilostazol-based dual anti-platelet agents for asian patients: an updated network meta-analysis [J]. J Neurol Sci, 2022, 442:120457.
[10] KHERALLAH R Y, KHAWAJA M, OLSON M, et al. Cilostazol: a review of basic mechanisms and clinical uses [J]. Cardiovasc Drugs Ther, 2022, 36(4):777-792.
[11] PARK H K, LEE J S, KIM B J, et al. Cilostazol versus aspirin in ischemic stroke with cerebral microbleeds versus prior intracerebral hemorrhage [J]. Int J Stroke, 2021, 16(9):1019-1030.
[12] CHEN H, LUO W, CAI X, et al. Cilostazol administration for subarachnoid hemorrhage: a meta-analysis of randomized controlled trials [J]. Clin Neuropharmacol, 2022, 45(5):111-116.
[13] LIN M P, MESCHIA J F, GOPAL N, et al. Cilostazol versus aspirin for secondary stroke prevention: systematic review and meta-analysis [J]. J Stroke Cerebrovasc Dis, 2021, 30(3):105581.
[14] CHIEN S C, CHEN C C, CHEN C T, et al. Ticagrelor versus clopidogrel in stent-assisted coil embolization of unruptured intracranial aneurysms [J]. Interv Neuroradiol, 2022, 28(5):568-574.
[15] PAN Y, MENG X, JIN A, et al. Time course for benefit and risk with ticagrelor and aspirin in individuals with acute ischemic stroke or transient ischemic attack who carry CYP2C19 loss-of-function alleles: a secondary analysis of the CHANCE-2 randomized clinical trial [J]. JAMA Neurol, 2022, 79(8):739-745.
[16] WANG A, MENG X, TIAN X, et al. Effect of hypertension on efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin in minor stroke or transient ischemic attack [J]. Stroke, 2022, 53(9):2799-2808.
[17] 陈前萍, 匡新. 常规凝血检测与血栓弹力图评价急性脑梗死患者近期预后的价值[J]. 实用临床医药杂志, 2021, 25(2): 36-39.