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[目的]探讨血管介入治疗联合抗凝及抗血小板治疗对急性动脉粥样硬化性脑梗死患者纤溶系统的影响。[方法]将2008年6月～2010年6月本院收治的96例急性动脉粥样硬化性脑梗死患者随机分为A、B、C3组,每组各32例,选择同期健康体检者32例作为对照(D组)。A组给予肠溶阿司匹林150～300mg口服,每天1次;B组给予低分子肝素钠5000IU腹部皮下注射,每天2次,连用3d;C组行经皮腔内血管成形支架置入术,术前给予氯吡格雷75mg口服,术后给予低分子肝素钠5000IU腹部皮下注射,继续口服氯吡格雷和肠溶阿司匹林维持治疗。比较治疗前、治疗后d73组患者血浆血管性假血友病因子(vWF)、组织型纤溶酶原激活物(tPA)及其抑制物-1(PAI-1)水平。[结果]脑梗死患者治疗前血浆vWF、tPA、和PAI-1水平显著升高,与健康者比较,差异有统计学意义(P﹤0.05);治疗后d7C组vWF、tPA水平显著高于A组和B组,血浆PAI-1显著低于A组和B组。[结论]脑血管球囊成形支架置入术联合抗凝及抗血小板治疗急性动脉粥样硬化性脑梗死,患者血液纤溶活性高于单纯抗血小板或抗凝治疗,可能更有利于预防急性期再发血栓形成。
[Objective] To investigate the effect of vascular interventional therapy combined with anticoagulation and antiplatelet therapy on fibrinolytic system in patients with acute atherosclerotic cerebral infarction. [Methods] A total of 96 patients with acute atherosclerotic cerebral infarction admitted to our hospital from June 2008 to June 2010 were randomly divided into A, B and C3 groups, 32 in each group. Cases as a control (D group). A group given enteric-coated aspirin 150 ~ 300mg orally, once a day; B group given low molecular weight heparin 5000IU abdominal subcutaneous injection, twice a day, continuous 3d; C group by percutaneous transluminal angioplasty stenting, preoperative Clopidogrel 75mg orally, postoperative low molecular weight heparin 5000IU abdominal subcutaneous injection, continue oral clopidogrel and enteric-coated aspirin maintenance treatment. The levels of plasma vWF, PAI-1 and plasma PAI-1 in patients with d73 before and after treatment were compared. [Results] The plasma levels of vWF, tPA and PAI-1 in patients with cerebral infarction were significantly higher than those in healthy controls (P <0.05). The levels of vWF and tPA in patients with cerebral infarction were significantly higher than those in patients with A PAI-1 in group B and group B were significantly lower than those in group A and B. [Conclusion] Cerebral angioplasty stenting combined with anticoagulation and antiplatelet therapy for acute atherosclerotic cerebral infarction, the blood fibrinolytic activity of patients is higher than the simple anti-platelet or anticoagulant therapy may be more conducive to the prevention of acute stage Recurrence of thrombosis.