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目的观察阿司匹林联合氯吡格雷治疗大脑中动脉狭窄所致脑梗死的临床疗效,探讨其对血清同型半胱氨酸(Hcy)水平的影响。方法选取2012年10月—2015年10月马鞍山市人民医院收治的大脑中动脉狭窄所致脑梗死患者85例,根据建档顺序分为对照组42例和观察组43例。在常规治疗基础上,对照组患者口服阿司匹林,观察组患者口服阿司匹林联合氯吡格雷;2个月为1个疗程,两组患者均治疗1个疗程。比较两组患者临床疗效,治疗前后血清Hcy水平、美国国立卫生研究院卒中量表(NIHSS)评分和改良Barthel指数(MBI)评分,随访1年内复发情况,治疗期间不良反应发生情况。结果观察组患者临床治疗有效率高于对照组(P<0.05)。治疗前两组患者血清Hcy水平比较,差异无统计学意义(P>0.05);治疗后观察组患者血清Hcy水平低于对照组(P<0.05);治疗后两组患者血清Hcy水平均低于治疗前(P<0.05)。治疗前两组患者NIHSS评分、MBI评分比较,差异无统计学意义(P>0.05);治疗后观察组患者NIHSS评分低于对照组,MBI评分高于对照组(P<0.05);治疗后两组患者NIHSS评分低于治疗前,MBI评分高于治疗前(P<0.05)。观察组患者随访1年内复发率低于对照组(P<0.05)。两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论阿司匹林联合氯吡格雷治疗大脑中动脉狭窄所致脑梗死的临床疗效确切,可有效降低血清Hcy水平及复发率,改善患者神经功能及日常生活活动能力,且安全性较高。
Objective To observe the clinical efficacy of aspirin plus clopidogrel in the treatment of cerebral infarction induced by middle cerebral artery stenosis and to explore its effect on serum homocysteine (Hcy) level. Methods From October 2012 to October 2015, 85 patients with cerebral infarction caused by middle cerebral artery stenosis in Maanshan People’s Hospital were selected and divided into control group (42 cases) and observation group (43 cases). On the basis of routine treatment, the patients in the control group took aspirin orally and the patients in the observation group took aspirin combined with clopidogrel orally. Two months were a course of treatment, and both groups were treated with one course of treatment. The clinical efficacy, serum Hcy level before and after treatment, NIHSS score and modified Barthel index (MBI) score were compared between two groups. The incidence of recurrence within one year follow-up and adverse reactions during treatment were compared. Results The effective rate of clinical treatment in observation group was higher than that in control group (P <0.05). There was no significant difference in serum Hcy levels between the two groups before treatment (P> 0.05). After treatment, the serum Hcy level in the observation group was lower than that in the control group (P <0.05) Before treatment (P <0.05). There was no significant difference in NIHSS score and MBI score between the two groups before treatment (P> 0.05). After treatment, NIHSS score of observation group was lower than that of control group, MBI score was higher than that of control group (P <0.05) The NIHSS scores of the patients in the group before treatment were lower than those before treatment (P <0.05). The recurrence rate in observation group within one year follow-up was lower than that in control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups during treatment (P> 0.05). Conclusion Aspirin plus clopidogrel is effective in treating cerebral infarction caused by middle cerebral artery stenosis, which can effectively reduce the serum Hcy level and recurrence rate, improve the neurological function and daily life activity of patients, and have higher safety.