摘要
目的探讨阿司匹林、氯吡格雷预处理联合低剂量阿替普酶治疗脑深部穿支动脉粥样硬化的临床疗效。方法选取天津市环湖医院2022-05—2024-02收治的急性穿支动脉粥样硬化病患者339例,其中阿司匹林、氯吡格雷预处理联合低剂量阿替普酶静脉溶栓治疗(观察组)166例,标准剂量阿替普酶静脉溶栓治疗(对照组)173例,记录临床数据资料,观察2组患者的近期神经功能改善、早期神经功能恶化、远期预后、出血并发症以及死亡情况。结果阿司匹林、氯吡格雷预处理联合低剂量阿替普酶组患者溶栓后出现早期神经功能恶化比例低于对照组[22.9%(38/166)比35.8%(62/173),χ^(2)=6.828,P=0.009],7 d神经功能改善情况优于对照组[68.1%(113/166)比53.8%(93/173),χ^(2)=7.282,P=0.007]。2组颅内出血发生率均较低[1.8%(3/166)比0.6%(1/173),χ^(2)=0.297,P=0.586],其他部位出血情况相比差异也无统计学意义[19.3%(32/166)比16.2%(28/173),χ^(2)=0.556,P=0.456]。随访90 d,观察组改良Rankin量表(mRS)评分0~2分比例高于对照组[74.7%(124/166)比63.6%(110/173),χ^(2)=4.895,P=0.027],观察组1例患者因症状性颅内出血死亡,2组病死率相比差异无统计学意义[0.6%(1/166)比0,P=0.490]。结论阿司匹林、氯吡格雷预处理联合低剂量阿替普酶对于急性穿支动脉粥样硬化患者安全有效,值得临床验证及推广。
Objective To investigate the clinical effiacy of aspirin,clopidogrel pretreatment combined with low-dose alteplase in the treatment of deep branch atheromatous disease.Methods Totally 339 patients with acute perforating arterial infarction admitted to Tianjin Huanhu Hospital from May 2022 to February 2024 were retrospectively studied.Of these,166 patients were treated with aspirin and clopidogrel pretreatment combined with low-dose alteplase intravenous thrombolysis(observation group),and 173 patients were treated with standard dose alteplase intravenous thrombolysis(control group).Baseline clinical data were recorded,and short-term neurological improvement,early neurological deterioration,long-term prognosis,bleeding complications,and mortality in both groups were observed.Results The observation group had a lower proportion of early neurological deterioration post-thrombolysis compared with the control group(22.9%(38/166)vs 35.8%(62/173)χ^(2)=6.828,P=0.009).Neurological improvement was greater in the low-dose group at 7 days(68.1%(113/166)vs 53.8%(93/173),χ^(2)=7.282,P=0.007).For safety outcomes,intracranial hemorrhage rates were similar between two groups(1.8%(3/166)vs 0.6%(1/173),χ^(2)=0.0.297,P=0.586),as well as extracranial bleeding events(19.3%(32/166)vs 16.2%(28/173),χ^(2)=0.556,P=0.456).Long-term functional outcomes,assessed by the modified Rankin scale(mRS)at 90-day follow-up,were significantly better in the observation group,with 74.7%(124/166)achieving favorable outcomes(mRS 0-2)compared to 63.6%(110/173)in the control group(χ^(2)=4.895,P=0.027).In the observation group,one patient died due to symptomatic intracranial hemorrhage,with no statistically significant difference in mortality rate between the two groups(0.6%(1/166)vs 0,P=0.490).Conclusion Aspirin and clopidogrel pretreatment with low-dose alteplase is safe and effective for patients with acute branch atheromatous disease.This approach merits further validation in larger clinical trials and potential adoption in clinical practice.
作者
张闪闪
张佩兰
ZHANG Shanshan;ZHANG Peilan(Tianjin Huanhu Hospital,Tianjin 300350,China)
出处
《中国实用神经疾病杂志》
2025年第11期1327-1332,共6页
Chinese Journal of Practical Nervous Diseases
基金
天津市卫生健康科技项目(编号:TJWJ2022XK030,TJWJ2024ZD013)。
关键词
脑梗死
阿司匹林
氯吡格雷
阿替普酶
静脉溶栓
穿支动脉
抗血小板聚集
Cerebral infarction
Aspirin
Clopidogrel
Alteplase
Intravenous thrombolysis
Perforating artery
Antiplatelet aggregation
