症状性颈动脉狭窄患者延长双联抗血小板治疗临床观察

目的 探讨双联抗血小板时间对症状性颈动脉狭窄患者缺血性卒中复发和动脉斑块活动性的影响. 方法 症状性颈动脉狭窄患者95例,根据发病后双联抗血小板的持续时间,分为短期双联抗血小板(SD)组(疗程<1月)67例及延长双联抗血小板(PD)组(疗程>3月)28例,2组患者的临床资料、MES、血清MMP-7和hs-CRP水平等基线数据的差别无统计学意义.分析并比较2组患者经双联抗血小板治疗后,脑卒中复发、出血并发症、经颅多普勒超声检测微栓子(MES)、血清基质金属蛋白酶-7(MMP-7)和超敏C反应蛋白(hs-CRP)水平的差别. 结果(1)随访6月后,SD组的MES阳性率及血清MMP-7、hs-CRP水平分别为(38.8％,26/67),(17.35±0.95)μg/L和(13.74±1.41)mg/L,均低于入院时水平(P<0.05);PD组的MES阳性率及血清MMP-7、hs-CRP水平分别为(17.9％,5/28),(16.94±0.62)μg/L和(13.05±1.03)mg/L,均低于入院时水平(P<0.05),且均低于SD组(P<0.05).(2)随访1年后,2组的脑梗死或短暂性脑缺血发作复发和出血并发症的差别无统计学意义(P>0.05). 结论 PD治疗可减少症状性颈动脉狭窄患者的MES,可能有利于降低缺血性卒中的复发率.

Clinical Observation Study of Prolonged Dual Antiplatelet Therapy in Patients with Symptomatic Carotid Stenosis

Objective To analyze the effects of the duration of dual antiplatelet therapy on ischemic stroke recurrence and artery plaque activity in patients with symptomatic carotid stenosis.Methods Subjects were 95 patients with symptomatic carotid stenosis who were admitted to department of Neurology,Fujian Medical University Union Hospital and The Affiliated First Hospital of Fujian Medical University.Clinical data,microembolic signals(MES)detected by transcranial Doppler,and serum level of MMP-7 and hs-CRP were investigated.67 patients were recruited in short-term dual antiplatelet therapy(SD)group(duration <1 month)while 28 patients were recruited in prolonged dual antiplatelet therapy(PD)group(duration >3 months),which were two different durations of dual antiplatelet therapy.The differences in ischemic stroke recurrence rate,hemorrhage complications,MES positive rate,and level of MMP-7 and hs-CRP were analyzed.Results There were no differences between the two groups in baseline data,MES,and the level of serum markers.After 1 year of follow-up,there were no significant differences between the two groups in ischemic stroke recurrence and hemorrhage complications.After 6 months of follow-up,in the SD group,MES positive rate(38.8％,26/67)were lower than that(53.7％,36/67)detected at admission,the serum levels of MMP-7 [(17.35±0.95)μg/L]were lower than that [(18.50±0.71)μg/L] detected at admission,and the serum levels of hs-CRP[(13.74±1.41)mg/L]were lower than that [(21.98±2.97)mg/L] detected at admission(all P<0.05).And,in the PD group,MES positive rate(17.9％,5/28)were lower than that(71.4％,20/28)detected at admission,the serum levels of MMP-7 [(16.94±0.62)μg/L]were lower than that [(18.28±0.58)μg/L]detected at admission,and the serum levels of hs-CRP[(13.05±1.03)mg/L])were lower than that [(21.06±3.21)mg/L] detected at admission(all P<0.05).MES positive rate and the serum levels of MMP-7 and hs-CRP in the PD group were both lower than that in the SD group(P<0.05).Conclusions Prolonged dual antiplatelet treatment may reduce the risk of ischemic stroke recurrence in symptomatic carotid stenosis by stabilizing artherosclerotic plaque.Further study in this area is needed.