兩種抗血小板方案治療反復TIA的療效比較研究

劉志強　彭小英

[摘要] 目的 對比分析兩種抗血小板治療方案在反復短暫性腦缺血發作（transient ischemic attack，TIA）患者中的應用價值。 方法 選取2015年6月～2017年6月收治的反復TIA發作患者90例為研究對象，以隨機數字表法分為A組45例、B組45例。A組早期給予替羅非班，后續采用阿斯匹林聯合氯吡格雷治療，B組給予阿斯匹林聯合氯吡格雷治療，觀察兩組患者治療后3 d、7 d內TIA復發次數，治療前后卒中發生風險及治療期間不良反應發生率、腦梗死發生率、血小板聚集率。 結果 A組治療后3 d、7 d內TIA復發次數同B組比較，明顯較少，差異有統計學意義（P<0.05）；治療前兩組ABCD2、ESRS評分無顯著差異（P>0.05），治療后均有改善，A組治療后ABCD2、ESRS評分同B組比較，明顯較低，差異有統計學意義（P<0.05）；A組治療期間不良反應發生率為6.67%，腦梗死發生率為11.11%，同B組的22.22%、28.89%比較，明顯較低，差異有統計學意義（P<0.05）；A組治療后血小板聚集明顯低于B組，差異有統計學意義（P<0.05）。 結論 替羅非班抗血小板在反復TIA治療中應用，可獲得更好療效，并能減少不良反應，更值得推廣。

[關鍵詞] 反復短暫性腦缺血發作；抗血小板治療；阿斯匹林；氯吡格雷；替羅非班

[中圖分類號] R743.3 [文獻標識碼] B [文章編號] 1673-9701（2017）36-0113-03

[Abstract] Objective To compare and analyze the value of two kinds of antiplatelet therapy in patients with recurrent transient ischemic attack （TIA）. Methods Totally 90 patients with recurrent TIA who were admitted in our hospital from June 2015 to June 2017 were selected and divided into group A（n=45） and group B（n=45） by random number table. The group A was given tirofiban at an early stage and subsequent use of aspirin combined with clopidogrel treatment. The group B was given aspirin combined with clopidogrel treatment. The number of TIA relapse within 3 d， 7 d after treatment， the risk of stroke before and after treatment and adverse reactions during treatment， the incidence of cerebral infarction and platelet aggregation rate between the two groups of patients were observed. Results The number of TIA recurrence in group A was significantly less than that in group B within 3 d and 7 d after treatment， and there was significant difference between the two groups（P<0.05）. There was no significant difference in ABCD2 and ESRS scores between the two groups before treatment（P>0.05）. After treatment， ABCD2 and ESRS scores improved in both groups. The ABCD2 and ESRS scores in group A were significantly lower than those in group B after treatment（P<0.05）. The incidence of adverse reactions in group A was 6.67%， the incidence of cerebral infarction was 11.11%， which was significantly lower than that（22.22% and 28.89%， respectively） in group B， and the difference was significant（P<0.05）. The platelet aggregation in group A was significantly lower than that in group B after treatment， and the difference was significant（P<0.05）. Conclusion The application of tirofiban antiplatelet in the treatment of repeated TIA can achieve better curative effect， reduce adverse reactions and is more worthy of promotion.

[Key words] Recurrent transient ischemic attacks； Antiplatelet therapy； Aspirin； Clopidogrel； Tirofiban

TIA具有較高發生率，若未及時予以治療，反復發作，可增加腦血管事件發生概率。研究指出[1]，TIA與血小板聚集具有密切相關性，抗血小板聚集是治療TIA主要方法。阿斯匹林聯合氯吡格雷作為經典用藥方案，在TIA治療中發揮重要作用，但也有報道顯示該方案不良反應較多，且有出血風險，患者可能出現抵抗現象，影響療效[2]。替羅非班是一種新型抗血小板聚集藥，具有強效、安全的優點。本研究通過對比，探討阿斯匹林聯合氯吡格雷抗血小板和替羅非班抗血小板在反復TIA治療中的臨床價值，現報道如下。

1 資料與方法

1.1 一般資料

選取2015年6月～2017年6月收治的反復TIA發作患者90例為研究對象，研究經倫理委員會審查并批準，以隨機數字表法分組。……