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目的:探讨氯吡格雷对急性脑梗死患者血小板活化功能和颈动脉硬化斑块的影响。方法:将60例急性脑梗死患者随机分为对照组和氯吡格雷组。两组均予以相同的抗高血压、降颅压、营养脑细胞及对症处理等治疗。对照组和氯吡格雷组分别在此基础上加用阿司匹林肠溶片100mg和氯吡格雷75mg,po,qd,连用6个月。观察治疗前后患者血小板活化功能和颈动脉硬化斑块的变化,并进行临床神经功能缺损评分的评定和不良反应观察。结果:两组患者治疗后血小板活化指标CD62p和CD63水平均明显下降,且氯吡格雷组比对照组下降更明显。氯吡格雷组治疗后斑块大小、厚度和中层内膜厚度(IMT)均明显减小,而对照组治疗前后却无明显变化。两组患者治疗后神经功能缺损评分均明显下降,且氯吡格雷组比对照组下降更明显,治疗其间均无明显不良反应。结论:氯吡格雷治疗急性脑梗死可抑制血小板活化,减少血小板聚集,从而减轻动脉粥样硬化病变,稳定斑块,改善梗死部位缺血缺氧和缺损神经功能,疗效显著、安全性较好。
Objective: To investigate the effect of clopidogrel on platelet activation and carotid plaque in patients with acute cerebral infarction. Methods: Sixty patients with acute cerebral infarction were randomly divided into control group and clopidogrel group. Both groups were given the same antihypertensive, intracranial pressure, nutritional brain cells and symptomatic treatment. Control group and clopidogrel group were added on the basis of aspirin enteric-coated tablets 100mg and clopidogrel 75mg, po, qd, once every 6 months. The changes of platelet activation and carotid plaque were observed before and after treatment. The clinical neurological deficit score was assessed and adverse reactions were observed. Results: After treatment, the levels of CD62p and CD63 in both groups were significantly decreased, and the reduction in clopidogrel group was more obvious than that in control group. The plaque size, thickness and IMT in the clopidogrel group were significantly decreased, while the control group had no significant changes before and after treatment. After treatment, neurological deficit scores of both groups were significantly decreased, and the clopidogrel group decreased more significantly than the control group, no significant adverse reactions during the treatment. Conclusion: Clopidogrel treatment of acute cerebral infarction can inhibit platelet activation, reduce platelet aggregation, thereby reducing atherosclerotic lesions, stabilizing plaque, improve infarct ischemia and hypoxia and defect nerve function, with significant efficacy and safety.