目的 探討阿加曲班聯(lián)合氯吡格雷治療大動脈粥樣硬化性腦梗死的臨床療效及對血清炎性因子影響。方法 選取2013年1月—2014年9月天津海濱人民醫(yī)院神經(jīng)內(nèi)科住院的大動脈粥樣硬化性腦梗死患者160例, 隨機分為對照組和治療組, 每組80例。對照組在常規(guī)治療的基礎上口服硫酸氫氯吡格雷片, 1片/次, 1次/d。治療組加用阿加曲班注射液, 第1、2天每天用阿加曲班注射液60 mg, 以500 mL生理鹽水稀釋, 24 h持續(xù)靜脈滴注;其后5 d每天用阿加曲班注射液10 mg以250 mL 生理鹽水稀釋, 分早晚2次持續(xù)靜脈滴注, 每次3 h。治療組其他治療同對照組。兩組均連續(xù)治療14 d。比較兩組的臨床療效, 比較兩組患者治療前, 治療7、14 d的NIHSS評分和Barthel指數(shù), 同時比較治療前, 治療3、7 d時兩組腫瘤壞死因子-α(TNF-α)、白細胞介素-8(IL-8)的變化。結(jié)果 治療組與對照組總有效率分別為91.25%、77.50%, 兩組比較差異有統(tǒng)計學意義(P<0.05)。兩組治療7、14 d時NIHSS評分均較同組治療前降低, Barthel指數(shù)升高, 同組治療前后差異有統(tǒng)計學意義(P<0.05)。治療后, 治療組NIHSS評分低于對照組, Barthel指數(shù)高于對照組, 兩組比較差異有統(tǒng)計學意義(P<0.05)。治療3、7 d, 兩組患者炎癥因子IL-8和TNF-α均較治療前顯著下降, 同組治療前后差異有統(tǒng)計學意義(P<0.05);治療后, 治療組這兩個炎癥因子均較對照組低, 兩組比較差異有統(tǒng)計學意義(P<0.05)。結(jié)論 阿加曲班聯(lián)合氯吡格雷治療大動脈粥樣硬化性腦梗死具有較好的臨床療效, 可降低NIHSS評分和炎癥因子TNF-α、IL-8, 同時能提高患者的Barthel指數(shù), 值得臨床推廣應用。

Objective To investigate the clinical effect of argatroban combined with clopidogrel in the treatment of large artery atherosclerotic cerebral infarction and its effect on serum inflammatory factors. Methods The patients with large artery atherosclerotic cerebral infarction (160 cases) of Tianjin Haibin People's Hospital from January 2013 to September 2014 were randomly divided into treatment and control groups, and each group had 80 cases. The patients in the control group were po administered with Clopidogrel Bisulfate Tablets on the basis of conventional treatment, one tablet/time, once daily. The patients in the treatment group were iv administered with Argatroban Injection (60 mg diluted with 500 mL physiological saline) through 24 h continuous iv pump infusion on the first 2 d. The next 5 d they were treated with Argatroban Injection (20 mg diluted with 250 mL physiological saline), through continuous 3 h iv infusion twice daily in the morning and evening. Other treatments in the treatment group were the same to the control group. The patients in two groups were treated for 14 d. After the treatment, the efficacy was evaluated, and NIHSS score and Barthel index before and 7, 14 d after the treatment in two groups were compared, while before and 3, 7 d after the treatment the changes of IL-8 and TNF-α in two groups were compared. Results The efficacies in the treatment and control groups were 91.25% and 77.50%, respectively, and there were differences between the two groups (P < 0.05). Within 7, 14 d after the treatment, the NIHSS scores of the two groups were significantly lower, and Barthel index were higher than those before the treatment, and the difference was statistically significant in the same group (P < 0.05). After treatment, NIHSS score of the treatment group was lower than that in the control group, and Barthel index was higher than that in the control group, with significant difference between two groups (P < 0.05). Within 3, 7 d after the treatment, IL-8 and TNF-α of the two groups were significantly lower, and the difference was statistically significant in the same group (P < 0.05). After treatment, the two inflammatory factors in the treatment group were lower than those in the control group, and there were differences between the two groups (P < 0.05). Conclusion Argatroban combined with clopidogrel has the good clinical effect in the treatment of large artery atherosclerotic cerebral infarction, and can reduce the NIHSS score and inflammatory factor TNF-α, IL-8. While Argatroban can improve the Barthel index, which is worth clinical promotion.