Zhongguo cuzhong zazhi (Aug 2018)

基于高分辨率磁共振成像的氯吡格雷和阿司匹林治疗症状性颅内动脉狭窄患者1年的疗效观察 1-year Efficacy Observation of Clopidogrel versus Aspirin Therapy for Symptomatic Intracranial Artery Stenosis Based on High-resolution Magnetic Resonance Imaging

  • 李媛，边洋，刘建国，戚晓昆，王占军，王玮，邱峰

DOI
https://doi.org/10.3969/j.issn.1673-5765.2018.08.003
Journal volume & issue
Vol. 13, no. 8
pp. 773 – 779

Abstract

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目的 通过高分辨率磁共振成像观察硫酸氢氯吡格雷片和阿司匹林肠溶片治疗症状性颅内动脉狭 窄（intracranial artery stenosis，IAS）的有效性及安全性，旨在为症状性IAS患者的药物治疗选择提供可 靠依据。 方法 收集影像及经颅多普勒检查证实大脑中动脉M1段存在重度管腔狭窄患者40例，在给予卒中 常规治疗的基础上，随机分为氯吡格雷组和阿司匹林组，每组20例。随访1年，观察两组患者颅内动 脉管腔狭窄程度的百分比变化、动脉斑块变化情况、缺血性卒中复发率、不良反应发生率及依从性。 结果 随访1年，氯吡格雷组和阿司匹林组颅内动脉管腔狭窄程度的百分比变化、动脉斑块变化 以及卒中复发率比较，差异无统计学意义。氯吡格雷组有1例（5%）出现不良反应，阿司匹林组有7 例（35%）出现不良反应，氯吡格雷组药物不良反应发生率低于阿司匹林组，比较差异有统计学意义 （χ 2=3.906，P＜0.05）。氯吡格雷组有2例（10%）停药，阿司匹林组有8例（40%）停药，氯吡格雷组服 药依从性高于阿司匹林组。因此药物不良反应发生率及依从性氯吡格雷组和阿司匹林组差异有统计 学意义（χ 2=4.800，P＜0.05）。 结论 针对IAS患者氯吡格雷和阿司匹林均可作为卒中二级预防首选用药，但对于依从性较差或既 往有胃肠道溃疡病史的患者，优先选择氯吡格雷。 Abstract: Objective To observe the efficacy and safety of clopidogrel versus aspirin therapy for symptomatic intracranial artery stenosis (IAS) based on high-resolution magnetic resonance imaging, so as to provide reliable evidence for drug selection in patients with symptomatic IAS. Methods 40 patients with symptomatic severe stenosis in M1 segment of middle cerebral artery confirmed by cerebral angiography and transcranial Doppler sonography, were randomly divided into clopidogrel group and aspirin group based on routine stroke management, with 20 cases in each group. The change rate of IAS, change degree of artery plaque, ischemic stroke recurrence rate, adverse reactions and drug compliance in two groups were examined at 1-year follow-up. Results The change degree of IAS, plaque changes and stroke recurrence rate of two groups at 1-year follow-up had no significant difference. Adverse reactions occurred in 1 case (5%) in clopidogrel group and 7 cases (35%) in aspirin group (χ 2=3.906, P <0.05). Two cases (10%) stopped taking clopidogrel in clopidogrel group and 8 cases (40%) stopped taking aspirin in aspirin group (χ 2=4.800, P <0.05). Conclusions Either clopidogrel or aspirin can be the preferred drugs for secondary prevention of stroke in patients with IAS, while for patients who had a prior history of gastrointestinal ulcer and a poor drug compliance, clopidogrel should be a better choice.

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