作者：杨华,武宁,贾帅,庞萌,陈菲,王炎强

单位：

1.221006 江苏省徐州市，徐州医科大学第二附属医院神经内科 2.261031 山东省潍坊市，潍坊医学院 3.261031 山东省潍坊市， 潍坊医学院附属医院神经内二科 通信作者：王炎强，E-mail：Wangqiangdoctor@126.com

Units：

1.Department of Neurology, the Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China 2.Weifang Medical University, Weifang 261031, China 3.Department of Neurology, Affiliated Hospital of Weifang Medical University, Weifang 261031, China Corresponding author: WANG Yanqiang, E-mail: Wangqiangdoctor@126.com

关键词：

卒中; 缺血性脑卒中; 大脑中动脉狭窄; 复发; 血栓弹力图; 抗栓效果;

Keywords：

Stroke; Ischemic stroke; Middle cerebral artery stenosis; Recurrent; Tthromboelastography;Antithrombotic effect

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.271

Funds：

山东省中医药科技发展计划项目（2019-0432）；山东省科技计划项目（202003070377）

摘要：

背景抗栓治疗是动脉粥样硬化所致缺血性脑卒中的重要干预策略,但部分患者仍存在卒中复发风险,进而增加卒中疾病负担。因此,评估抗栓效果具有重要的临床意义。目的 基于血栓弹力图(TEG)评价大脑中动脉狭窄致缺血性脑卒中复发患者的抗栓效果。方法 选取2015年3月至2019年10月在徐州医科大学第二附属医院神经内科就诊的大脑中动脉狭窄致缺血性脑卒中患者163例,其中卒中未复发65例,卒中复发98例;单用阿司匹林治疗75例,阿司匹林联合氯吡格雷治疗88例。收集所有患者一般资料、TEG指标及抗血小板药物抵抗发生率。结果 单用阿司匹林治疗的卒中复发患者最大振幅(MA)低于单用阿司匹林治疗的卒中未复发患者,阿司匹林抵抗发生率高于单用阿司匹林治疗的卒中未复发患者(P <0.05)。阿司匹林联合氯吡格雷治疗的卒中复发患者凝血反应时间(R值)短于阿司匹林联合氯吡格雷治疗的卒中未复发患者(P <0.05)。结论 基于TEG发现,单用阿司匹林治疗的大脑中动脉狭窄致缺血性脑卒中复发患者存在阿司匹林抵抗及血小板功能低下情况,而采用阿司匹林联合氯吡格雷治疗的大脑中动脉狭窄致缺血性脑卒中复发患者的R值缩短,血液呈高凝状态。

Abstract：

【Abstract】　Background Antithrombotic therapy is an important intervention strategy for patients with ischemicstroke caused by atherosclerosis, but some patients still have the risk of stroke recurrence, which increases the burden ofstroke disease. Therefore, it is of great clinical significance to evaluate the antithrombotic effect. Objective To evaluatetheantithrombotic effect in patients with recurrent ischemic stroke caused by middle cerebral artery stenosis based on thromboelastogram (TEG) . Methods A total of 163 patients with ischemic stroke caused by middle cerebral artery stenosis in theDepartment of Neurology, the Second Affiliated Hospital of Xuzhou Medical University from March 2015 to October 2019 wereselected, including 65 cases of non-recurrent stroke and 98 cases of recurrent stroke; 75 cases were treated with aspirin alone and88 cases were treated with aspirin combined with clopidogrel. The general data, TEG indexes and the incidence of antiplatelet drugresistance were collected. Results The maximum amplitude (MA) in patients with recurrent stroke treated with aspirin alone waslower than that in patients with non-recurrent stroke treated with aspirin alone, and incidence of aspirin resistance in patients withrecurrent stroke treated with aspirin alone was higher than that in patients with non-recurrent stroke treated with aspirin alone(P < 0.05) . The coagulation reaction time (R value) of recurrent stroke patients treated with aspirin combined with clopidogrel wasshorter than that of non-recurrent stroke patients treated with aspirin combined with clopidogrel (P < 0.05) . Conclusion Basedon TEG this paper finds that the patients with recurrent ischemic stroke caused by middle cerebral artery stenosis treated withaspirin alone have aspirin resistance and low platelet function, while the patients with recurrent ischemic stroke caused by middlecerebral artery stenosis treated with aspirin combined with clopidogrel have shortened R value and hypercoagulable blood.

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