作者：梁冰1 ，徐斌2 ，张平2 ，宋景贵1 ，刘欢欢3

单位：

1.453000河南省新乡市，新乡医学院第二附属医院神经内科　 2.453000河南省新乡市，新乡医学院第一附 属医院神经内科　3.453000 河南省新乡市，河南省生物精神病学重点实验室

Units：

1.Department of Neurology, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453000, China 2.Department of Neurology, the First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453000, China 3.Henan Key Laboratory of Biological Psychiatry, Xinxiang 453000, China

关键词：

脑梗死；孤立性脑桥梗死；氯吡格雷；肝素，低分子量；治疗结果

Keywords：

Brain infarction; Isolated pontine infarction; Clopidogrel; Heparin, low-molecular-weight; Treatment outcome

CLC：

R 743.33

DOI：

10.12114/j.issn.1008-5971.2024.00.082

Funds：

2021年度河南省医学科技攻关计划联合共建项目（LHGJ20210542）；河南省高等学校重点科研项目 （22A320042）；2022年新医二附院精神神经开放课题项目（2022-xyefykfkt-004）

摘要：

目的　探讨氯吡格雷联合低分子肝素治疗孤立性脑桥梗死的有效性及安全性。方法　回顾性收集2021 年6月—2023 年 2月新乡医学院第一附属医院神经内科收治的 179例孤立性脑桥梗死患者，根据治疗方法不同将其分为 对照组（ n=112 ）和治疗组（ n=67）。其中对照组患者给予氯吡格雷联合阿司匹林治疗，连续治疗 14 d；治疗组患者给 予氯吡格雷（连续治疗14 d）联合低分子肝素（连续治疗7～10 d）治疗。比较两组患者有效性指标〔入院时和入院后 第14天美国国立卫生研究院卒中量表（NIHSS）评分及其差值，住院期间早期神经功能恶化（END）、早期复发性缺 血性卒中（ERIS）发生情况，出院后6个月内改良Rankin量表（mRS）评分及预后良好、脑梗死复发情况〕、安全性 指标（包括住院期间及出院后6个月内症状性颅内出血、脑梗死出血转化、颅外出血发生情况）。采用倾向性评分匹 配（PSM）对两组患者一般资料进行1∶1匹配，匹配容差为0.02。结果　PSM后，对照组和治疗组均为56例，两组患 者男性占比、年龄、发病至入院时间及有脑梗死史、高血压史、糖尿病史、高脂血症史、冠心病史、吸烟史、饮酒史 者占比比较，差异无统计学意义（P＞0.05）。治疗组患者入院后第14天NIHSS评分低于对照组，NIHSS评分差值大于 对照组，住院期间END发生率低于对照组（P＜0.05）。两组患者住院期间及出院后6个月内颅外出血发生率比较，差 异无统计学意义（P＞0.05）。结论　与氯吡格雷联合阿司匹林相比，氯吡格雷联合低分子肝素能更有效地减轻孤立性 脑桥梗死患者神经功能缺损程度，降低END发生率，且未增加住院期间及出院后6个月内出血风险。

Abstract：

Objective To explore the efficacy and safety of clopidogrel combined with low molecular heparin in the treatment of isolated pontine infarction. Methods A total of 179 patients with isolated pontine infarction admitted to the Department of Neurology, the First Affiliated Hospital of Xinxiang Medical University from June 2021 to February 2023 were retrospectively collected and divided into control group (n=112) and treatment group (n=67) according to different treatment methods. The patients in the control group were treated with clopidogrel combined with aspirin for 14 days. The patients in the treatment group were treated with clopidogrel for 14 days combined with low molecular weight heparin for 7-10 d. The effectiveness indexes [National Institutes of Health Stroke Scale (NIHSS) score at admission and 14th day after admission and its difference value, incidence of early neurological deterioration (END) and early recurrent ischemic stroke (ERIS) during hospitalization, modified Rankin Scale (mRS) score, good prognosis and recurrence of cerebral infarction within 6 months after discharge] and safety indexes (including symptomatic intracranial hemorrhage, hemorrhagic transformation of cerebral infarction, and extracranial hemorrhage during hospitalization and within 6 months after discharge) were compared between the two groups. The propensity score matching (PSM) was used to perform 1∶1 matching on the general data of the two groups of patients, and the matching tolerance was 0.02. Results After PSM, there were 56 cases in the control group and 56 cases in the treatment group. There was no significant difference in male proportion, age, time from onset to admission and the proportion of patients with brain infarction history, hypertension history, diabetes history, hyperlipidemia history, coronary heart disease history, smoking history and drinking history between the two groups (P > 0.05) . At the 14th day after admission, the NIHSS score in the treatment group was lower than that in the control group, the difference value of NIHSS score was greater than that in the control group, and the incidence of END during hospitalization was lower than that of the control group (P < 0.05) . There was no significant difference in the incidence of extracranial hemorrhage during hospitalization and within 6 months after discharge between the two groups ( P > 0.05) . Conclusion Compared with clopidogrel combined with aspirin, clopidogrel combined with low molecular weight heparin can more effectively reduce the degree of neurological deficits and incidence of END in patients with isolated pontine infarction, and do not increase the risk of bleeding during hospitalization and within 6 months after discharge.

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