Abstract：【Objective】To investigate the efficacy of dual antiplatelet therapy in patients with acute cerebral infarction (ACI) associated with H-type hypertension.【Methods】 A total of 100 patients with H-type hypertension related ACI, who received treatment in our hospital, were randomly divided into an observation group and a control group, with 50 patients in each group. Both groups received conventional ACI treatment. The control group was treated with aspirin enteric-coated tablets for antiplatelet therapy, while the observation group received a combination of clopidogrel hydrogen sulfate tablets in addition to the control group's treatment. Both groups maintained the treatment for 8 weeks. The NIH Stroke Scale (NIHSS) scores before and after treatment, the modified Rankin Scale (mRS) scores after treatment, platelet-related parameters, clinical efficacy, and drug-related adverse events were compared between the two groups.【Results】After treatment, the NIHSS scores of both groups were significantly lower than before treatment (P<0.05), and the observation group had even lower scores than the control group (P<0.05). The total effective rate of treatment in the observation group was higher than that in the control group (P<0.05). The mRS scores of patients in the observation group were lower than those in the control group after treatment (P<0.05).Compared with before treatment, the levels of homocysteine (Hcy), mean platelet volume (MPV), and platelet distribution width (PDW) significantly decreased in both groups after treatment (P<0.05), and the levels of Hcy, MPV, and PDW in the observation group were significantly lower than those in the control group after treatment (all P<0.05).There was no significant difference in the total incidence of bleeding between the observation group and the control group (P>0.05).【Conclusion 】The combination of aspirin and clopidogrel hydrogen sulfate tablets for the treatment of ACI patients with concurrent H-type hypertension can reduce neurological deficits, improve the treatment effective rate, and is relatively safe.
白管兵, 潘波, 潘娜. 双联抗血小板治疗急性脑梗死伴H型高血压患者的疗效[J]. 医学临床研究, 2024, 41(4): 540-543.
BAI Guanbing, PAN Bo, PAN Na. Efficacy of Dual Antiplatelet Therapy in Patients with Acute Cerebral Infarction and H-type Hypertension. JOURNAL OF CLINICAL RESEARCH, 2024, 41(4): 540-543.
[1] LEE H L, KIM J T, LEE S J, et al. Comparative effectiveness of dual antiplatelet therapy with aspirin and clopidogrel versus aspirin monotherapy in mild-to-moderate acute ischemic stroke according to the risk of recurrent stroke: an analysis of 15000 patients from a nationwide, multicenter registry[J].Circ Cardiovasc Qual Outcomes,2020,13(11):e006474. [2] JOHNSTON S C, EASTON J D, FARRANT M, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA[J].N Engl J Med,2018, 379(3): 215-225. [3] 郭小锋, 白海岗. 丹参川芎嗪注射液联合双联抗血小板治疗老年急性脑梗死的临床疗效和不良反应观察[J].贵州医药, 2021, 45(12): 1963-1965. [4] YE M B, CHEN Y L, WANG Q, et al. Aspirin plus clopidogrel versus aspirin mono-therapy for ischemic stroke:a meta-analysis[J].Scand Cardiovasc J,2019, 53(4): 169-175. [5] KWON H M, LEE Y S, BAE H J, et al. Homocysteine as a predictor of early neurological deterioration in acute ischemic stroke[J].Stroke,2014, 45(3): 871-873. [6] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南 2018[J].中华神经科杂志, 2018, 51(9): 666-682. [7] 中华医学会心血管病学分会高血压学组, 中华医学会心血管病学分会精准心血管病学学组, 中国医师协会高血压专业委员会. H型高血压诊断与治疗专家共识[J].全科医学临床与教育, 2016, 14(3): 243-248. [8] 宋长曌, 刘翠, 陈三民, 等. H型高血压与脑分水岭梗死的关系[J].中西医结合心脑血管病杂志, 2021, 19(5): 846-848. [9] 车静, 蔡耘, 刘娜, 等. 急性脑梗死患者血糖波动与NIHSS评分、mRS评分及血清炎症因子水平的相关性研究[J].老年医学与保健, 2022, 28(1): 92-97. [10] LAN L H, RONG X M, SHEN Q Y, et al. Effect of alteplase versus aspirin plus clopidogrel in acute minor stroke[J].Int J Neurosci,2020, 130(9): 857-864. [11] 张晶晶, 冷超. 同型半胱氨酸水平对老年男性高血压患者血栓前状态及血栓事件的影响[J].中国老年学杂志, 2016, 36(12): 2877-2880. [12] 孔繁亮, 吴同果. 同型半胱氨酸对血小板聚集的影响[J].广东医学, 2015, 36(20): 3252-3254. [13] 梁茜茜, 张庆, 李莉, 等. 阿司匹林联合氯吡格雷治疗急性脑梗死的临床研究[J].中国临床药理学杂志, 2016, 32(16): 1446-1468. [14] TAN Y, PAN Y, LIU L, et al. One-year outcomes and secondary prevention in patients after acute minor stroke: results from the China National Stroke Registry[J].Neurol Res,2017, 39(6): 484-491. [15] PARK H K, KIM B J, HAN M K, et al. One-year outcomes after minor stroke or high-risk transient ischemic attack: Korean multicenter stroke registry analysis[J].Stroke,2017, 48(11): 2991-2998.
2024, Vol. 41 
