【摘要】 目的:目的:探讨氯吡格雷联合奥扎格雷钠对后循环脑梗死患者血液流变学、神经功能、炎症因子的影响。方法:用计算机随机数字法将90例后循环脑梗死患者分为观察组和对照组各45例。观察组患者予以氯吡格雷联合奥扎格雷钠治疗,对照组患者予以奥扎格雷钠治疗。观察两组患者治疗前后血小板活化程度(CD_62p、CD₆₃阳性表达率)、血液流变学指标、神经功能[美国国立卫生研究院卒中量表（NIHSS）、Barthel指数]、炎症因子[超敏C反应蛋白（hs-CRP）、白细胞介素-1β（IL-1β）、单核细胞趋化蛋白-1（MCP-1）]及其他细胞因子[细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）、类胰岛素生长因子-1（IGF-1）、低氧诱导因子-1α（HIF-1α）]变化情况,比较两组患者并发症发生率。结果:治疗14 d后,两组患者血小板CD_62p、CD₆₃阳性表达率以及全血高切黏度、全血低切黏度、血浆黏度、红细胞比容、红细胞沉降率、红细胞聚集指数、纤维蛋白原均较治疗前降低,且观察组低于对照组（均P<0.05）;两组患者NHISS评分均较治疗前降低,且观察组低于对照组（P<0.05）;Barthel指数均较治疗前升高,且观察组高于对照组（P<0.05）;两组患者血清hs-CRP、IL-1β、MCP-1、ICAM-1、VCAM-1、HIF-1α水平均较治疗前降低,且观察组低于对照组（均P<0.05）;IGF-1较治疗前升高,且观察组高于对照组（P<0.05）;两组患者血小板减少、颅内出血发生率比较差异均无统计学意义（均P>0.05）。结论:氯吡格雷联合奥扎格雷钠治疗后循环脑梗死可有效降低患者血小板活化程度和血液黏度,减轻炎症反应,且不良反应少,有利于短期内神经功能的提高。更多还原

【Abstract】 Objective:To explore the effects of clopidogrel combined with sodium ozagrel on hemorheology,neurological function and serum inflammatory factors in patients with posterior circulation cerebral infarction.Methods:90 patients with posterior circulation cerebral infarction were selected and randomly divided into observation group and control group,with 45 cases in each group.Observation group was treated with clopidogrel combined with sodium ozagrel,and control group was treated with sodium ozagrel.The platelet activation degree(positive expression rates of CD_{62 p} and CD₆₃),hemorheology,neurological function [National Institutes of Health Stroke Scale（NIHSS）,Barthel index],inflammatory factors [hypersensitive C-reactive protein（hs-CRP）,interleukin-1β（IL-1β）,monocyte chemoattractant protein-1（MCP-1）] and other cytokines [intercellular adhesion molecule-1（ICAM-1）,vascular cell adhesion molecule-1（VCAM-1）,insulin-like growth factor-1（IGF-1）,hypoxia-inducible factor-1α（HIF-1α）] before and after treatment were observed in the two groups.The incidence rates of complications were compared between the two groups.Results:After 14 days of treatment,the positive expression rates of platelet CD_{62 p} and CD₆₃,whole blood high-shear viscosity,whole blood low-shear viscosity,plasma viscosity,hematocrit,erythrocyte sedimentation rate,erythrocyte aggregation index and fibrinogen in the two groups were decreased in comparison with those before treatment,and the indexes in observation group were lower than those in control group（all P<0.05）.The NHISS scores in the two groups were lower than those before treatment,and the score in observation group was lower than that in control group（P<0.05）.The Barthel index was higher than that before treatment,and the index in observation group was higher than that in control group（P<0.05）.The serum levels of hs-CRP,IL-1β,MCP-1,ICAM-1,VCAM-1 and HIF-1α in the two groups were lower than those before treatment,and the levels in observation group were lower than those in control group（all P<0.05）.The level of IGF-1 was higher than that before treatment,and the level in observation group was higher than that in control group（P<0.05）.There were no statistically significant differences in the incidence rates of thrombocytopenia and intracranial hemorrhage between the two groups（allP>0.05）.Conclusion:Clopidogrel combined with sodium ozagrel for posterior circulation cerebral infarction can effectively reduce platelet activation degree and blood viscosity,and relieve inflammatory response,and has fewer adverse reactions,which can help to improve the short-term neurological function.更多还原