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目的观察氯吡格雷片联合阿司匹林肠溶片治疗急性缺血性脑卒中的临床疗效和安全性,及其对细胞色素P450 2C19(CYP2C19)基因表达的影响。方法将64例急性缺血性脑卒中患者随机分为对照组32例与试验组32例。对照组在发病24 h内口服阿司匹林肠溶片100 mg qd;试验组在对照组治疗的基础上,予以口服硫酸氢氯吡格雷75 mg qd。2组患者均治疗14 d。比较2组患者的临床疗效、血流动力学、CYP2C19基因表达水平情况,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为93.75%(30/32例)和75.00%(24/32例),差异有统计学意义(P<0.05)。治疗后,试验组和对照组全血低切黏度分别为(17.08±1.90),(19.03±2.37)mPa·s;血浆黏度分别为(1.70±0.19),(2.01±0.22)mPa·s;血小板聚集率分别为(54.02±6.45)%,(61.98±6.53)%;CYP2C19基因表达水平分别为0.98±0.12,1.35±0.21,差异均有统计学意义(P<0.05)。治疗后,试验组和对照组的纤维蛋白分别为(3.43±0.41),(3.60±0.41)g·L~(-1),差异无统计学意义(P>0.05)。2组患者的药物不良反应主要有头痛和恶心,且试验组和对照组的药物不良反应发生率分别为9.38%和15.63%,差异无统计学意义(P>0.05)。结论与单用阿司匹林肠溶片相比,氯吡格雷片联合阿司匹林肠溶片治疗急性缺血性脑卒中的临床疗效显著提高,且不增加药物不良反应的发生率。
Objective To observe the clinical efficacy and safety of clopidogrel combined with aspirin enteric-coated tablets in the treatment of acute ischemic stroke and its effect on the gene expression of cytochrome P450 2C19 (CYP2C19). Methods 64 patients with acute ischemic stroke were randomly divided into control group (32 cases) and experimental group (32 cases). The control group took aspirin enteric-coated tablets 100 mg qd within 24 h after onset. The experimental group was given oral clopidogrel hydrogen sulfate 75 mg qd on the basis of the control group. Two groups of patients were treated for 14 days. The clinical efficacy, hemodynamics, CYP2C19 gene expression level, and the incidence of adverse drug reactions in the two groups were compared. Results After treatment, the total effective rates of the experimental group and the control group were 93.75% (30/32 cases) and 75.00% (24/32 cases) respectively, the difference was statistically significant (P <0.05). After treatment, the low blood viscosity of the whole blood of the experimental group and the control group were (17.08 ± 1.90) and (19.03 ± 2.37) mPa · s respectively, and the plasma viscosities were (1.70 ± 0.19) and (2.01 ± 0.22) mPa · s respectively. (54.02 ± 6.45)% and (61.98 ± 6.53)%, respectively. The CYP2C19 gene expression levels were 0.98 ± 0.12 and 1.35 ± 0.21, respectively, with statistical significance (P <0.05). After treatment, the levels of fibrin in the test group and the control group were (3.43 ± 0.41) and (3.60 ± 0.41) g · L -1, respectively, with no significant difference (P> 0.05). Adverse drug reactions in the two groups were mainly headache and nausea. The adverse drug reaction rates in the two groups were 9.38% and 15.63%, respectively, with no significant difference (P> 0.05). Conclusion Compared with aspirin enteric-coated tablets alone, the clinical efficacy of clopidogrel combined with aspirin enteric-coated tablets in the treatment of acute ischemic stroke was significantly increased, and the incidence of adverse drug reactions was not increased.