奥拉西坦联合阿司匹林及氯吡格雷对TIA疗效及神经修复功能的影响

doi:10.3760/cma.j.cn441417-20241106-12003

摘要/Abstract

摘要：

目的　探讨奥拉西坦联合阿司匹林及氯吡格雷对短暂性脑缺血发作（TIA）疗效及神经修复功能的影响。方法　采用前瞻性研究，选取2021年3月至2024年3月西安大兴医院神经内科收治的100例TIA患者作为研究对象，按信封抽签法随机分为对照组和奥拉西坦组。对照组50例，男29例、女21例，年龄（63.87±5.84）岁，病程（1.57±0.35）d，椎基动脉18例、颈内动脉32例。奥拉西坦组50例，男31例、女19例，年龄（63.74±5.71）岁，病程（1.62±0.42）d，椎基动脉15例、颈内动脉35例。对照组给予阿司匹林及氯吡格雷治疗，奥拉西坦组在对照组的基础上给予奥拉西坦治疗，比较两组治疗后的临床疗效，治疗前后的神经修复功能、相关评分、实验室指标及氧化应激水平。采用t、χ²检验进行统计比较。结果　治疗后，奥拉西坦组总有效率［94.0%（47/50）］高于对照组［80.0%（40/50）］（P<0.05）；奥拉西坦组胰岛素样生长因子-1为（25.25±2.92）g/L、脑源性神经营养因子为（39.17±4.47）μg/L、神经生长因子为（189.37±25.45）ng/L，均高于对照组的（22.45±2.53）g/L、（33.77±4.13）μg/L、（170.12±22.38）ng/L（均P<0.05）；奥拉西坦组的单核趋化蛋白-1为（136.64±15.18）μg/L、肿瘤坏死因子-α为（7.36±0.90）μg/L、基质金属蛋白酶为（95.78±10.71）ng/L，均低于对照组的（150.75±18.24）μg/L、（9.75±1.11）μg/L、（117.12±13.85）ng/L（均P<0.05）；奥拉西坦组超氧化物歧化酶为（83.53±8.28）U/L、一氧化氮为（83.25±3.25）μmol/L、谷胱甘肽过氧化物酶为（92.72±6.13）U/L，均高于对照组的（77.52±7.82）U/L、（74.67±3.31）μmol/L、（85.68±5.21）U/L（均P<0.05）；奥拉西坦组的蒙特利尔认知评估量表评分为（27.10±3.14）分、简易精神状态量表评分为（23.45±2.85）分、改良Barthel指数评分为（53.56±7.45）分，均高于对照组的（24.76±2.82、21.13±2.43、49.97±6.56）分，美国国立卫生研究院卒中量表评分为（12.69±1.44）分，低于对照组的（15.78±1.52）分（均P<0.05）。结论　奥拉西坦联合阿司匹林及氯吡格雷对TIA患者疗效及神经修复功能的影响较为显著。

关键词: 奥拉西坦, 阿司匹林, 氯吡格雷, 短暂性脑缺血发作, 神经功能

Abstract:

Objective　To explore the effect oxiracetam combined with aspirin and clopidogrel for patients with transient ischemic attack (TIA) and its influence on neurological repair function. Methods　A total of 100 patients with TIA admitted to Department of Neurology, Xi'an Daxing Hospital from March 2021 to March 2024 were selected for the randomized controlled trial. They were divided into a control group and an oxiracetam group by the method of drawing lots from envelopes, with 50 cases in each group. There were 29 males and 21 females in the control group; they were (63.87±5.84) years old; their disease course was (1.57±0.35) d; 18 cases had lesions on the vertebrobasilar artery, and 32 cases on the internal carotid artery. There were 31 males and 19 females on the oxiracetam group; they were (63.74±5.71) years old; their disease course was (1.62±0.42) d; 15 cases had lesions on the vertebrobasilar artery, and 35 cases on the internal carotid artery. The control group took aspirin and clopidogrel, and the oxiracetam group took oxiracetam, aspirin, and clopidogrel. The clinical efficacies and neurological repair function, relevant scores, laboratory indicators, and oxidative stress levels before and after the treatment were compared between the two groups by t and χ² tests. Results　After the treatment, the total effective rate in the oxiracetam group was higher than that in the control group [94.0% (47/50) vs. 80.0% (40/50); P<0.05]. The levels of insulin-like growth factor-1, brain-derived neurotrophic factor, and nerve growth factor in the oxiracetam group were higher than those in the control group [(25.25±2.92) g/L vs. (22.45±2.53) g/L, (39.17±4.47) μg/L vs. (33.77±4.13) μg/L, and (189.37±25.45) ng/L vs. (170.12±22.38) ng/L; all P<0.05]. The levels of monocyte chemoattractant protein-1, tumor necrosis factor-α, and matrix metalloproteinase in the oxiracetam group were lower than those in the control group [(136.64±15.18) μg/L vs. (150.75±18.24) μg/L, (7.36±0.90) μg/L vs. (9.75±1.11) μg/L, (95.78±10.71) ng/L vs. (117.12±13.85) ng/L; all P<0.05]. The levels of superoxide dismutase, nitric oxide , and glutathione peroxidase in the oxiracetam group were higher than those in the control group [(83.53±8.28) U/L vs. (77.52±7.82) U/L, (83.25±3.25) μmol/L vs. (74.67±3.31) μmol/L, and (92.72±6.13) U/L vs. (85.68±5.21) U/L; all P<0.05]. The scores of the Montreal Cognitive Assessment Scale , Mini-Mental State Examination, and Modified Barthel Index in the oxiracetam group were higher than those in the control group (27.10±3.14 vs. 24.76±2.82, 23.45±2.85 vs. 21.13±2.43, and 53.56±7.45 vs. 49.97±6.56), and the score of the National Institutes of Health Stroke Scale was lower (12.69±1.44 vs. 15.78±1.52) (all P<0.05). Conclusion　Oxiracetam combined with aspirin and clopidogrel for patients with TIA is effective and has a significant impact on their neurological repair function.

Key words: Oxiracetam, , Aspirin, , Clopidogrel, , Transient ischemic attack, , Neurological function

郑春利刘蕾杨伟毅. 奥拉西坦联合阿司匹林及氯吡格雷对TIA疗效及神经修复功能的影响 [J]. 国际医药卫生导报, 2025, 31(12): 1948-1952.

Zheng Chunli, Liu Lei, Yang Weiyi.

Effect of oxiracetam combined with aspirin and clopidogrel for patients with TIA and its influence on neurological repair function [J]. International Medicine and Health Guidance News, 2025, 31(12): 1948-1952.

参考文献

[1]Mendelson SJ, Prabhakaran S. Diagnosis and management of transient ischemic attack and acute ischemic stroke: a review[J]. JAMA, 2021,325(11):1088-1098. DOI: 10.1001/jama.2020.26867.

[2]Lioutas VA, Ivan CS, Himali JJ, et al. Incidence of transient ischemic attack and association with long-term risk of stroke[J]. JAMA, 2021,325(4):373-381. DOI: 10.1001/jama.2020.25071.

[3]刘晓菲,刘晓娟.阿加曲班联合阿司匹林治疗短暂性脑缺血发作的疗效及对血流变学、血小板指标的影响[J].血栓与止血学,2022,28(3):585-586. DOI:10.3969/j.issn.1009-6213.2022.03.100.

[4]王从过,唐珊珊,马晶晶,等.长期服用阿司匹林预防缺血性脑卒中的有效性及安全性分析[J].蚌埠医学院学报,2022,47(10):1372-1376,1382. DOI:10.13898/j.cnki.issn.1000-2200.2022.10.010.

[5]郎驿天,朱春黎,陶文绮,等.氯吡格雷对比阿司匹林用于缺血性脑卒中二级预防的药物经济学评价[J].中国药房,2023,34(7):837-843. DOI:10.6039/j.issn.1001-0408.2023.07.13.

[6]陈美心,刘驰,付欢.丁苯酞联合奥拉西坦、多奈哌齐治疗老年卒中合并血管性痴呆患者的疗效[J].西北药学杂志,2024,39(5):102-107. DOI:10.3969/j.issn.1004-2407.2024.05.015.

[7]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.中国脑出血诊治指南(2019)[J].中华神经科杂志,2019,52(12):994-1005. DOI:10.3760/cma.j.issn.1006-7876.2019.12.003.

[8]张虎,第五永长,杨谦,等.中老年轻度认知功能障碍患者中医证候要素与MMSE及MoCA量表评分相关性研究[J].中华中医药杂志,2024,39(4):2021-2026.

[9]牛伟华,杨慧锋. MoCA和MMSE量表评估慢性心力衰竭患者认知功能障碍的应用比较[J].护士进修杂志,2022,37(20):1825-1828. DOI:10.16821/j.cnki.hsjx.2022.20.001.

[10]罗晓彬,陈坚帅,魏淑华.阿司匹林分别联合氯吡格雷、阿加曲班对短暂性脑缺血发作病人缺血修饰白蛋白、神经功能影响[J].蚌埠医学院学报,2023,48(12):1689-1692. DOI:10.13898/j.cnki.issn.1000-2200.2023.12.015.

[11]焦腾飞,肖书玲,杨晶,等. NIHSS评分及肺部感染预测缺血性脑卒中晚期癫痫发作的价值评估[J].脑与神经疾病杂志,2024,32(8):518-522.

[12]邹瑜聪,林炜明,周静,等.非医疗专业护工使用Barthel指数评估脑卒中患者日常生活活动能力的可行性分析[J].中国医药导报,2024,21(13):120-124. DOI:10.20047/j.issn1673-7210.2024.13.30.

[13]Shahjouei S, Sadighi A, Chaudhary D, et al. A 5-decade analysis of incidence trends of ischemic stroke after transient ischemic attack: a systematic review and meta-analysis[J]. JAMA Neurol, 2021,78(1):77-87. DOI: 10.1001/jamaneurol.2020.3627.

[14]邢波,侯冠昕,冯冠森,等.吲哚布芬联合氯吡格雷对比阿司匹林联合氯吡格雷在急性轻型脑卒中患者中的临床疗效观察[J].实用药物与临床,2024,27(4):265-270. DOI:10.14053/j.cnki.ppcr.202404005.

[15]何谷芬,肖子建,罗娜.阿司匹林辅助早期康复训练对老年缺血性脑卒中的疗效及对患者炎性因子、凝血和神经肢体运动功能的影响[J].中国老年学杂志,2023,43(11):2684-2687. DOI:10.3969/j.issn.1005-9202.2023.11.036.

[16]胡志强,魏巍,陶先明.桂枝茯苓丸加味联合氯吡格雷治疗痰瘀阻络型脑卒中有效性观察[J].湖北中医药大学学报,2023,25(1):20-23. DOI:10.3969/j.issn.1008-987x.2023.01.04.

[17]杜杰,王建民,杨建彬.血栓通注射液联合奥拉西坦对老年缺血性脑卒中的作用[J].西北药学杂志,2024,39(3):153-157. DOI:10.3969/j.issn.1004-2407.2024.03.028.

[18]刘化飞,唐松林.奥拉西坦联合倍他司汀对卒中后眩晕患者炎症因子及神经功能的影响[J].脑与神经疾病杂志,2023,31(1):48-52.

[19]段晓云,张辰慧,张宏,等.中风醒脑液联合奥拉西坦治疗老年缺血性脑卒中的临床效果[J].中国老年学杂志,2022,42(11):2618-2621. DOI:10.3969/j.issn.1005-9202.2022.11.005.

[20]李文玲,孟相营,张元媛,等.奥拉西坦辅助奥卡西平治疗老年脑卒中后癫痫临床观察[J].山东医药,2022,62(1):78-80. DOI:10.3969/j.issn.1002-266X.2022.01.019.

[21]陈佳,李偲,王鸿雁.项丛刺疗法联合吞咽康复训练对脑卒中吞咽障碍患者吞咽功能及血清BDNF、NGF、IGF-1的影响[J].武汉大学学报(医学版),2022,43(5):762-767. DOI:10.14188/j.1671-8852.2020.0722.

[22]康乐乐,苗婵婵,高海茸.司来吉兰联合多巴胺制剂对帕金森病患者的治疗效果及血清BDNF、NGF、IGF-1水平的影响[J].海南医学,2023,34(4):493-496. DOI:10.3969/j.issn.1003-6350.2023.04.007.

[23]侯道荣,刘振,崔斯童,等.丹参酮II-A通过调控TLR4/IκBα/NFκB信号通路抑制LPS诱导的细胞炎症[J].中国药理学通报,2021,37(2):210-214. DOI:10.3969/j.issn.1001-1978.2021.02.012.

[24]朱渝,谭勇,赵立波.双嘧达莫促进奥拉西坦对皮质下缺血性血管性痴呆的疗效并机制探讨[J].神经损伤与功能重建,2022,17(2):110-112. DOI:10.16780/j.cnki.sjssgncj.20210036.