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

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