Clinical study of antiplatelet therapy strategies in patients with symptomatic new-onset subcortical infarction
血栓弹力图在症状性新发皮质下梗死的脑小血管病患者抗血小板治疗策略的临床研究

摘要

目的 运用血栓弹力图（TEG）评价存在症状性新发皮质下小梗死的脑小血管病（CSVD）患者抗血小板治疗后脑微出血灶的变化以及抗血小板效果。方法 将存在症状性新发皮质下梗死的CSVD患者80例作为研究对象，随机分为A 组、B组，选择无新发皮质下梗死的CSVD患者40例为对照组，A组口服阿司匹林肠溶片，B组口服硫酸氢氯吡格雷片，对照组患者不使用抗血小板药物。A、B两组患者入组前、入组后6月均接受头颅核磁共振（MRI）、磁敏感加权成像（SWI）及TEG检查，对照组入组前后只接受头颅MRI、SWI检查。结果 三组患者治疗前脑微出血灶数量无统计学差异，治疗后A、B两组分别与对照组相比，分别与本组治疗前相比，差异均具有统计学意义。A、B两组治疗后，TEG参数R值、K值均高于治疗前，α角、MA值均低于治疗前。A、B两组患者在血小板抑制率疗效方面不存在差异性。A组和B组患者中血小板抑制率良好、有效、效果不良或无效三组之间比较，A组中良好、有效、效果不良或无效组分别与B组进行比较，脑微出血灶增加量均无明显差异。结论 阿司匹林肠溶片、硫酸氢氯吡格雷片在CSVD的二级预防中抗血小板聚集效果无明显差异，但均有可能促进脑微出血灶的发生，不同的血小板抑制率与脑微出血灶的增加无明显相关。

Abstract

Objective To use thrombohemogram (TEG) to evaluate the changes of cerebral microhemorrhage focus and antiplatelet effect in patients with symptomatic new-onset subcortical infarction (CSVD).
Methods 80 CSVD patients with symptomatic new subcortical infarction were taken as study subjects and randomly divided into group A and group B. 40 CSVD patients without new subcortical infarction were selected as the control group. In group A, oral aspirin enteropolated tablets, group B, and the control group did not use antiplatelet drugs. Patients in groups A and B underwent head MRI (MRI), magnetic sensitivity weighted imaging (SWI) and TEG examination before and 6 months after enrollment, while the control group only underwent head MRI and SWI examination before and after enrollment.
Results There was no significant difference in the number of cerebral microbleeding lesions in the three groups. Groups A and B were from the control group and the control group. After group A and B, R and K values of TEG parameters were higher than before treatment, and α angle and MA values were lower than before treatment. There was no difference in the efficacy of platelet inhibition rate between patients in groups A and B. By comparison between the three groups in group A and B were good, effective, ineffective or ineffective, or ineffective in group A and group B, there was no significant difference in the increase of cerebral microhemorrhage lesions.
Conclusion   There was no significant difference in antiplatelet aggregation effect between aspirin enteric-coated tablets and clopidogrel sulfate tablets in the secondary prevention of CSVD, but both may promote the occurrence of cerebral microbleeding foci, and different platelet inhibition rates were not significantly associated with the increase of cerebral microbleeding foci.