补阳还五汤联合阿司匹林治疗短暂性脑缺血发作时阿司匹林抵抗的临床研究

摘要

目的：对比观察补阳还五汤联合阿司匹林治疗短暂性脑缺血发作（transient ischemic attack，TIA）时阿司匹林抵抗的临床疗效。方法参照标准选取潍坊医学院附属医院2010年9月～2013年10月收治的TIA患者80例，分为实验组（n=40）与对照组（n=40）。实验组口服补阳还五汤和阿司匹林治疗，对照组患者服用氯吡格雷和阿司匹林治疗，采用比浊法分别检测各研究对象治疗前、治疗第30天、治疗第60天及治疗第90天的花生四烯酸（arachidonic acid，AA）和二磷酸腺苷（adenosine diphosphate，ADP）水平，随访观察2组治疗期间各时间段的TIA复发例数、脑梗死例数及不良反应事件（如皮肤黏膜出血、便血等）的发生情况。结果2组患者治疗第30天、治疗第60天及治疗第90天的ADP和AA值与治疗前相比均显著下降（P<0.05）。实验组治疗前、治疗第30天、治疗第60天及治疗第90天的ADP和AA值与对照组相比均无统计学差异；2组治疗90天内的复发率、脑梗死率与对照组均无统计学差异；2组治疗期间发生不良反应情况存在统计学差异（P<0.05）。结论补阳还五汤联合阿司匹林治疗短暂性脑缺血发作时阿司匹林抵抗的临床疗效与氯吡格雷联合阿司匹林治疗相当，但可降低不良反应事件的发生率。%Objective To observe and compare the clinical efifcacy of buyanghuanwu decotion combined with aspirin in treatment of aspirin resistance when transient ischemic attack(TIA). Methods 80 patients with TIA from September 2010 to October 2013 in Affiliated Hospital of Weifang Medical College were selected according to the standards and divided into two groups, with 40 cases in each group. Experimental group were orally administered with buyanghuanwu decotion and aspirin. Control group were orally administered with clopidogrel and aspirin. The levels of arachidonic acid (AA) and adenosine diphosphate (ADP) before therapy and in the 60 th and 90 th treatment day were detected by turbidimetry, respectively. Follow-up studies were performed to observe the recurrence numbers of TIA, cerebral infarction cases and adverse events, such as mucocutaneous hemorrhage and hemafacia in two groups during therapy. Results The levels of AA and ADP were decreased constantly with the therapy time in both two groups. The levels of ADP and AA in experimental group before therapy and in the 60 th and 90 th treatment day were not signiifcantly different from those in control group. No signiifcant differences of reoccurrence rate and the cerebral infarction rate were found between the two groups. However, there was statically signiifcant difference in the occurrence of adverse events between the two groups (P<0.05). Conclusion The clinical efifcacy of the combined treatment of buyanghuanwu decotion with aspirin shows no signiifcant difference with the combined treatment of clopidogrel and aspirin, but with lower incidence rate of adverse events.