双联抗血小板治疗伴易损斑块的轻度症状性颈动脉狭窄的疗效和安全性

目的：探讨阿司匹林联合氯吡格雷治疗伴易损斑块的症状性颈动脉狭窄患者的疗效和安全性。方法利用颈动脉超声检查筛选205例存在颈动脉易损斑块，且颈动脉狭窄＜50％的缺血性卒中患者，随机分为阿司匹林治疗组（单抗组）102例和阿司匹林联合氯吡格雷治疗组（双抗组）103例，比较两组治疗90 d内外周血基质金属蛋白酶－9（MMP －9）的变化，以及卒中和血管性意外事件的发生率。结果治疗21 d后，双抗组血液中M M P －9浓度下降值高于单抗组[（77．26±13．71）ng／ml比（96．86±16．52）ng／ml ，P＜0．01]。双抗组90 d内脑梗死总复发率和同侧复发率均低于单抗组（3．88％比11．76％，P ＝0．035；1．94％比8．82％，P ＝0．029），两组对侧脑梗死复发率差异无统计学意义（1.94％比2．94％，P＝0．643）。双抗组同单抗组相比，出血事件（0．97％比0，P＞0．05）和急性冠脉综合征的发生率（1．94％比5．88％， P ＝0．145）差异均无统计学意义。结论对于伴易损斑块的症状性颈动脉狭窄患者，阿司匹林联合氯吡格雷双联抗血小板治疗相对阿司匹林单抗治疗更具优势。

Efficacy and safety of dual antiplatelet therapy in mild symptomatic carotid stenosis with vulnerable plaque

Objective To explore the efficacy and safety of dual antiplatelet therapy in mild symp‐tomatic carotid stenosis with vulnerable plaque .Methods Totals of 205 patients with symptomatic low -grade stenosis (<50% ) and vulnerable plaque were randomly divided into the mono antiplatelet group (102 cases) and the dual antiplatelet group (103 cases) .The changes of serum MMP -9 ,the incidence of stroke and the adverse vascular events were compared within 90 days .Results After 21 days of treat‐ment ,the declined MMP -9 level of the dual -group was higher than the mono -group [(96 .86 ± 16 .52) ng/ml vs (77 .26 ± 13 .71) ng/ml ,P< 0 .01] .The total and ipsilateral stroke recurrence rates of the dual-group was less than the mono -group (3 .88% vs 11 .76% ,P = 0 .035 ;1 .94% vs 8 .82% , P = 0 .029) ,while there was no significant difference on the contralateral stroke recurrence rates be‐tween two groups (1 .94% vs 2 .94% ,P= 0 .643) .There were no significant difference in the incidences of bleeding (0 .97% vs 0 ,P = 1 .000) and acute coronary syndrome (1 .94% vs 5 .88% ,P = 0 .145) . Conclusions Dual antiplatelet therapy may have an advantage over mono antiplatelet therapy for mild symptomatic carotid stenosis with vulnerable plaque .