摘要：

目的 探讨大脑中动脉微栓子信号与急性缺血性卒中的相关性，以及单联和双联抗血小板治疗效果。方法 采用经颅多普勒超声（TCD）监测129 例急性缺血性卒中患者大脑中动脉微栓子信号，单因素和多因素前进法Logistic 回归分析筛查微栓子信号阳性危险因素，阿司匹林单药或联合氯吡格雷双联抗血小板治疗，评价药物疗效和预后。结果 129 例患者中42 例（32.56%）微栓子信号阳性。Logistic 回归分析显示，高脂血症是微栓子信号阳性的独立危险因素（OR = 0.335，95%CI：0.147 ~ 0.764；P = 0.009）。经抗血小板治疗后，双抗组患者微栓子信号消失率高于单抗组（χ² = 16.701，P = 0.000）；与治疗前相比，两组患者治疗后NIHSS 评分减少（P = 0.000），与单抗组相比，双抗组患者治疗后NIHSS 评分亦减少（P = 0.025），表明抗血小板治疗有效且双联抗血小板治疗效果优于单抗治疗。结论 高脂血症是TCD 监测微栓子信号阳性的独立危险因素，双联抗血小板治疗可以阻止微栓子信号形成并改善患者近期预后。

关键词: 脑缺血, 超声检查, 多普勒, 经颅, 血小板聚集抑制剂

Abstract:

Objective  To explore the correlation between microembolic signals (MES) in middle cerebral artery (MCA) and the occurrence of acute ischemic stroke and also evaluate the clinical effect of single and dual antiplatlet therapy.  Methods  A total of 129 cases with acute ischemic stroke were tested by transcranial Doppler (TCD) ultrasonography to detect MES. Univariate and multivariate Logistic regression analysis were adopted to analyze and screen the positive risk factors for MES. Medication effects and prognosis were evaluated by treatment of aspirin and combination therapy of aspirin and clopidogrel.  Results  Among 129 patients, 42 patients (32.56% ) were detected MES positive. According to Logistic regression analysis, hyperlipidemia was the independent risk factor of patients with MES positive (OR = 0.335, 95%CI: 0.147-0.764; P = 0.009). After antiplatelet treatment, the disappearence rate of MES was higher in the dual-therapy treatment group than that in the monotherapy group ( χ² = 16.701, P = 0.000). The NIHSS score decreased significantly after 14 d of treatment in both groups (P = 0.000). The decrease of NIHSS score in dual-therapy group was more than that in monotherapy group (P = 0.025). It proves the effectiveness of antiplatelet treatment and the advantage of dual antiplatelet is superior to single antiplatelet.  Conclusions  This study demonstrated that hyperlipidemia is the independent risk factor for MES positive detected by TCD and dual-therapy can inhibit the formation of MES and improve the recent prognosis.

Key words: Brain ischemia, Ultrasonography, Doppler, transcranial, Platelet aggregation inhibitors