To investigate the clinical assessment of dual-enhanced antiplatelet therapy after cerebrovascular intervention to reduce the risk of cerebral infarction recurrence, and to provide a reference for the prevention and treatment of cerebral infarction recurrence risk. 202 patients with cerebral infarction who underwent cerebrovascular intervention in Tianjin Fifth Central Hospital from January 2018 to October 2022 were selected as study subjects. The patients were divided into a treatment group (n=104) based on randomized controlled single-blind method with 61 males and 43 females with a mean age of (62.33±2.57) years old and a control group (n=98) with 56 males and 42 females with a mean age of (62.49±2.36) years old. The control group was given aspirin mono-antiplatelet therapy, and the treatment group was given clopidogrel doublet augmented antiplatelet therapy on the basis of the control group, and both groups continued the treatment for 2 months. Platelet counts, coagulation indexes and inflammatory factors were compared between the two groups before and after treatment, and the America National Institutes of Health Stroke Scale (NIHSS) score was used to assess the neurological functions of the two groups before and after treatment, and the recurrence of cerebral infarction in the two groups was counted within 6 months after treatment. In addition, the patients in the treatment group were divided into the cerebral infarction recurrence group and the cerebral infarction non-recurrence group according to whether they had cerebral infarction recurrence within 6 months after treatment, and the clinical data of the patients in the treatment group were collected to analyze the influencing factors of the dual-enhancement antiplatelet therapy for the recurrence of cerebral infarction in patients with cerebral infarction after cerebral vascular intervention by multifactorial logistic regression. The results showed that after treatment, patients in the treatment group had an international normalized ratio (INR) of (1.76±0.38), a platelet activation rate of (39.52±4.79)%, a platelet aggregation rate of (48.54±5.21)%, a tumor necrosis factor-alpha (TNF-alpha) of (28.37±4.47)ng/L, an interleukin 6 (IL-6) of (24.77±3.52)ng/L, a high-sensitivity C-reactive protein (hs-CRP) of (7.39±1.53)mg/L and an NIHSS score of (6.11±1.39) were lower than those of the control group (2.32±0.41), (44.81±6.37)%, (51.39±5.58)%, (39.66±4.51) ng/L, (29.25±4.04) ng/L, (9.03±1.78) mg/L and (9.93±1.46) points (all P<0.05). At 6-month follow-up of all patients, cerebral infarction recurred in 16 (15.38%) patients in the treatment group and in 33 (33.67%) patients in the control group (χ2=9.185, P<0.05). Kaplan-Meier results showed a statistically significant difference in the rate of recurrence without cerebral infarction in the treatment group compared with the control group(LogRank χ2=4.595,P<0.05). Logistic regression analysis showed that smoking history, cervical vascular plaque, post-treatment NIHSS score, post-treatment stenosis score, post-treatment INR, post-treatment hs-CRP and CYP2C19 gene polymorphism were independent influences on the recurrence of cerebral infarction in cerebral infarction patients with cerebral vascular interventions followed by doublet augmentation of antiplatelet therapy (all P<0.05). In conclusion, dual-enhanced antiplatelet therapy may be an effective measure to reduce the risk of cerebral infarction recurrence after cerebrovascular intervention in patients with cerebral infarction, but it is still influenced by more factors.
探讨脑血管介入治疗后双联增强抗血小板治疗对降低脑梗死再发风险的临床应用，为防治脑梗死再发风险提供参考。选取2018年1月至2022年10月在天津市第五中心医院行脑血管介入治疗的202例脑梗死患者作为研究对象，根据随机对照单盲法将患者分为治疗组（n=104），其中男性61例，女性43例，年龄（62.33±2.57）岁；对照组（n=98），男性56例，女性42例，年龄（62.49±2.36）岁。对照组给予阿司匹林单抗血小板治疗，治疗组在对照组基础上再予以氯吡格雷双联增强抗血小板治疗，两组均持续治疗2个月。对比两组治疗前后的血小板活性指标及炎症因子，并采用美国国立卫生研究院卒中量表（NIHSS）评分评估两组治疗前后的神经功能，并统计两组患者治疗后6个月内脑梗死再发情况。另将治疗组患者根据治疗后6个月内是否脑梗死再发分成脑梗死再发组、脑梗死未再发组，收集治疗组患者的临床资料，多因素logistic回归分析脑梗死患者脑血管介入治疗后双联增强抗血小板治疗脑梗死再发的影响因素。结果显示，治疗后，治疗组患者的国际标准化比值（INR）为（1.76±0.38）、血小板活化率为（39.52±4.79）%、血小板聚集率为（48.54±5.21）%、肿瘤坏死因子α（TNF-α）为（28.37±4.47）ng/L、白细胞介素6（IL-6）为（24.77±3.52）ng/L、高敏C反应蛋白（hs-CRP）为（7.39±1.53）mg/L及NIHSS评分为（6.11±1.39）分均低于对照组（2.32±0.41）、（44.81±6.37）%、（51.39±5.58）%、（39.66±4.51）ng/L、（29.25±4.04）ng/L、（9.03±1.78）mg/L、（9.93±1.46）分（P均<0.05）。对所有患者进行6个月的随访，治疗组有16例（15.38%）患者脑梗死再发，对照组有33例（33.67%）患者脑梗死再发（χ2=9.185，P<0.05）。Kaplan-Meier结果显示，治疗组与对照组的无脑梗死再发率对比，差异有统计学意义（LogRank χ2=4.595，P<0.05）；logistic回归分析显示，吸烟史、颈部血管斑块、治疗后NIHSS评分、治疗后血管狭窄评分、治疗后INR、治疗后hs-CRP及CYP2C19基因多态性均是脑梗死患者脑血管介入治疗后双联增强抗血小板治疗脑梗死再发的独立影响因素（P均<0.05）。综上，双联增强抗血小板治疗可能是有效降低脑梗死患者脑血管介入治疗后脑梗死再发风险的措施，但仍受较多因素影响。.