Investigation Of The Effect Of Clopidogrel On Inflammatory Markers In Patients With Acute Ischemic Stroke

BackgroundAcute ischemic stroke is generalized cerebral infarction, with focal cerebral ischemic necrosis caused by acute cerebral insufficiency, so relevant clinical signs and symptoms turning up. Many clinical observations have found that the common reasons of acute ischemic stroke includes:(1)thrombopoiesis based on athermanous plaque;(2)Embolus includes the embolus of heart source and not the embolus of heart source;(3)vascular inflammatory, vascular injury. Chronic inflammatory has a great relationship with atherosclerosis:(1)Inflammatory is initiating agent of atherosclerosis, Inflammatory can cause vascular endothelial injury, activate macrophages and promote fat deposition, which lead the formation of early stage pathological changes;(2) Inflammation has a great relationship with plaques unstable,studys show that activated macrophages release organization degrading enzymes and matrix metalloproteinases,which can depredate fibrous cap of surface of plaques.(3)Inflammation plays part in vascular restenosis, inflammatory cells and inflammatory factors cause migration and hyperplasia, consequently vascular restenosis formation.Atherosclerosis is the main physiopathologic basis of heart cerebrovascular disease and chronic inflammation plays an important part in the origin and development of the whole process. So the role of inflammation in acute ischemic stroke is a hot issue in clinical study. Many studies have demonstrated that inflammation plays an important part in the origin and development of acute ischemic stroke, so how to restrain inflammation effectively is becoming universal focus in clinicians. External studies show that clopidogrel can lower inflammatory markers effectly:such as CD62P, CRP, ICAM-1, IL-6, ESR, et al.compared with aspirin, it has better clinical effect in acute ischemic stroke patients. But similar report has not founded inland. Observing dynamic variation of inflammatory marker in patients with acute ischemic stroke to investigate the effect of clopidogrel on serum levels of inflammatory markers in patients with acute ischemic stroke and mechanism, superiority of clopidogrel to treat acute ischemic stroke.Objective(1) To investigate the relationship between inflammatory factors and acute ischemic stroke.(2) To investigate the effect of clopidogrel on serum levels of inflammatory markers in patients with acute ischemic strokeMethod156acute ischemic stroke patients from May2010to December2010in neurology department of our hospital were enrolled. All patients were diagnosed according to diagnostic criteria reformulated by the fourth cerebrovascular disease meeting of china and proved by CT or MRI.They were divided into experimental group (n=82, clopidogrel75mg/d and control group (n=74, aspirin100mg/d).The level of hs-CRP, IL-6and P-selectin were measured; The score of neurological deficits before treatment and7d,14d after treatment were gained according to standard reformulated by the fourth cerebrovascular disease meeting of china.Results(1) There is no difference in basic clinical data between experimental and control group(P>0.05),including age,sex, body mass index, total cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, systolic blood pressure and diastolic blood pressure.(2) The scores of neurological deficits in two groups are20.79±6.97and20.68±7.03respectively, P>0.05.The scores of neurological deficits after treatment are lower than before treatment in two groups, P<0.05. The scores of neurological deficits in experimental group are significant lower than in control group after treatment.(3) Before treatment, all kinds of inflammatory factors have no statistical significance between two groups. The levels of inflammatory factors are higher after7d treatment than before treatment, P<0.05;they are lower in experimental group than in control group, P<0.05;But in14d, they are both lower than before treatment, they are still lower in experimental group than in control group, P<0.05.(4) Pearson relation analysis shows that levels of inflammatory factors positively correlated with the score of neurological deficits, r=0.563,0.478,0.467;all P<0.05.(5) The major complications in both groups is subcutaneous bleeder, they improved after reducing drug dose and drug withdrawal, receiving no special handling.9happened in experimental group (10.9%) and7in control group (9.5%), P>0.05.Conclusion(1) Inflammation plays an important part in pathological physiology process of acute ischemic stroke, detecting inflammatory marker in acute ischemic stroke patients and dynamic detection can reflect state of an illness and prognosis.(2)Clopidogrel can lower serum levels of inflammatory markers effectly, its curative effect is better than aspirin; its superiority is that clopidogrel not only has antiplatelet action, but also has obvious anti-inflammatory action.Clopidogrel has great effect in patients with acute ischemic stroke, Inflammatory inhibition may be one of the mechanisms. Clopidogrel has a great important clinical significance.