脑梗死溶栓后24小时内抗血小板治疗对血栓、出血状态的影响及其机制

Intravenous thrombolysis is one of the confirmed effective treatment for acute brain infarction, but there are still cerebrovascular reocclusions occurred in some patients within 24h after thrombolysis. Because the activation and agrregation of platelet is one of the key factors for cerebrovascular reocclusion, study on the role and mechanism of antipletelet treatment within 24h after thrombolysis for brain infarction on the status of thrombosis and bleeding is of great imporrtance for prevention and treatment of cerebrovascular reocclusion or cerebral hemorrhage. Recent studies showed that antiplatelet treatment prior to intravenous thrombolysis increased the risk of cerebral hemorrhage, but significantly reduced the risk of cerebrovascular reocclusion, which reduces the rate of death and disability in patients with brain infarction. Till now, there is no studies on the role and mechanism of antipletelet treatment within 24h after thrombolysis for brain infarction on the status of thrombosis and bleeding. Therefore, we propose the hypothesis: the abnormal status of thrombosis and bleeding is one of the key mechanisms for cerebrovascular reocclusions or cerebral haemorrhage; there may be a safe and effective antiplatelet treatment within the 24h after thrombolysis. Based on our previous studies, using experimental study in rabbits with brain infarction and cohort study in patients with brain infarction, employing various means of evaluating the status of thrombosis and bleeding, this study will systematically explore the role and mechanism of antipletelet treatment within 24h after thrombolysis for brain infarction. This study will provide some theoretical and experimental evidence on timely addition of antiplatelet therapy after thrombolysis, and which has important clinical significance for reduceing the risk of death and disability of patients with brain infarction.

静脉溶栓是急性脑梗死确证有效的首要治疗措施，溶栓后24h内发生血管再闭塞是较多患者面临的重大临床问题。文献报道及我们的前期研究显示溶栓后血小板的持续激活聚集是血管再闭塞的关键因素之一，故探讨溶栓后24h内抗血小板治疗对血栓、出血状态的影响及其机制，对防治脑梗死溶栓后血管再闭塞或脑出血非常重要，但目前未见脑梗死溶栓后24h内抗血小板治疗对血栓、出血状态影响及其机制的系统研究。综上，我们提出假说：脑梗死溶栓后24h内血栓、出血状态异常是血管再闭塞或脑出血的重要机制之一，可能存在安全有效的早期抗血小板治疗时机。本研究基于前期研究基础，采用脑梗死溶栓兔的实验研究和脑梗死溶栓患者的观察研究，利用多种检测手段，系统研究脑梗死溶栓后24h内抗血小板治疗对血栓、出血状态的影响及其机制，为及时加用抗血小板治疗奠定理论与实验依据，对降低脑梗死静脉溶栓患者的死亡和残疾风险具有重要意义。

本研究基于前期研究基础，采用脑梗死溶栓兔的实验研究和脑梗死溶栓患者的观察研究，利用多种检测手段，系统研究脑梗死溶栓后24h内抗血小板治疗对血栓、出血状态的影响及其机制。本研究主要结果：（1）静脉溶栓前抗血小板治疗可以降低溶栓后24h内血小板聚集功能，有改善脑血管再通的趋势，但并不增加溶栓后出血风险。（2）脑梗死兔静脉溶栓后24小时内抗血小板治疗可以降低溶栓后24h内血小板聚集功能，可以改善脑血管再通，但并不增加脑梗死兔溶栓后出血风险。本研究主要结果为临床脑梗死溶栓患者24小时内及时加用抗血小板治疗奠定理论与实验依据，对降低脑梗死患者的死亡和残疾风险具有重要意义。