硫酸氢氯吡格雷联合西洛他唑治疗下肢动脉硬化闭塞症的随机对照临【摘要】目的评价硫酸氢氯吡格雷联合西洛他唑治疗下肢动脉硬化闭塞症（PAD）的有效性及安全性。方法84例未行血管腔内成形术或血管重建手术的下肢动脉硬化闭塞症患者，随机分为对照组和治疗组，各42例。所有患者均采用保守治疗，给予甲钴胺+硫辛酸+丹红注射液+前列地尔，均为静脉给药。对照组同时给予西洛他唑治疗，治疗组在对照组基础上给予氯吡格雷治疗，首次600mg，后150mg/d连续7d，后改为75mg/d连续8周。评价PAD治疗疗效、血流动力学及下肢溃疡坏死发生率。结果治疗组与对照组显效率对比（81.0%VS52.4%，P=0.026）、总有效率对比（97.6%VS85.7%，P=0.048），治疗组均显著高于对照组，两组比较差异具有统计学意义（P<0.05）。治疗组6个月内再次发生溃疡坏疽发生率为2.4%，对照组为7.1%，两组发生率比较差异无统计学意义（P>0.05）。治疗组与对照组踝肱指数（ABI）改善程度对比[（0.9±0.2）VS（0.8±0.3）]、足背动脉最大血流速度对比[（37.6±3.8）VS（32.4±2.9）]cm/s，?N动脉最大血流速度对比[（67.2±8.6）VS（55.4±5.4）]cm/s，治疗组改善均优于对照组，两组比较差异具有统计学意义（P<0.05）。两组血小板聚集率分别为[（29.2±15.2）VS（39.2±11.7）]%，差异具有统计学意义（P<0.05）。氯吡格雷治疗并未明显增加不良反应。结论氯吡格雷联合西洛他唑治疗PAD有效安全，可预防下肢溃疡坏死发生率，可作为PAD的联合治疗方案。【关键词】氯吡格雷;下肢动脉病变;临床研究DOI：10.14163/jki.11-5547/r.2015.04.006ResearchofrandomizedcontrolclinicalexperimentonclopidogrelhydrogensulfatecombinedwithcilostazolinthetreatmentofperipheralarterialdiseaseZHOUBai-li，ZHOUQing-hai，XUHai-feng，etal.QinghaiProvincePeople’sHospital，Xining810007，China【Abstract】ObjectiveToevaluatetheeffectivenessandsafetyofclopidogrelhydrogensulfatecombinedwithcilostazolinthetreatmentofperipheralarterialdisease（PAD）.MethodsTherewere84PADpatients，whodidnotundergopercutaneoustransluminalangioplastyorvascularreconstruction，andtheywererandomlydividedintocontrolgroupandtreatmentgroupwith42casesineachgroup.Allthepatientsreceivedconservativetreatmentbyintravenousadministrationofmecobalamine+lipoicacid+Danhonginjection+alprostadil.Thecontrolgroupwastreatedbycilostazolaswell，whilethetreatmentgroupreceivedadditionalclopidogrelby600mgatthefirsttime，andthenby150mg/dfor7d，andlaterby75mg/dfor8weeks.ThecurativeeffectofPADtreatment，haemodynamics，andincidenceoflowerlimbulcernecrosiswereevaluated.ResultsTheexcellenteffectrateofthetreatmentgroupandthecontrolgroup（81.0%VS52.4%，P=0.026），andthetotaleffectiverateofthetwogroup（97.6%VS85.7%，P=0.048）wereallhigherinthetreatmentgroupthanthecontrolgroup.Thedifferencehadstatisticalsignificancebetweenthetwogroups（P<0.05）.Theincidenceofrecurrentulcersandgangrenewas2.4%inthetreatmentgroup，and7.1%inthecontrolgroup.Therewasnostatisticallysignificantdifferencebetweenthetwogroups（P>0.05）.Thetreatmentgrouphadlargerimprovementinanklebrachialindex（ABI）[（0.9±0.2）VS（0.8±0.3）]，dorsalispedisarterymaximumbloodflowvelocity[（37.6±3.8）VS（32.4±2.9）]cm/s，andpoplitealarterymaximumbloodflowvelocity[（67.2±8.6）VS（55.4±5.4）]cm/sthanthecontrolgroup，andthedifferencebetweenthetwogroupshadstatisticalsignificance（P<0.05）.Theplateletaggregationratesofthetwogroupswere[（29.2±15.2）VS（39.2±11.7）]%，andthedifferencehadstatisticalsignificance（P<0.05）.Treatmentbyclopidogreldidnotobviouslyincreasetheadversereactions.ConclusionThecombinationofclopidogrelandcilostazoliseffectiveandsafeintreatingPAD，anditcanre...