| Objective: To evaluate the effect of Argatroban in treating perforating infarction,whether it is superior to the DAPT treatment.Evaluation of perforating infarction with different etiology and location by 3.0T high resolution magnetic resonance imaging,to analyze the efficacy and possible mechanism of Argatroban and DAPT in treating infarct of perforating branches of different etiology and different parts.Methods:From January 2016 to January 2018,the Second Affiliated Hospital of Nanchang University was admitted to the Department of Neurology.For the first time,the clinical diagnosis of ischemic stroke is in line with the standard set by the Fourth National Conference on cerebrovascular diseases in 1995.The onset time is 6h-48 h,age is 18 years old-80 years old,sex is not limited.Magnetic resonance imaging sequences(including T1 WI,T2WI,T2-FLAIR,3D-TOF-MRA,DWI)were used to check 76 patients with the criteria of perforating artery infarction according to the CISS classification principle.Randomly divided into argatroban treatment group(37 cases,2 cases not completed,35 cases completed)and aspirin combined with clopidogrel treatment group(39 cases in group,36 cases completed).The general clinical data were collected,Before treatment,NIHSS was used to assess neurological deficit and Barthel index(BI)to assess activities of daily living(ADL).NIHSS scores were scored again on first days,third days,1 weeks,fourteenth days and 90 days after treatment,and ADL and improved mRS for 90 days,and the safety of mRS at 90 days.Before treatment,the subgroup analysis of 3.0T MRI for the patients with perforating branch area infarction was divided into the carrier artery stenosis group(including the vulnerable plaque or the stenosis >50%)and the carrier artery stenosis group according to the stenosis of the carrier artery(the proximal intracranial responsible vessels),and the subgroup analysis according to the anterior circulation perforator infarction and the posterior ring perforator infarction group.Objective to analyze the effect of argatroban on Perforating infarction and analyze the difference of therapeutic effect caused by different mechanisms.All data were analyzed by SPSS21.0.Results:1.From January 2016 to January 2018,a total of 76 patients were included,of which there were 37 cases of argatroban group(2 cases uncompleted),35 cases in the actual group,39 cases of double resistance group(3 cases uncompleted),36 cases in the actual group,and 71 patients in the total group.Two groups of age,sex,hypertension,diabetes,hyperlipidemia,smoking and drinking history,before treatment,blood lipid,liver and kidney function,coagulation function,carrier artery stenosis and the proportion of each group were not statistically significant(p> 0.05).2.Compared with before treatment,the NIHSS score of Argatroban group was significantly improved on the third day after treatment.To the ninetieth day follow-up,the NIHSS score(F=19.834,p <0.001)and BI score(t=-11.897,p <0.001)were significantly improved.The difference was statistically significant,and no patient had a progressive stroke.The NIHSS score was significantly improved after 1 weeks of DAPT treatment.At the ninetieth day follow-up,the NIHSS score(F=18.523,P<0.001)and the BI score(t=--11.684,p <0.001)were significantly improved,of which 1 were progressed in second days(1/36).In the first,third,seventh,fourteenth,and ninetieth day NIHSS scores of the Argatroban group and the double resistance group,the third day effect of the Argatroban group was better than the double resistance group,and the difference was statistically significant(t=-2.296,p =0.025).The difference was not statistically significant after March(t=-0.602,p=0.549).After March,the comparison between the mRS groups was compared.The number of mRS < 1 in the agate group was 20(more than 12),and the difference between the 2 groups was statistically significant(c2=4.064,p =0.044)..3.It was found that there was no statistical difference in the time segments of vs carrier artery stenosis(P > 0.05),according to the comparison of the group of carrier artery stenosis group.There was a significant difference in the NHISS score of vs group without stenosis after seventh days(t=-2.721,P=0.01),But there was no significant difference in NHISS score between 90 days(t=-1.733,p=0.092).There was no statistical difference(t=-1.733,p =0.092);there was a statistically significant difference(t=-2.557,p =0.021)at the 3 day(t=-2.557,p =0.021)of the carrier artery without stenosis of carrier artery in Argatroban group without stenosis of vs double resistance group(t=-2.557,p =0.021),and at 90 days(t=-2.137,p =0.041).There was no significant difference in DAPT at each time interval.4.There was a significant difference in the NHISS score between the anterior circulation and the posterior circulation of the Argatroban group in 90 days(t=2.180;p =0.030),and the posterior circulation group was superior to the anterior circulation group;there was no statistical difference between the pre circulation and the posterior circulation in each time period(p > 0.05),and there was no difference between the front cycle of the Argatroban group and the pre cycle of the double anti group.The difference(p > 0.05)was significant.There was a significant difference between the posterior circulation of the Argatroban group and the double resistant group at third days(t=-2.408;p =0.022)and 90 days(t=-2.072;p =0.047),and there was no significant difference between the whole and the posterior circulation group(p > 0.05).5.There was no statistical difference between the whole group before treatment and 1 weeks after treatment(p > 0.05).The APTT was a statistical difference between before and after argatroban treatment(p < 0.05),but in the safety range,there were 1 cases of gingival bleeding in argatroban group and the monitoring of coagulation function in the safety range.There was no bleeding after 12 hours of drug withdrawal.No serious bleeding and other adverse events occurred during the two groups.No adverse events occurred in the two groups during the follow-up period.Conclusion: Argatroban and DAPT are safety and effective for the perforating regional infarction within 6 hours and 48 hours,On the third day of treatment,Argatroban was more effective than DAPT.;the forward treatment may obtain better neural function improvement;The effect of Argatroban on treatment of simple perforating infarction without artery stenosis was more significant than DAPT.For patients with posterior circulation perforating artery infarction,argatroban is better than the DAPT. |
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