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目的 研究比较替格瑞洛与氯吡格雷联合阿司匹林对糖尿病合并急性脑梗死(DACI)患者神经功能恢复及血管内皮生长因子(VEGF)、基质金属蛋白酶9(MMP-9)、血管紧张素Ⅱ(Ang-Ⅱ)的影响.方法 选取DACI患者193例,随机分为替格瑞洛组(97例)和氯吡格雷组(96例).在常规治疗的基础上,两组患者均给予阿司匹林肠溶片(100 mg·d-1,qd),同时分别给予替格瑞洛(90 mg·d-1,bid)或氯吡格雷(75 mg· d-1,qd),连续用药14 d.观察患者治疗前后美国国立卫生院神经功能缺损(NIHSS)评分、血小板聚集率和血清VEGF、MMP-9、Ang-Ⅱ水平变化情况.结果 与治疗前比较,两组NIHSS评分、血小板聚集率、MMP-9、Ang-Ⅱ水平均显著下降(P＜0.01),且替格瑞洛组NIHSS评分、血小板聚集率、MMP-9、Ang-Ⅱ水平明显低于氯吡格雷组(P＜ 0.05,P＜0.01);两组VEGF水平均显著上升(P＜0.01),且替格瑞洛组明显高于氯吡格雷组(P＜0.01).结论 替格瑞洛与氯吡格雷联合阿司匹林治疗均可改善DACI患者的神经功能,预防脑梗死发生,替格瑞洛效果优于氯吡格雷.“,”AIM To study the effect of ticagrelor and clopidogrel combined with aspirin on neurological function recovery and the levels of serum vascular endothelial growth factor (VEGF),matrix metalloproteinase9 (MMP-9),and angiotensin Ⅱ (Ang-Ⅱ) in patients with diabetes mellitus complicated acute cerebral infarction.METHODS Totally 193 patients were selected and randomly divided into ticagrelor group (97 patients) and clopidogrel group (96 patients).On the basis of conventional treatment,the ticagrelor group and clopidogrel group were respectively given ticagrelor (90 mg·d-1,bid) and clopidogrel (75 mg·d-1,qd) plus aspirin (100 mg·d-1,qd) for 14 days.The changes of National Institute of Health stroke scale (NIHSS) score,platelet aggregation rate,and the levels of VEGF,MMP-9 and Ang-Ⅱ in the patients were observed before and after the treatment.RESULTS Compared with before the treatment,the NIHSS scores,platelet aggregation rates,and levels of MMP-9 and Ang-Ⅱ of the two groups were decreased (P ＜ 0.01),and the ticagrelor group was significantly lower than the clopidogrel group (P ＜ 0.05,P ＜ 0.01);the VEGF levels of the two groups were increased (P ＜ 0.01),and the ticagrelor group was significantly higher than the clopidogrel group (P ＜0.01).CONCLUSION Both ticagrelor and clopidogrel combined with aspirin could improve neurologic function and prevent cerebral infarct in patients with diabetes mellitus complicated acute cerebral infarction,but ticagrelor is better than clopidogrel.