Ninety patients with acute cerebral infarction treated in Yidu Central Hospital of Weifang (Weifang, China) were analyzed. According to the different treatment plans of these patients, those treated with the combination of the two drugs were divided into group B (n=50), and those treated with aspirin alone were group A (n=40). Comparing the general clinical baseline data between group B and A, the difference was not significant (P>0.05) (Table I).

Inclusion criteria: All patients included in this study were diagnosed and treated in the above hospital, and were confirmed as cerebral infarction with complete clinical data.

Exclusion criteria: i) Patients suffering from serious endocrine diseases; ii) patients whose onset time and admission time exceed 6 h; iii) patients with gastrointestinal hemorrhage and gastrointestinal inflammation; iv) patients suffering from chronic liver diseases, adrenal gland diseases and serious heart diseases for a long time and (v) patients with long-term taboo symptoms related to surgical treatment of this disease.

The family members of the patients were informed by telephone, and an informed consent was signed voluntarily. The study was examined and approved by the Ethics Committee of Yidu Central Hospital of Weifang.

Group A: Patients were administered aspirin enteric-coated tablets (SFDA approval no: H20065051; Shenyang Shuangding Pharmaceutical Co., Ltd.) 100 mg/time, once a day for 3 weeks.

Group B: Patients were administered aspirin enteric-coated tablets combined with clopidogrel. Aspirin 100 mg/time was taken orally first, followed by clopidogrel sulfate tablets (SFDA approval no: H20000542; Shenzhen Salubris Pharmaceutical Co., Ltd.) 75 mg/time, once a day for 3 weeks.

A total of 4 ml venous blood was taken at two time points, before the first treatment and three weeks after treatment, in the fasting state of the patient. Serum was obtained by low speed centrifugation for 4–5 min at 1,800 × g at 4°C. Enzyme-linked immunosorbent assay was used to detect the expression level of hs-CRP (SFDA Approval no: 2400848; Getein Biotechnology Co., Ltd.) BIOBASE2000 automatic enzyme immunoassay analyzer (Jinan Xinbeixi Biotechnology Co., Ltd.) was used; radioimmunoassay was used to analyze the expression levels of sICAM-1 (item no: im-E10088; Shanghai Kanglang Biotechnology Co., Ltd.) and TNF-α (item no: JLC7047-96T; Wuhan MSK Biotechnology Co., Ltd.); DFM-96 radioimmunoassay γ counter (Hefei Zhongchen Light Industrial Machinery Co., Ltd.) was used.

The NIHSS scores of patients in group A and B before and after treatment were compared (NIH Stroke Scale, NIHSS) (13). Τhe levels of hs-CRP, TNF-α and sICAM-1 in blood samples taken from patients before and after treatment were compared between the two groups. Τhe adverse reactions after treatment, such as gastrointestinal hemorrhage, malignant vomiting, allergy and arrhythmia, were compared between the two groups.

The total effective rates of patients in group A and B were compared: Εvaluation criteria (14): i) Basic rehabilitation: dysfunction score reduced by 91–100% and degree of disability was 0; ii) markedly effective: dysfunction score reduced by 46–90%, while the degree of disability was between 1 and 3; iii) effective: dysfunction score reduced by 18–45%; iv) no change: dysfunction score decreased or increased <18%; v) deterioration: dysfunction score increased >18%; vi) death. Total effective rate = basic rehabilitation + markedly effective + effective.

SPSS 19.0 (SPSS, Inc., Chicago, IL, USA) was used for statistical analysis of comprehensive data, χ² test was used for counting data, and (mean ± SD) for measurement data. Paired t-test was used for comparison of expression level before and after treatment in the same group. The expression levels of groups A and B at the same time point were compared by independent-samples t-test. P-value <0.05 was considered to be statistically significant.

Basic conditions of group A and B, such as age, sex, hypertension, hyperlipidemia, diabetes, and personal habits (smoking and drinking), were compared, and had significant differences (P>0.05) (Table I).

i) Before treatment, the hs-CRP level of patients in group A was 62.89±12.05 mg/l, while that of patients in group B was 63.27±13.20 mg/l. There was no significant difference in hs-CRP level between the two groups before treatment (P>0.05). The post-treatment levels of the two groups were 40.39±10.37 mg/l and 22.59±7.65 mg/l, respectively, with significant difference (P<0.001). Comparing the levels of groups A and B after treatment, it was concluded that those of group B were significantly lower than those of group A after treatment (P<0.001) (Fig. 1).

ii) Before treatment, the TNF-α level of patients in group A was 18.14±3.13 μg/l, while that of patients in group B was 18.01±3.09 μg/l. There was no significant difference in hs-CRP level between the two groups before treatment (P>0.05). The post-treatment levels of the two groups were 11.19±2.01 μg/l and 6.13±1.79 μg/l respectively (P<0.001). Comparing the levels of groups A and B after treatment, it was concluded that group B was significantly lower than group A (P<0.001) (Fig. 2).

iii) Before treatment, the level of serum-related cytokine sICAM-1 in group A was 444.74±20.78 ng/ml, while that in group B was 448.31±22.01 ng/ml. There was no significant difference in hs-CRP levels between the two groups before treatment (P>0.05). The post-treatment levels of the two groups were 272.77±12.48 ng/ml and 230.59±20.03 ng/ml respectively, with significant difference (P<0.001). Comparing the levels of groups A and B after treatment, it was concluded that those of group B were significantly lower than those of group A (P<0.001) (Fig. 3).

Before treatment, the NIHSS score of patients in group A was 16.54±2.33, while that in group B was 16.72±2.29. There was no significant difference between the two groups before treatment (P>0.05). The post-treatment scores of the two groups were 7.18±0.72 and 3.43±0.67, respectively, with significant difference (P<0.001). NIHSS after treatment in group B was significantly lower than that in group A (P<0.001) (Fig. 4).

Clinical efficacy of patients in the two groups were compared. In group A, there were 6 cases of basic rehabilitation, 15 cases of markedly effective, 10 cases of effective, 9 cases without change, and no deterioration or death; its total effective rate was 77.5%. In group B, there were 9 cases of basic rehabilitation, 20 cases of markedly effective, 19 cases effective, 2 cases without change, and no deterioration or death; its total effective rate was 96%. The total effective rate of group B was significantly higher than that of group A, and the difference was significant (P<0.05) (Table II).

We observed the adverse reactions of gastrointestinal hemorrhage, malignant vomiting, allergy and arrhythmia. In group A, there were 3 cases of gastrointestinal hemorrhage, 6 cases of malignant vomiting, 3 cases of allergy and 7 cases of arrhythmia, totaling 19 cases (47.5%). In group B, there was 1 case of gastrointestinal hemorrhage, 1 case of malignant vomiting, 2 cases of allergy and 2 cases of arrhythmia, totaling 6 cases (12%). The incidence of adverse reactions in group B was significantly lower than that in group A, and the difference was significant (P<0.05) (Table III).