阿司匹林使用与腔梗长期的再发脑卒中减少有关  

Aspirin reduced long-term recurrent stroke in patients with lacunar stroke

作　　者：孔涛 陈敬洲[1] 孙凯[1] 张伟丽[1] 王继征[1] 汪道文[2] 秦勤 马爱群[4] 宋雷[1] 惠汝太 KONG Tao;CHEN Jin-zhou;SUN Kai;ZHANG Wei-li;WANG Ji-zheng;WANG Dao-wen;QIV qin;MA Ai-qun;SONG Lei;HUI Ru-tai(Fuwai Hospital National Center for Cardiovascular Disease,Chinese Academy of Medical Science and Peking Union Medical College,Beijing,100037,China)

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院心内科,北京市100037 [2]华中科技大学同济医学院附属同济医院心内科,武汉市430030 [3]天津胸科医院心内科,天津市300070 [4]西安交通大学医学院第一附属医院心内科,西安市710061

出　　处：《中国分子心脏病学杂志》2018年第5期2600-2605,共6页Molecular Cardiology of China

基　　金：国家重点基础研究发展计划(2006CB503800);国际科技合作项目(2009DFB30050)

摘　　要：目的腔隙性脑梗死患者长期预后不佳,再发脑卒中风险较高,但抗血小板治疗减少再发脑卒中风险的证据有限。我们在一个多中心的队列研究中,探讨阿司匹林治疗对腔隙性脑梗死患者再发脑卒中风险的长期影响。方法 2000年11月1日至2011年11月1日收集来自兖州、西安、重庆、武汉、北京、天津6个地区7个中心因脑卒中就诊,年龄为34-74岁的患者共2000人。入选患者分为3种类型脑卒中,分别为:脑血栓形成、腔隙性脑梗死及颅内出血。本研究中共有544例腔隙性脑梗死患者纳入分析。纳入分析的患者分为两组(使用阿司匹林组n=342,未使用阿司匹林组n=202)。研究使用Kaplan-Meier生存分析及COX分析阿司匹林使用与再发脑卒中风险的相关性。结果 544例患者平均随访4.1年,再发脑卒中患者99例,心血管事件125例,心血管死亡31例及全因死亡59例。Kaplan-Meier生存分析显示与未使用阿司匹林组相比,使用阿司匹林组患者有更低的再发脑卒中及心血管事件风险(log-rank test,P=0.049, 0.047)。COX向后逐步多因素回归分析显示阿司匹林使用显著减少腔梗患者再发脑卒中风险(HR=0.67, 95%CI:0.45-0.99, P<0.05)。结论阿司匹林显著减少腔梗患者长期再发脑卒中的风险。Objective Lacunar infarction showed an unfavorable prognosis in the long-term with a high recurrent stroke risk, aspirin has been widely used to prevent ischemic stroke but the effects of antiplatelet therapy on lacunar infarction is limited. We investigated the long-term effect of aspirin treatment on long-term(4-year follow up) stroke recurrence among patients with lacunar stroke in a multicenter prospective cohort.Methods Between November 2000 and November 2001, 2000 consecutive stroke patients(age 35-74 years) were recruited from seven clinical centers. 3 subtypes of stroke: cerebral thrombosis(thrombosis), lacunar infarction(lacunar), and ICH(Intracranial Hemorrhage) were recruited. In the present study,a total of 544 patients with lacunar stroke were finally included in the analysis. We divided these patients into 2 groups(aspirin,n=342 and no aspirin users, n=202).The association of aspirin treatment with stroke recurrence was evaluated using Kaplan-Meier analysis and Cox regression models. Results During a median 4.1-year follow-up for 544 stroke patients, the following major events occurred: recurrent strokes 99 patients, major vascular events(stroke, MI, vascular death) 125 cases, vascular deaths 31 cases and all-cause death 59 cases. Kaplan-Meier analysis showed that aspirin users had a higher probability of future recurrent stroke and vascular events compared with nonusers(log-rank test, P=0.049, 0.047, respectively). Multivariate stepwise Cox proportional hazard analysis with backward elimination showed that use of aspirin(HR = 0.67, 95% CI: 0.45-0.99, P < 0.05) significantly reduced the stroke recurrence in patients with lacunar stroke. Conclusion Compared with aspirin nonusers, aspirin provided a favorable effects on stroke recurrence, reduced stroke recurrence in patients with lacunar stroke.

关 键 词：腔隙性脑梗死 阿司匹林 再发脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]