老年男性脑出血患者重启抗血小板治疗对临床结局的影响  

Effect of restarting antiplatelet therapy on clinical outcomes in elderly male patients with intracranial hemorrhage

作　　者：朱子凡 陈建桥 石学志 李月蕊 李轶 郑瑾[1] 刘宏斌 ZHU Zi-Fan;CHEN Jian-Qiao;SHI Xue-Zhi;LI Yue-Rui;LI Yi;ZHENG Jin;LIU Hong-Bin(Department of Cardiology,Second Medical Center,Southern Medical Branch,Chinese PLA General Hospital,Beijing 100853,China;Yangfangdian Outpatient Department,Southern Medical Branch,Chinese PLA General Hospital,Beijing 100853,China;National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China;Chinese PLA Medical School,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第二医学中心心血管内科,北京100853 [2]中国人民解放军总医院京南医疗区羊坊店门诊部,北京100853 [3]中国人民解放军总医院国家老年疾病临床医学研究中心,北京100853 [4]解放军医学院,北京100853

出　　处：《中华老年多器官疾病杂志》2022年第9期641-645,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家重点研发计划(2020YFC2008304)。

摘　　要：目的探讨重启抗血小板治疗对老年男性脑出血(ICH)患者临床结局的影响。方法回顾性分析2006年1月至2021年12月解放军总医院第二医学中心收治的113例老年ICH男性患者的临床资料,根据是否重启抗血小板治疗,分为重启抗血小板组(Re-AP组,67例)和未重启抗血小板组(Non-AP组,46例)。收集患者基线资料和临床结局(缺血性血管事件、复发性ICH、全因死亡、血管性死亡)等。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验、Mann-Whitney U检验、χ^(2)检验或Fisher精确检验进行组间比较。采用单变量和多变量Cox比例风险回归模型分析临床结局事件的危险因素。结果与Non-AP组相比,Re-AP组患者房颤、服用他汀类药物的比例更高,脑叶出血的比例和血肌酐水平更低。重启抗血小板的中位时间为178(46,780)d。Cox多因素回归分析显示,重启抗血小板治疗与缺血性血管事件的风险降低独立相关(HR=0.377,95%CI 0.160~0.888;P=0.026);重启抗血小板治疗与复发性ICH的风险增加无关(HR=1.563,95%CI 0.767~3.184;P=0.219);重启抗血小板治疗与全因死亡(HR=0.734,95%CI 0.404~1.336;P=0.312)和血管性死亡(HR=0.454,95%CI 0.159~1.293;P=0.139)的风险增加无关;年龄(HR=1.100,95%CI 1.048~1.155;P=0.000)和血肌酐升高(HR=1.009,95%CI 1.005~1.014;P=0.000)是全因死亡的独立危险因素;血肌酐升高是血管性死亡的独立危险因素(HR=1.009,95%CI 1.001~1.017;P=0.028)。结论对于老年男性ICH患者,中位时间178 d后重启抗血小板治疗能够降低缺血性血管事件的风险,且不增加ICH复发的风险。。Objective To investigate the effect of restarting antiplatelet therapy on clinical outcomes in elderly male patients with intracranial hemorrhage(ICH).Methods Clinical data of 113 elderly male ICH patients admitted in the Second Medical Center of Chinese PLA General Hospital from January 2006 to December 2021 were collected and retrospectively analyzed.According to whether antiplatelet therapy was restarted,they were divided into restart antiplatelet group(Re-AP,n=67)and non-restart antiplatelet group(Non-AP,n=46).Their baseline data and clinical outcomes(ischemic vascular events,recurrent ICH,all-cause death,and vascular death)were recorded.SPSS statistics 26.0 was used for data analysis.Depending on the data types,student′s t test,Mann-Whitney U test,Chi-square test,or Fisher′s exact test was employed for comparison between groups.Univariate and multivariate Cox proportional hazards regression models were applied to analyze the risk factors for clinical outcome events.Results The Re-AP group had larger proportions of atrial fibrillation and statin use,and lower ratio of lobar hemorrhage and lower serum creatinine level than the Non-AP group.The median time to restart antiplatelet therapy was 178(46,780)d.Multivariate Cox regression analysis showed that restarting antiplatelet therapy was independently associated with a reduced risk of ischemic vascular events(HR=0.377,95%CI 0.160-0.888;P=0.026),but not associated with an increased risk of recurrent ICH(HR=1.563,95%CI 0.767-3.184;P=0.219),all-cause mortality(HR=0.734,95%CI 0.404-1.336;P=0.312)or vascular death(HR=0.454,95%CI 0.159-1.293;P=0.139).Age and elevated creatinine level were independent risk factors for all-cause mortality(HR=1.100,95%CI 1.048-1.155;P=0.000;HR=1.009,95%CI 1.005-1.014;P=0.000),and elevated serum creatinine level was an independent risk factor for vascular death(HR=1.009,95%CI 1.001-1.017;P=0.028).Conclusion In elderly male patients with ICH,restarting antiplatelet therapy after a median time of 178 d reduces the risk of ischemic vasc

关 键 词：老年人 脑出血 重启抗血小板治疗 缺血性血管事件 复发性ICH 全因死亡 血管性死亡 

分 类 号：R743.34[医药卫生—神经病学与精神病学]