不同抗血小板方案治疗轻型急性脑卒中的安全性和有效性比较  

Comparison of safety and efficacy of different antiplatelet regimens in minor acute

作　　者：邓婷 张通[1] 芦海涛[2] 姚晓华[1] 刘芦姗[1] 刘小蒙 陈敬绵[1] DENG Ting;ZHANG Tong;LU Haitao;YAO Xiaohua;LIU Lushan;LIU Xiaomeng;CHEN Jingmian(Department of Emergency,China Rehabilitation Research Center Beijing Boai Hospital,Beijing,100068,China;Department of Neurology,China Rehabilitation Research Center Beijing Bo'ai Hospital)

机构地区：[1]中国康复研究中心北京博爱医院急诊科,北京100068 [2]中国康复研究中心北京博爱医院神经内科

出　　处：《临床急诊杂志》2023年第5期237-242,共6页Journal of Clinical Emergency

摘　　要：目的:探讨3种不同抗血小板方案治疗轻型急性缺血性脑卒中(acute ischemic stroke, AIS)的安全性和有效性,以便对AIS进行更精准的抗血小板治疗。方法:登记2017年1月1日-2019年12月31日期间我院急诊科诊治的轻型AIS患者资料,根据治疗方案不同分为单抗组[单抗血小板治疗(SAPT)+瑞舒伐他汀]、21 d双抗组[21 d双抗血小板治疗(DAPT)+瑞舒伐他汀]和7 d双抗组(7 d DAPT+强化瑞舒伐他汀)。主要观察指标为随访90 d内再发脑梗死事件、出血事件,以及他汀相关性肝损害和他汀相关性肌病(statin-associated myopathy, SAM)。结果:(1)再发脑梗死比较:单抗组26例(20.00%),21 d双抗组4例(5.97%),7 d双抗组7例(8.05%);与单抗组比较,21 d双抗组(HR=0.271,95%CI:0.095~0.776,P=0.015)及7 d双抗组(HR=0.367,95%CI:0.159~0.847,P=0.019)明显降低了再发脑梗死风险;而21 d双抗组与7 d双抗组比较差异无统计学意义(HR=0.737,95%CI:0.216~2.518,P=0.627)。(2)出血事件比较:单抗组1例(0.77%),21 d双抗组6例(8.96%),7 d双抗组2例(2.30%),3组比较差异有统计学意义(χ2=8.198,P=0.008);21 d双抗组与单抗组比较,差异有统计学意义(P=0.007),7 d双抗组与单抗组比较,差异无统计学意义(P=0.566);尽管21 d双抗组与7 d双抗组比较,差异无统计学意义(P=0.079),但21 d双抗组出血事件发生率(8.96%)明显高于7 d双抗组(2.30%)。(3)随访期间3组患者中均未发现他汀相关性肝损害和SAM病例。结论:7 d DAPT+强化瑞舒伐他汀是轻型AIS最佳治疗方案,在降低再发脑梗死风险方面与21 d DAPT+瑞舒伐他汀方案具有同等效应,且极少导致出血及他汀相关性肝损害及SAM等不良事件的发生。Objective:The aim of this study was to evaluate the safety and efficacy of three different antiplate-let regimens in minor acute ischemic stroke(AIS),in order to provide a more accurate antiplatelet therapy for AIS.Methods:Patients with minor AIS in the emergency department of our hospital from January 2017 to De-cember 2019 were registered and divided into three groups according to the different therapy regimens:single anti-platelet therapy(SAPT)group(SAPT+rosuvastatin),21-day dual antiplatelet therapy(DAPT)group(21-day DAPT+rosuvastatin),and 7-day DAPT group(7-day DAPT+intensive rosuvastatin).The primary outcomes were recurrent cerebral infarction,bleeding events,statin-induced liver injury and statin-associated myopathy(SAM)during 90-day follow-up in an intention-to-treat analysis.Results:ORecurrent cerebral infarction:there were 26 cases(20.00%)in the SAPT group,4 cases(5.97%)in the 21-day DAPT group,and 7 cases(8.05%)in the 7-day DAPT group;Compared to the SAPT group,the risk of recurrent cerebral infarction was significantly reduced in the 21-day DAPT group(hazard ratio[HR],0.271;95%confidence interval[CIJ,0.095-0.776;P=0.015)and the 7-day DAPT group(HR,0.367;95%CI,0.159-0.847;P=0.019),while there was no signifi-cant difference between the 21-day DAPT group and the 7-day DAPT group(HR,0.737;95%CI,0.216-2.518;P=0.627).@Bleeding events:there was 1 case(0.77%)in the SAPT group,6 cases(8.96%)in the 21-day DAPT group,and 2 cases(2.30%)in the 7-day DAPT group.There was a significant difference between the three groups(x?=8.198,P=0.008);There was a statistically significant difference between the 21-day DAPT group and the SAPT group(P=0.007),while there was no significant difference between the 7-day DAPT group and the SAPT group(P=0.566);Although there was no significant difference between the 21-day DAPT group and the 7-day DAPT group(P=0.079),the incidence of bleeding events in the 21-day DAPT group(8.96%)was significantly higher than that in the 7-day DAPT group(2.30%).?No cases of statin-induced liver injury

关 键 词：抗血小板治疗 强化瑞舒伐他汀 轻型急性脑卒中 再发脑梗死 

分 类 号：R743.3[医药卫生—神经病学与精神病学]