阿司匹林与氯吡格雷双重抗血小板治疗对合并微小未破裂颅内动脉瘤的轻型缺血性卒中的有效性和安全性:与单用阿司匹林的比较  

Efficacy and safety of dual antiplatelet therapy with clopidogrel and aspirin for minor ischemic stroke with tiny unruptured intracranial aneurysm:comparison with aspirin alone

作　　者：李晨曦 王会亮 张效峰 韩继兰[2] 范凌燕 杜业亮[2] 邢国平[2] Li Chenxi;Wang Huiliang;Zhang Xiaofeng;Han Jilan;Fan Lingyan;Du Yeliang;Xing Guoping(School of Clinical Medicine,Shandong Second Medical University,Weifang 261042,China;Department of Neurology,Weifang People's Hospital,Weifang 261041,China)

机构地区：[1]山东第二医科大学临床医学院,潍坊261042 [2]潍坊市人民医院神经内科,潍坊261041

出　　处：《国际脑血管病杂志》2024年第9期661-667,共7页International Journal of Cerebrovascular Diseases

基　　金：潍坊市科技发展计划项目(2021YX085)。

摘　　要：目的探讨双重抗血小板治疗(dual antiplatelet therapy,DAPT)对合并微小未破裂颅内动脉瘤(unruptured intracranial aneurysm,UIA)的轻型缺血性卒中(minor ischemic stroke,MIS)患者的有效性和安全性。方法回顾性纳入2022年10月1日至2024年2月29日潍坊市人民医院神经内科收治的合并微小UIA的MIS患者。MIS定义为基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分≤3分。微小UIA定义为直径≤3 mm的UIA。根据抗血小板治疗方案分为阿司匹林单药治疗组和阿司匹林+氯吡格雷DAPT组。主要转归指标为发病后90 d时的临床转归,改良Rankin量表(modified Rankin Scale,mRS)评分0~1分定义为转归良好,>1分定义为转归不良。次要转归指标包括动脉瘤破裂、脑出血和脑缺血事件复发。应用多变量logistic回归分析确定转归不良的独立影响因素。结果共纳入183例合并微小UIA的MIS患者。男性108例(59.0%),中位年龄68岁(四分位数间距:61~73岁);UIA均为单发性;所有患者发病前mRS评分均为0分;发病后90 d时,152例(83.1%)转归良好,31例(16.9%)转归不良,无病例发生UIA破裂出血。94例(51.4%)仅口服阿司匹林,随访期间14例(14.9%)复发脑缺血事件,73例(77.7%)转归良好;89例(48.6%)为DAPT,随访期间出现5例(5.6%)复发脑缺血事件,79例(88.8%)转归良好。阿司匹林组脑缺血事件复发率显著高于DAPT组(χ^(2)=4.227,P=0.040),而转归良好率显著低于DAPT组(χ^(2)=4.006,P=0.045)。多变量logistic回归分析显示,基线NIHSS评分是转归不良的独立危险因素(优势比4.597,95%置信区间1.864~11.339;P=0.001),而DAPT是转归良好的独立保护因素(优势比0.265,95%置信区间0.079~0.892;P=0.032)。结论与单用阿司匹林比较,合并微小UIA的MIS患者阿司匹林与氯吡格雷短期联合应用可改善转归,减少脑缺血事件复发,且安全性良好。Objective To investigate the efficacy and safety of dual antiplatelet therapy(DAPT)in patients with minor ischemic stroke(MIS)and tiny unruptured intracranial aneurysm(UIA).Methods Patients with MIS and tiny UIA admitted to the Department of Neurology,Weifang People's Hospital from October 1,2022 to February 29,2024 were included retrospectively.MIS was defined as baseline National Institutes of Health Stroke Scale(NIHSS)score≤3.Tiny UIA was defined as UIA with a diameter of≤3 mm.According to the antiplatelet therapy regimen,the patients were divided into an aspirin alone group and an aspirin+clopidogrel DAPT group.The main outcome measure was the clinical outcome at 90 days after onset.The modified Rankin Scale(mRS)score 0-1 was defined as a good outcome and>1 was defined as a poor outcome.Secondary outcome measures included aneurysm rupture,cerebral hemorrhage,and recurrence of cerebral ischemic events.Multivariate logistic regression analysis was used to identify the independent influencing factors for poor outcome.Results A total of 183 patients with MIS and tiny UIA were included,including 108 males(59.0%),median aged 68 years(interquartile range,61-73 years).All the UIAs were solitary.The mRS score of all patients before onset was 0;152 patients(83.1%)had good outcome at 90 days after onset,31(16.9%)had poor outcome,and no UIA occurred rupture bleeding.Of the 94 patients(51.4%)who received aspirin monotherapy,14 patients(14.9%)experienced recurrent cerebral ischemic events during follow-up,and 73(77.7%)had good outcome.Of the 89 patients(48.6%)who received DAPT,5(5.6%)experienced recurrent ischemic events during follow-up,and 79(88.8%)had good outcome.The recurrence rate of cerebral ischemic events in the aspirin group was significantly higher than that in the DAPT group(χ^(2)=4.227,P=0.040),while the good outcome rate was significantly lower than that in the DAPT group(χ^(2)=4.006,P=0.045).Multivariate logistic regression analysis showed that baseline NIHSS score was an independent risk factor for po

关 键 词：缺血性卒中 颅内动脉瘤 阿司匹林 氯吡格雷 治疗结果 

分 类 号：R74[医药卫生—神经病学与精神病学]