短暂性脑缺血发作后卒中危险性的评估及干预效果的临床研究

Evaluation of risk of stroke and effect of intervention in patients after transient ischemic attack

目的评估短暂性脑缺血发作（TIA）患者发生卒中的危险性及抗血小板剂的干预效果。方法256例TIA患者随机分为干预组和对照组，各128例。对照组予一般措施及安慰剂，干预组在一般措施上加用氯吡格雷（75mg／d），并分别在发病后7d、1、3、6个月比较两组卒中发病率、症状、体征和神经功能缺损评分情况，并监测血液流变学情况。结果对照组7d、1、3、6个月时卒中发生率分别为8．59％，14．06％，21．09％和28．13％；干预组为0．00％，4．69％，8．59％和11．72％，两组存在显著差异（P〈0．05）。干预组在研究后血液流变学改变、卒中患者病理征出现、脑梗死面积、神经功能缺损评分等方面，亦与对照组存在显著差异（P〈0．05）。结论TIA后卒中危险性比普通人群高得多，须及早二级预防，抗血小板药物效果确切，且安全。

Objective To evaluate the risk of stroke in patients after transient ischemic attack（TIA）, and study the effect of intervention with antiplatelet drug. Methods 256 patients with TIA were randomly divided into intervention group and control group（ 128 in each group）. All patients were treated with routine treatment, and in addition the antiplatelet drug （clopidogrel,75 mg / d）was added to the intervention group, placebo was added to the control group. After 7 days,1 month,3 months and 6 months,comparative analysis were made between two groups in incidence, clinical symptom, sign and neurological function defects score （with Edinburgh- Scandina stroke scale, MESSS） of stroke patients. And the hemorheology indexeswere observed. Results After 7 days, 1 month,3 months and 6 months, the stroke incidences of control group were 8.59%, 14.06% ,21.09% and 28.13%. In intervention group, the incidences were 0. 00% ,4. 69%, 8.59% and 11.72%. The difference was significant（P 〈 0. 05）. In pathological reflex, brain infarct area and MESSS of stroke patients, the differences were significant（P 〈 0. 05 ）between two groups. After treatment, there were also significant difference（P 〈 0.05 ） in hemorheology indexes of patients. Conclusion The stroke incidence of patients after TIA was significandy highter than general population, and Secondary Prevention of Stroke must be performed early. Antiplatelet drug is safe and effective for stroke prevention.