伴脑出血史的缺血性卒中患者使用抗血小板药物二级预防的调查

Antiplatelet use： secondary prevention for ischemic stroke with a history of intracranial hemorrhage

目的 通过结局调查分析既往有脑出血史的缺血性卒中患者使用抗血小板药物（antiplatelet drugs,APD）的状况以及使用APD对再发脑出血和再发脑梗死的影响.方法 随访我院既往有过脑出血的脑梗死患者的单中心、回顾性队列研究.统计学方法采用生存曲线及Logistic回归分析APD对既往有过脑出血患者缺血性卒中二级预防结局的影响.结果 既往有过脑出血的缺血性卒中合并心房颤动和心肌梗死的患者在心内科就诊时更易接受服用APD.既往有过脑出血患者缺血性卒中二级预防中APD没有增加再发脑出血（OR=1.149,95%CI0.376～3.513,P=0.808） 未良好控制的高血压和脑叶出血是再发脑出血的危险因素 APD的使用能明显降低再发脑梗死的发生（OR=0.410,95%CI0.203～0.826,P=0.013）.既往有过脑出血的缺血性卒中患者服用APD再发脑出血间隔时间均值为39个月,未服APD患者为45个月（X2=1.257,P=0.262）.既往有过脑出血的缺血性卒中患者服用APD再发脑梗死间隔时间均值为42个月,末服APD患者为22个月（X2=14.315,P=0.001）.结论 既往有过脑出血的缺血性卒中患者,通过APD进行缺血性卒中二级预防可获益,再发肭出血未见增多.考虑到本调查中脑叶出血和高血压控制不良容易再发脑出血,使用APD时把血压控制在正常范围并排除既往有过脑叶出血的病例,也许是更为安全的选择.

Objective To investigate the usage of antiplatelet drugs（APD）therapy in ischemic stroke with a history of intracranial hemorrhage（ICH）and impact of APD therapy in recurrences of the ICH and the ischemic stroke. Methods In a retrospective study, all survivors of ischemic stroke with ICH who visited our hospital previous to this study were followed by clinic visit or by telephone interview and recurrent ICH, ischemic stroke, and APD use were recorded. Kaplan-Meier plot and Logistic regression were used to assess the effect of APD on recurrent ICH and isclemic stroke. Results Recurrent ICH was more common in patients with lobar hemorrhage compared than patients with deep hemorrhage. APD use was more common for prevention of myocardial infarction and atrial fibrillation. APD use did not increase ICH recurrence （OR = 1. 149, 95% CI 0. 376-3.513, P=0.808）and did not shorten duration of ICH recurrence（X2=1.257, P=0.262） however, it did reduce ischemic stroke recurrence（OR=0.410, 95% CI0. 203-0.826, P=0.013）and prolonged duration（X2 =14.315, P=0.001）. Conclusion APD use was not associated with ICH recurrence and was beneficial to recurrence ischemic stroke in this observation study.