双重抗血小板治疗短暂性脑缺血发作的临床效果及安全性观察

Efficacy and safety of dual-antiplatelet therapy on transient ischemic attack

目的研究阿司匹林联合氯吡格雷治疗短暂性脑缺血发作（TIA）的临床疗效及安全性。方法收集2012年1月至2014年1月在首都医科大学附属北京安贞医院住院的120例TIA患者的临床资料进行回顾性分析。根据患者用药情况分为2组，即单用阿司匹林100mg／d或氯吡格雷75mg／d组（单抗组，60例），阿司匹林100mg／d联合氯吡格雷75mg／d组（双抗组，60例）。记录患者性别、年龄、病史、影像学资料，观察2组患者TIA于抗凝治疗7及21d后是否进展为脑梗死以及脑LH血、消化道出血、牙龈出血、皮肤黏膜出血等出血不良反应的发生情况。结果2组患者在性别、年龄、高血压史、高脂血症史、糖尿病史、吸烟饮酒史、既往脑梗死史、既往脑出血史方面差异均无统计学意义（均P〉0．05）。双抗组治疗7及21d后TIA进展为脑梗死的病例占比少于单抗组，差异有统计学意义[1．7％（1／60）比11．7％（7／60）、3．3％（2／60）比13．3％（8／60），P〈0．05]。2组治疗7d后均无出血发生；治疗21d后，双抗组有3例发生出血，单抗组有2例发生出血，2组差异无统计学意义（P〉0．05）。结论阿司匹林联合氯吡格雷双重抗血小板治疗TIA疗效明显，出血不良反应小。

Objective To analyze the efficacy and safety of dual-antiplatelet therapy with aspirin and elopidogrel treating transient ischemie attack（TIA）. Methods Totally 120 patients with TIA from January 2012 to January 2014 in Beijing Anzhen Hospital, Capital Medical University were analyzed, a retrospective analysis was conducted. All patients were divided into 2 groups： mono-anti group（60 cases, aspirin 100 mg/d or clopidogrel 75 mg/d）and dual-anti group（60 cases, aspirin 100 mg/d and c]opidogrel 75 rag/d）. Gender, age, medical his- tory, imaging data, the progression of disease（develop to cerebral infarction or not）at 7 and 21 d after treatment and adverse reactions（cerebral hemorrhage, gastrointestinal bleeding, gingival bleeding, mucocutaneous hemor- rhage）were observed： Results There were no significant differences in gender, age, history of hypertension, hyperlipidemia, diabetes, smoking, drinking, cerebral infarction and cerebral hemorrhage between groups （ P 〉 0. 05）. At 7 and 21 d after treatment, rates of cerebral infarction in dual-anti group were significantly lower than those in mono-anti group[ 1.7% （ 1/60）vs 11.7% （7/60）, 3.3% （2/60）vs 13.3% （8/60） ] （P 〈0.05）. At 7 d after treatment, no bleeding occurred in 2 groups; At 21 d after treatment, there were 3 eases of bleeding in dual-anti group and 2 cases in mono-anti group ; the difference between groups was not significant （ P 〉 0. 05 ）. Conclusion Dual-antiplatelet therapy with aspirin and c]opidogrel on TIA is safe and effective.