强化抗血小板治疗在缺血性脑卒中复发高危患者二级预防中的临床研究

目的观察强化抗血小板药物氯吡格雷在缺血性脑卒中复发高危患者二级预防中的长期疗效及安全性。方法采用艾森卒中风险评分（ESRS）量表筛选住院的急性非心源性缺血性脑卒中复发高危患者100例，随机分为氯吡格雷组和阿司匹林组，每组50例。两组均给予脑卒中常规治疗，氯吡格雷组予氯吡格雷75mg及阿司匹林100mg口服，1周后仅予氯吡格雷75mg，口服。阿司匹林组予阿司匹林200mg，口服，1周后改为100mg，口服。随访3个月和1年，观察两组缺血性脑卒中复发率及药物不良反应发生率。结果随访3个月时，脑卒中复发率：阿司匹林组为6．3％，氯吡格雷组为2．0％，差异无统计学意义（P〉0．05）；药物不良反应发生率：阿司匹林组为14％，氯吡格雷组为2％，差异有统计学意义（P〈0．05）。随访1年时，脑卒中复发率：阿司匹林组为13％，氯吡格雷组为2％，差异有统计学意义（P〈0．05）；药物不良反应发生率：阿司匹林组为38％，氯吡格雷组为6％，差异有统计学意义（P〈0．01）。结论缺血性脑卒中复发高危患者二级预防中强化抗血小板治疗可降低脑卒中复发风险，长期应用获益较高，安全性好。

Clinical Studies of Intensive Antiplatelet Therapy for Secondary Prevention of Ischemic Stroke in Highrisk Patients

Aim To observe the long-term efficacy and safety of antiplatelet drug clopidogrel for secondary prevention of relapsing ischemic stroke in high-risk patients. Methods ESSEN Stroke Risk Score （ESRS） was adopted to select 100 high risk patients with acute non-cardiac recurrent ischemic stroke. These patients were randomly divided into a clopidogrel group and a aspirin group, 50 cases in each group. Both groups were given conventional treatments. In clopidogrel group, plavix 75 mg and aspirin 100 mg were given orally, a week later, only plavix 75 mg orally. In aspirin group, aspirin 200 mg were given orally also for one week, then 100 mg orally. Follow-up for 3 months, 1 year, the ischemic stroke recurrence rates and incidence of adverse drug reactions were observed. Results Follow-up for 3 months, the stroke recurrence rate was 6.3% in aspirin group, 2% in clopidogrel group, the difference was not statistically significant （P〉0.05）; the incidence of adverse reactions was 14% in aspirin group, 2% in clopidogrel group, the difference wasstatistically significant （P〈0.05）. Followed-up for 1 year, the stroke recurrence rate was 13% in aspirin group, 2% in clopidogrel group, the difference was statistically significant （P〈0.05）. The incidence of adverse reactions is 38% in aspirin group, 6% in clopidogrel group, the difference was statistically significant （P〈 0.01）. Conclusion Intensive antiplatelet therapy for secondary prevention of ischemic stroke in high-risk patients can reduce the risk of recurrent stroke and be used in the long-term with high safety.