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阿司匹林在脑梗死二级预防中获益与风险的前瞻性队列研究

Prospective Cohort Study on Benefits and Risks of Making Use of Aspirin in the Secondary Prevention of Stroke

DOI：

中文关键词: 阿司匹林卒中二级预防前瞻性队列研究脑梗死上消化道出血颅内出血

英文关键词:Aspirin Secondary prevention of stroke Prospective cohort study Cerebral infarction Upper gastrointestinal bleeding Intracranial hemorrhage

基金项目:

作者	单位
孙毅鸿	舟山市普陀区人民医院神经内科（浙江舟山 316100 ）；
蒋辉	舟山市普陀区人民医院神经内科
吴竹兵	舟山市普陀区人民医院神经内科
王先岳	舟山市普陀区人民医院神经内科
高瞻	舟山市普陀区人民医院神经内科
周达成	舟山市普陀区人民医院神经内科
郑荣远	温州医科大学附属第一医院神经内科

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中文摘要:

摘要目的:调查长期规律服用阿司匹林（ASA）对于脑梗死患者二级预防的获益与引发出血事件的风险。方法：收集2012年4月～2014年4月普陀区人民医院脑梗死住院患者901例。根据是否长期服用ASA分为暴露组439例和非暴露组462例，前瞻性追踪调查6个月，分别记录其终点事件（脑梗死复发、症状性颅内出血及上消化道出血），分析评价ASA在二级预防中的获益与风险。结果：暴露组与非暴露组脑梗死复发率分别为8.7%和13.4%（P<0.05），暴露组缺血性卒中复发率减少4.7%，NNT=21。暴露组与非暴露组总症状性出血事件发生率分别为23.9%和16.2%（P<0.05），暴露组总症状性出血事件增加7.7%，NNT=13。其中症状性上消化道出血发生率暴露组为16.4%，非暴露组为11.7%，差异有统计学意义（P<0.05），暴露组增加了4.7%，NNT=21；症状性颅内出血发生率暴露组为7.5%，非暴露组为4.5%，差异无统计学意义（P>0.05）。结论：长期服用ASA虽能降低4.7%的脑梗死复发率，但是总症状性出血事件也有明显增加（7.7%），尤其是上消化道出血事件增加4.7%，颅内出血略有增加趋势。ASA预防卒中复发，获益与风险并存。

英文摘要:

ABSTRACT Objective:To investigate the benefits and risks of initiating bleeding events for cerebral infarction patients who took aspirin regularly for a long time in the secondary prevention of stroke.Methods:901 cases of patients who received treatment and determinately diagnosed as dying of cerebral infarction in the Putuo People’s Hospital from April 2012 to April 2014 had been collected. According to whether they were taking the ASA for a long term or short one, the patients have been divided to two groups, the exposed group (439 cases) and unexposed group (462 cases),followed up investigation periodically for 6 months. Their outcome events had been recorded (recurrence of cerebral infarction, symptomatic intracranial bleeding or hemorrhage of digestive tract). Analyzed and evaluated the benefits and risks of taking aspirin in the secondary prevention of stoke.Results:The rate of recurrence of cerebral infarction of the exposed group was 8.7%, while the rate of unexposed group was 13.4%(P<0.05). The rate of the ischemic stroke recurrence of the exposed group had been reduced by 4.7% (NNT=21). The rate of the general incidence of symptomatic hemorrhagic events of the exposed group was 23.9%, while the rate of the unexposed group was 16.2%(P<0.05). The rate of the general symptomatic hemorrhagic events of the exposed group had been increased by 7.7%(NNT=13). More specifically, the rate of the symptoms of upper digestive tract hemorrhage of the exposed group was 16.4%, and the unexposed group was 11.7%(P<0.05), the rate had been increased by 4.7%(NNT=21). Additionally, The rate of the incidence of symptomatic intracranial hemorrhage of the exposed group was 7.5%, and the rate of the unexposed group was 4.5%（P>0.05）. Conclusion:Although long time use of ASA could decrease the rate of the recurrence of cerebral infarction to 4.7%, the rate of the general incidence of symptomatic hemorrhagic events had increased sharply (7.7%), specifically the rate of the symptoms of upper digestive tract hemorrhage had increased by 4.7%, and the rate of incidence of symptomatic intracranial hemorrhage was also having the increasing trend. There were both benefits and risks for patients taking aspirin in the prevention of the stroke recurrence.

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