阿司匹林降低腔隙性卒中患者的复发卒中风险。

Aspirin reduced recurrent stroke risk in patients with lacunar stroke.

机构信息

Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.

Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Acta Neurol Scand. 2019 Jul;140(1):78-83. doi: 10.1111/ane.13105. Epub 2019 May 9.

DOI:10.1111/ane.13105

PMID:31002173

Abstract

OBJECTIVES

Lacunar stroke had an unfavorable prognosis in the long term with a high risk of recurrent stroke, aspirin has been widely used to prevent ischemic stroke, but data on the effect of antiplatelet therapy on lacunar infarction are limited. We investigated the long-term effect of aspirin treatment on stroke recurrence risk in patients with lacunar stroke in a multicenter prospective cohort.

METHODS

Between November 2000 and November 2001, 2000 consecutive stroke patients (age 35-74 years) were recruited from seven clinical centers. For the present study, a total of 544 patients with lacunar infarction were finally included in the analysis. The patients were divided into two groups (aspirin group, n = 342 and non-aspirin group, n = 202).The effect of aspirin on stroke recurrence was evaluated by using Kaplan-Meier analysis and Cox regression models.

RESULTS

During a median 4.1-year follow-up for 544 patients with lacunar stroke, 99 recurrent strokes, 125 major vascular events (stroke, myocardial infarction, and vascular death), 31 vascular deaths, and 59 all-cause deaths were identified. Kaplan-Meier analysis showed that aspirin non-users had a higher risk of future recurrent stroke and of vascular events than did aspirin users (log-rank test, P = 0.049, 0.047, respectively). Aspirin significantly reduced the stroke recurrence in patients with lacunar stroke analyzed with multivariate stepwise analysis using model of Cox proportional hazards with backward elimination (HR = 0.67, 95% CI 0.45-0.99).

CONCLUSION

We concluded that aspirin significantly reduced stroke recurrence in patients with lacunar stroke.

摘要

目的

腔隙性卒中的长期预后不佳，复发风险高，阿司匹林已广泛用于预防缺血性卒中，但抗血小板治疗对腔隙性梗死的效果数据有限。我们在一项多中心前瞻性队列研究中调查了阿司匹林治疗对腔隙性卒中患者卒中复发风险的长期影响。

方法

2000 年 11 月至 2001 年 11 月，7 个临床中心共招募了 2000 例连续卒中患者（年龄 35-74 岁）。在本研究中，共有 544 例腔隙性梗死患者最终纳入分析。患者分为两组（阿司匹林组，n=342；非阿司匹林组，n=202）。采用 Kaplan-Meier 分析和 Cox 回归模型评估阿司匹林对卒中复发的影响。

结果

在中位随访 4.1 年期间，544 例腔隙性卒中患者中发生了 99 例复发性卒中、125 例主要血管事件（卒中、心肌梗死和血管死亡）、31 例血管死亡和 59 例全因死亡。Kaplan-Meier 分析显示，与阿司匹林使用者相比，阿司匹林非使用者未来发生复发性卒中及血管事件的风险更高（对数秩检验，P=0.049，0.047）。多变量逐步 Cox 比例风险分析采用向后消除模型显示，阿司匹林显著降低了腔隙性卒中患者的卒中复发风险（HR=0.67，95%CI 0.45-0.99）。