目的 研究长期应用阿司匹林100 mg/d剂量对首次缺血性卒中患者脑梗死再发的预防作用及其出血事件发生的危险性.方法 采用临床病例回顾性分析方法,收集首次发生的缺血性卒中病例581例,分为服药组和未服药组,以出现脑出血、第2次脑梗死、胃肠道出血为研究终点,观察2组脑梗死再发及出血事件发生的情况,并对2组中首发腔隙性脑梗死的患者第2次脑梗死及出血事件的发生情况进行亚组分析.结果 最终参加随访患者545例,其中服药组260例,未服药组285例.服药组患者脑梗死复发率明显低于未服药组(P=0.002,RR=0.516,95%CI=0.312～0.739);2组脑出血发生率无明显差异(P=0.423,RR=1.233,95%CI=0.692～2.197);2组胃肠道出血的发生率无明显差异(P=0.227,RR=3.288,95%CI =0.340～31.814).服药组腔隙性脑梗死患者的脑梗死复发率明显低于未服药组(P=0.010,RR=0.616,95%CI=0.289～0.893);服药组腔隙性脑梗死患者脑出血发生率与未服药组腔隙性梗死患者相比无明显差异(P=0.269,RR=0.852,95%CI= 0.657～3.611).结论 首次发生缺血性卒中(包括腔隙性脑梗死)的患者,应用阿司匹林100 mg/d进行二级预防,可以有效地减少其脑梗死的复发,且没有明显增加出血不良作用的发生.%Objective To assess the effects of 100 mg/d aspirin on the secondary prevention of ischemic stroke and its risk of hemorrhagic events. Methods A retrospective study was carried out. Total of 581 patients with first ischemic stroke were divided into two groups: aspirin group and control group. The end point was a new ischemic stroke or cerebral hemorrhagic, gastrointestinal bleeding. The recurrence of ischemic stroke and bleeding events were observed and a subgroup analysis for cerebral ischemic recurrence and bleeding events was conducted for patients with first lacunar stroke in two groups. Results 545 cases were included in the present study, 260 patients were allocated to aspirin group and 285 patients were allocated to control group. The recurrence rate of ischemic stroke in aspirin group was obviously lower than that in control group( P =0.002, RR= 0.516, 95％ CI= 0. 312 ～ 0.739 ); there was no significant difference in incidence of cerebral hemorrhagic between the two groups( P =0.423, RR= 1. 233, 95％ CI= 0. 692 ～2. 197 ); there was no obvious difference in incidence of gastrointestinal bleeding between the two groups( P= 0.227, RR= 3. 288,95％ CI= 0. 340～ 31. 814 ). The recurrence rate of ischemic stroke in patients with first lacunar stroke in aspirin group was significantly lower than that of patients with first lacunar stroke in control group( P= 0.010, RR= 0.616, 95 ％ CI= 0.289 ～0. 893 ); there was no significant difference in incidence of cerebral hemorrhagic between patients with first lacunar stroke in the two groups( P= 0.269, RR= 0. 852,95％ CI=0.657 ～ 3. 611 ). Conclusion For patients presenting with the first ischemic stroke( including lacunar infarction ), 100mg/d aspirin could reduce recurrence rate of ischemic stroke without increasing the rate of cerebral hemorrhage and gastrointestinal bleeding.
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