目的 探討阿加曲班聯(lián)合阿司匹林治療高危非致殘性缺血性腦血管病（HR-NICE）的有效性及安全性。方法 前瞻性納入2019年1月—2020年12月蘇州市立醫(yī)院北區(qū)收治的248例HR-NICE患者作為研究對象，采用隨機數(shù)字表法將患者隨機分為聯(lián)合組（n=123）及雙抗組（n=125）。聯(lián)合組患者采用阿加曲班注射液靜脈滴注（前48 h每日60 mg連續(xù)靜脈滴注，后5 d每日20 mg分2次靜脈滴注，共7 d）聯(lián)合口服阿司匹林腸溶片100 mg/d治療。雙抗組采用阿司匹林聯(lián)合硫酸氫氯吡格雷片（氯吡格雷首劑300 mg，后阿司匹林100 mg/d+氯吡格雷75 mg/d，共7 d）。比較兩組7 d卒中復(fù)發(fā)進展率，治療24 h、7 d的美國國立衛(wèi)生研究院卒中量表（NIHSS）評分變化，90 d的良好預(yù)后情況以及出血事件的發(fā)生率。結(jié)果 治療后，聯(lián)合組和雙抗組的卒中進展發(fā)生率分別為8.94%和13.60%，組間比較差異無統(tǒng)計學(xué)意義（P>0.05）。治療7 d后，兩組的NIHSS評分較治療前均顯著降低（P<0.05），但兩組治療7 d后的總有效率、NIHSS評分及90 d良好預(yù)后比例差異均無統(tǒng)計學(xué)意義（P>0.05）。兩組均無出血事件發(fā)生。結(jié)論 阿加曲班聯(lián)合阿司匹林治療HR-NICE安全、有效，效果與雙抗治療相當(dāng)。

Objective To investigate the efficacy and safety of argatroban combined with aspirin in the treatment of high-risk non disabling ischemic cerebrovascular disease (HR-NICE). Methods Totally 248 patients with HR-NICE treated in the North District of Suzhou Municipal Hospital from January 2019 to December 2020 were prospectively included as the research object. The patients were randomly divided into combined group (n=123) and double antibody group (n=125) by random number table method. Patients in the combined group were treated with intravenous infusion of Argatroban Injection (60 mg daily for the first 48 h, 20 mg daily for two times for the next five days, a total of seven days) combined with oral Aspirin Enteric Coated Tablets 100 mg/d. The double antibody group was treated with aspirin combined with Clopidogrel Bisulfate Tablets (the first dose of clopidogrel was 300 mg, the second dose of aspirin was 100 mg/d + clopidogrel 75 mg/d, a total of seven days). The recurrence and progression rate of stroke at seven days, the changes of NIHSS score at 24 h and seven days, the good prognosis at 90 days and the incidence of bleeding events were compared between the two groups. Results After treatment, the incidence of stroke progression in the combined group and the double antibody group were 8.94% and 13.60% respectively. There was no significant difference between the two groups (P>0.05). After seven days of treatment, the NIHSS score of the two groups was significantly lower than that before treatment (P<0.05), but there was no significant difference in the total effective rate, NIHSS score and the proportion of good prognosis at 90 days between the two groups (P>0.05). There were no bleeding events in both groups. Conclusion Argatroban combined with aspirin is safe and effective in the treatment of HR-NICE, but the effect is not better than double antibody treatment.

江蘇省干部保健課題（BJ18011）