阿司匹林对急性脑梗死患者胃黏膜损伤的临床研究

目的：探讨不同剂量阿司匹林（ASA）对急性脑梗死患者胃黏膜的损伤。方法：137例急性脑梗死患者随机分成ASA治疗组（负荷量／维持量，mg):150/50,300/50,300/100,450/150及对照组，观察服药前和服药后48h、14d临床症状、大便潜血试验、胃镜下胃黏膜表现及胃黏膜病理学指标，采用放免法测定了胃液前列腺素E2（PGE2）和血浆血栓素B2（TXB2）水平。结果：ASA450／150mg组服药后48h大便潜血阳性率、胃镜下胃黏膜病变程度及胃黏膜病理学指标均显著高于300／100mg,150/50mg组及对照组（P值均＜0．01），而胃液PGE2水平较后三组显著降低（P值均＜0．001），后三组间比较无显著差异。结论：急性脑梗死患者服用ASA负量300mg，每日维持量100mg能显著降低血浆TXB2水平，对胃黏膜近期无明显损伤。

Lesions of Gastric Mucosa Caused by Aspirin in Patients with Acute Cerebral Infarction

Objective: To investigate the lesion of gastric mucosa caused by different doses of aspirin in patients with acute cerebral infarction. Methods: 137 patients with acute cerebral infarction were randomly divided into the following aspirin treating groups (loading dose/maintaining dose, mg): 150/50, 300/100, 450/150 and the control group. The clinical symptoms were observed: stools occult blood test, gastroscopy and gastric mucosal histologic examination were carried out: the levels of prostaglandin E2(PGE2) in gastric juice and throbomxane B2(TXB2) in plasma were measured with radioimmunoassay before and 48 hrs, 14 days after treatment. Results: The positive rates of stools occult blood test, the degree of gastric mucosal lesion endoscopically and the histopathologic index were significantly higher in the group with 450/150mg of aspirin than those in groups with 300/100mg, 150/50mg of aspirin and control group (P <0. 01, all). While the PGE2 level in gastric juce was markedly lower in group with 450/150mg of aspirin than that in other three groups(P<0.001, all). There was no difference of the indices mentioned above in other three groups. Conclusion: These results suggest that 300mg of aspirin as loading dose and 100mg of aspirin daily as maintaining dose to patients with acute cerebral infarction can markedly reduce plasma but does not cause marked damage to gastric mucosa in the near future.