小剂量阿加曲班治疗TOAST分型下急性缺血性卒中的疗效分析

目的〖KG*2〗观察小剂量阿加曲班治疗不同病因分型下急性缺血性卒中患者的有效性与安全性。〖HTH〗方法〖KG*2〗回顾性分析发病48 h内的急性缺血性卒中患者124例，按愿意接受阿加曲班治疗的患者依据TOAST（Trial of Org 10172 in Acute Stroke Treatment）分型分为大动脉粥样硬化型(large-artery atherosclerosis,LAA)42例,心源性栓塞型(cardiac embolism,CE)39例,小动脉闭塞型(small artery occlusion，SAO)38例。入院后7 d内每天给予阿加曲班注射液20 mg，同时联合阿斯匹林100 mg等常规治疗。于治疗前与治疗后7 d、14 d美国国立卫生院卒中（National Institutes of Health Stroke Scale,NHISS）量表、Barthel指数（Barthel Index,BI）评定量表评分，比较近期临床疗效；观察住院期间消化道、皮肤黏膜、颅内等部位出血以及病情恶化、死亡等不良事件发生情况。〖HTH〗结果〖KG*2〗3组治疗后NHISS评分均呈下降趋势，BI指数均呈升高趋势，CE组变化幅度最大，组间、时间点、组间·时间点交互作用差异有统计学意义（P＜0.05）。CE组治疗总有效率高于LAA组和SAO组，差异有统计学意义（P＜0.05）。3组不良事件发生率差异无统计学意义（P＞0.05）。〖HTH〗结论〖KG*2〗TOAST病因分型下的急性缺血性卒中患者早期联合应用小剂量阿加曲班治疗均可获益，且不增加出血风险，其中CE类型疗效最佳。

The efficacy of low-dose argatroban in the treatment of acute ischemic stroke under TOAST classification

ObjectiveTo observe the efficacy and safety of low-dose argatroban in the treatment of patients with acute ischemic stroke under different etiology. MethodsA retrospective analysis of 124 patients with acute ischemic stroke within 48 hours of onset was divided into LAA group according to the Trial of Org 10172 in Acute Stroke Treatment(TOAST) classification of patients with argatroban. In the CE group and the SAO group, 20 mg of argatroban injection was given daily for 7 days after admission, and conventional treatments such as 100 mg of aspirin were combined. The short-term clinical effects were compared before treatment and 7 d, 14 d after treatment with the National Institutes of Health Stroke Scale(NHISS) and Barthel Index(BI) rating scale. The bleeding of digestive tract, skin and mucosa, intracranial and other adverse events during hospitalization were observed. ResultsAfter treatment, the NHISS scores of the three groups showed a downward trend, and Bi index showed an upward trend. The change range of CE group was the largest, and there were significant differences among groups, time points and interaction between groups(P＜0.05). The total effective rate of CE group was higher than that of LAA group and Sao group(P＜0.05). There was no significant difference in the incidence of adverse events among three groups(P＞0.05). ConclusionThe early combined use of low-dose argatroban in patients with acute ischemic stroke under TOAST etiology can benefit without increasing the risk of bleeding, with CE being the best.