急性期抗血小板及调脂治疗对缺血性卒中患者预后影响的前瞻性随访研究

目的：探讨缺血性卒中患者急性期抗血小板、调脂治疗与预后的关系。方法：收集自2007年1月～2008年5月在卒中单元病房住院治疗的1016例急性缺血性脑卒中患者，男630例，女386例，平均年龄64．54±11．60岁。根据是否服用抗血小板的药物和是否应用他汀类调脂药进行分组，分别分为使用组和未使用组。应用N1HSS评分了解各组入院时、随访3月和随访12月后的神经功能缺损程度，根据改良Rankin评分（mRs）评价各组患者预后、复发率和病死率的差异。结果：缺血性脑卒中男性患者发病年龄较女性患者早（P〈0．001）。其中使用抗血小板治疗927例，随访3月及12月抗血小板治疗组神经功能缺损程度较术使用者轻，NIHSS评分比较有显著性差异（P〈0．05），使用抗血小板治疗组改善明显（P〈0．05），预后不良发生率和病死率均较术使用背低（P〈0．001），然而，复发率在两组之间比较无差异（P〉0．05）。同样，使用他汀类调脂药者随访3月和随访12月的病死率和预后不良发生率均低于未使用组（P〈0．001），但复发率在两组之间比较无差异（P〉0．05）。结论：使用抗血小板药及他汀类调脂药将能改善患者预后，明显降低缺血性卒中患者的预后不良的发生率和病死率。

Prospective Follow- up Study of the Prognosis of Ischemic Stroke among Patients Treated with Antiplatelet or Statins at Acute Stage

OBJECTIVE： To explore the relationship between prognosis and antiplatelet and statins treatment among patients with ischemie stroke at acute stage. METHODS： From Janury 2007 to May 2008, a total of 1016 patients with acute isehemic stroke were enrolled, including 630 males and 386 females. Their average age was 64. 54 ± 11.60 years. According to the antiplatelet or statins treatment these patients were divided into two groups including treatment group and control group. The neurological function of patients in 24 hours, the third month and one year after the onset of acute ischemic stroke was followed according to NIHSS score, and the incidence of unfavourable prognosis, recurrence rates and mortality rates were evaluated using modified rankin scale. RESULTS ： The men had the significantly higher incidence of ischemie stroke than women, and the ages of onset in women patients were older than the men patients. Patients without receiving antiplatelet treatment had the more severe neurological impairment than patients receiving anti-plate treatment. After 3 and 12 months follow - up unfavorable prognosis and mortality rates were lower in antiplatelet treatment group （ P 〈 0. 001 ） and recurrence rates were not difference between two groups （ P 〉 0. 05 ）. Patients receiving statins treatment had lower mortality rates and unfavorable prognosis compared with those without receiving statins treatment （ P 〈 0. 001 ）, but recurrence rates were not difference between two groups （P 〉 0. 05）. CONCLUSIONS： Antiplatelet and statins treatment can not only improve prognosis of patients with ischemic stroke but also decrease the incidence of unfavorable prognosis and mortality rates.