补阳还五汤联合阿司匹林治疗短暂性脑缺血发作阿司匹林抵抗患者的随机对照观察

Treatment of Aspirin Resistance Patients at Transient Ischemic Attack by Buyang Huanwu Decoction Combination with Aspirin： a Randomized Control Observation

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DOI：10.7661/CJIM.2013.05.0593

中文关键词: 补阳还五汤阿司匹林抵抗短暂性脑缺血发作随机对照

英文关键词:Buyang Huanwu Decoction aspirin resistance transient ischemic attack randomized control

基金项目:

作者	单位	E-mail
张磊	新疆维吾尔自治区中医医院老年病科（乌鲁木齐 830000）	zhang30lei@tom.com
刘涛

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中文摘要:

目的探讨补阳还五汤联合阿司匹林（aspirin， ASP）治疗短暂性脑缺血发作（TIA）时阿司匹林抵抗（AR）的疗效和安全性。方法筛选TIA后服用阿司匹林作为二级预防的AR患者86例，剔除2例（因依从性差），将84例随机分为2组，治疗组予补阳还五汤联合ASP，对照组予氯吡格雷联合ASP，分别治疗30、60、90天后采用比浊法测定以花生四烯酸（AA）和二磷酸腺苷（ADP）诱导的血小板聚集率（PAG）。观察治疗后90天内TIA复发或进展为脑梗死的病例数，观察出血等不良事件发生率。结果两组治疗前后各时间段ADP与AA诱导的PAG下降趋势相似，疗效相当（P>0.05），在终点事件（包括缺血性脑血管病事件、TIA复发、脑梗死）的风险控制方面，两组比较，差异无统计学意义（P>0.05）。治疗组出血1例（轻微消化道出血），对照组出血4例（皮肤黏膜出血3例，便血1例），治疗组较对照组出血风险降低了76.29%。结论补阳还五汤联合ASP对AR的治疗效果及对终点事件的控制与氯吡格雷联合ASP相当，且降低了出血风险。

英文摘要:

Objective To investigate the curative effect and safety of Buyang Huanwu Decoction （BHD） combined aspirin （ASP） in treatment of aspirin resistance （AR） patients at transient ischemic attack （TIA）. Methods Recruited were 86 AR patients at TIA who took ASP as the secondary prevention. Two cases were rejected due to poor compliance. The rest 84 patients were randomly assigned to the treatment group and the control group. Those in the treatment group were treated with BHD and ASP， while those in the control group took Clopidogrel and ASP. After 30，60，and 90 day of treatment， arachidonic acid （AA） and adenosine diphosphate （ADP） induced platelet aggregation rate （PAG） were detected using turbidimetry. After treatment of 90 days， the case numbers of TIA recurrence or of progressing to cerebral infarction were counted. The incidence of adverse events was also observed. Results The ADP and AA induced PAG showed similar decreasing tendency in the treatment group and the control group at each time point （P>0.05）. There was no statistical difference in the risk control of end point events （including ischemic cerebrovascular diseases， TIA recurrence， cerebral infarction） between the two groups （P>0.05）. One patient suffered from bleeding （mild gastrointestinal bleeding） in the treatment group， while 4 patients suffered from bleeding （3 due to skin and mucous membrane bleeding and 1 to stool bleeding）. The bleeding risk was lowered by 76.29% in the treatment group when compared with the control group. Conclusions BHD combined ASP showed similar efficacy in treating AR and controlling endpoint events. Besides， they lowered bleeding risk.

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