DOI：10.12037/YXQY.2016.12-20阿加曲班联合阿司匹林治疗急性后循环脑梗死的临床效果和安全性评估付建忠，黄开梅，王锋，沈蓉（南京医科大学附属苏州医院　神经内科，江苏　苏州　215001）【摘要】目的评估阿加曲班联合阿司匹林治疗急性后循环脑梗死的临床效果和安全性。

方法选取2013年1月至2015年12月于本院住院治疗的急性后循环脑梗死患者92例为研究对象。

采用抽签法将入选患者随机分为单抗组（阿司匹林治疗）、双抗组（阿司匹林＋氯吡格雷治疗）和观察组（阿加曲班＋阿司匹林治疗），所有患者治疗7天后均改为单用阿司匹林治疗。

分别于入院时（起病48小时内）、治疗1周及1个月后，采用美国国立卫生研究院卒中量表（National Institutes of Health StrokeScale，NIHSS）和巴氏指数（Barthel index，BI）评分评估三组患者的神经功能和生活能力，并于入院时和治疗1周后检测三组患者血小板（blood platelet，PLT）、活化部分凝血活酶时间（activated partialthromboplastin time，APTT）、凝血酶原国际标准化比值（international normalized ratio，INR）。

结果入院时三组患者NIHSS评分和BI评分比较差异均无显著性（P＞0.05）。

治疗1周后，观察组患者NIHSS评分低于单抗组和双抗组（P＝0.014，P＝0.039），BI评分高于单抗组（P＝0.020），与双抗组比较无显著差异（P＞0.05）。

治疗1个月后，双抗组和观察组患者NIHSS评分均低于单抗组（P＝0.010，P＜0.001），观察组患者NIHSS评分低于双抗组（P＝0.031）；双抗组和观察组患者BI评分均显著高于单抗组（P＝0.025，P＝0.017），观察组患者BI评分高于双抗组（P＝0.046）。

治疗1周内，单抗组患者均未发生出血事件；双抗组和观察组各有1例患者发生出血事件，但两组患者出血事件发生率比较差异无显著性（χ2＝0.001，P＝0.999）。

入院时和治疗1周后，三组患者PLT、APTT及INR比较差异均无显著性（F＝1.416，P＝0.248）。

结论阿加曲班联合阿司匹林治疗急性后循环脑梗死的效果优于单用阿司匹林和阿司匹林联合氯吡格雷，且安全性较好。

【关键词】急性后循环脑梗死；阿加曲班；阿司匹林；神经功能恢复；安全性Effect and safety of combined treatment with argatroban and aspirin in acute posterior circulation cere-bral infarctionFU Jian-zhong, HUANG Kai-mei, WANG Feng, SHEN Rong (Department of Neurology, the AffiliatedSuzhou Hospital of Nanjing Medical University, Jiangsu, Suzhou 215001, China)Corresponding author: FU Jian-zhong, E-mail: fujianzhong_js@【Abstract】Objective　To evaluate the effects and safety of combined treatment with argatroban and aspirinin acute posterior circulation cerebral infarction. Method　92 patients with posterior circulation cerebralinfarction treated in our hospital from January 2013 to December 2015 were selected as the subjects, theywere randomly divided into three groups, including simple anti-platelet group, combined anti-platelet groupand observed group by sortition, which were respectively given aspirin, aspirin and clopidogrel, argatrobanand asprin. After 7 days, all patients changed to use aspirin simply. National Institutes of Health StrokeScale (NIHSS) and Barthel index (BI) were taken to evaluate the neurological function and living ability atadmission (48 hours after disease onset), 1 week and 1 month after treatment. Blood platelet (PLT), activated partialthromboplastin time (APTT) and international normalized ratio (INR) were examined at admissionand 1 week after treatment. Result　There were no significant differences in NIHSS scores and BI scores atadmission among the three groups (P＞0.05). 1 week after treatment, the NIHSS score of observation groupwas significantly lower than simple anti-platelet group and combined anti-platelet group (P＝0.014, P＝通讯作者：付建忠　E-mail：fujianzhong_js@0.039); the BI score of observation group was significantly higher than simple anti-platelet group (P＝0.020), and there was no significant difference in BI score between observation group and combined anti-platelet group (P＞0.05). 1 month after treatment, the NIHSS score of observation group and combined anti-platelet group were lower than simple anti-platelet group (P＝0.010, P＜0.001), the NIHSS score of observation group was lower than combined anti-platelet group (P＝0.031). The BI score of observation group and combined anti-platelet group were significantly higher than simple anti-platelet group (P＝0.025, P＝0.017), and the BI score of observation group was higher than combined anti-platelet group (P＝0.046). Within 1 week after treatment, there was no bleeding event in simple anti-platelet group, combined anti-platelet group and observation group of 1 case of patients with bleeding events, but the two groups of patients with bleeding events was not significant difference (χ2＝0.001, P＝0.999). There were no significant differences in PLT, APTT and INR among the three groups after admission and 1 week after treatment (F＝1.416, P＝0.248). Conclusion　The effects of combined treatment with argatroban and aspirin in posterior circulation cerebral infarction is better than both asprin simple anti-platelet treatment and combined anti-platelet treatment with aspirin and clopidogrel, also with satisfied safety.【Key words】Acute psterior circulation cerebral infarction; Argatroban; Asprin; Neurological function recovery; Safety目前，神经病学界对脑梗死的抗凝治疗仍存争议，研究发现，虽然抗凝治疗对改善脑梗死患者的神经功能具有一定作用，但同时可能引起出血事件[1]。

由于后循环供血区涉及生命中枢，目前医学界认为后循环脑梗死的治疗须较前循环脑梗死更积极，如主张尽可能争取溶栓治疗，适当放宽溶栓时间窗，更为积极抗凝[2-5]。

阿加曲班是一种凝血酶抑制剂，相对于肝素，其出血风险较小，安全性较高[6]。

本研究采用3种不同方案治疗急性后循环脑梗死，以评估阿加曲班联合阿司匹林对急性后循环脑梗死的治疗效果和安全性。