阿司匹林单独或与氯吡格雷联合治疗对缺血性脑卒中患者再入院影响的回顾性队列研究

发布时间：2018-10-16 13:28

【摘要】：目的:既往对于阿司匹林与氯吡格雷联合治疗预防脑卒中再发效果是否优于阿司匹林单独用药的研究结果不一致,本研究利用北京市城镇职工医疗保险数据库的资料,在大样本人群数据的基础上比较联合用药和单独用药对缺血性脑卒中患者再入院的影响。方法:采用回顾性队列研究的设计方法,从北京市城镇职工医疗保险数据库中提取主诊断为缺血性脑卒中的患者。患者的首条入院记录作为本研究的基线,根据患者的基线用药情况分为阿司匹林单独用药组、阿司匹林和氯吡格雷联合用药组。随访患者用药后是否因为主要结局事件再次入院,主要结局事件包括:(1)缺血性脑卒中复发;(2)脑梗死的出血性转化;(3)心肌梗死;(4)消化道出血。采用KaplanMeier方法比较两组之间的生存情况,并用Log-Rank检验生存曲线的差异。为控制混杂因素对基线的影响,对患者的基线数据采用倾向评分进行1∶1配对,并采用Cox比例风险模型计算风险比(hazard ratio,HR)。结果:从2010年1月至2013年9月纳入研究的患者共计27 695人,其中联合用药组4 047人,单独用药组23 648人。由于患者的基线特征不均衡可比,所以用倾向评分进行1∶1配比,配比后两组各有4 046人。调整了一般人口学特征如年龄、性别、民族及伴随疾病情况和合并用药情况后,两组的生存曲线差异没有统计学意义(P=0.06),组间的主要结局事件的HR值为0.91(0.82~1.01,P=0.07),差异没有统计学意义。协变量中性别HR=1.36(1.20~1.55,P0.05),伴随糖尿病HR=1.36(1.20~1.54,P0.05)、血脂异常HR=1.13(1.00~1.27,P=0.05)、心脏病HR=1.39(1.22~1.58,P0.05)差异有统计学意义,合并使用其他抗血小板药物HR=1.05(0.95~1.17,P0.05)不增加再入院风险。结论:联合使用阿司匹林和氯吡格雷预防患者再次入院的效果与单独使用阿司匹林的效果差异没有统计学意义,有合并症的患者首次发病后在防治复发的同时应积极治疗合并症。
[Abstract]:Objective: to study whether the combination of aspirin and clopidogrel is better than aspirin alone in preventing stroke recurrence. On the basis of large sample population data, the effects of combination therapy and single medication on readmission of ischemic stroke patients were compared. Methods: a retrospective cohort study was used to extract the patients diagnosed as ischemic stroke from the medical insurance database of urban workers in Beijing. The patient's first admission record was used as the baseline of the study. According to the baseline, the patients were divided into aspirin alone group and clopidogrel combination group. The main outcome events include: (1) recurrence of ischemic stroke; (2) hemorrhagic transformation of cerebral infarction; (3) myocardial infarction; (4) gastrointestinal hemorrhage. KaplanMeier method was used to compare the survival of the two groups, and Log-Rank was used to test the difference of survival curve. In order to control the influence of confounding factors on baseline, the baseline data of patients were matched with tendency score at 1:1 and Cox proportional risk model was used to calculate the risk ratio (hazard ratio,HR). Results: from January 2010 to September 2013, a total of 27 695 patients were enrolled in the study, including 4 047 in the combined drug group and 23 648 in the single drug group. Because the baseline features of the patients were not balanced and comparable, the 1:1 proportioning was carried out with the tendency score, and there were 4 046 people in each group after matching. After adjusting the general demographic characteristics such as age, sex, nationality and concomitant diseases and combined use of drugs, there was no significant difference in survival curve between the two groups (P0. 06), and the HR value of the main outcome events between the two groups was 0. 91 (0. 82 卤1. 01% P0. 07), and the difference was not statistically significant. There were significant differences in sex HR=1.36 (1.20 卤1.55), diabetic HR=1.36 (1.201.54), dyslipidemia HR=1.13 (1.00 ~ 1.27) and heart disease HR=1.39 (1.221.58) in covariates. The combination of other antiplatelet drugs HR=1.05 (0.951.17P0.05) did not increase the risk of readmission. Conclusion: there was no significant difference in the effect of combined aspirin and clopidogrel in the prevention of readmission compared with aspirin alone. Patients with complications should be actively treated while preventing and treating recurrence after their first onset.
【作者单位】：北京大学公共卫生学院流行病与卫生统计学系;北京大学医学部教育处;
【基金】：国家自然科学基金(81230066,81573226)资助~~
【分类号】：R743.3

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