目的 探讨阿加曲班联合阿司匹林治疗高危非致残性缺血性脑血管病（HR-NICE）的有效性及安全性。方法 前瞻性纳入2019年1月—2020年12月苏州市立医院北区收治的248例HR-NICE患者作为研究对象，采用随机数字表法将患者随机分为联合组（n=123）及双抗组（n=125）。联合组患者采用阿加曲班注射液静脉滴注（前48 h每日60 mg连续静脉滴注，后5 d每日20 mg分2次静脉滴注，共7 d）联合口服阿司匹林肠溶片100 mg/d治疗。双抗组采用阿司匹林联合硫酸氢氯吡格雷片（氯吡格雷首剂300 mg，后阿司匹林100 mg/d+氯吡格雷75 mg/d，共7 d）。比较两组7 d卒中复发进展率，治疗24 h、7 d的美国国立卫生研究院卒中量表（NIHSS）评分变化，90 d的良好预后情况以及出血事件的发生率。结果 治疗后，联合组和双抗组的卒中进展发生率分别为8.94%和13.60%，组间比较差异无统计学意义（P>0.05）。治疗7 d后，两组的NIHSS评分较治疗前均显著降低（P<0.05），但两组治疗7 d后的总有效率、NIHSS评分及90 d良好预后比例差异均无统计学意义（P>0.05）。两组均无出血事件发生。结论 阿加曲班联合阿司匹林治疗HR-NICE安全、有效，效果与双抗治疗相当。
Objective To investigate the efficacy and safety of argatroban combined with aspirin in the treatment of high-risk non disabling ischemic cerebrovascular disease (HR-NICE). Methods Totally 248 patients with HR-NICE treated in the North District of Suzhou Municipal Hospital from January 2019 to December 2020 were prospectively included as the research object. The patients were randomly divided into combined group (n=123) and double antibody group (n=125) by random number table method. Patients in the combined group were treated with intravenous infusion of Argatroban Injection (60 mg daily for the first 48 h, 20 mg daily for two times for the next five days, a total of seven days) combined with oral Aspirin Enteric Coated Tablets 100 mg/d. The double antibody group was treated with aspirin combined with Clopidogrel Bisulfate Tablets (the first dose of clopidogrel was 300 mg, the second dose of aspirin was 100 mg/d + clopidogrel 75 mg/d, a total of seven days). The recurrence and progression rate of stroke at seven days, the changes of NIHSS score at 24 h and seven days, the good prognosis at 90 days and the incidence of bleeding events were compared between the two groups. Results After treatment, the incidence of stroke progression in the combined group and the double antibody group were 8.94% and 13.60% respectively. There was no significant difference between the two groups (P>0.05). After seven days of treatment, the NIHSS score of the two groups was significantly lower than that before treatment (P<0.05), but there was no significant difference in the total effective rate, NIHSS score and the proportion of good prognosis at 90 days between the two groups (P>0.05). There were no bleeding events in both groups. Conclusion Argatroban combined with aspirin is safe and effective in the treatment of HR-NICE, but the effect is not better than double antibody treatment.