摘要： 目的 探讨ABCD3-Ⅰ评分系统评价阿司匹林单药及其与氯吡格雷联合治疗短暂性脑缺血发作的有效性和安全性。方法 122 例短暂性脑缺血发作患者分别接受阿司匹林单药（单抗组）或阿司匹林与氯吡格雷联合（双抗组）治疗，并根据ABCD3-Ⅰ评分系统进一步分为低危组、中危组和高危组，评价各亚组患者缺血性卒中和药物不良反应发生率。结果 治疗3 周时，低危组无一例发生缺血性卒中，其他各组分别为：中危单抗组9/20 例、中危双抗组2/19 例，高危单抗组10/19 例、高危双抗组3/20 例，组间差异有统计学意义（P = 0.031，0.019）。单抗组和双抗组患者药物不良反应均以恶心、反酸等消化道症状为主（χ² = 0.000，P = 1.000），无明显出血倾向、肝肾功能未见异常。结论 ABCD3-Ⅰ评分系统可以作为评价抗血小板药物安全性的指标。阿司匹林联合氯吡格雷可能较阿司匹林单药预防缺血性卒中更具优势。

关键词: 脑缺血发作, 短暂性, 阿司匹林, 血小板聚集抑制剂

Abstract: Objective  To evaluate the efficacy and safety of aspirin monotherapy and aspirin combining with clopidogrel therapy in treating transient ischemic attack (TIA) according to different risk stratification.  Methods  A total of 122 TIA patients was divided into 2 groups: single resistance group (treated only by aspirin) and dual anti-platelet aggregation group (treated with aspirin and clopidogrel). According to Age, Blood pressure, Clinical features, Duration, and Diabetes plus Dual TIA (ABCD3-Ⅰ) score, they were further divided into low-risk, middle-risk and high-risk groups. The incidences of ischemic stroke and adverse events in each group were evaluated.  Results  After 3-week treatment, the incidence of ischemic stroke in low-risk groups was both 0, while it was 9/20 in middle-risk single resistance group, 2/19 in middle-risk dual anti-platelet aggregation group, 10/19 in high-risk single resistance group, and 3/20 in high-risk dual anti-platelet aggregation group. The differences among those groups were statistically significant (P = 0.031, 0.019). The most common drug adverse reactions were nausea and acid regurgitation ( χ² = 0.000, P = 1.000). No obvious bleeding tendency or liver and kidney dysfunction was found.  Conclusions  ABCD3-Ⅰ score may be used as the safety evaluation index of anti-platelet drugs. The application of aspirin combining with clopidogrel may have an advantage over aspirin monotherapy in the prevention of ischemic stroke.

Key words: Ischemic attack, transient, Aspirin, Platelet aggregation inhibitors