????????? IHD = ??????; COPD = ???????; HIV = ????????; AIDS = ??????????; CVD = ????

1
???????????????????

• ? ? ?
• ??????????????
• ?????????????
• ????????

2
??-??????????
19.0
????????? IHD ?????? COPD ??????? HIV
???????? AIDS ?????????? CVD ????
WHO The World Heart Report 1999, Nikkei Medical
1999, Japan Welfare Ministry 1997
3
????????????

• ????700?
• ??????250?
• ??????150?
• 2/3????

4
??????

• ??
• ??
• ??
• ??
• ??
• ????
• ????
• ??
• ??

• ??????????,???????????????,?????????????????
  
• ?????
• ????(Decade of Brain)
• 1990

5
??
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
?????????
11
?????

• ?12???????????
• ?21???????????

12
??????????
TCM
????
??????
????
??????
????
???
????
13
????
14
?????????
15
??????
????
?? ????
????
?? ????? ????????
????
?? ????
16
??????????????

• ????
• RR7(-522)

• ?????????
• RR-36(-15-51)
• NNT400

JAMA 20022881388-1395
17
??????
Women's Health Study
??????????? ????????????
N Engl J Med 2005, 3521295
18
WHS-??????????

• 39,876 ?????,??45?(10??????
• ?2.5)
• 100mg??????????1?
• ???? N 19,934 ??? N 19,942
• ??10?
• ???? ????????? (?????, ?
• ????, ???????????)

N Engl J Med 2005, 3521295
19
WHS?????????
??
??
??????17
0.02
0.02
p 0.04
???
????
????????
????????
0.01
0.01
????
???
p 0.83
0.00
0.00
0
2
4
6
8
10
0
2
4
6
8
10
????
????
N Engl J Med 2005, 3521295
20
WHS?????????
A
B
???????24
????????
p 0.009
0.02
p 0.31
0.02
???
???????????
0.01
0.01
???????????
????
????
???
0.00
0.00
0
2
4
6
8
10
0
2
4
6
8
10
????
N Engl J Med 2005, 3521295
21
??????????
???????????????45????? ?????????????????????
?????????????,???? ???,????????????(75-150mg)
???????????????????,2005
22
?????????
23
????
TIA/??

• ?????????

???
???
???? ASA Ticlopidine Clopidogrel ASA/Dipyidamole
?? Warfarin
24
??????????????

• ????
• RR-28(19-36)
• NNT77

• Thienopyridines
• RR-13(3-22)
• NNT64

JAMA 20022881388-1395
25
?????( Antithrombotic Trialists
Collaboration)????

• ??
• ?????????????????????????
• ????
• 287?????
• 135,000?????????????
• 77,000 ?????????????

1. Antithrombotic Trialists Collaboration. BMJ
2002 324 7186.
26
ATT????-??????????

• ?? ????
• ??????
• ?????
• ???????
• ??????/???????
• ??????
• ??????(???????????)
• ??????(?????)
• ?????? (???)
• ?? (????)
• ???? 22 2

1.0
0.5
0.0
1.5
2.0
???? ???????????????
????
??????
Antithrombotic Trialists Collaboration. BMJ
2002 324 7186.
27
????????????????
23
30
25
20
???????? ()
plt0.0001
plt0.0001
p0.0003
15
10
5
?????? (plt0.0001)
0
????
?????TIA
????
versus placebo TIA, transient ischaemic
attack Antithrombotic Trialists Collaboration.
BMJ 20023247186.
28
????????????????????
22
2plt0.00001
40
35
30
25
???????? ()
20
15
?????????????????
10
5
0
?????? ?????
??? ???
?????
??? ???
Antiplatelet Trialists Collaboration. BMJ
199430881106.
29
???????????? (75150mg)
???? ???? 5001500 mg /? 160325 mg
/? 75150 mg /? lt 75 mg /? ???????? 23
2 (p lt 0.0001)
1.0
0.5
0.0
1.5
2.0
????
??????
1. Antithrombotic Trialists Collaboration. BMJ
2002 324 7186.
30
???????TIA??????????
?????????TIA(??????????? ??????)???,??????????,? ?
??(75-150mg/d),???????????? ????????(aggrenox),???
??(75mg/d)
????????????????, ???????????,50-100mg/d
??????????,??????
???????????????????,2005
31
?????????
32
?????????????
?????????14
3.9
14
2P0.04
??4????
3.3
????
??
CAST (Chinese Acute Stroke Trial) Collaborative
Group, Lancet 19973491641-49
33
??????????????
Lancet 19973491641-49 Lancet 19973491569-81
34
???????????/?????????
International Stroke Trial Collaborative Group,
Lancet 19973491569-81
35
?????????????
???????????????????, ????????,???100-300mg/d
????????????????,??? ????24?????????,???100-300mg/
d
????????????, ???????????????????
???????????????????,2005
36
????????

• ????
• ????
• ????

• ???????
• ??
• ??

????
????
????

• ??
• ??????
• ?????????
• ????
• ?????
• ?????????

• ??
• ??????
• ??????
• ????
• ?????
• ??????

37
Thanks