Sterzer P, Meintzschel F, Rösler A, Lanfermann H, Steinmetz H, Sitzer M
Department of Neurology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
Stroke. 2001 Dec 1;32(12):2817-20. doi: 10.1161/hs1201.099663.
Recent investigations have suggested an important role of statins in the prevention of stroke and dementia independent of their lipid-lowering properties. Using transcranial Doppler sonography (TCD), we examined acetazolamide reactivity as a marker of cerebral vasoreactivity in patients with subcortical small-vessel disease before and after pravastatin treatment.
In 16 patients (mean age 68+/-10 years) with subcortical small-vessel disease, cerebral vasomotor reactivity was tested using TCD insonating the middle cerebral artery. Cerebral blood flow velocity (CBFV) increase after bolus injection of 1 g acetazolamide was determined before and after 2-month treatment with pravastatin sodium 20 mg daily.
Relative CBFV increase was significantly greater after pravastatin treatment (41.9+/-23.7% versus 55.7+/-18.3%, P=0.004). Comparison of CBFV at rest before and after treatment with pravastatin did not show significant differences. There was a strong negative correlation between the pravastatin-induced enhancement of vasomotor reactivity and the pretreatment CBFV increase (beta=-0.64, P=0.019). No associations were found between the effect of pravastatin on vasomotor reactivity and pretreatment levels or changes of LDL cholesterol.
This pilot study provides the first evidence for a significant improvement of cerebral vasomotor reactivity by statin therapy in patients with cerebral small-vessel disease. The results may help to elucidate the preventive effect of statins and provide insights into the pathophysiology of cerebral small-vessel disease.
近期研究表明，他汀类药物在预防中风和痴呆方面具有重要作用，且独立于其降脂特性。我们使用经颅多普勒超声（TCD），检测了普伐他汀治疗前后皮质下小血管疾病患者的乙酰唑胺反应性，以此作为脑血管反应性的标志物。
对16例（平均年龄68±10岁）皮质下小血管疾病患者，采用TCD对大脑中动脉进行检测，以测试脑血管舒缩反应性。在每日服用20 mg普伐他汀钠治疗2个月前后，分别测定静脉注射1 g乙酰唑胺后大脑血流速度（CBFV）的增加情况。
普伐他汀治疗后，相对CBFV增加显著更大（41.9±23.7%对55.7±18.3%，P = 0.004）。普伐他汀治疗前后静息状态下的CBFV比较，未显示出显著差异。普伐他汀诱导的血管舒缩反应增强与治疗前CBFV增加之间存在强烈的负相关（β = -0.64，P = 0.019）。未发现普伐他汀对血管舒缩反应的影响与治疗前低密度脂蛋白胆固醇水平或变化之间存在关联。
这项初步研究首次证明，他汀类药物治疗可使脑小血管疾病患者的脑血管舒缩反应性显著改善。这些结果可能有助于阐明他汀类药物的预防作用，并为脑小血管疾病的病理生理学提供见解。
