Martí-Fàbregas Joan, Gomis Meritxell, Arboix Adrià, Aleu Aitziber, Pagonabarraga Javier, Belvís Robert, Cocho Dolores, Roquer Jaume, Rodríguez Ana, García María Dolores, Molina-Porcel Laura, Díaz-Manera Jordi, Martí-Vilalta Josep-Lluis
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Stroke. 2004 May;35(5):1117-21. doi: 10.1161/01.STR.0000125863.93921.3f. Epub 2004 Apr 8.
Statins may be beneficial for patients with acute ischemic stroke. We tested the hypothesis that patients pretreated with statins at the onset of stroke have less severe neurological effects and a better outcome.
We prospectively included consecutive patients with ischemic stroke of <24-hour duration. We recorded demographic data, vascular risk factors, Oxfordshire Classification, National Institutes of Health Stroke Scale (NIHSS) score, admission blood glucose and body temperature, cause (Trial of Org 10172 in Acute Treatment [TOAST] criteria), neurological progression at day 3, previous statin treatment, and outcome at 3 months. We analyzed the data using univariate methods and a logistic regression with the dependent variable of good outcome (modified Rankin Scale [mRS] 0 to 1, Barthel Index [BI] 95 to 100).
We included 167 patients (mean age 70.7+/-12 years, 94 men). Thirty patients (18%) were using statins when admitted. In the statin group, the median NIHSS score was not significantly lower and the risk of progression was not significantly reduced. Favorable outcomes at 3 months were more frequent in the statin group (80% versus 61.3%, P=0.059 with the mRS; 76.7% versus 51.8%, P=0.015 with the BI). Predictors of favorable outcome with the BI were: NIHSS score at admission (OR: 0.72; CI: 0.65 to 0.80; P<0.0001), age (OR: 0.96; CI: 0.92 to 0.99; P=0.017), and statin group (OR: 5.55; CI: 1.42 to 17.8; P=0.012).
Statins may provide benefits for the long-term functional outcome when administered before the onset of cerebral ischemia. However, randomized controlled trials will be required to evaluate the validity of our results.
他汀类药物可能对急性缺血性脑卒中患者有益。我们检验了这样一个假设，即脑卒中发病时接受他汀类药物预处理的患者神经功能影响较轻且预后较好。
我们前瞻性纳入了发病时长小于24小时的连续性缺血性脑卒中患者。我们记录了人口统计学数据、血管危险因素、牛津郡分类、美国国立卫生研究院卒中量表（NIHSS）评分、入院时血糖和体温、病因（急性治疗中奥扎格雷钠试验[TOAST]标准）、第3天的神经功能进展、既往他汀类药物治疗情况以及3个月时的预后。我们使用单变量方法和以良好预后（改良Rankin量表[mRS]0至1，Barthel指数[BI]95至100）为因变量的逻辑回归分析数据。
我们纳入了167例患者（平均年龄70.7±12岁，94例男性）。30例患者（18%）入院时正在使用他汀类药物。在他汀类药物组中，NIHSS评分中位数没有显著降低，病情进展风险也没有显著降低。他汀类药物组3个月时的良好预后更为常见（mRS评估时为80%对61.3%，P = 0.059；BI评估时为76.7%对51.8%，P = 0.015）。BI评估良好预后的预测因素为：入院时NIHSS评分（OR：0.72；CI：0.65至0.80；P < 0.0001）、年龄（OR：0.96；CI：0.92至0.99；P = 0.017）以及他汀类药物组（OR：5.55；CI：1.42至17.8；P = 0.012）。
在脑缺血发作前给予他汀类药物可能对长期功能预后有益。然而，需要进行随机对照试验来评估我们结果的有效性。
