McGirt Matthew J, Garces Ambrossi Giannina L, Huang Judy, Tamargo Rafael J
Department of Neurosurgery, Johns Hopkins University Hospital, Baltimore, Maryland, USA.
J Neurosurg. 2009 May;110(5):968-74. doi: 10.3171/2008.10.JNS08901.
Vasospasm is the major cause of disability and death after aneurysmal subarachnoid hemorrhage (aSAH). Although the results of 2 randomized clinical trials demonstrated that statin decreases the incidence of symptomatic cerebral vasospasm after aSAH, retrospective studies have failed to confirm this. The authors conducted a prospective observational study to determine whether a standardized regimen of simvastatin would reduce the incidence of cerebral vasospasm and improve neurological outcomes in patients with aSAH.
Since 1991, all patients with aSAH admitted to the authors' institution have been prospectively followed up with standardized outcomes recording. Starting in September 2005, all patients admitted with aSAH were given enteral simvastatin (80 mg/day for 14 days) in addition to the standard care. The incidence of symptomatic cerebral vasospasm, length of hospitalization, in-hospital mortality rate, and discharge Glasgow Outcome Scale scores in these 170 patients were compared to data obtained in 170 consecutive patients who underwent treatment in our unit prior to the introduction of statin therapy.
The 5-year study period included 340 consecutively treated patients (170 who received statins and 170 who did not). Patients who received simvastatin therapy were more frequently male (29 vs 20%) and had a smaller median aneurysm diameter (6 vs 7 mm). Baseline characteristics were otherwise similar between the cohorts. There were no differences in the incidence of symptomatic vasospasm (25.3 vs 30.5%; p = 0.277), in-hospital mortality rate (18 vs 15%; p = 0.468), length of hospitalization (21 +/- 15 vs 19 +/- 12 days; p = 0.281), or poor outcome at discharge (Glasgow Outcome Scale Scores 1-2: 21.7 vs 18.2%; p = 0.416) between the simvastatin and nonstatin cohorts. There were no statin-related complications.
The uniform introduction of simvastatin did not reduce the incidence of symptomatic cerebral vasospasm, death, or poor outcome in patients with aSAH. Simvastatin was well tolerated, but its benefit may be less than has been previously reported.
血管痉挛是动脉瘤性蛛网膜下腔出血（aSAH）后致残和死亡的主要原因。尽管两项随机临床试验的结果表明他汀类药物可降低aSAH后症状性脑血管痉挛的发生率，但回顾性研究未能证实这一点。作者进行了一项前瞻性观察性研究，以确定辛伐他汀的标准化治疗方案是否会降低aSAH患者脑血管痉挛的发生率并改善神经功能预后。
自1991年以来，作者所在机构收治的所有aSAH患者均接受了前瞻性随访，并记录标准化结果。从2005年9月开始，所有收治的aSAH患者除接受标准治疗外，还给予肠内辛伐他汀（80毫克/天，共14天）。将这170例患者的症状性脑血管痉挛发生率、住院时间、院内死亡率和出院时格拉斯哥预后评分与在他汀类药物治疗引入之前在本单位接受治疗的170例连续患者的数据进行比较。
5年研究期内共连续治疗340例患者（170例接受他汀类药物治疗，170例未接受）。接受辛伐他汀治疗的患者男性比例更高（29%对20%），动脉瘤中位直径更小（6毫米对7毫米）。两组患者的基线特征在其他方面相似。症状性血管痉挛的发生率（25.3%对30.5%；p = 0.277）、院内死亡率（18%对15%；p = 0.468）、住院时间（21±15天对19±12天；p = 0.281）或出院时预后不良（格拉斯哥预后评分1 - 2：21.7%对18.2%；p = 0.416）在辛伐他汀组和非他汀组之间无差异。未出现与他汀类药物相关的并发症。
统一使用辛伐他汀并未降低aSAH患者症状性脑血管痉挛的发生率、死亡率或不良预后。辛伐他汀耐受性良好，但其益处可能低于先前报道。
