Stead Latha G, Vaidyanathan Lekshmi, Kumar Gautam, Bellolio M Fernanda, Brown Robert D, Suravaram Smitha, Enduri Sailaja, Gilmore Rachel M, Decker Wyatt W
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Stroke Cerebrovasc Dis. 2009 Mar-Apr;18(2):124-7. doi: 10.1016/j.jstrokecerebrovasdis.2008.09.016.
Statins have been shown to improve the functional outcome of patients after an ischemic stroke. We hypothesized that daily statin intake improves functional outcome after an acute ischemic stroke in patients with low-density lipoprotein (LDL) less than or equal to 100 mg/dL.
This was a prospective cohort study during a 22-month period of patients presenting with an acute ischemic stroke and lipid profiles measured. The functional disability was determined using modified Rankin scale score (0-2 good outcome, 3-6 bad outcome) at discharge. Chi-square test for binary data and nonparametric tests for nonnormally distributed variables were used for analysis.
Of 508 patients, 207 presented with an LDL of 100 mg/dL or less and were included in the analysis. There was no significant difference in admission stroke severity (National Institutes of Health Stroke Scale [NIHSS]; P = .18), age (P = .31), and sex (P = .06) between those taking statins and not taking statins. Patients with LDL less than or equal to 100 mg/dL and taking statins (n = 100) were significantly more likely to have a good functional outcome (odds ratio 1.91; 95% confidence interval 1.05-3.47) when compared with those not on the medication. After adjusting for age, sex, and NIHSS, statin intake still predicted a better functional outcome (P < .0001).
Daily statin intake appears to result in a better functional outcome after an ischemic stroke in patients with ideal LDL levels (<or=100 mg/dL) before and after adjusting for age and stroke severity. Pleiotropic effects of statins may play a role in this.
他汀类药物已被证明可改善缺血性中风患者的功能结局。我们假设，对于低密度脂蛋白（LDL）小于或等于100mg/dL的急性缺血性中风患者，每日服用他汀类药物可改善功能结局。
这是一项前瞻性队列研究，为期22个月，纳入急性缺血性中风患者并测量其血脂水平。出院时使用改良Rankin量表评分（0 - 2为良好结局，3 - 6为不良结局）确定功能残疾情况。采用二元数据的卡方检验和非正态分布变量的非参数检验进行分析。
508例患者中，207例LDL为100mg/dL或更低，纳入分析。服用他汀类药物和未服用他汀类药物的患者在入院时的中风严重程度（美国国立卫生研究院卒中量表[NIHSS]；P = 0.18）、年龄（P = 0.31）和性别（P = 0.06）方面无显著差异。与未服用药物的患者相比，LDL小于或等于100mg/dL且服用他汀类药物的患者（n = 100）更有可能获得良好的功能结局（优势比1.91；95%置信区间1.05 - 3.47）。在调整年龄、性别和NIHSS后，服用他汀类药物仍可预测更好的功能结局（P < 0.0001）。
在调整年龄和中风严重程度前后，对于LDL水平理想（<或 = 100mg/dL）的缺血性中风患者，每日服用他汀类药物似乎可带来更好的功能结局。他汀类药物的多效性可能在此过程中发挥作用。
