Unitat d'Ictus, Servei de Neurologia, Hospital del Mar, Departament de Medicina de la Universitat Autònoma de Barcelona, IMIM-Hospital del Mar, NeuroMar, Barcelona, Spain.
Eur J Neurol. 2010 Mar;17(3):443-8. doi: 10.1111/j.1468-1331.2009.02838.x. Epub 2009 Nov 12.
Statins treatment may have potential clinical impact in vascular disease beyond cholesterol lowering. Its benefits have been documented in cerebral ischaemia and in subarachnoid haemorrhage. In intracerebral haemorrhage (ICH), experimental models in statin-treated animals have better outcome than non-treated ones, but in humans the relationship is unclear. We investigated whether patients treated with statins before the onset of intracerebral haemorrhage have a better outcome at 3 months than patients without statins pre-treatment.
Retrospective review of primary intracerebral haemorrhage case series from a prospective stroke register. We recorded demographics, vascular risk factors, previous statin treatment, Glasgow coma scale (GCS) at onset, ICH scale, hematoma volume and location, ventricular extension of the hematoma, and functional outcome at 3 months. The effect of prior statin treatment on good outcome (modified Rankin scale [mRS] 0 to 2) was analysed by logistic regression analysis.
We included 269 patients (age 71.9 +/- 12.4, mean +/- SD, 152 males). Thirty-four patients (12.6%) were on prior statin treatment when admitted. There were no differences in fasting serum cholesterol and triglycerides levels between the statin pre-treated groups and the group without statin pre-treatment. Multivariate regression analysis showed a significant association between age (OR: 0.95; CI 0.92-0.97), ICH volume (OR: 0.96; CI 0.94-0.98), GCS (OR: 1.55; CI 1.21-1.98), pre-treatment with statins (OR: 4.21; CI 1.47-12.17; P = 0.008), and good outcome at 3 months.
Statins pre-treatment of patients with intracerebral haemorrhage may provide better functional outcome at 3 months of acute onset.
他汀类药物治疗除了降低胆固醇外,在血管疾病方面可能具有潜在的临床影响。其益处已在脑缺血和蛛网膜下腔出血中得到证实。在脑出血(ICH)中,他汀类药物治疗动物的实验模型比未治疗的动物有更好的结果,但在人类中,这种关系尚不清楚。我们研究了在脑出血发作前接受他汀类药物治疗的患者在 3 个月时的结局是否优于未接受他汀类药物治疗的患者。
对前瞻性卒中登记处的原发性脑出血病例系列进行回顾性分析。我们记录了人口统计学、血管危险因素、既往他汀类药物治疗、发病时的格拉斯哥昏迷量表(GCS)、ICH 量表、血肿体积和位置、血肿的脑室延伸以及 3 个月时的功能结局。通过逻辑回归分析,分析了既往他汀类药物治疗对良好结局(改良 Rankin 量表[mRS]0-2)的影响。
我们纳入了 269 名患者(年龄 71.9±12.4,平均值±标准差,152 名男性)。34 名患者(12.6%)入院时正在服用他汀类药物。他汀类药物预处理组和未接受他汀类药物预处理组的空腹血清胆固醇和甘油三酯水平无差异。多变量回归分析显示,年龄(OR:0.95;95%CI 0.92-0.97)、ICH 体积(OR:0.96;95%CI 0.94-0.98)、GCS(OR:1.55;95%CI 1.21-1.98)、他汀类药物预处理(OR:4.21;95%CI 1.47-12.17;P=0.008)与 3 个月时的良好结局显著相关。
脑出血患者在急性发作前接受他汀类药物治疗可能会在 3 个月时获得更好的功能结局。