Eichel Roni, Khouri Salim T, Cohen Jose E, Ben-Hur Tamir, Paniri Ruth, Keidar Michal, Leker Ronen R
Cerebrovascular Service and the Periz and Chantel Sheinberg Cerebrovascular Research Laboratory, Department of Neurology, Hadassah-Hebrew University Medical Center, Israel.
Neurol Res. 2010 Nov;32(9):905-9. doi: 10.1179/016164110X12656393664928. Epub 2010 Mar 10.
Angiotensin-converting enzyme inhibitors (ACEI) exert protective effects in patients with stroke but their effects remain unknown in patients with intracerebral hemorrhage (ICH).
We recruited consecutive patients with acute ICH and analysed pre-admission demographic variables and drug therapy as well as clinical and radiological parameters. Functional and neurological outcomes were determined with the modified Rankin score (mRS) and the NIH Stroke Scale (NIHSS) score administered 90 days after ICH.
Three hundred and ninety-nine patients were included over 6 years with a mortality rate of 47.3%. Before ICH, 130 patients (32.6%) used ACEI. ACEI-treated patients more often had vascular co-morbidities and were more frequently treated with anti-platelets. Admission NIHSS scores were significantly higher in ACEI-treated patients but 90 days NIHSS scores were not. Improvement from baseline NIHSS scores was significantly larger in ACEI-treated patients. Pre-ICH use of ACEI was not associated with lower mortality or better functional outcome on univariate analysis. On multivariable logistic regression analysis, controlling for possible confounding variables, ACEI use was not associated with increased chances for good outcome and failed to show an influence on mortality.
In conclusion, our study does not support a possible neuroprotective effect for ACEI use prior to the occurrence of ICH.
血管紧张素转换酶抑制剂（ACEI）对中风患者具有保护作用，但其对脑出血（ICH）患者的影响尚不清楚。
我们连续招募急性脑出血患者，分析入院前的人口统计学变量、药物治疗以及临床和影像学参数。采用改良Rankin量表（mRS）和脑出血90天后的美国国立卫生研究院卒中量表（NIHSS）评分来确定功能和神经学预后。
6年期间共纳入399例患者，死亡率为47.3%。脑出血前，130例患者（32.6%）使用ACEI。使用ACEI治疗的患者更常伴有血管合并症，且更频繁地接受抗血小板治疗。ACEI治疗组患者入院时的NIHSS评分显著更高，但90天时的NIHSS评分无差异。ACEI治疗组患者从基线NIHSS评分的改善情况显著更大。单因素分析显示，脑出血前使用ACEI与较低死亡率或更好的功能预后无关。多变量逻辑回归分析在控制可能的混杂变量后，使用ACEI与良好预后机会增加无关，且未显示对死亡率有影响。
总之，我们的研究不支持在脑出血发生前使用ACEI可能具有神经保护作用这一观点。
