Unit of Cerebrovascular Diseases, Service of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain.
BMC Neurol. 2010 Jun 18;10:47. doi: 10.1186/1471-2377-10-47.
Data from different studies suggest a favourable association between pretreatment with statins or hypercholesterolemia and outcome after ischaemic stroke. We examined whether there were differences in in-hospital mortality according to the presence or absence of statin therapy in a large population of first-ever ischaemic stroke patients and assessed the influence of statins upon early death and spontaneous neurological recovery.
In 2,082 consecutive patients with first-ever ischaemic stroke collected from a prospective hospital-based stroke registry during a period of 19 years (1986-2004), statin use or hypercholesterolemia before stroke was documented in 381 patients. On the other hand, favourable outcome defined as grades 0-2 in the modified Rankin scale was recorded in 382 patients.
Early outcome was better in the presence of statin therapy or hypercholesterolemia (cholesterol levels were not measured) with significant differences between the groups with and without pretreatment with statins in in-hospital mortality (6% vs 13.3%, P = 0.001) and symptom-free (22% vs 17.5%, P = 0.025) and severe functional limitation (6.6% vs 11.5%, P = 0.002) at hospital discharge, as well as lower rates of infectious respiratory complications during hospitalization. In the logistic regression model, statin therapy was the only variable inversely associated with in-hospital death (odds ratio 0.57) and directly associated with favourable outcome (odds ratio 1.32).
Use of statins or hypercholesterolemia before first-ever ischaemic stroke was associated with better early outcome with a reduced mortality during hospitalization and neurological disability at hospital discharge. However, statin therapy may increase the risk of intracerebral haemorrhage, particularly in the setting of thrombolysis.
来自不同研究的数据表明，在缺血性卒中患者中，使用他汀类药物或高胆固醇血症与预后之间存在有利关联。我们研究了在首次发生缺血性卒中的大人群中，根据他汀类药物治疗的存在与否，住院死亡率是否存在差异，并评估了他汀类药物对早期死亡和自发性神经功能恢复的影响。
在 19 年期间（1986-2004 年），从一个前瞻性基于医院的卒中登记处连续收集了 2082 例首次发生的缺血性卒中患者，381 例患者记录了卒中前使用他汀类药物或高胆固醇血症。另一方面，382 例患者记录了有利的结局，定义为改良 Rankin 量表的 0-2 级。
存在他汀类药物治疗或高胆固醇血症时，早期结局更好，治疗组与未治疗组在住院死亡率（6%比 13.3%，P=0.001）、无症状（22%比 17.5%，P=0.025）和严重功能受限（6.6%比 11.5%，P=0.002）方面存在显著差异，住院期间的感染性呼吸道并发症发生率也较低。在逻辑回归模型中，他汀类药物治疗是唯一与住院期间死亡呈负相关的变量（比值比 0.57），与有利的结局呈直接相关（比值比 1.32）。
首次发生缺血性卒中前使用他汀类药物或高胆固醇血症与更好的早期结局相关，住院期间死亡率降低，出院时神经功能障碍减轻。然而，他汀类药物治疗可能会增加颅内出血的风险，特别是在溶栓治疗的情况下。
