Centre Hospitalier, Universitaire de Sherbrooke CHUS, Department of Neurology, University of Sherbrooke, Sherbrooke, Quebec, Canada.
Can J Neurol Sci. 2010 Nov;37(6):791-6. doi: 10.1017/s0317167100051453.
Some studies have suggested an association between hypocholesterolemia and intracerebral hemorrhage (ICH). In the SPARCL trial, statin use increased ICH risk. We tested the hypothesis that use of statins affects the volume of spontaneous ICH and contributes to the progression of ICH volume between baseline and follow-up CT scans.
Consecutive cases of spontaneous ICH were reviewed. Secondary causes were excluded. We measured ICH volume on the baseline and follow-up CT scans using the AxBxC/2 method. Multivariate analysis and logistic regression modeling were used. The primary outcome was the ICH volume on the baseline CT scan. Secondary outcomes included volume variation between the baseline and the first follow up CT scans and death.
Of 303 subjects, 71 were taking a statin at the time of the ICH (23%). Statin users were significantly more likely to be younger, to have co-morbidities and take anticoagulant or anti-platelet medication. They also had a higher baseline ICH volume than non-statin users (median 31.2 [10, 82.1] ml vs 16 [4, 43.8] ml; p=0.006). Adjusting for possible confounders, statins remained associated with an increased ICH volume (p=0.007). There was a significant mean ICH volume progression between the first and second CT scans in statin users (+10.8 vs +0.9 ml; p=0.03; 95% CI: [-1, +22.6] [-2.5, +4.3]). No difference in mortality was seen between the two groups.
Treatment with HMG-CoA reductase inhibitors may be a risk factor for increased ICH volume in spontaneous brain hemorrhages and could contribute to hemorrhage's volume progression.
一些研究表明，低胆固醇血症与脑出血（ICH）之间存在关联。在 SPARCL 试验中，他汀类药物的使用增加了 ICH 的风险。我们检验了这样一个假设，即他汀类药物的使用会影响自发性脑出血的体积，并导致基线和随访 CT 扫描之间 ICH 体积的进展。
回顾性分析连续自发性脑出血患者。排除继发性病因。我们使用 AxBxC/2 方法测量基线和随访 CT 扫描上的 ICH 体积。采用多元分析和逻辑回归模型。主要结局是基线 CT 扫描上的 ICH 体积。次要结局包括基线和首次随访 CT 扫描之间的体积变化和死亡。
在 303 例患者中，71 例（23%）在发生 ICH 时正在服用他汀类药物。他汀类药物使用者更年轻，合并症更多，并且服用抗凝或抗血小板药物。与非他汀类药物使用者相比，他们的基线 ICH 体积也更高（中位数 31.2 [10，82.1] ml 比 16 [4，43.8] ml；p=0.006）。在调整了可能的混杂因素后，他汀类药物仍与 ICH 体积增加相关（p=0.007）。在他汀类药物使用者中，第一次和第二次 CT 扫描之间的 ICH 体积有显著的平均进展（+10.8 比+0.9 ml；p=0.03；95%CI：[-1，+22.6] [-2.5，+4.3]）。两组之间的死亡率无差异。
HMG-CoA 还原酶抑制剂的治疗可能是自发性脑出血 ICH 体积增加的一个危险因素，并可能导致出血体积的进展。
