Washington University, School of Medicine, Department of Neurology, 600 South Euclid Avenue, Campus Box 8111, St. Louis, MO 63110, USA.
Stroke. 2011 May;42(5):1307-13. doi: 10.1161/STROKEAHA.110.600957. Epub 2011 Mar 31.
Statin pretreatment has been associated with improved outcomes in patients with ischemic stroke. Although several mechanisms have been examined in animal models, few have been examined in patients. We hypothesized that patients using statins before stroke onset may have greater reperfusion than patients not using statins.
Acute ischemic stroke patients underwent 2 MR scans: within 4.5 (tp1) and at 6 hours (tp2) after stroke onset. Regions of reperfusion were defined by prolonged mean transit time (MTT) at tp1, which normalized at tp2. Four MTT thresholds were assessed to ensure that results were not spuriously based on an arbitrary threshold. Baseline characteristics, relative reperfusion, and change in NIHSS between tp1 and 1-month follow-up (ΔNIHSS) were compared between patients who were using statins at stroke onset and those who were not.
Thirty-one stroke patients were prospectively enrolled; 12 were using statins and 19 were not. Baseline characteristics did not differ between the 2 groups except the statin group had greater coronary artery disease (P=0.03). Patients using statins showed significantly greater reperfusion compared to untreated patients across all MTT thresholds. For MTT of 4 seconds, median relative reperfusion was 50% (interquartile range, 30%-56%) in the preexisting statin group versus 13% (interquartile range, 5%-36%) in the untreated group (P=0.014). The statin group had greater ΔNIHSS (8.8±4.0 points) compared to the untreated group (4.4±5.7 points; P=0.028).
Statin use before ischemic stroke onset was associated with greater early reperfusion and NIHSS improvement. Further studies in larger populations are required to confirm our preliminary findings.
他汀类药物预处理与缺血性脑卒中患者的预后改善相关。虽然在动物模型中已经研究了几种机制，但在患者中研究较少。我们假设在卒中发作前使用他汀类药物的患者可能比不使用他汀类药物的患者具有更大的再灌注。
急性缺血性脑卒中患者接受了 2 次磁共振扫描：卒中发作后 4.5 小时（tp1）和 6 小时（tp2）。通过在 tp1 时延长平均通过时间（MTT）来定义再灌注区域，在 tp2 时恢复正常。评估了 4 个 MTT 阈值，以确保结果不是基于任意阈值的虚假结果。比较了在卒中发作时使用他汀类药物和未使用他汀类药物的患者之间的基线特征、相对再灌注和 tp1 与 1 个月随访时 NIHSS 变化（ΔNIHSS）。
前瞻性纳入了 31 例卒中患者；12 例使用他汀类药物，19 例未使用。两组患者的基线特征无差异，除了他汀类药物组的冠心病更多（P=0.03）。使用他汀类药物的患者与未治疗的患者相比，在所有 MTT 阈值下均表现出显著更大的再灌注。对于 MTT 为 4 秒，在预先存在的他汀类药物组中，中位数相对再灌注为 50%（四分位距，30%-56%），而在未治疗组中为 13%（四分位距，5%-36%）（P=0.014）。与未治疗组相比，他汀类药物组的 NIHSS 改善更大（8.8±4.0 分）（P=0.028）。
在缺血性卒中发作前使用他汀类药物与更大的早期再灌注和 NIHSS 改善相关。需要更大的人群研究来证实我们的初步发现。
