一项关于二十碳五烯酸治疗脑血管痉挛疗效的前瞻性、多中心、随机研究：EVAS 研究。
A prospective, multicenter, randomized study of the efficacy of eicosapentaenoic acid for cerebral vasospasm: the EVAS study.
机构信息
Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan; Department of Neurosurgery, Ootemachi Hospital, Kitakyushu, Fukuoka, Japan.
Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
出版信息
World Neurosurg. 2014 Feb;81(2):309-15. doi: 10.1016/j.wneu.2012.09.020. Epub 2012 Sep 29.
OBJECTIVE
The sphingosylphosphorylcholine-Rho-kinase pathway plays an important role in Ca(2+) sensitization of vascular smooth muscle contraction. Eicosapentaenoic acid (EPA) inhibits sphingosylphosphorylcholine -Rho-kinase-activated Ca(2+)-sensitization in vitro and in subarachnoid hemorrhage (SAH) models in vivo and has also been shown to inhibit the occurrence of cerebral vasospasm (CIV) after the onset of SAH in a prospective, nonrandomized study. The current prospective, multicenter, randomized study was performed to confirm the preventive effects of EPA on CIV in patients with SAH.
METHODS
The trial population comprised 162 patients who underwent surgical clipping within 72 hours of the onset of SAH. Of these patients, 81 received 2700 mg/day EPA from the day after surgery until day 30 (EPA group), and 81 did not receive EPA (control group). The primary end point was the occurrence of symptomatic vasospasm (SV) or cerebral infarction caused by CIV.
RESULTS
The occurrences of SV (15% vs. 30%; P = 0.022) and CIV (7% vs. 21%; P = 0.012) were lower in the EPA group. Multivariate analysis revealed an adjusted odds ratio of 0.39 (95% confidence interval, 0.17-0.89; P = 0.028) for SV inhibition by EPA and 0.27 (95% confidence interval, 0.09-0.72; P = 0.012) for CIV inhibition.
CONCLUSIONS
These results indicate that oral EPA reduces the frequency of SV and CIV after the onset of aneurysmal SAH.
目的
鞘氨醇磷酸胆碱 - Rho-激酶途径在血管平滑肌收缩的 Ca(2+)敏化中发挥重要作用。二十碳五烯酸（EPA）抑制体外鞘氨醇磷酸胆碱 -Rho-激酶激活的 Ca(2+)-敏化作用以及蛛网膜下腔出血（SAH）模型中的体内 Ca(2+)-敏化作用，并且还已显示抑制蛛网膜下腔出血后发生的脑血管痉挛（CIV）的发生在一项前瞻性、非随机研究中。本项前瞻性、多中心、随机研究旨在证实 EPA 对 SAH 患者 CIV 的预防作用。
方法
试验人群包括 162 名在蛛网膜下腔出血发作后 72 小时内接受手术夹闭的患者。这些患者中，81 名患者术后第 1 天至第 30 天每天接受 2700 毫克 EPA（EPA 组），81 名患者未接受 EPA（对照组）。主要终点是症状性血管痉挛（SV）或 CIV 引起的脑梗死的发生。
结果
EPA 组 SV（15% vs. 30%；P = 0.022）和 CIV（7% vs. 21%；P = 0.012）的发生率较低。多变量分析显示，EPA 抑制 SV 的调整比值比为 0.39（95%置信区间，0.17-0.89；P = 0.028），EPA 抑制 CIV 的调整比值比为 0.27（95%置信区间，0.09-0.72；P = 0.012）。
结论
这些结果表明，口服 EPA 可降低动脉瘤性蛛网膜下腔出血后 SV 和 CIV 的发生率。
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