Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
PLoS One. 2014 Jan 21;9(1):e84389. doi: 10.1371/journal.pone.0084389. eCollection 2014.
Statins reportedly improve clinical outcomes for ischemic stroke patients. However, it is unclear whether the contribution of statin treatment varies depending on the severity of stroke. We sought to investigate the relationship between statin use and the outcome of acute first-ever ischemic stroke patients stratified by stroke severity.
A total of 7,455 acute first-ever ischemic stroke patients without statin treatment before onset were eligible from the China National Stroke Registry. A National Institutes of Health Stroke Scale (NIHSS) score of 0 to 4 was defined as minor stroke, and a NIHSS score of >4 was defined as non-minor stroke. We analyzed the association between statin use during hospitalization and mortality as well as functional outcome (measured by a modified Rankin Scale score of 0-5) at 3 months after onset using multivariable logistic regression models.
A total of 3,231 (43.3%) patients received statin treatment during hospitalization. Multivariable analysis showed that statin use during hospitalization decreased mortality of ischemic stroke patients (OR, 0.51; 95%CI, 0.38-0.67), but did not improve poor functional outcomes (OR, 0.95; 95CI%, 0.81-1.11) at 3 months. The interaction between statin use and stroke severity was significant both in dependence and death outcome (P = 0.04 for dependence outcome, P = 0.03 for death outcome). After stratification by stroke severity, statin use during hospitalization decreased the mortality of stroke (OR, 0.44; 95%CI, 0.31-0.62) and poor functional outcome (OR, 0.73; 95%CI, 0.57-0.92) at 3 months in the non-minor stroke group.
Statin use during hospitalization may improve the clinical outcome of acute first-ever ischemic stroke depending on the severity of stroke. Non-minor stroke patients may obtain benefit from statin treatment with improvements in poor functional outcomes and mortality.
据报道，他汀类药物可改善缺血性脑卒中患者的临床结局。然而，他汀类药物治疗的效果是否因卒中严重程度而异尚不清楚。本研究旨在探讨按卒中严重程度分层的急性首发缺血性脑卒中患者中，他汀类药物的使用与结局之间的关系。
本研究共纳入了 7455 例发病前未接受他汀类药物治疗的急性首发缺血性脑卒中患者，其美国国立卫生研究院卒中量表（NIHSS）评分为 04 分为轻度卒中，评分>4 分为非轻度卒中。采用多变量逻辑回归模型分析了住院期间使用他汀类药物与发病后 3 个月时的死亡率及功能结局（采用改良Rankin 量表评分 05 分进行评估）之间的关系。
共有 3231 例（43.3%）患者在住院期间接受了他汀类药物治疗。多变量分析显示，住院期间使用他汀类药物可降低缺血性脑卒中患者的死亡率（OR，0.51；95%CI，0.380.67），但不能改善 3 个月时的不良功能结局（OR，0.95；95%CI，0.811.11）。他汀类药物使用与卒中严重程度之间的交互作用在依赖结局和死亡结局方面均有统计学意义（依赖结局：P=0.04；死亡结局：P=0.03）。按卒中严重程度分层后，在非轻度卒中亚组中，住院期间使用他汀类药物可降低卒中后 3 个月时的死亡率（OR，0.44；95%CI，0.310.62）和不良功能结局（OR，0.73；95%CI，0.570.92）。
住院期间使用他汀类药物可能会根据卒中严重程度改善急性首发缺血性脑卒中患者的临床结局。非轻度卒中患者可能会从他汀类药物治疗中获益，改善不良功能结局和死亡率。
