Chung Wu-Fu, Liu Shih-Wei, Chang Peng-Yuan, Lin Feng-Shu, Chen Li-Fu, Wu Jau-Ching, Chen Yu-Chun, Liu Laura, Huang Wen-Cheng, Cheng Henrich, Lo Su-Shun
Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan.
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan.
Int J Environ Res Public Health. 2015 Jan 5;12(1):402-13. doi: 10.3390/ijerph120100402.
The disabling pathophysiologic effects of lipid and neuroprotective effects of statins have recently been demonstrated for acute spinal cord injuries in animal models. This large scale population-based study aimed to investigate the effect hyperlipidemia and the use of statins in patients with lumbar spine injury. The National Health Insurance Research Database of Taiwan was used to identify patients with lumbar spine injury. A total of 2844 patients were grouped into three: no hyperlipidemia, hyperlipidemia using low-dose of statins (≤90 of the defined daily dosage (DDD)), and severe hyperlipidemia using high-dose of statins (>90 DDD). A Cox multiple regression model was used to compare the incidence rates of disability among the three groups. The results showed that patients with hyperlipidemia appeared a higher risk of permanent disability (adjusted HR = 1.38, p = 0.28). In subgroup analysis, patients with severe hyperlipidemia had a higher risk of disability (adjusted HR = 3.1, p < 0.004), whereas hyperlipidemia using low-dose statins had a similar risk of permanently disability (adjusted HR = 0.83, p = 0.661). Hyperlipidemia adversely affected the neurological outcomes of lumbar spinal injury. Statins may have the potential to reverse this higher risk of disability. However, this beneficiary effect of statins only existed in patients using a lower dose (≤90 DDD).
脂质的致残病理生理效应和他汀类药物的神经保护作用最近在动物模型的急性脊髓损伤中得到了证实。这项基于大规模人群的研究旨在调查高脂血症和他汀类药物的使用对腰椎损伤患者的影响。台湾国民健康保险研究数据库被用于识别腰椎损伤患者。总共2844名患者被分为三组：无高脂血症、使用低剂量他汀类药物（≤规定日剂量（DDD）的90）的高脂血症患者，以及使用高剂量他汀类药物（>90 DDD）的严重高脂血症患者。使用Cox多元回归模型比较三组之间的残疾发生率。结果显示，高脂血症患者出现永久性残疾的风险更高（调整后的风险比=1.38，p=0.28）。在亚组分析中，严重高脂血症患者的残疾风险更高（调整后的风险比=3.1，p<0.004），而使用低剂量他汀类药物的高脂血症患者出现永久性残疾的风险相似（调整后的风险比=0.83，p=0.661）。高脂血症对腰椎损伤的神经学结果产生不利影响。他汀类药物可能有逆转这种较高残疾风险的潜力。然而，他汀类药物的这种有益作用仅存在于使用较低剂量（≤90 DDD）的患者中。
