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急性缺血性卒中患者接受阿替普酶治疗时早期使用他汀类药物

Early Use of Statin in Patients Treated with Alteplase for Acute Ischemic Stroke.

作者信息

Geng Jieli, Song Yeping, Mu Zhihao, Xu Qun, Shi Guowen, Sun Yameng, Chen Ying, Lin Yan, Pan Yuanmei, Yu Lin, Yang Guo-Yuan, Li Yansheng

机构信息

Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200025, China.

Department of Neurology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China.

出版信息

Acta Neurochir Suppl. 2016;121:269-75. doi: 10.1007/978-3-319-18497-5_47.

Abstract

Studies have reported that statin usage before stroke can increase the incidence of intracerebral hemorrhage after thrombolytic treatment. However, whether the administration of statin at an early stage of ischemic stroke increases hemorrhage occurrence is unknown. The aim of this study was to assess the effect of statin on neurological imaging and functional outcomes after intravenous alteplase treatment, within 24 h of acute ischemic stroke attack. A total of 119 consecutive acute ischemic stroke patients treated by intravenous alteplase were recruited, of which 71 patients (59.7 %) were given statin therapy within 24 h of stroke onset. The physiological parameters, including demography, vascular risk factors, and clinical characteristics were recorded. The occurrence of intracerebral hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), 90-day functional outcomes, and mortality in the patients were further analyzed. There were 24 occurrences of ICH after alteplase treatment (20.2 %) and there was no difference when patients were treated with statin (p = 0.280). Multivariate logistic regression analysis showed no significant correlation between the administration of statin and the occurrence of ICH (p = 0.230) or sICH (p = 0.949). There was a trend toward better neurological function with higher statin dose. The use of statin in the early stage of ischemic stroke is safe and does not increase the risk of intracerebral hemorrhage after alteplase treatment, suggesting that a clinical trial of early statin treatment on a large scale following thrombolysis is needed for further evaluation.

摘要

研究报告称,中风前使用他汀类药物会增加溶栓治疗后脑出血的发生率。然而,在缺血性中风早期使用他汀类药物是否会增加出血的发生尚不清楚。本研究的目的是评估在急性缺血性中风发作后24小时内,他汀类药物对静脉注射阿替普酶治疗后神经影像学和功能结局的影响。共招募了119例接受静脉注射阿替普酶治疗的连续性急性缺血性中风患者,其中71例患者(59.7%)在中风发作后24小时内接受了他汀类药物治疗。记录了包括人口统计学、血管危险因素和临床特征在内的生理参数。进一步分析了患者脑出血(ICH)、症状性脑出血(sICH)的发生情况、90天功能结局和死亡率。阿替普酶治疗后有24例发生ICH(20.2%),使用他汀类药物治疗的患者之间无差异(p = 0.280)。多因素逻辑回归分析显示,他汀类药物的使用与ICH(p = 0.230)或sICH(p = 0.949)的发生无显著相关性.他汀类药物剂量越高,神经功能有改善的趋势。在缺血性中风早期使用他汀类药物是安全的,不会增加阿替普酶治疗后脑出血的风险,这表明需要进行大规模的溶栓后早期他汀类药物治疗的临床试验以作进一步评估。

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