Chan David Yuen Chung, Chan Danny Tat Ming, Sun Tin Fung David, Ng Stephanie Chi Ping, Wong George Kwok Chu, Poon Wai Sang
a Division of Neurosurgery , Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong , Hong Kong.
Br J Neurosurg. 2017 Feb;31(1):72-77. doi: 10.1080/02688697.2016.1208806. Epub 2016 Nov 23.
Chronic subdural haematoma (CSDH) is a common neurosurgical condition. Burr-hole for drainage is an effective treatment. However, recurrence can be up to 8-33% and is associated with morbidities and mortalities. The underlying pathogenesis was postulated to be localised inflammation and pathological aberrant vessels formation. Atorvastatin, an HMG-CoA reductase inhibitor, is a type of lipid-lowering medication. In animal studies and a preliminary clinical trial, Atorvastatin was shown to be effective in the treatment of CSDH. It was found to inhibit inflammation and promote vascular maturation at the neomembrane of CSDH. Our study aimed to investigate the efficacy of Atorvastatin in CSDH. During the study period from January to December 2014, Atorvastatin was used in 12 CSDH patients with Glasgow Coma Scale (GCS) 13-15 or Markwalder's Grading Scale (MGS) Grade 0-2. They were retrospectively compared with GCS- and MGS-matched controls who had not used statin. Improvement with haematoma resolution at 3 months was 75% (9/12) for the Atorvastatin group, versus 42% (5/12) for the Control group (p = 0.0977). The risk of deterioration requiring burr-hole drainage was 16.7% (2/12) in the Atorvastatin group, versus 58.3% (7/12) in the Control group (p = 0.0447). The Odds Ratio (OR) of deterioration requiring burr-hole drainage with Atorvastatin was 0.143 (95%CI: 0.021-0.958), which favours the use of Atorvastatin in CSDH (p = 0.0451). The Number needed to treat (NNT) was 2.4 (p = 0.0447; 95%CI: 1.31-14.93). In conclusion, this retrospective cohort comparison study has shown that CSDH with Atorvastatin had a lower rate of deterioration and burr-hole drainage.
慢性硬膜下血肿（CSDH）是一种常见的神经外科疾病。钻孔引流是一种有效的治疗方法。然而，复发率可达8%-33%，且与发病率和死亡率相关。其潜在发病机制被认为是局部炎症和病理性异常血管形成。阿托伐他汀是一种HMG-CoA还原酶抑制剂，是一种降脂药物。在动物研究和一项初步临床试验中，阿托伐他汀被证明对CSDH的治疗有效。研究发现它能抑制炎症并促进CSDH新生膜处的血管成熟。我们的研究旨在探讨阿托伐他汀治疗CSDH的疗效。在2014年1月至12月的研究期间，12例格拉斯哥昏迷量表（GCS）评分为13-15分或马克瓦尔德分级量表（MGS）为0-2级的CSDH患者使用了阿托伐他汀。将他们与未使用他汀类药物的GCS和MGS匹配的对照组进行回顾性比较。阿托伐他汀组3个月时血肿消退改善率为75%（9/12），而对照组为42%（5/12）（p = 0.0977）。阿托伐他汀组需要钻孔引流的恶化风险为16.7%（2/12），而对照组为58.3%（7/12）（p = 0.0447）。使用阿托伐他汀需要钻孔引流恶化的比值比（OR）为0.143（95%CI：0.021-0.958），这支持在CSDH中使用阿托伐他汀（p = 0.0451）。治疗所需人数（NNT）为2.4（p = 0.0447；95%CI：1.31-14.93）。总之，这项回顾性队列比较研究表明，使用阿托伐他汀治疗的CSDH恶化率和钻孔引流率较低。
