Choi Kyu-Sun, Kim Jae Min, Yi Hyeong-Joong, Lee Seon-Heui, Lim Taeho, Kim Wonhee, Cho Youngsuk, Cheong Jin-Hwan
Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, South Korea.
Department of Nursing Science, College of Nursing, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon, 406-799, South Korea.
Eur J Clin Pharmacol. 2017 Sep;73(9):1071-1081. doi: 10.1007/s00228-017-2221-7. Epub 2017 Mar 14.
We aimed to quantitatively assess the effects of short-term statin use on delayed ischemic neurologic deficits (DINDs) and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH) through a meta-analysis of the available evidence.
We searched the electronic databases up to April 8, 2016 to retrieve relevant studies comparing the outcomes between immediate statin-treated in statin-naïve patients and untreated patients following aneurysmal SAH. Meta-analysis was performed using Review Manager 5.3.
Eight randomized controlled clinical trials (RCTs) and 5 observational studies involving 2148 patients met the eligibility criteria. In the RCTs, statins were found to significantly reduce the occurrence of DINDs (relative risk (RR), 0.76; 95% confidence interval (CI), 0.61-0.94; P = 0.01), but did not significantly reduce poor functional outcomes (RR, 1.01; 95% CI, 0.87-1.16; P = 0.93) or mortality (RR, 0.80; 95% CI, 0.58-1.11; P = 0.18). In observational studies, statin use was not associated with any reduction in DINDs, poor outcome, or mortality. Meta-analysis of RCTs indicated a significant reduction in DINDs and mortality in patients with high-dose statin use (RR, 0.63; 95% CI, 0.42-0.95; P = 0.03; I = 0%; and RR, 0.36; 95% CI, 0.15-0.86; P = 0.02; I = 0%, respectively).
The present meta-analysis suggests that statin use may prevent DINDs in patients with aneurysmal SAH. Based on our findings, the role of statins in improving neurological outcome was limited. However, the risk of DINDs and mortality decreased with higher statin doses in a dose-dependent manner. Hence, further well-designed RCTs with modified protocols in specific patients are required.
我们旨在通过对现有证据进行荟萃分析，定量评估短期使用他汀类药物对动脉瘤性蛛网膜下腔出血（SAH）患者延迟性缺血性神经功能缺损（DIND）和临床结局的影响。
我们检索了截至2016年4月8日的电子数据库，以检索比较初治他汀类药物患者立即接受他汀类药物治疗与未治疗患者结局的相关研究。使用Review Manager 5.3进行荟萃分析。
八项随机对照临床试验（RCT）和五项观察性研究涉及2148例患者，符合纳入标准。在RCT中，发现他汀类药物可显著降低DIND的发生率（相对风险（RR），0.76；95%置信区间（CI），0.61 - 0.94；P = 0.01），但未显著降低不良功能结局（RR，1.01；95%CI，0.87 - 1.16；P = 0.93）或死亡率（RR，0.80；95%CI，0.58 - 1.11；P = 0.18）。在观察性研究中，使用他汀类药物与DIND、不良结局或死亡率的降低均无关联。RCT的荟萃分析表明，高剂量使用他汀类药物的患者DIND和死亡率显著降低（RR分别为0.63；95%CI，0.42 - 0.95；P = 0.03；I² = 0%；以及RR为0.36；95%CI，0.15 - 0.86；P = 0.02；I² = 0%）。
本荟萃分析表明，使用他汀类药物可能预防动脉瘤性SAH患者发生DIND。基于我们的研究结果，他汀类药物在改善神经功能结局方面的作用有限。然而，DIND和死亡率风险随他汀类药物剂量增加呈剂量依赖性降低。因此，需要在特定患者中进行进一步设计良好的改良方案RCT。
