Yu Yuetian, Zhu Cheng, Liu Chunyan, Gao Yuan
Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China.
Department of Emergency, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China.
Biomed Res Int. 2017;2017:5642704. doi: 10.1155/2017/5642704. Epub 2017 Mar 5.
. To investigate whether prior treatment of atorvastatin reduces the frequency of hospital acquired pneumonia (HAP). . Totally, 492 patients with acute ischemic stroke and Glasgow Coma Scale ≤ 8 were enrolled in this study. Subjects were assigned to prior atorvastatin treatment group ( = 268, PG) and no prior treatment group ( = 224, NG). All the patients were given 20 mg atorvastatin every night during their hospital stay. HAP frequency and 28-day mortality were measured. Levels of inflammatory biomarkers [white blood cell (WBC), procalcitonin (PCT), tumor necrosis factor-alpha (TNF-), and interleukin-6 (IL-6)] were tested. . There was no significant difference in the incidence of HAP between PG and NG (25.74% versus. 24.55%, > 0.05) and 28-day mortality (50.72% versus 58.18%, > 0.05). However, prior statin treatment did modify the mortality of ventilator associated pneumonia (VAP) (36.54% versus 58.14%, = 0.041) and proved to be a protective factor (HR, 0.564; 95% CI, 0.310~0.825, = 0.038). Concentrations of TNF- and IL-6 in PG VAP cases were lower than those in NG VAP cases ( < 0.01). . Prior atorvastatin treatment in patients with ischemic stroke was associated with a lower concentration of IL-6 and TNF- and improved the outcome of VAP. This clinical study has been registered with ChiCTR-ROC-17010633 in Chinese Clinical Trial Registry.
研究阿托伐他汀的前期治疗是否能降低医院获得性肺炎（HAP）的发生率。本研究共纳入492例急性缺血性脑卒中且格拉斯哥昏迷量表评分≤8分的患者。将受试者分为阿托伐他汀前期治疗组（n = 268，PG组）和未进行前期治疗组（n = 224，NG组）。所有患者在住院期间每晚服用20mg阿托伐他汀。测量HAP发生率和28天死亡率。检测炎症生物标志物[白细胞（WBC）、降钙素原（PCT）、肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）]水平。PG组和NG组之间HAP发生率（25.74%对24.55%，P>0.05）和28天死亡率（50.72%对58.18%，P>0.05）无显著差异。然而，他汀类药物前期治疗确实改变了呼吸机相关性肺炎（VAP）的死亡率（36.54%对58.14%，P = 0.041），并被证明是一个保护因素（HR，0.564；95%CI，0.310~0.825，P = 0.038）。PG组VAP病例中TNF-α和IL-6的浓度低于NG组VAP病例（P<0.01）。缺血性脑卒中患者的阿托伐他汀前期治疗与较低的IL-6和TNF-α浓度相关，并改善了VAP的预后。本临床研究已在中国临床试验注册中心注册，注册号为ChiCTR-ROC-17010633。
