From the Departments of Neurology (J.W., S.A., K.M., D.J.R., J.C., S.P.) and Neurosurgery (E.S.C.), Columbia University Medical Center, New York, NY; Department of Neurology (J.W.), Yale School of Medicine, New Haven, CT; and Departments of Neurology, Neurosurgery, and Radiology (F.A.-M.), Westchester Medical Center, New York Medical College, Valhalla.
Neurology. 2019 Apr 30;92(18):e2145-e2149. doi: 10.1212/WNL.0000000000006931. Epub 2019 Feb 6.
To test the hypothesis that in patients with spontaneous intracerebral hemorrhage (ICH), perihemorrhagic edema to hematoma ratio (rPHE) on admission CT scan (aCT) is unaffected by home statin use when time from symptom onset to aCT is controlled for.
In a single-center prospective cohort of 176 consecutive ICH patients, 2 investigators independently determined hematoma and perihemorrhagic edema (PHE) volumes by using semiautomated validated software. rPHE were dichotomized at the median ratio (>0.75 vs ≤0.75). We used binary logistic regression to test for associations with rPHE.
In patients using statins as home medication before hospital admission (n = 38) compared to patients without prior statin use (n = 138), median PHE volumes were 15.8 mL (interquartile range [IQR] 6.5-39.4) vs 10.8 mL (IQR 5.1-26.8), = 0.2. rPHE was 0.71 (IQR 0.56-1.0) vs 0.74 (IQR 0.52-1.0), = 0.79. In a binary logistic regression model, time of aCT relative to symptom onset (odds ratio [OR] 1.02, confidence interval [CI] 1.01-1.12, = 0.016) and presence of intraventricular hemorrhage on aCT (OR 0.40, CI 0.20-0.78, = 0.007) were but prior statin use was not (OR 1.17, CI 0.55-2.52, = 0.68) associated with rPHE.
Use of statins before hospital admission for ICH is not associated with reduced rPHE on admission CT. In future studies, imaging timing relative to ICH onset needs to be controlled for in order to avoid confounding.
检验假设，即对于自发性脑出血（ICH）患者，当控制从症状发作到 CT 检查的时间时，入院 CT 扫描（aCT）上的血肿周围水肿与血肿比（rPHE）不受家庭他汀类药物使用的影响。
在 176 例连续的 ICH 患者的单中心前瞻性队列研究中，2 名研究者通过使用半自动验证软件独立确定血肿和血肿周围水肿（PHE）体积。rPHE 按中位数比（>0.75 与≤0.75）进行二分。我们使用二项逻辑回归来检验 rPHE 的相关性。
与入院前未使用他汀类药物的患者（n=138）相比，入院前使用他汀类药物作为家庭药物的患者（n=38）的中位 PHE 体积分别为 15.8 mL（四分位距[IQR] 6.5-39.4）和 10.8 mL（IQR 5.1-26.8），=0.2。rPHE 分别为 0.71（IQR 0.56-1.0）和 0.74（IQR 0.52-1.0），=0.79。在二项逻辑回归模型中，aCT 相对于症状发作的时间（比值比[OR] 1.02，95%置信区间[CI] 1.01-1.12，=0.016）和 aCT 上存在脑室内出血（OR 0.40，95%CI 0.20-0.78，=0.007）是 rPHE 的相关因素，但入院前使用他汀类药物（OR 1.17，95%CI 0.55-2.52，=0.68）不是 rPHE 的相关因素。
ICH 入院前使用他汀类药物与入院 CT 上 rPHE 降低无关。在未来的研究中，需要控制成像时间相对于 ICH 发作的时间，以避免混杂因素。
