他汀类药物治疗动脉瘤性蛛网膜下腔出血患者脑血管痉挛、死亡率和迟发性脑缺血的疗效：一项随机对照试验的系统评价和荟萃分析。
Efficacy of Statins in Cerebral Vasospasm, Mortality, and Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
机构信息
Department of Neurosurgery, Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
Department of Neurosurgery, Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
出版信息
World Neurosurg. 2019 Nov;131:e65-e73. doi: 10.1016/j.wneu.2019.07.016. Epub 2019 Jul 8.
BACKGROUND
Aneurysmal subarachnoid hemorrhage (aSAH) is an acute cerebrovascular disease with frequent cerebral vasospasm and delayed cerebral ischemia (DCI). The use of statins for patients with aSAH is controversial. The present study evaluated the efficacy of statins in aSAH-induced vasospasm, DCI, delayed ischemic neurological deficit (DIND), mortality, and other outcomes.
METHODS
A literature search was performed in PubMed, EMBASE, and the Cochrane Library. English reports of patients with aSAH who had been treated with statins without combination were included. The outcomes, including cerebral vasospasm, DIND, DCI, mortality, disability, and creatine kinase/alanine aminotransferase/aspartic transaminase elevation, were extracted for meta-analysis.
RESULTS
A total of 13 studies, with 776 versus 821 patients treated with statins versus placebo, were retained for the statistical meta-analysis. The results showed that statin administration significantly reduced the frequency of vasospasm (relative risk [RR], 0.76; 95% confidence interval [CI], 0.63-0.91; P = 0.003), DIND (RR, 0.76; 95% CI, 0.63-0.91; P = 0.003), vasospasm-DCI (RR, 0.49; 95% CI, 0.32-0.74; P = 0.0008), and mortality (RR, 0.73; 95% CI, 0.54-0.98; P = 0.03). Statins showed insignificant efficacy in the prevention of disability (RR, 0.92; 95% CI, 0.71-1.20), a neurological poor prognosis (RR, 0.75; 95% CI, 0.45-1.27), and creatine kinase/alanine aminotransferase/aspartic transaminase elevation (RR, 1.90; 95% CI, 0.55-6.50).
CONCLUSIONS
Statins significantly reduced the incidence of vasospasm, DIND, DCI, and mortality in individuals with aSAH, suggesting its efficacy in aSAH.
背景
动脉瘤性蛛网膜下腔出血（aSAH）是一种常见的急性脑血管疾病，易发生脑血管痉挛和迟发性脑缺血（DCI）。对于 aSAH 患者使用他汀类药物的效果存在争议。本研究评估了他汀类药物治疗 aSAH 引起的血管痉挛、DCI、迟发性缺血性神经功能缺损（DIND）、死亡率和其他结局的效果。
方法
在 PubMed、EMBASE 和 Cochrane 图书馆中进行文献检索。纳入了单独使用他汀类药物治疗且未联合其他药物的 aSAH 患者的英文报告。提取了包括脑血管痉挛、DIND、DCI、死亡率、残疾以及肌酸激酶/丙氨酸氨基转移酶/天冬氨酸氨基转移酶升高在内的结局指标，进行荟萃分析。
结果
共纳入 13 项研究，其中 776 例患者接受他汀类药物治疗，821 例患者接受安慰剂治疗，进行了统计学荟萃分析。结果表明，他汀类药物治疗可显著降低血管痉挛的发生率（相对风险 [RR]，0.76；95%置信区间 [CI]，0.63-0.91；P=0.003）、DIND（RR，0.76；95% CI，0.63-0.91；P=0.003）、血管痉挛-DCI（RR，0.49；95% CI，0.32-0.74；P=0.0008）和死亡率（RR，0.73；95% CI，0.54-0.98；P=0.03）。他汀类药物在预防残疾（RR，0.92；95% CI，0.71-1.20）、神经预后不良（RR，0.75；95% CI，0.45-1.27）和肌酸激酶/丙氨酸氨基转移酶/天冬氨酸氨基转移酶升高（RR，1.90；95% CI，0.55-6.50）方面效果不显著。
结论
他汀类药物可显著降低 aSAH 患者血管痉挛、DIND、DCI 和死亡率的发生率，表明其对 aSAH 具有疗效。
Zotero 插件