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他汀类药物治疗可降低急性缺血性脑卒中早期癫痫发作的发生率:倾向评分分析。

Statin treatment can reduce incidence of early seizure in acute ischemic stroke: A propensity score analysis.

机构信息

Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.

Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.

出版信息

Sci Rep. 2020 Feb 6;10(1):1968. doi: 10.1038/s41598-020-58652-w.

Abstract

A previous study showed early statin administration in patients with acute ischemic stroke (AIS) was associated with a lower risk of early-onset seizure (ES), which is a high risk of epilepsy, but this retrospective study design may not have eliminated confounding factor effects. We aimed to verify the determinants and prognostic significance of ES and clarify the effects of statin administration. Consecutive AIS patients without a history of epilepsy were enrolled. The relationship between ES (within 7 days of index-stroke) and statin treatment was assessed using multivariate and propensity scores (PS). Of 2,969 patients with AIS, 1,623 (54.6%) were treated with statin, and 66 (2.2%) developed ES. In logistic regression models, cortical stroke lesion [odds ratio (OR), 2.82; 95% confidence interval (CI), 1.29-7.28) and pre-morbid modified Rankin Scale (per 1 point) (OR, 1.39; 95% CI, 1.18-1.65) were higher risks for ES, while statin significantly reduced the risk of ES (OR, 0.44; 95% CI, 0.24-0.79). In accordance with PS-matching, statin treatment produced consistent results for ES after adjusting by inverse probability of treatment-weighting PS (OR, 0.41; 95% CI, 0.22-0.75). In conclusion, as previously, statin treatment was independently associated with a lower risk of ES in AIS.

摘要

先前的研究表明,急性缺血性脑卒中(AIS)患者早期使用他汀类药物与早期发作性癫痫(ES)的风险降低相关,ES 是癫痫的高风险因素,但这种回顾性研究设计可能无法消除混杂因素的影响。我们旨在验证 ES 的决定因素和预后意义,并阐明他汀类药物治疗的作用。连续纳入无癫痫病史的 AIS 患者。使用多变量和倾向评分(PS)评估 ES(在指数中风后 7 天内)与他汀类药物治疗之间的关系。在 2969 例 AIS 患者中,1623 例(54.6%)接受了他汀类药物治疗,66 例(2.2%)发生了 ES。在逻辑回归模型中,皮质卒中病灶(优势比[OR],2.82;95%置信区间[CI],1.29-7.28)和预发病改良 Rankin 量表(每增加 1 分)(OR,1.39;95% CI,1.18-1.65)是 ES 的更高风险因素,而他汀类药物治疗显著降低了 ES 的风险(OR,0.44;95% CI,0.24-0.79)。根据 PS 匹配,在通过逆概率治疗加权 PS 调整后,他汀类药物治疗对 ES 的结果一致(OR,0.41;95% CI,0.22-0.75)。总之,与之前的研究一致,他汀类药物治疗与 AIS 中 ES 的风险降低独立相关。

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